Resp Path Gomez structural Flashcards
Bronchopulmonary sequestrations (2)
No normal airway connection, no pulmonary circulation,
Extra lobar - outside lung tissue (other cong defect)
Intralobar - Recurrent Inf, Bronchiectasis, acquired
RDS (newborn) (definition, causes, and intrauterine induction) Risk with O2
Lack of surfactant. Mom anesthesia, DM, C section, cord wrapped around neck. To induce give move steroids.
Risk - retinopathy with O2 administration
L/S ratio
Lecithin/ sphingomyelin ratio, Used to tell maturity of lungs through amniocentesis.
2 both lungs are mature
Bronchopulmonary dysplasia. Time frame, Dx req, factors involved
Req 28 days of O2 therapy and age >36 weeks.
Alveolar hypoplasia
Decreased VEGF
Increased TNF, iL-8
Cystic Fibrosis (genes, Signs, Dx, clinical presentation)
CFTR Gene absent or missing,
508 heterozygosity (70%)
DX - Sibling w/ CF, ^ sweat Cl on 2 occasions, Nasal Ion transport, ID of mutations.
Immunoreactive trypsinogen-pancreatic protein elevated
Clinically - recurrent infections and salty sweat
Pancreatic insufficiency, Decreased ADK vitamins
Atelectasis - 3 types
Compression - Fluid pneumo, Mediastinum away
Resorption - Obstruction, air past obstruction will get absorbed by blood, lung will shrink and mediastinum toward
Contraction - Fibosis/scarring
Acute lung injury (4 criteria)
Acute dyspnea, Hypoxemia, Bilateral infiltrates, No Hx of heart failure
Adult ARDS (describe, cells, hemodynamic state, Conditions associated with(4))
Alveolar/capillary wall dmg w/ neutrophils. 2º loss of surfactant, (d/t loss of type 2 pneumocyte)
Prothrombotic
Sepsis, Gastric Aspiration, Head injury, diffuse pulmonary infection
Acute interstitial pneumonia
Similar presentation to ARDs but no causative disorder identified (basically idiopathic)
Chronic Diffuse Lung Disease (2 types)
Obstructive - Low FEV/FVC (COPD, emphysema, bronchiectasis, astham, chronic bronchitis)
Restrictive - normal FEV/FVC (Obesity, ard, fibrosis)
Emphysema (3 of 4 types and associations)
Centriacinar/centrilobular (95%) - SMOKING Upper Lobar (bronchi)
Panacinar/Panlobar - SMOKING, Alpha-1 antitryptase deficiency, Lower Lobes (Bronchi to Alveoli)
Distal Acinar - Pneumothorax (alveloi)
Emphysema MOA and inhibitor, Clinical presentation
Neutrophils release elastase to degrade tissues in lungs, (inhibited by alpha 1 antitryptase
Clinical - Low FEV/FVC, Barrel chest, Punk Puffers, High TLC
Random increased air conditions
Compensatory - Removal of one lung
Obstructive overinflation - Water heater thing
Interstital emphysema - sounds like rice crispies
Chronic Bronchitis (Dx time frame, histological findings, physiological findings, Leads to ?)
3 months/year for 2 consecutive years
Hyperplasia of goblet cells, Bronchiectasis, Increased Reid index (Ratio of glands to total thickness >.4 = hyperplasia) , Bronchiolitis obliterans
Leads to cor pulmonal
Asthma (definition, inducers)
Partially reversible - bronchiodilaters,
Aggravations - Cold, exercise, allergens
Can lead to fibrosis
Type 1 asthma ( factors to know)
Hypersensitivity - IgE, increased TH2, Eosinophils
Drug induced asthma
Primarily aspirin, leukotriens can produce bronchoconstriction
Curschmann Spiral
Asthma - shed epithelium
Bronchiectasis
Permenant dilation, recurrent infections, Cystic fibrosis
Kartageners
Cystic fibrosis, situs inversus, ciliary retardation, Male infertility
Categories of chronic interstital lung disease
Usual interstital pneumonia, Nonspecific interstital pneumonia, Cryptogenic (unsure of cause), Pneumoconiosis, Sarcoidosis, Eosinophilic pneumonia,
Idiopathic pulmonary fibrosis/ Usual interstital (cells, inhibited factor, Clinical)
Hyperplasia of Type 2 - increased mucous, Inhibition of caveolin allows deposition of collagen
Clinical - Digital clubbing (bone enlargement d/t hypoxemia and nonspecific ), honeycomb lung
Nonspecific interstital pneumonia (clinical)
SOB and cough for several moths
No honeycombing/fibrosis
Milder than IPF/UIP
Cryptogenic Organizing Pneumonia
Alveolar disease w/ well circumscribed lesions. No fibrosis
Collagen vascular disorder-related insterstital lung disease (caplan syndrome)
Usually Rheumtoid arthritis, When combined with pneumoconiosis is caplan syndrome
Coal workers pneumoconiosis (2 types)
Simple - asymptomatic, some nodules
Complex - SOB, symptomatic, >2 cm lesions, Can lead to pulmonary massive fibrosis, Pulm HTN, Cor Pulmonale
Silicosis(frequency, Increased risk, appearance)
Mos prevalent environemtnal pneumoconiosis in the world, increased incidence of TB, Birefringent in polarization, Carcinogenic
Asbestos (associated health problems, buzz words, xray)
Mesothelioma(ampiboles) = asbestos, but lung cancer is more common (laryngeal carcinoma) Fibrous pleural plaques
xray - peripheral plaques(meso) by ribs.
Sarcoidosis ( xray, histological buzzword, diagnostic test)
Granulomas, anergy to PPD/candida, Increased ACE, Asteroid bodies - inside cell, Schaumann body - calcified body inside macrophage
Hypersensitivity pneumonitis (location and types 3)
Alveolar, Farmers - Actinomyces in hay , Brid fancier - serum in feces, Humdfier lung - thermophillic actinomyces
Intersitial diseases related to smoking (3)
Desquamative Interstitial pneumonia - Smokers macrophages, steroids and not smoking cures
Respiratory bronchiolitis-associated interstital lung disease - Pigmented macrophages in Bronchioles w/ peribronchiolar fibrosis
Pulmonary Langerhans Cell Hitiocytosis ** - Eosinophilic granuloma, CD1a associated
Pulmonary alveolar proteinosis (clinical presentation + 3 classes
Build up of surfactant - shiny gelatinous phlegm.
Autoimmune(90%) Ab to GM-CSF ( defecting phagocytosis of surfactant)
Secondary - Rare - pneumocoiosis associated
Hereditary - Rare- fatal w/o transplant
Pulmonary embolism (location, COD, 2º major effect, types)
Lower lobe, Death d/t arrythmia from strain on R ventricle d/t emboli,
acute cor pulmonale
Fat, marrow, aminotic fluid, talc (gloves)
Primary pulmonary HTN (gene and demographic)
Lack of BMPR2 - smooth muscle hypertrophy
Females 20-40 yrs
Goodpasture (ab, Clinical signs)
Ab to collagen 4. Renal failure, ^ creatinine, SOB, Hemoptysis.
Idiopathic pulmonary hemosiderosis (demographics, location, tmnt)
Children, deposits in alveolar walls, Immunosupression works
Polyangitis w/ Granulomatosis (wegners) (triad, antibody)
Upper resp lesions, Granulomatous vascular lesions, Masses in lungs, problems in kidneys
PR3/c-anca
Pneumonia Syndromes (community, 4 alveolar w/ associations, Atypical pneumonias (4), Aspiration (4), Immunocompromised (5)
(alveolar)
Strept pneumoniae - MOST COMMON increased risk of splenectomy
Haemophilus influenza - COPD
Staph Aureus - Common post viral pneumonia
Pseudomonas aeruginosa - cystic fibrosis
Atypical interstitial Myco pneumoniae (cold agglutins) Chlamydia Coxiella burnetti Viruses
Aspiration (lead to necrotizing pneumonia/lung abscess)
Bacteroides, Fusobacterium, Peptostrept, Prevotella
Immunocompro
Myco avium-intracellular, Cytomegalovirus, Pneumocystis jirovecii, Aspergillosis, Candidiasis
Viral pneumonias
Usually a chest cold but can be fatal
Pulmonary abscess (Organisms 4, presentation, Sources)
Staph aureus, Bacteroides, fusobacterium, Peptococcus
Present - foul smelling/bloody sputum, non specific, empyema, hemorrhage, brain abscess
Sources - Aspiration, septic embolism, neoplasm
Respiratory Syncytial Virus (demographic/associated symptoms)
Most common cause of Bronchiolitis/pneumonia in kinds <12 months.
Otitis Media associated
TB Pneumonia
Chronic,
Primary - Ghon Complex (Lymph node and lesion)
Secondary - Reactivation of old lesion
Milliary - shotgun appearance, vessel invasion
Fungal Pneumonias (Species, Size, Location)
Histoplasma capsulatum - smaller than RBC, ohio, michigan, carribean (Dumbbell, granuloma
Blastomyces dermatidis - about RBC size, Central/SE US, india, africa,
Cocciodes immitis - bigger than RBC, Cali, Mexico, Far West
Immunocompromised pneumonies (5)
Pneumocystis Jirovecii, Cytomegalovirus, Myco Avium cellulair, Aspergillus, Candida
Indications for lung transplant (4)
Emphysema, Idiopathic pulmonary fibrosis, Cystic fibrosis, Idiopahic/Familial pulmonary HTN
Immunocompromised organism Buzz words
Pneumocystis jirovecii -Frothy/Cotton candy exudate, Cup and Saucer cells
Cytomegalo virus - Owl eye
Candida - spaghetti and meatball
Cryptococcus - mucous capsule - will have a surrounding area on mucin stain
Aspergillus - 45º hyphae
Pulmonary Hamartoma
Same/right tissue in an abberant place, “popcorn calcifications”
Pancoast tumor (location and associated syndrome)
Apical lung tumor, Ulnar nerve pain,
Horner - Enopthalmos, Ptosis, Miosis, Anhidrosis
Paraneoplastic syndromes
PTHrp - Squamous cell carcinoma
ADH, ACTH, Calcitonin
Squamous cell Carcinoma (location, associated hormone)
98% of smokers - D/T dmg of epithelium,
Central - bronchioles
PTHrp - Parathyroid hormone related protein (hypercalcemia)
Adenocarcinoma (demographic, location, Gene)
Female non-smokers
Peripheral
Mucin production
TTF1 positive (Thyroid transcription factor 1)
Bronchioloalveolar Carcinoma in Situ
Alveolar, aerogenous spread, Non invasive vs Micronvasive which has <5mm spread
Large Cell Carcinoma (location/defining characteristic)
Undifferentiated and Central or peripheral
Small Cell Carcinoma (location, cell type, hormone/ion)
Central w/ some peripheral growth
Neuroendocrine, ^ADH, ^ Ca
Pleural Neoplasms (Most common type, buzz words)
MEtastatic are most common
Primary - more rare, MEsothelioma
Calretenin, Mesothelin, WT-1
Mesothelioma (appearance & histological)
Can look like adenocarcinoma
Thick band encasing lungs
Long packed microvili
