Respiratory Flashcards
What should you consider with a child with nasal polyps
Cystic fibrosis
Triad seen in aspirin (ASA) intolerant Asthma
Asthma
Aspirin induced bronchospasm
Nasal polyps
Adolescent male
Tumor
Profuse epistaxis
Angifibroma
Pleomorphic keratin positive epithelial cells in a background of lymphocytes
What are the 2 demographic profile of patients commonly seen with this disease?
Nasopharyngeal carcinoma
African children
Adolescent Chinese
Laryngeal papilloma is associated with what HPV
HPV 6 & 11 (low risk HPV)
Presenting with koilocytic change
Single in adults
Multiple in children
Key mediators of pain
As in pleuritic chest pain in pneumonia
Bradykinin
Prostaglandin E2
Most common causes of lobar pneumonia
Strep pneumoniae (95%) — most common cause of CAP Klebsiella pneumoniae —enteric flora that is aspirated (patient prone to aspiration at risk: alcoholics, diabetics, nursing home px); currant jelly sputum is from thick mucoid capsule of K. Pneumoniae
Four phases of lobar pneumonia
Congestion — congestive vessels and edema
Red hepatization — develop exudate in the lung (consolidation)
Grey hepatization — break down of exudates
Resolution — heal lung by regeneration of lining (Type Il pneumocytes)
Most common cause of atypical pneumonia
Young adults, miltary recruits, students living in dormitory
Complication associated with it is?
Mycoplasma pneumoniae
autoimmune hemolytic anemia— IgM against I antigen on RBCs
Bacterial cause of aspiration pneumonia
Bacteroides
Fusobacterium
Peptococcus
— anearobic bacteria in oropharynx
Cytokines involved in Asthma
IL 4
IL 5
IL 10
—all released by TH2 lymphocytes
Allows plasma cell to class switch into IgE
IL 4
Causes chemotaxis of eosinophils
IL 5
Inhibits differentiation of T cells to TH1 cells
Inducing Th2 cell production
IL 10
Describe pathophysio early phase of asthma
Early phase—mast cells has surface IgE receptors that are stimulated by allergens causing cross linking, activating mast cells
Mast cells dump preformed histamine granules
What are the effects of preformed histamine granules released from activated mast cells?
Histamine induced vasodilation (at arterioles)
Histamine induced increased vascular permeability (at post venule capillaries)
Describe second phase of mast cell activation
Inflammation
Production of leukotrienes — LTC4, LTD4, LTE4
— vasoconstriction (constrict smooth muscles of blood vessels)
— increased vascular permeability (constrict the pericytes)
— bronchoconstriction (constrict smooth muscle of bronchus)
What are the key players in late phase of Asthma?
Continued inflammation
Eosinophils release major basic protein
Perpetuation of bronchoconstriction
What are the 2 pathologic findings associated with asthma?
Curshmann spirals
Charcot Leyden crystals
Shed epithelium that form whorled mucus plugs
Curshmann spirals
Breakdown of major basic protein from eosinophils
Eosinophilc, hexagonal, double pointed needle - like crystals
Charcot-Leyden crystals
Triad of Aspirin induced asthma
Asthma
Bronchospasm
Nasal polyps
—COX inhibition causes leukotriene overproduction = airway constriction
What part of cilia is affected in Kartagener syndrome
Dynein arm
