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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
What organism gives you RUST sputum
Strep Pneumo
26
What organism gives you red jelly sputum
Klebsiella pneumonia
27
What organism is associated with lung abscesses
Staph Aureus! purple cluster of cocci | HIGH mortality
28
What organism causes walking pneumonia
Mycoplasma pneumonia | Sx dont present the same; less fever, no chills, mild cough, no sputum, no abscess, no leukocytosis
29
What usually causes hospital acquired pneumonia
Pseudomonas and Klebsiella pneumonia | also common cause of infx in CF patients
30
What organism causes community acquired PNA
Strep Pneumo, two little blue balls (gram +) | **vaccine for pneumococcus80-90% effective, good for high risk (alcoholic, DM, cancer, sickle cell)
31
What organism causes PNA in AIDS patients
Pneumocystis carinii (protozoa and fungi charac.), but it doesn't cause Dz in healthy patients
32
What are common infectious characteristics of pneumocystis carinii
only infects legs, doesn't spread cysts in alveoli cause inflammation= fluid blocks gas exchange Sudden onset fever, cough, dyspnea
33
What organism is an opportunistic fungi
Cryptococcus neoformans- #1 cause of meningitis in AIDS its | Pigeon droppings in soil
34
What are characteristic features of cryptococcus neoformans
birds are not affected, no human to human transmission | India ink shows oval budding yeast w/ surrounding polysaccharide capsule
35
What are microscopic characteristics of Coccidiomycosis
Spherules: large vacuoles with thick walls Endospores: inside spherules and when released, form new spherules
36
Are valley fever patients usually symptomatic
No | but if they are, its flu like Sx (fever, malaise, cough)
37
What kind of organism is TB
acid fast bacillus with waxy capsule- obligate AEROBE | does NOT attract PMN (not an acute bacterial infx)
38
What are the phases of TB
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
What is a Ghon complex
peripheral parenchymal granuloma with infected draining hilar lymph node
40
What is Scrofula
TB spreads to hilar lymph nodes causing unilateral cervical adenines
41
What is military spread
multiple small TB granulomas in well oxygenated organs
42
What is Potts disease
TB spread to vertebra (vertebral osteoarthritis)
43
What is a tuberculoma
benign tumor caused by military spread of TB
44
What stain is used to identify TB
Acid fast stain, it can't be ID on gram stain due to waxy capsule
45
What kind of organism is Legionella pneumophilia and how did it get its name
gram - got it's name from legionnaire's convention in Philadelphia in 1976 infects by inhalation from humidifiers or air conditioning
46
Which lung cancers are central vs. peripheral
Central: squamous cell and large cell carcinoma Peripheral: adenocarcinoma
47
What are characteristic Sx of central lung cancers
bronchial obstruction with PNA cough, hemoptysis
48
What lung cancer has the LEAST association to smoking
adenocarcinoma
49
What lung cancer has the STRONGEST association to smoking
Squamous cell and small cell carcinoma | if smoking si d/c, normal bronchial epithelium is restored, but cilia never grow back
50
What lung cancer resembles lobar PNA (diffuse)
Bronchialveolar carcinoma- grows along alveolar walls, causes copious mucus in sputum IF w/ goblet cell hyperplasia, but usually NONmucinous
51
Which lung cancer has THE strongest association to smoking, and is a hormone producer
small cell carcinoma- can cause diabetes insidious d/t ADH, ACTH, or PTH production
52
What bronchogenic carcinomas come from stem cells
undifferentiated large cell carcinoma
53
What 4 types of cells do bronchogenic carcinomas come from
Stem cells neuroendocrine cells goblet cells pseudo stratified
54
What bronchogenic carcinomas come form goblet cells
adenocarcinomas
55
What lung cancer has the highest reactivity to radiation
small cell carcinoma, the GBM of lung cancer- a highly malignant tumor with neuroendocrine features
56
Which organ has the highest spread of metastatic lung cancer
Adrenal glands | also goes to brain, bone, and liver
57
Which lung cancer has the best prognosis
Squamous cell carcinoma, it likes to metastasize later on
58
What are the two oncogene mutations
``` K-ras (correlated to smoking, large and squamous cell carcinoma) Myc oncogene (over expression in small cell carcinoma ```
59
What are the two tumor suppressors
P53 (mutation in small cell and non-small cell carcinoma | Retinoblastoma ((mainly small cell, also in non small cell)
60
What chromosome mutation is involved most in lung cancer
deletion on short arm of chromosome 3 | 3p
61
What is "oat cell" cancer
tumor of neuroendocrine cells (small cell carcinoma)
62
What is "scar cell" cancer
peripheral adenocarcinoma (can originate form pulmonary scars)
63
What cancer can be Dx with bronchoscope
squamous cell carcinoma
64
What is a rind tumor
malignant mesothelioma, associated with Asbestos exposure. commonly in pleura, also in peritoneum It encases and compresses the lung, looking like a grapefruit rind
65
What does mesothelioma often present with
pleural effusion, pleural mass, CP, weight loss, malaise

Nayla patho (9 decks)

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