Respiratory/lungs Flashcards
__________is the most common cause of community acquired pneumonia in patients over 40
Clinical Presentation: Fever, productive cough, Infiltrates on CXR
Hemoptysis is frequent and is characteristically “rusty”
Pneumococcus
Gram +
alpha hemolytic
A sputum cytology specimen shows Curschmann spirals, Charcot-Leyden crystals, and acute inflammatory cells in a background of abundant mucus. Many of the inflammatory cells are eosinophils. Which of the following lung diseases is the patient with such a specimen most likely to have?
Bronchiectasis Foreign body aspiration Atopic asthma Centrilobular emphysema Chronic bronchitis
Asthma:
Clinical Features: Chest tightness, a nonproductive cough, inspiratory and expiratory wheezes, tachypnea, dyspnea, prolonged expiratory phase
Histologic Features: Mucus-containing Curschmann spirals, eosinophils and Charcot-Leyden crystals
Treatment: Short acting β2-agonists (albuterol), Long acting β2-agonists (salmeterol), Anticholinergics (ipratropium), Inhaled steroids (Budesonide, Fluticasone), Oral Steroids (prednisone)
63-year-old male worked for 20 years in the sandblasting business, and he used no respiratory precautions during that time. He now has increasing dyspnea without fever, cough, or chest pain. Which of the following inflammatory cell types is most crucial to the development of his underlying disease?
Plasma cell Mast cell Eosinophil Macrophage Natural killer cell
Macrophage
History of work as a Sandblaster = Silicosis (silica is a major component of sand)
Silica particles are ingested by alveolar macrophages
Dead macrophages release free silica particles and fibrogenic factors
The released silica is then re-ingested by macrophages and the process is amplified
Increased risk for TB
_______ causes plexiform lesions and are seen with severe, long standing disease
Pulmonary HTN
Leadss to right vent hypertrophy and cor pulmonale
What disease process is being descrubed?
Neutrophils are activated by acute insult and release enzymes, which damage pulmonary capillary endothelium-Type I and II pneumocytes
Histologic appearance: Hyaline membranes
Radiographic Appearance: Bilateral infiltrates progressing to “white out”, ICU sign = if you’re given a CXR with numerous lines and tubes on a test, think ARDS
Acute Respiratory Distress Syndrome (ARDS) AKA diffuse alveolar damange (DAD)
What disease is being described?
Triad of diffuse alveolar hemorrhage, glomerulonephritis and a circulating autoantibody to a component of basement membranes…linear deposit of IgG on immunoflueoresence
Goodpasture’s Syndrome:
Renal failure AND alveolar destruction
A 70-year-old female is referred to an ophthalmologist for right eye problems. The findings include enophthalmos, miosis, anhidrosis, and ptosis. She also has pain in the right upper chest region that radiates down her right arm. A chest radiograph is shown below. Which of the following conditions is she most likely to have?
Bronchopneumonia Bronchiectasis Squamous cell carcinoma Sarcoidosis Tuberculosis
Squamous cell carcinoma
This is a pancoast tumor (most often squamous)…may extend into the cervical sympathetic chain causing horners syndrome (enopthalmous, miosis, anhydrosis)
Mixed type III/IV hypersensitivity reaction to environmental antigen causing dyspnea, cough, chest
tightness, headache. Often seen in farmers and those exposed to birds.
A lung biopsy shows interstitial infiltrates of lymphocytes and plasma cells, minimal interstitial fibrosis. and small granulomas.
Hypersensitivity pneumonitis
Improves with removal of exposure
Chronic exposure (often in farmers) lead to interstitial fibrosis
A 49-year-old male is found to have an elevated serum calcium concentration
A chest radiograph reveals a 7-cm right hilar lung mass. A chest CT shows prominent central necrosis in this mass. Which of the following neoplasms is most likely to be associated with these findings?
Metastatic colonic adenocarcinoma
Small cell carcinoma
Bronchioloalveolar carcinoma
Squamous cell carcinoma
Large cell carcinoma
Squamous cell carcinoma-may produce parathyroid-like hormone–> produces calcium as a paraneoplastic syndrome
Metastatic will present with multiple lung masses
Small cell may produce endocrine (ACTH) or nervous system (lamber eaton) paraneoplastic syndrome
A 78-year-old male increasing dyspnea over the past 4 months.
CT scan shows a dense, bright, right pleural mass encasing most of the right lung, and a pleural biopsy shows spindle cells that invade adipose tissue.
Inhalation of which of the following materials is probably an important factor in development of this mass?
Asbestos Bird dust Silica Cotton fibers Coal dust
Mesothelioma:
Complication of asbestos exposure, neoplasm of mesothelial cells, most common in the pleura
Histologic Appearance: Glands and tubules admixed with sheets of spindle cells
Encasing the lung is characteristic of mesothelioma
What disease process is being described?
Irreversible Dilation of Bronchi Caused by Destruction of Bronchial Walls
Due to prolonged/recurrent infections or prolonged atelectasis (tumor, pneumonia, ect.)
Clinical Presentation: Chronic cough with copious production of mucopurulent sputum (often described as several cups full of sputum), Hemoptysis
Radiographic Appearance: dilated bronchi with thickened walls
Bronchiectasis
Due to necrotizing inflammation with damage to airway walls
Causes include Cystic Fibrosis (most common cause)
Kartagener syndrome (inherited defect in dyenin arm)
Tumor or foreign body
Necrotizing infection (described above)
Damage to the bronchial mucosa by major basic protein of eosinophils is characteristic of what respiratory condition?
Asthma
Unopposed action of neutrophil-derived elastase resulting fomr A1AT deficeincy is characteristic of what respiratory condition?
COPD/emphysema
A 45-year-old female who is not a smoker is found to have the PiZZ phenotype of α1- antitrypsin deficiency. She suffers from increasing respiratory difficulty that limits her activities. What condition is probably present in her lungs?
Sarcoidosis Bronchiectasis Interstitial fibrosis Centrilobular emphysema Panacinar emphysema
Empysema:
Panacinar = due to A1AT deficiency, worse in lower lobes (increased blood flow = increased presence of neutrophils + elastase)
Cenrtilobular = due to cigarette smoking, worse in upper lobes (think of smoke rising)
Is emphysema worse in upper or lower parts of lung?
Typically centrilobular worse in upper lobes if cause is smoking (smoke rises)
It will be panacinar that is more severe in lower lobes is caused by A1AT deficiency (PiZZ homozygous is worst risk)
Which type of lung cancer can mimic pneumonia…something like pleuritic chest pain, 3-weel hx of cough, month of abx treatment but no relief.
- Kaposi sarcoma
- Bronchial carcinoid
- Hamartoma
- Bronchoiloavlveolar carcinoma
Bronchioloalveolar Carcinoma:
Distinctive subtype of adenocarcinoma that grows purely along preexisting alveolar walls (lepidic growth)
Clinical Presentation: Peripheral tumor that may mimic pneumonia
Good prognosis: 100% survival at 5 years
