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Pathoma > Respiratory > Flashcards

Respiratory Flashcards

1
Q

inflammation of the nasal mucosa

most common cause?

A

rhinitis
adenovirus
*common cold: sneezing, congestion, runny nose

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2
Q

allergic rhinitis

A

rhinitis due to type 1 hypersens
eosinophils
assoc w asthma/eczema

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3
Q

most high yield complication of rhinitis? occurs when?

A

nasal polyp
repeated bouts
cystic fibrosis
Asprirn-intolerant asthma

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4
Q

ASA-intolerant asthma

A

asthma
aspirin-induced bronchospasm
nasal polyps

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5
Q

angiofibroma
see only in what population?
presentation?

A

benign
only adolescent males
profuse epistaxis

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6
Q 
nasopharyngeal carcinoma
what virus?
what patients?
what nodes?
what on biopsy?
A 
malignant
EBV-driven
african kids/chinese young adult
cervical nodes
biopsy: "pleomorphic keratin-positive epithelial cells in a background of lymphocytes"
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7
Q

acute epiglottitis

presentation?

A

H flu type b - most common in immunized and non-immunized

fever, sore throat, drooling w dysphagia, muffled voice, inspiratory stridor

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8
Q

laryngotracheobronchitis (croup)
most common cause?
presentation?

A

inflammation of upper airway
parainfluenza virus most common
hoarse “barking” cough and inspiratory stridor

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9
Q

vocal cord nodule

A

due to overuse
myxoid degeneration of connective tissue
hoarseness; resolved w rest

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10
Q

laryngeal papilloma
what virus?
diff btw kids/adults?
presents w?

A 
benign tumor on vocal cord
HPV 6 and 11
SINGLE in adults
MULTIPLE in kids
hoarseness
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11
Q

laryngeal carcinoma

A

low risk squamous cell on vocal cord
alcohol/tobacco
hoarseness, cough, stridor

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12
Q

pneumonia is an infection of what part of the lung?

A

parenchyma

via mucus plugging, dmg to escalator, cough reflex etc

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13
Q

characteristics of pneumonia

A 
fever/chills
yellow-green/rusty sputum
tachypnea w pleuritis
bradykinin/PGE2 are key mediators of PAIN
dec breath sounds/dull to perc
elevated WBC
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14
Q

3 patterns of pneumonia

A

lobar (bacterial)
broncho (bacterial; runs along sm airways)
interstitial (increased markings on CxR; atypical/viral)

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15
Q

lobar pneumonia

A

bacterial: 1) S. pneumo (older), 2) Klebsiella (enteric flora that is aspirated –> think risks); elderly, alcoholics, diabetics; currant jelly sputum, abcess

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16
Q

4 phases of lobar pneumonia

A

congestion
red hepatization (blood)
grey hepatization
resolution

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17
Q

stem cell of the lung

A

Type II pneumocyte

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18
Q

“hepatization”

A

becomes dark and solid like liver

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19
Q

bronchopneumonia

A

bacterial
scattered/patchy/multifocal/bilateral
surrounds bronchioles

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20
Q

most common cause of secondary pneumonia - post-viral URI

A

S. aureus
often complicated by abscess/empyema

virus knocks out escalator

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21
Q

bug causing pneumonia superimposed on COPD

A

H. influenzae

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22
Q

bug causing pneumonia in CF pts

A

Pseudomonas

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23
Q

bug causing CAP and superimposed on COPD

A

Moraxella

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24
Q

CAP, COPD, immunocompromised, intracellular organism best seen on silver stain

A

Legionella

water source

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25
Q

interstitial pneumonia (aka?)
hallmark sign on CxR?
air sacs be like whaaat?

A

diffuse IS infiltrates (in wall; no major consolidation in air sacs)
ATYPICAL: upper resp i.e. minimal sputum, cough, low fever
increased lung markings
air sacs relatively clear

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26
Q

most common cause of atypical (IS) pneumonia

A

Mycoplasma (dorms/barracks)

autoimmune hemolytic anemia (IgM v. I antigen on RBC’s –> cold hemolytic anemia) and ERYTHEMA MULTIFORME

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27
Q

second most common cause of atypical pneumonia in young adults

A

Chlamydia pneumoniae

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28
Q

most common cause of atypical pneumonia in infants?

A

respiratory syncytial virus

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29
Q

bug causing atypical pneumonia w posttransplant immunosuppressive therapy?

A

CMV

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30
Q

bug causing atypical pneumonia in elderly, immunocompromised, preexisting lung disease?

A

Influenza virus

risk for superimposed S. aureus or H influenzae

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31
Q

bug causing atypical pneumonia in farmers or vets?

A 
Coxiella burnetii
high fever (Q fever)
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32
Q

what makes Coxiella different from other rickettsiae?

A

1) causes pneumonia
2) does NOT requires arthropod vector for tx (highly-heat resistant endospores)
3) does not produce skin rash

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33
Q

aspiration pneumonia
top 3 bugs?
classic location?

A

anaerobic bacteria in oropharynx
Bacteroides, Fuso, Pepto
RLL

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34
Q

Primary Tuburculosis

symptomatic?

A

focal caseating necrosis in LOWER lobe and hilar nodes
fibrosis+calcification –> GHON complex
no; asymptomatic

35
Q

miliary TB or bronchopneumonia due to which form of TB?

A

secondary reactivated TB

36
Q

presentation of TB

A

fevers/night sweats
cough w hemoptysis
weight loss
run AFB stain to detect mycobacterium and r/o fungi

37
Q

TB can spread to where?

A

any tissue
meninges w granulomas @ BASE
cervical nodes
KIDNEY (most common organ –> sterile pyuria)
lumbar vertebrae (Pott disease (when bone is involved))

38
Q

to have chronic bronchitis, you need?

A

chronic productive cough lasting >3 months for >2 years

39
Q

Reid Index?

A

ratio of mucinus glands in the lung
smokers >50%
defines chronic bronchitis

40
Q

why does cyanosis occur in chronic bronchitis?

A

up PaCO2 so less PaO2 in alveolus so less partial pressure to push across capillaries

41
Q

physiology of emphysema

A

destruction of alveolar air sacs –> loss of elastic recoil and collapse –> air trapping

42
Q

inflammation in lung produces?

A

proteases –> our protection to this is antiproteases (antitrypsin) so to not allow for destruction

e.g. smokers –> debris and inflammation –> up proteases

43
Q

smoker’s emphysema

A

centriacinar most severe UPPER lobes

44
Q

a1-antitrypsin deficiency emphysema

may also present with?

A

panacinar
most severe in LOWER lobes
liver cirrhosis
the deficiency is that the protein is not IN THE BLOOD
still is produced in the liver but is misfolded and accum in ER of hepatocytes (PAS +)

45
Q

most common clinical mutation of a1-AT deficiency?

A

PiM –> PiZ (misfolding and accum in ER)

hetero: PiMZ (asymptomatic but decreased circulating level of a1-AT) these pts at high risk for emphysema so DON’T SMOKE
homo: PiZZ (panacinar + cirrosis)

46
Q

presentation of a1-AT?

A 
dysnea
cough but NO SPUTUM
prolonged expiration w pursed lips
weight loss
inc AP diameter
47
Q

pathogenesis of asthma

A

allergens –> TH2 phenotype in CD4 T cells of genetically susceptible individuals –> TH2s secrete IL-4 (IgE switch)/IL-5 (calls in EOS)/IL-10 (promotes TH2 cell production)

48
Q

features of asthma: what do you find in the mucus?

A

Curschmann spirals admixed w Charcot-Leyden crystals

49
Q

bronchiectasis pathogenesis?
occurs when?
unique complication?

A

necrotizing inflammation w damage to airway walls –> abnormal dilation –> loss of tone and air trapping (cannot accelerate/remove air)

CF/Kartagener/tumor/foreign body/necrotizing infection/allergic bronchopulmonary aspergillosis (asthmatics & CF)

secondary amyloidosis (AA deposition) …primary is AL via plasma cell overproduction

50
Q

what does fibrosis do to the elasticity of the lung? airways?

A

increases

holds airways open

51
Q

IPF
primary mediating factor?
where does fibrosis begin?
tx?

A 
fibrosis of the lung interstitium
TGF-B from injured pneumocytes
r/o drugs (bleo/amio, radiation)
subpleural
tx: transplant
52
Q

Pneumoconioses

what cell mediates?

A

MP’s engulf foreign particles and lay down fibrosis (to wall off the foreign material)
need chronic exposure to cause clinical sx

53
Q

coal workers’ pneumoconiosis

assoc w?

A

carbon dust
massive exposure –> diffuse fibrosis (black lung)
assoc w RA (Caplan syndrome)

54
Q

silicosis

what professions?

A

silica; sandblasters/silica miners
nodules in upper lobes
inc TB risk (impaired phagolysosome formation by MP’s) ONLY ‘coniosis that inc TB risk

55
Q

berylliosis
what professions?
inc risk for what?

A

beryllium; miners and aerospace
noncaseating granulomas, hilar nodes and systemic organs
inc risk for lung cancer

56
Q

asbestosis

fibrosis of lung/pleura, cancer of lung/pleura

A

construction/plumbers/shipyard
pleural plaques, ferruginous bodies
inc risk for carcinoma/mesothelioma

57
Q

sarcoidosis

common in what population?

A

noncaseating granulomas in lung and hilar nodes (epithelioid histiocytes w giant cells)
systemic disease
african-am females
CD4 helper T response
ASTEROID BODY (configuration of giant cells)

58
Q

sarcoidosis can involve what other organs?

tx?

A

uveitis
skin –> nodules or eryth. nodosum
salivary/lacrimal glands (mimics Sjogren’s) but you know if you see N.C. granulomas
hypercalcemia bc N.C. granulomas have 1-a-hydroxylase activity and thus activate vit D
steroids or resolves spontaneously

59
Q

hypersensitivity pneumonitis

A

granulomas with EOSINOPHILS

e.g. pigeons

60
Q

pulmonary HTN
characteristic lesion?
classic presenting sign?

A

> 25mmHg
plexiform lesion (tuft of capillaries; indicate severe, long-standing disease)
exertional dyspnea

61
Q

primary pulmonary HTN

A

young adult females
familial INACTIVATING MUT in BMPR2 –> proliferating mutations in vascular smooth muscle –> plexiform lesions and atherosclerosis of pulm artery

62
Q

one unique way to get secondary pulmonary HTN?

A

recurrent PE

63
Q

ARDS

hallmark finding?

A

hyaline membrane formation –> inc surface tension (easy collapse) and thickened membrane w dec diffusion
“diffuse whiteout of the lung”

64
Q

etiology of ARDS

tx?

A

activation of NP’s w protease and ROS damage of TYPE 1 & 2 pneumocytes –> repair (fibrosis) instead of regeneration bc type 2’s gone
underlying cause + ventilation w PEEP

65
Q

Neonatal RDS due to what?
findings?
3 main causes

A

due to inadequate surfactant –> excess E required to open air sacs
tachypnea, accessory muscle use, hypoxemia/cyanosis
1) prematurity (screen w L/S ratio*), 2) C-section delivery (steroids; cause surfactant release by type 2 pneumocytes (no stress assoc w delivery so no surfactant release) 3) maternal diabetes (high blood sugar –> baby’s pancreas produces insulin, insulin inhibits surfactant production)

*Lecithin (phosphatidylcholine) is key component of surfactant and increases by week 48 of development

66
Q

complications of neonatal ARDS?

A

hypoxemia inc risk for PDA and necrotizing enterocolitis (dec O2 to gut)
supplemental O2 –> ROS injury (retinal blindness)

67
Q

most common cancers: incidence
most common cause of cancer mortality?
avg age of presentation?
key RF’s

A

1) breast/prostate, 2) lung**, 3) colorectal

avg age of presentation = 60
cigarette smoke (polycyclic aromatic HC's), radon (generated from uranium decay), uranium miners, asbestos
68
Q

classic CxR finding in lung cancer? next step?

A

“coin lesion” solitary nodule
next step?
past CxR’s –> if new lesion –> biopsy

69
Q

2 high-yield benign “coin-lesions”

A 
granuloma (histoplasma e.g.)
bronchial hamartoma (tissue belongs there but is disorganized)
70
Q

lung carcinoma

A

small cell (15%) not amenable to surgical resection, instead tx w chemo

non-small cell (85%) tx with surgical resection, no chemo

71
Q

non-small cell e.g’s

A

adenocarcinoma (40%): glands/mucus
squamous cell (30%): keratin pearls, IC bridges
large cell (10%): don’t see any of the above chars
carcinoid tumor

72
Q

small cell carcinoma

A

via poorly-differentiated neuroendocrine cells (Kulchitsky)
chromogranin positive
male smokers
central
paraneoplastic syndromes (Eaton-Lambert e.g.)
mitotic activity on histo

73
Q

squamous cell

A

pink keratin pearls/IC bridges
most common in M smokers
central
PTHrP

74
Q

adenocarcinoma

A

most common tumor in nonsmokers and female smokers
peripheral
no paraneoplastic syndromes

75
Q

large cell carcinoma

A

if r/o others
smoking
central OR peripheral
poor prog

76
Q

bronchioloalveolar carcinoma
arises from which cell?
prognosis?

A 
columnar cells grow along preexisting bronchioles and alveoli
Clara cells
NOT related to smoking
peripheral
pneumonia-like on imaging
excellent prognosis
77
Q

Carcinoid tumor

A

WELL-DIFFERENTIATED neuroendocrine cells
CHROMOGRANIN positive (as in all neuroendocrine tumors
not related to smoking
polyp-like mass in bronchus
can rarely cause carcinoid syndrome
histo: not mitotically active “nests” of cells

78
Q

most common sources of lung metastasis?

hallmark on imaging?

A

breast/colon
“cannon ball nodules”
more common than primary tumors

79
Q

TNM staging

A

T: size/extension
N: spread to hilar/mediastinal nodes
M: spread (adrenal is unique to lung met)

overall 15% 5y survival

80
Q

complications of lung cancer

A

pleural involvement (adenocarc)
SVC syndrome (vein distension, blue discoloration of arms/face)
hoarseness/diaphragmatic paralysis
Horner syndrome

81
Q

parietal & visceral pleura lined by what type of cells?

A

mesothelial

82
Q

spontaneous PTX due to?

what age?

A

rupture of emphysematous bleb
young adults
trachea shifts to side of collapse

83
Q

tension ptx trachea where?

A

trachea to opposite side

84
Q

mesothelioma
assoc w?
presents w?

A

malignant neoplasm
assoc w asbestos
recurrent pleural effusions (bc mesothelium makes fluid)
dyspnea, chest pain

Pathoma (5 decks)

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