Resp Flashcards

1
Q

What are the 4 components of COPD

A

Chronic bronchitis
Emphysema
Bronchial asthma
Bronchiectasis

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2
Q

What is chronic bronchitis

A

fibrous thickening of proximal bronchi

goblet cell hypertrophy and hyperplasia= lumens fill with mucus

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3
Q

What is emphysema

A

Enlarged alveoli with wall destruction

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4
Q

What is Bronchial asthma

A

bronchial tree has increased response to stimuli
More permeable vessels
Smooth muscle contraction (histamine, bradykinin, PG)

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5
Q

What is bronchiectasis

A

permanent bronchial dilation due to chronic bronchitis

filled with mucopurulent dx that is NOT cleared by coughing

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6
Q

What are the Dx requirements for chronic bronchitis

A

chronic cough and sputum for 3 months/yr for 2 consecutive years

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7
Q

What is the main cause of chronic bronchitis

A

smoking! pseudo stratified columnar become stratified squamous (metaplasia)
severity correlates to # cigarettes smoked

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8
Q

What are blebs

A

Sub-pleural (SF) air bubbles formed by ruptured alveoli, can cause PTX if they pop
Pulmonary Emphysema

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9
Q

What are bullae

A

Parenchymal (deep) air bubbles >1 cm

Pulmonary emphysema

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10
Q

What do Emphysema lungs look like

A

White, billowy lungs filled with air that touch in the middle

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11
Q

What is a “blue bloater”

A

hypoxia during coughing causes cyanosis
AND, peribronchial fibrosis squeezes vessels further
CHRONIC BRONCHITIS

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12
Q

What is a pink puffer

A

Pt hyperventilates and oxygenates well, but tachypnea makes their IC muscles thick=barrel chest
Emphysema

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13
Q

What are the two types of asthma

A

Extrinsic: exposure to allergens (pollen, dander, food) affecting kids mostly
Intrinsic: non-immune mechanism (heat/cold, exercise, chemicals, pollution)
Both have wheezing on expiration, cough, dyspnea

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14
Q

What are Curschmann spirals

A

Whirls of epithelial cells in mucus in bronchi of pt with bronchial asthma

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15
Q

What is a potential cause of bronchiectasis

A

Alveolar pneumonia

info spread to alveoli=recurrent PNA= lobe adhesion

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16
Q

What is a common outcome of bronchiectasis

A

Halitosis

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17
Q

What is the main complication of rupture of blebs

A

pneumothorax

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18
Q

What is a genetic reason for emphysema

A

Alpha 1 antitryptolysin deficiency (rarely)

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19
Q

What are the types of alveolar pneumonia

A

bronchopneumonia: limited to segmental bronchi

lobar pneumonia: entire lobe white out (hepatization)

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20
Q

What is interstitial pneumonia

A

inflammation of alveolar walls
Viral
diffuse, bilateral

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21
Q

What must you see go gram stain to know it’s aspiration PNA

A

food, surrounding bacteria, surrounding PMN

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22
Q

What are Sx of all PNA

A

high fever, chills, cough, expectoration, SOB, dyspnea, tachypnea

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23
Q

What are ways to “lose your gag reflex”

A

alcohol consumption
neuro dysfunction (stroke, meningitis, alzheimer)
High opiates

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24
Q

What happens when you lose your gag reflex

A

anything in the stomach can come up and go into the lungs, bacteria follow the food, and PNA develops in the lower rest tract

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25
Q

What organism gives you RUST sputum

A

Strep Pneumo

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26
Q

What organism gives you red jelly sputum

A

Klebsiella pneumonia

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27
Q

What organism is associated with lung abscesses

A

Staph Aureus! purple cluster of cocci

HIGH mortality

28
Q

What organism causes walking pneumonia

A

Mycoplasma pneumonia

Sx dont present the same; less fever, no chills, mild cough, no sputum, no abscess, no leukocytosis

29
Q

What usually causes hospital acquired pneumonia

A

Pseudomonas and Klebsiella pneumonia

also common cause of infx in CF patients

30
Q

What organism causes community acquired PNA

A

Strep Pneumo, two little blue balls (gram +)

**vaccine for pneumococcus80-90% effective, good for high risk (alcoholic, DM, cancer, sickle cell)

31
Q

What organism causes PNA in AIDS patients

A

Pneumocystis carinii (protozoa and fungi charac.), but it doesn’t cause Dz in healthy patients

32
Q

What are common infectious characteristics of pneumocystis carinii

A

only infects legs, doesn’t spread
cysts in alveoli cause inflammation= fluid blocks gas exchange
Sudden onset fever, cough, dyspnea

33
Q

What organism is an opportunistic fungi

A

Cryptococcus neoformans- #1 cause of meningitis in AIDS its

Pigeon droppings in soil

34
Q

What are characteristic features of cryptococcus neoformans

A

birds are not affected, no human to human transmission

India ink shows oval budding yeast w/ surrounding polysaccharide capsule

35
Q

What are microscopic characteristics of Coccidiomycosis

A

Spherules: large vacuoles with thick walls
Endospores: inside spherules and when released, form new spherules

36
Q

Are valley fever patients usually symptomatic

A

No

but if they are, its flu like Sx (fever, malaise, cough)

37
Q

What kind of organism is TB

A

acid fast bacillus with waxy capsule- obligate AEROBE

does NOT attract PMN (not an acute bacterial infx)

38
Q

What are the phases of TB

A

Primary: lesion containing organism with caseous necrosis, asymptomatic, limited
Progressive: lesion enlarges rapidly causing necrosis and liquefaction
Reactivation: when immunosuppressed, bronchial erosion and blood vessel destruction (hemoptysis)
Recovery: CD4 and CD8 cells resist organism with cell mediated immunity

39
Q

What is a Ghon complex

A

peripheral parenchymal granuloma with infected draining hilar lymph node

40
Q

What is Scrofula

A

TB spreads to hilar lymph nodes causing unilateral cervical adenines

41
Q

What is military spread

A

multiple small TB granulomas in well oxygenated organs

42
Q

What is Potts disease

A

TB spread to vertebra (vertebral osteoarthritis)

43
Q

What is a tuberculoma

A

benign tumor caused by military spread of TB

44
Q

What stain is used to identify TB

A

Acid fast stain, it can’t be ID on gram stain due to waxy capsule

45
Q

What kind of organism is Legionella pneumophilia and how did it get its name

A

gram -
got it’s name from legionnaire’s convention in Philadelphia in 1976
infects by inhalation from humidifiers or air conditioning

46
Q

Which lung cancers are central vs. peripheral

A

Central: squamous cell and large cell carcinoma
Peripheral: adenocarcinoma

47
Q

What are characteristic Sx of central lung cancers

A

bronchial obstruction with PNA cough, hemoptysis

48
Q

What lung cancer has the LEAST association to smoking

A

adenocarcinoma

49
Q

What lung cancer has the STRONGEST association to smoking

A

Squamous cell and small cell carcinoma

if smoking si d/c, normal bronchial epithelium is restored, but cilia never grow back

50
Q

What lung cancer resembles lobar PNA (diffuse)

A

Bronchialveolar carcinoma- grows along alveolar walls, causes copious mucus in sputum IF w/ goblet cell hyperplasia, but usually NONmucinous

51
Q

Which lung cancer has THE strongest association to smoking, and is a hormone producer

A

small cell carcinoma- can cause diabetes insidious d/t ADH, ACTH, or PTH production

52
Q

What bronchogenic carcinomas come from stem cells

A

undifferentiated large cell carcinoma

53
Q

What 4 types of cells do bronchogenic carcinomas come from

A

Stem cells
neuroendocrine cells
goblet cells
pseudo stratified

54
Q

What bronchogenic carcinomas come form goblet cells

A

adenocarcinomas

55
Q

What lung cancer has the highest reactivity to radiation

A

small cell carcinoma, the GBM of lung cancer- a highly malignant tumor with neuroendocrine features

56
Q

Which organ has the highest spread of metastatic lung cancer

A

Adrenal glands

also goes to brain, bone, and liver

57
Q

Which lung cancer has the best prognosis

A

Squamous cell carcinoma, it likes to metastasize later on

58
Q

What are the two oncogene mutations

A
K-ras (correlated to smoking, large and squamous cell carcinoma)
Myc oncogene (over expression in small cell carcinoma
59
Q

What are the two tumor suppressors

A

P53 (mutation in small cell and non-small cell carcinoma

Retinoblastoma ((mainly small cell, also in non small cell)

60
Q

What chromosome mutation is involved most in lung cancer

A

deletion on short arm of chromosome 3

3p

61
Q

What is “oat cell” cancer

A

tumor of neuroendocrine cells (small cell carcinoma)

62
Q

What is “scar cell” cancer

A

peripheral adenocarcinoma (can originate form pulmonary scars)

63
Q

What cancer can be Dx with bronchoscope

A

squamous cell carcinoma

64
Q

What is a rind tumor

A

malignant mesothelioma, associated with Asbestos exposure. commonly in pleura, also in peritoneum
It encases and compresses the lung, looking like a grapefruit rind

65
Q

What does mesothelioma often present with

A

pleural effusion, pleural mass, CP, weight loss, malaise