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respiratory pathology Flashcards

1
Q

spontaneous vs tension pneumothorax

A

sp- due to rupture of emphysematous bleb in young adults –> collapses portion of lung and trachea shifts to SIDE OF COLLAPSE (SAME SIDE) ten- penetrating chest injury –> TRACHEA TO OPPOSITE SIDE OF INJURY

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2
Q

chronic bronchitis

A

hypertrophy of bronchial mucinous glands (reid index >50%) chronic productive cough (due to excess mucous production) for atleast 3 months for min of two years, cyanosis (mucus traps co2) associatedw smoking

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2
Q

A1AT defficiency

A

rare cause of emphysema lack of antiprotease leaves air sacs vulnerable to protease mediated damage –> lower lobe pancinar emphysema may cause liver cirhhosis due to mutant A1AT buildup in ER of hepatocytes

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3
Q

what triad characterized aspirin intolerant asthma?

A

asthma aspirin induced bronchospasms nasal polyps

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3
Q

what does surfactant do? what happens without?

A

it decreases surface tension in lungs, preventing collapse of alveolar air sacs after expiration lack of surfactant leads to air sac collapse and formation of hyaline membranes

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3
Q

unique site of distant metastasis of lung cancer

A

adrenal gland

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4
Q

bronchiectasis

A

obstructive; permanent dilation of bronchioles and bronchi due to necrotizing inflammation with damage to airway walls; loss of airway tone –> air trapping presents with cough, dyspnea and foul smelling sputum

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5
Q

large cell carcinoma

A

poorly differentiated large cells NO keratin pearls, mucin, glands, or intercellular bridges POOR PROGNOSIS, central or peripheral

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6
Q

primary vs secondary pulmonary hypertension

A

pri- young adult females, inactivated BMPR2 mutation that causes vascular SM proliferation sec- due to hypoxemia (COPD or interstitial lung disease) or increased volume in the pulmonary circuit (congenital heart disease); may arise from pulmonary embolism

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7
Q

central; poorly differentiated small cells from neuroendocrine cells male smokers

A

small cell carcinoma

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7
Q

penumonia like consolidation on imaging with excellent prognosis

A

bronchioloalveolar carcinoma

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8
Q

dysphagia

A

trouble swallowing

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8
Q

risk factors for laryngeal carcinoma?

A

alcohol tobacco laryngeal papilloma

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9
Q

pathogenesis of asthma

A

type 1 hypersensitivity 1) allergens induce TH2 CD4 t cells 2) TH2 cells secrete IL4 (class switch to IgE), IL5(attract eosinophils), and IL10 (TH2 stimulation and TH1 inhibition) 3) reexposure to allergen leads to IgE mediated mast cell activation 4) histamine release 5) production of leukotrienes C4 D4 and E4 causes bronchoconstriction, inflammation and edema (early rxn) 6) late rxn = inflammation, eosinophil protein, damages cells and perpetuates bronchoconstriction

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10
Q

treatment for acute respiratory distress syndrome

A

treat underlying cause ventilation with + end expiratory pressure (PEEP) damage and loss of type 2 pneumocytes leaves scarring and fibrosis

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11
Q

laryngotracheobronchitis

A

croup upper airway inflammation presents with hoarse, barking cough and inspiratory stridor

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11
Q

phases of lobar pneumonia

A

1) congestion of vessels and edema 2)red hepatization - exudate neutrophils and hemorrhage fill alveolar spaces making lung more solid 3) gray hepatization - degeneration of red cells 4) resolution

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12
Q

lung cancer treatment small cell carcinoma vs nonsmall cell carcinoma

A

SCC - treat with chemo NSCC - treat with surgical resection, not chemo

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13
Q

laryngeal papilloma

A

benign papillary tumor of the vocal cord presents w hoarseness single in adults, multiple in children

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13
Q

acute respiratory distress syndrome

A

alveolar damage; leakage of protein rich fluids leads to edema edema + necrotic epithelial cells = hyaline membranes in alveoli

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13
Q

mesothelioma

A

malignant neoplasm of mesothelial cells associated with occupational asbestos presents with pleural effusions, dyspnea, and chest pain tumor encases the lung

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14
Q

who is at risk for aspiration pneumonia? where does it occur usually?

A

comatose alcoholics right lower lobe due to easier entrance in right mainstem

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15
Q

what is asthma associated with?

A

childhood presentation allergic rhinitis, eczema, family history of atopy

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15
Q

squamous cell carcinoma

A

keratin pearls or intercellular bridges most common tumor in male smokers may produce PTHrP

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17
croup is another name for?
laryngotracheobrinchitis
17
penumonia
infection of lung parenchyma when normal defense are impaired; involves alveolar sacs
17
systemic disease with noncaseating granulomas in multuple organs
sarcoidosis
17
what can chronic exposure with hypersensitivity pneumonitis lead to?
interstitial fibrosis
18
three ways to diagnose pneumonia
CXR sputum gram stain and culture blood culture
18
pneumoconioses
restrictive; interstitial fibrosis due to chronic exposure to small fibrogenic particles (carbon/coal, silica, berrylium, asbestos) --\> alveolar macrophages engulf foreign particles and induce fibrosis
20
lobar pneumonia
consolidation of an entire lung lobe due to bacteria steptococcus pneumonia or klebsiella pneumonia
20
COPD
chronic obstructive pulmonary disease diseases w airway obstruction - lung does not empty and air gets trapped decreased volume expired (FVC); especially volume expired in first sec (FEV1) --\> decreased fev1:fvc ratio lung capacity increases(TLC)
20
interstitial fibrosis due to occupational exposures
pneumoconioses
21
symptoms of pneumonia
fever/chills productive cough (yellow green pus or rusty (blood) sputum) tachypnea with pleuritic chest pain decreased breath sounds dullness to percussion elevated WBC
22
asthma
reversible airway bronchoconstriction, usually due to allergic stimuli (atopic) (type 1 hypersensitivity)
22
stellate inclusions
asteroid bodies seen in giant cells with sarcoidosis
23
charcott leyden crystals
eosinophil derived crystals seen in asthma
24
pink PAS+ globules in hepatocytes
liver cirhhosis mutant A1AT in hepatocytes ER
26
clinical term for nosebleed?
epistaxis
27
nasal polyp
protrusion of edematous inflamed nasal mucosa
28
churshmann spirals
spiral shaped mucus plugs seen in asthma
30
secondary TB
reactivation of mycobacterium tuberculosis that forms cavitary foci of caseous necrosis commonly due to AIDs and aging
31
sarcoidosis
noncaseating granulomas in multiple organs classically in black women can involve hilar lymph nodes, lungs, uvea, skin, and glands symptoms= dyspnea or cough, elevated ACE, hypercalcemia
32
neonatal respiratory distress syndrome
respiratory distress due to low surfactant levels hypoxemia with cyanosis, increasing respiratory effort
33
rhinitis presents w? caused by?
sneezing, congestion, and runny nose (common cold) rhinovirus
34
atypical pneumonia
interstitial, diffuse infiltrates mild upper respiratory symptoms (mimimal sputum and low fever) bacterial or viral
35
presents with hypoxemia and cyanosis with breathing trouble due to thickened diffusion barrier and collapse of air sacs
acute respiratory distress syndrome
36
three patterns of pneumonia
lobar pneumonia bronchopneumonia interstitial pneumonia
36
what causes plexiform lesions when chronic?
pulmonary HTN
37
pulmonary hypertension
high pressure in pulmonary circuit (MAP \>25 mmHG) characterized by exertional dyspnea, atherosclerosis of pulmonary trunk, SM hypertrophy in pulmonary arteries, LV hypertrophy, and intimal fibrosis
38
pneumothorax
accumulation of air in pleural space
39
vocal cord nodule/singers nodule
nodule on true vocal cord due to excessive use; usually bilateral presents with hoarseness and resolves with rest
41
atopic means hypersensitivity type....?
1/allergic
41
loss of elastic recoil and collapse of airways in exhalation?
emphysema
42
histology of sarcoidosis
stellate inclusions (asteroid bodies) seen within giant cells
43
inflammation of nasal mucosa?
rhinitis
44
columnar cells that grow along preexisting bronchioles and alveoli arise from clara cells
bronchioloalveolar carcinoma
45
what causes laryngeal papilloma?
HPV 6 and 11
46
symptoms of ideopathic pulmonary fibrosis
cough, dyspnea, fibrosis on lung CT (subpleural patches diffuse with honeycomb lung)
47
presents with fever, cough and dyspnea hours after exposure and resolves with removal of exposure
hypersensitivity pneumonitis
49
symptoms of secondary TB
fevers, night sweats, cough w hemoptysis, weight loss
49
4 types of obstructive diseases
chronic bronchitis emphysema asthma bronchiectasis
51
what commonly causes acute epiglottitis? and who gets it?
H influenzae non immunized children
52
risk of supplemental oxygen with neonatal respiratory distress syndrome
free radical injury
54
in general, restrictive diseases are...
due to interstitial diseases of lung or chest wall abnormalities restricted filling of the lung= decreased TLC, decreased FEV1, decreased FVC; increased FEV1:FVC ratio
55
what anaerobic bacteria cause aspiration pneumonia?
bacteroides fusobacterium peptococcus
57
primary TB
asymptomatic but leads to +PPD; presents with focal caseating necrosis in lower lobes/hilar lymph nodes that undergoes fibrosis and calcification, forms Ghon complex
58
laryngeal carcinoma
squamous cell carcinoma usually from epithelial lining of vocal cord hoarseness, cough, and stridor
59
primary TB usually occurs where? and secondary TB?
primary - lower lobes of lung and hilar lymph nodes secondary - apex of lungs (poor drainage and high oxygen tension)
60
what makes up an angiofibroma? who typically gets them?
large blood vessels and fibrous tissue adolescent males with nosebleed
61
how do you get acute respiratory distress syndrome?
usually secondary to sepsis, infection, shock, DIC, aspiration, drugs, etc activation of neutrophils induces protease and free radical damage to pneumocytes
63
emphysema
destruction of alveolar air sacs due to imbalance of proteases and antiproteases -inflammation produces excessive proteases; or -lack of A1AT(alpha 1 antitrypsin) so less neutralization
65
benign tumor of nasal mucosa?
angiofibroma
67
what does parainfluenza virus cause?
laryngotracheobronchitis/croup
68
bronchopneumonia
scattered patchy consolidation centered around bronchioles; usually multifocal and bilateral
69
what do you see in acute respiratory distress syndrome CXR?
lung white out
71
symptoms of emphysema
dyspnea, cough, minimal sputum, prolonged expiration w pursed lips (pink puffer), weight loss, barrel chest, complications=hypoxemia/cor pulmonale
73
symptoms of asthma
dyspnea, wheezing, productive cough with spiral shaped mucus plugs (curshmann spirals), eorinophil derived crystals (charcott leyden crystals), severe attack can cause asthmaticus and death
75
ghon complex
calcified focal TB lesion involving lymph node source of long term infection and viable bacteria
76
tuberculosis is caused by
inhalation of aerosolized mycobacterium tuberculosis
78
in secondary TB, AFB stain reveals...
acid fast bacilli
79
if coin lesion is benign, it could be
NOT lung cancer 1) granuloma (TB or fungus) 2) bronchial hamartoma (benign tumor of lung tissue and cartilage)
80
where does TB commonly spread?
mininges cervical lymph nodes kidneys lumbar vertebra
81
how to treat ideopathic pulmonary fibrosis?
lung transpantation
83
bronchiectasis can be caused by
cystic fibrosis kartagener syndrome (defect in dynein arm associated with ciliary movement) tumor allergic bronchopulmonary aspergillosis (aspergillus fungus)
84
damage to alveolar-capillary interface
acute respiratory distress syndrome
85
most common tumor in male smokers
squamous cell carcinoma
86
what cancer is rapid with early metastasis may release ADH or ACTH
small cell carcinoma
88
acute epiglottitis
inflammation of epiglottis presents with: fever, sore throat, drooling and dysphagia, muffled voice, inspiratory stridor, risk of airway obstruction
89
surfactant is made by.. when?
type 2 pneumocytes from lecithin begins week 28 but not adequate until 34th
89
causes of neonatal respiratory distress syndrome
premature births (before week 34), c section delivery (lack of steroids decrease surfactant synthesis), and maternal diabetes (insulin decreases surfactant production)
90
COPD and interstitial lung diseases both cause
hypoxemia --\> secondary pulmonary hypertension
91
pleural effusions, dyspnea, and chest pain tumor encases the lung
mesothelioma
92
hypersensitivity pneumonitis
granulomatous reaction to inhaled organic antigens "pigeon breeders" lung presents with fever, cough and dyspnea hours after exposure and resolves with removal of exposure
93
A1AT deficiency severity
PiMM - normal PiZ - low levels of A1AT PiMZ - asymptomatic heterzygotes but decreased A1AT and at risk for smokers emphysema PiZZ - homozygotes, HIGH risk for panacinar emphysema and cirhhosis
94
well differentiated neuroendocrine cells; chromogranin +
carcinoid tumor
95
lung cancer
average age = 60 often a solitary coin lesion biopsy essential for diagnosis risk factors: smoking, radon, asbestos
96
nasopharyngeal carcinoma is associated with \_\_\_\_? presents with -----? and typically affects?
EBV; cervical lymph node involvement; african children and chinese adults
97
ground glass appearrance of infant lung
neonatal respiratory distress syndrome
98
multiple cannonball nodules on imaging
metastasis to lung commonly from breast and colon carcinoma
99
what two cancers are not related to smoking?
bronchioloalveolar carcinoma carcinoid tumor
101
what composes a vocal cord nodule?
myxoid degenerative CT
102
what can cause nasal polyps?
repeated rhinitis cystic fibrosis aspirin intolerant asthma
103
malignant tumor of nasopharyngeal epithelium?
nasopharyngeal carcinoma
105
4 types of NON small cell carcinomas
adenocarcinoma, squamous cell carcinoma, large cell carcinoma, carcinoid tumor
106
ideopathic pulmonary fibrosis
fibrosis of lung interstitium, possibly due to TGF-beta from injured pneumocytes that induces fibrosis
107
adenocarcinoma
glands or mucin; peripheral, plurae involvement most common tumor in nonsmokers and female smokers
108
4 restrictive diseases
ideopathic pulmonary fibrosis pneumoconioses sarcoidosis hypersensitivity pneumonitis
109
trachea shifted to side of injury? trachea shifted to opposite side?
same side = spontaneous pneumothorax opposite = tension pneumothorax
110
allergic rhinitis
type 1 hypersensitivity rxn, inflammatory infiltrate with eosinophils associated with asthma and eczema

CPR 2nd half (6 decks)

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