Respiratory Flashcards
0
Q
Chronic bronchitis Dx requirements
A
Chronic productive cough lasting 3 months over a minimum of 2 years
1
Q
COPD changes in FEV, FVC, TLC (spirometry)
A
Decrease FVC, MORE decrease in FEV1, decrease in FEV1/FVC ratio, increase in TLC
2
Q
Chronic bronchitis is associated with
A
Smoking
3
Q
% of wall is mucous glands in CHronic bronchitis
A
> 50%, measures in Reid index, hypertrophy of bronchial mucinous glands
4
Q
The excess mucous goes where in chronic bronchitis
A
Coughed up or can plug parts of lung
5
Q
What is Reid index?
A
Measure of the thickness of the glands in the bronchial wall
7
Q
Clinical features of chronic bronchitis
A
Productive cough, cyanosis, inc. PaCO2, dec. PaO2, inc. risk of infection and cor pulmonale
8
Q
Emphysema mechanism of disease
A
loss of elasticity, destruction of the alveolar air sacs, the many air sacs now act as one (one reason for obstructive disease), air drag and loss of elasticity allows for some “collapse” of the walls of bronchioles (second reason for obstruction)
9
Q
EMphysema cause
A
imbalance of proteases and anti-proteases; smokers cause the increase in protease activity; alpha 1 anti trypsin def. leads to less antiprotease protection
10
Q
what is most common cause of emphysema
A
smoking
11
Q
2 categories of emphysema
A
panacinar and centriacinar
12
Q
smoking causes which kind of emphysema
A
centriacinar, mainly upper lobes
13
Q
alpha 1 anti trypsin def causes which emphysema
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pan-acinar, lower lobes mainly
14
Q
A1AT def also involves
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liver, causing cirrhosis
15
Q
most clinically relevent allele muattions for A1AT
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PiZ allele, now protein accumulates in ER
16
Q
PiMZ heterozygotes
A
higher risk for emphysema with smoking but otherwise assyptomatic
17
Q
clinical features of emphysema
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dyspnea, cough, no sputum, pursed lips with prolonged expiration, lbs loss, inc. AP diameter (barrel chest)
18
Q
functional residual capacity is what in empysema
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increased and in a fibrosis of lung then the FRC will decrease
19
Q
late complications of emphysema
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hypoxemia, cor pulmonale
20
Q
Asthma descript
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revrsible airway bronchoconstrict, usually from a type 1 hypersensitivity rxn
21
Q
Asthma pathogenesis
A
allergins induce TH2 phenotype CD4 t cells of genetically susceptible individuals, the TH2 cells secrete IL-4,5,10
22
Q
IL 4 important for what
A
IgE shift
23
Q
IL5 important for
A
eosinphil
24
Q
IL10 important for
A
Th2 dif and block Th1 form
25
early phase of asthma
mast cell activation leading to contriction, from the leukotrienes
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late phase of asthma
inflammation and major basic protein potentiate the bronchoconstriction
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clinical features of asthma
dyspnea, wheezing, productive cough with curschmann spirals with charcot leyden crystals, severe unrelenting attack can lead to status asthmaticus and death
28
non allergic causes of asthma
exercise, viral infection, aspirin (aspirin intolerant asthma), occupational exposure
29
nasal polyps associations
chronic rhinitis
adults+asthma + polyps = aspirin intolerant asthma
child + polyps = CF
30
Bronchiectasis definition
permant dilation of bronchioles and bronchi causing loss of airway tone and results in air trapping
31
Bronchiectasis causes
CF, kartagener syndrome, tumor or foreign body, nectrotizing infection, allergic bronchopulmonary aspergillosis-----all in all its due to inflammation eith damage to the air way walls
32
clinical features of bronchiectasis
cough, dyspnea, foul smelling sputum, with complications of hypoxemia with cor pulmonale and 2ndary amyloidosis
33
restrictive diseases spirometry findings
cant fill lung thus dec. TLC, decreased more FVC, decreased FEV1, increased FEV1/FVC ratio
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causes of restrictive diseases
interstital diseases causing fibrosis of the interstitium or even a chest wall issue (ex obesity)
35
Idiopathic pulmonary fibrosis is what kind of disease
restrictive disease with fibrosis of the lung interstitium
36
etiology of idiopathic pulm. fibrosis
cyclical lung injury, TGF-Beta thought to be agent causing the fibrosis....must exclude other causes to be able to give this Dx
37
clinical features of IPF
progressive dyspnea, cough, fibrosis seen on lung CT leads to a honey comb lung, Tx is lung transplant
38
Pneumoconioses def.
interstitial fibrosis due to occupational exposure, requires chronic exposure to fibrogenic small particles
39
Coal workers pneumoconiosis
carbon dust is the causeitive agent
40
Coal workers pneumoconiosis pathologic findings
diffuse fibrosis (black lung), assoc. with RA (Caplan syndrome)
41
Anthracosis def.
mild exposure to carbon from pollution, not clinically relevant
42
Silicosis
exposure to silica, as in using a sandblaster or working in a silica mine
43
silicosis pathologic findings
fibrotic nodules in upper lobes of lungs
44
which pneumocosis inc. risk for TB?
silicosis, the silica impairs the phagolysosome formation by macrophages
45
Berylliosis
beryllium, miners and also from the aerospace industry
46
berylliosis path. finsdings
non-caseating granulomas in lung, hilar nodes, systemic organs
47
berylliosis increases risk for what
lung cancer
48
Asbestosis
asbestos fibers, seen in construct workers, plumbers, shipyard workers
49
asbestosis path. findings
fibrosis of lung and pleura with inc. risk for lung cancers and mesothelioma. lung cancer has higher incidence
50
asbestosis lesions characteristics
lesions has long golden brown fibers with associated iron (asbestos bodies)
51
WHat pneumoconiosis is similar to sarcoidosis
berylliosis
52
Sarcoidosis is what type of lung issue
restrictive disease
53
Sarcoidosis def
systemic disease characterized by non-caseating granulomas in multiple organs
54
Sarcoidosis most common population
african american females
55
sarcoidosis etiology
unknown, likely due to CD4 T-helper response
56
characteristic findsing in sarcoidosis
asteroid bodies
57
granulomas from sarcoidosis generally involve
hilar nodes and lung
58
other tissues involved in sarcoidosis
Uveitis, cutaneous nodules or erythema nodosum, salivary/lacrimal glands (may mimic sjogren syndrome),
59
clinical features of sarcoidosis
dyspnea, cough, elvated serum ACE, hypercalcemia, Tx is steroids, but can spontaneously regress
60
non-caseating granulomas have what activity
1 alpha hydroxylase activity
61
Hypersensitivity pneumonitis is what class
restrictive disease
62
hypersensitivity pneumonitis has what patholgy
granulomatous rxn to inhaled oragnic antigens
63
hypersensitivity oneumonitis clinical features
fever, cough, dyspnea that resolves with removal of exposure...chronic exposure can lead to interstitial fibrosis, remember also there will be eosinophils also
64
pulmonary mean arterial P, normal and what dictatses pulm. HTN
10 is normal and over 25 is HTN
65
pulm htn characterized by
atherosclerosis of pulm trunk, smooth muscle hypertrophy of pulm arteries, intimal fibrosis, plexiform lesions in longstanding disease
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pulm htn leads to
RV hypertrohpy and corpulmonale
67
pulm htn clinical features
exertional dyspnea and right sided heart failure
68
primary pulm htn details
classically in young adult females, unknown etiology, familial forms related to BMPR2 mutations inactivating kind (leads to proliferation of vascular smooth muscle)
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secondary pulm htn causes
due to hypoxemia (COPD), or inc. volume in pulm. circuit (congenital heart disease), recurrent pulm. embolism can be a cause also
70
acute respiratory distress syndrome
leakage of protein fluid into air sac leading to a hyaline membrane in the air sacs
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ARDS clinical features
hypoxemia and cyanosis (due to the fact the diffusion of air is limited from thicker air sac now from hyaline membrane), white out on CXR, respiratory distress
72
ARDS etiology
sepsis, infection, shock, trauma, aspiration, pancreatitis, DIC, hypersensitivity rxns, drugs.....neutros are activiated causing free radical damage and protease damage (type I and II pneumocytes are damaged)
73
ARDS Tx
address underlying cause, ventilation with positive end expiratory pressure, recovery may be complicated by interstitial fibrosis
74
neonatal resp. distress syndrome
due to inadequate surfactant levels (surfactant from type II pneumocytes)
75
neonatal resp. distress syndrome clinical features
increasing resp. effot after birth, tachypnea with accessory use, grunts, hypoxemia with cyanosis, diffuse granularity of lung on x-ray
76
neonatal resp. distress syndrome associations
prematurity (L:S ratio for screening), C-section delivery, maternal diabetes
77
L:S ratio meaning
higher L = more surfactant, ratio wants to be >2 then lung is mature, L = lecicin which is phosphatidylcholine
78
steroids do what to surfactant levels
increase them which is why when C section there is less stress thus less steroids thus less surfactant
79
high insulin from fetus does what to surfactant
inhibits it
80
complications of neonatal resp. distress syndrome
hypoxemia increases risk for persistence of PDA and necrotizing enterocolitis and the supplement O2 cna inc. risk for free radical injury
81
carcinogenic in smoke from tobacco
polycyclicaromatic hydrocarbons
82
key risk factors for lung cancer
cig. smoke, radon, asbestos
83
lung cancer presentation
non specific Sx, solitary nodule usually (coin lesion)
84
benign lung lesions more common in
young...they usually are granulomas or a bronchial hamartoma (lung tissue + cartilage) and is usually calcified
85
small cell carcinomas usually cannot be what
resected
86
subtypes of non small cell carcinoma
adenocarcinoma, squamous cell carcinoma, large cell carcinoma, carcinoid tumor
87
mucous or gland secretions
adenocarcinoma
88
keratin pearls are part of what aling with intercellular bridges
squamous cell carcinoma
89
no glands, no secretions, no intercellular bridges
large cell carcinoma
90
small cell carcinoma characteristics
poorly diff. small cells, arise from neuroendocrine cells (Kulchitsky cells), high mitotic activity
91
small cell carcinoma association
male smokers
92
small cell carcinoma location
Central
93
small cell carcinoma comments
rapid growth and early metastasis; may produce ADH, ACTH, or cause eaton lambert syndrome...(paraneoplastic syndromes)
94
squamous cell carcinoma characteristics
keratin pearls, intercellular bridges
95
if tumor starts with S
smoking assoc., central location, paraneoplastic syndromes
96
squamous cell carcinoma association
smoking
97
squamous cell carcinoma location
central
98
squamous cell carcinoma comments
paraneoplastic syndrome of PTHrP
99
adenocarcinoma characteristics
glands or mucin
100
adenocarcinoma associations
most common in non smokers and females
101
adenocarcinoma location
peripheral
102
large cell carcinoma characteristics
poorly diff. large cells, NO keratin pearls, NO intecellular bridges, NO glands or mucin
103
large cell carcinoma association
smoking
104
large cell carcinoma location
central or peripheral
105
large cell carcinoma comments
poor prognosis
106
bronchioloalverolar carcinoma characteristics
columnar cells that grow along preexisting bronchioles and alveoli; arise from clara cells
107
bronchioloalveolar carcinoma association
not related to smoking
108
bronchioloalveolar carcinoma location
peripheral
109
bronchioloalveolar carcinoma comment
may present with pneumonia-like consolidation on imaging; excellent prognosis
110
carcinoid tumor characteristics
well diff. neuroendocrine cells; chromogranin +
111
carcinoid tumor associations
not related to smoking
112
carcinoid tumors location
central or peri; classically forms a polyp like mass in bronchus
113
carcinoid tumor comments
low grade malignancy; rarely causes carcinoid syndrome
114
metastasis to lung characteristics
most common from breast and colon carcinoma
115
metastasis to lung location
multiple cannon ball nodules on imaging
116
metastasis to lung comments
more common than primary tumors
117
unique site of distant spread from lung cancer
adrenal gland
118
local complications of lung cancers
pleural involvement, obstruction of SVC (SVC syndrome..dilated veins in head and neck, edema in arms, blue discorloation of arms and face), involvement of recurrent laryngeal or phrenic nerve, compression of the sympathetic chain (can cause horners)
119
what lines the pleuras
meso cells
120
pneumothorax def
air in the pleural space
121
spontaneous pneumothorax characteristics
rupture of emphysematous bleb, seen in young adults, results in collapse of portion of lung, trachea shifts to side of collapse
122
tension pneumothorax chatracterisitcs
arise from a penetrating chest wall injury, trachea pushed to opp. side of injury, medical emergency, Tx with insertion of chest tube
123
mesothilioma characteristics
malignant neoplasm of mesothelial cells, highly assoc. with occupational exposure to asbestos, presents with recurrent pleural effusions, dyspnea, chest pain, tumor encases the lung
124
pneumonia occurs when
normal lung defenses are impaired
125
clinical features of pneumonia
fever, chills, cough with eyllow green or rusty sputum, pleuritic chest pain, dec. breath sounds with dullness to percussion, elevated WBC
126
3 patterns seen on CXR for pneumonia
lobar, bronchopneumonia, interstitial
127
lobar pneumonia look on CXR
1 lobe
128
bronchopneumonia look on CXR
patchy spots
129
interstitial pneumonia look on CXR
interstiium involved leading an increase in the lung markings
130
lobar and broncho pneumonia most common caustive agents
bacteria
131
interstitial pneumonia causitive agents
viral mainly
132
most common cause of lobar pneumonia
Strept. pneumoniae, klebsiella pneumoniae
133
most common cause of community acquired pneumonia
S. pneumoniae, usually seen in middle aged adults and elderly
134
klebsiella pneumoniae characterisitcs
affects malnourished and debilitated individuals, especially elderly, alcoholics, diabetics. thick mucoid capsule results in gelatinous sputum (currant jelly)
135
4 classic phases of lobar pneumonia
Congestion then Red Hepatization then Grey Hepatization then Resolution
136
Congestion phase of lobar pneumonia
congestion or blood, edema
137
Red hepatization phase of lobar pneumonia
exudate in lung, includes RBC
138
Grey hepatization phase in lobar pneumonia
the RBC exudate breaks down
139
Type I or II is the stem cell for lung
type II
140
Bronchopneumonia characteristics
scattered patchy consolidation centered around bronchioles; often multifocal and B/L
141
Key causes of Bronchopneumonia
S. aureus, H. influenzae, P. aeruginosa, M. catarrhalis, Legionella
142
S. aureus with lung
most common cause of secondary pneumonia (bacterial on top of viral pneumonia); often complicated by abscess or empyema
143
H. flu with the lung
common cause of secondary pneumonia and pneumonia superimposed on COPD
144
Pseudomonas on lung
pneumonia in CF pt
145
Moraxella catarrhalis on lung
CAP and pneumonia super imposed on COPD levels
146
Legionella on lung
CAP, pneumonia superimposed on COPD, pneumonia in immunocomprimised; xmitted from H2O source; intracellular organism
147
interstitial pneumonia differences with Sx
they are more mild than the others, inflammation seen in the walls of air sacs
148
causes of interstitial pneumonia
mycoplasma pneumoniae, chlamydia, RSV, CMV, influenza, coxiella burnetii
149
mycoplasma pneumoniae on lung
most common atypical, young adults (dormatories), can produce cold agglutinin hemolytic anemia, not visible on gram stain
150
chlamydia on lung
2nd most common atypical pneumonia in young adults
151
RSV on lung
most common atypical in infants
152
CMV on lung
post transplant surgury most common, atypical
153
influenza on lung
atypical in elderly, immunocompromiesed, pre-exist lung disease
154
coxiella B. on lung
Q fever, farmers and vets, atypical pneumonia, HAVE A HIGH FEVER UNLIKE OTHERS
155
Aspiration pneumonia causes
bacteriodies, fusobacterium, peptococcus
156
primary TB characteristics
focal caseating necrosis in lower lobe of lung and hilar nodes, foci undergo fibrosis and calcification (Ghon complex)
157
secondary TB characterisitcs
due to reactivation, occurs at apex of lung, caseous necrosis and may lead to miliary TB (scattered all over lung) or TB bronchopneumonia
158
clinical features of secondary TB
fever, night sweats, cough, hemoptysis, lbs loss, Bx show caseating granulomas with acid fast bacilli
159
systemic spread of TB where
meningies (base of brain), cervical nodes, kidney (sterile pyuria, most common organ), lumbar vertebrase (Pott disease)
160
Obstructive diseases
Emphysema, chronic bronchitis, asthma, bronchi ecstasies
161
Restrictive diseases
Fibrosing, grabulomas etc
