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CPR 2nd half > respiratory pathology > Flashcards

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
Q

croup is another name for?

A

laryngotracheobrinchitis

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17
Q

penumonia

A

infection of lung parenchyma when normal defense are impaired; involves alveolar sacs

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17
Q

systemic disease with noncaseating granulomas in multuple organs

A

sarcoidosis

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17
Q

what can chronic exposure with hypersensitivity pneumonitis lead to?

A

interstitial fibrosis

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18
Q

three ways to diagnose pneumonia

A

CXR sputum gram stain and culture blood culture

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18
Q

pneumoconioses

A

restrictive; interstitial fibrosis due to chronic exposure to small fibrogenic particles (carbon/coal, silica, berrylium, asbestos) –> alveolar macrophages engulf foreign particles and induce fibrosis

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20
Q

lobar pneumonia

A

consolidation of an entire lung lobe due to bacteria steptococcus pneumonia or klebsiella pneumonia

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20
Q

COPD

A

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)

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20
Q

interstitial fibrosis due to occupational exposures

A

pneumoconioses

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21
Q

symptoms of pneumonia

A

fever/chills productive cough (yellow green pus or rusty (blood) sputum) tachypnea with pleuritic chest pain decreased breath sounds dullness to percussion elevated WBC

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22
Q

asthma

A

reversible airway bronchoconstriction, usually due to allergic stimuli (atopic) (type 1 hypersensitivity)

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22
Q

stellate inclusions

A

asteroid bodies seen in giant cells with sarcoidosis

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23
Q

charcott leyden crystals

A

eosinophil derived crystals seen in asthma

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24
Q

pink PAS+ globules in hepatocytes

A

liver cirhhosis mutant A1AT in hepatocytes ER

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26
Q

clinical term for nosebleed?

A

epistaxis

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27
Q

nasal polyp

A

protrusion of edematous inflamed nasal mucosa

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28
Q

churshmann spirals

A

spiral shaped mucus plugs seen in asthma

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30
Q

secondary TB

A

reactivation of mycobacterium tuberculosis that forms cavitary foci of caseous necrosis commonly due to AIDs and aging

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31
Q

sarcoidosis

A

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

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32
Q

neonatal respiratory distress syndrome

A

respiratory distress due to low surfactant levels hypoxemia with cyanosis, increasing respiratory effort

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33
Q

rhinitis presents w? caused by?

A

sneezing, congestion, and runny nose (common cold) rhinovirus

34
Q

atypical pneumonia

A

interstitial, diffuse infiltrates mild upper respiratory symptoms (mimimal sputum and low fever) bacterial or viral

35
Q

presents with hypoxemia and cyanosis with breathing trouble due to thickened diffusion barrier and collapse of air sacs

A

acute respiratory distress syndrome

36
Q

three patterns of pneumonia

A

lobar pneumonia bronchopneumonia interstitial pneumonia

36
Q

what causes plexiform lesions when chronic?

A

pulmonary HTN

37
Q

pulmonary hypertension

A

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
Q

pneumothorax

A

accumulation of air in pleural space

39
Q

vocal cord nodule/singers nodule

A

nodule on true vocal cord due to excessive use; usually bilateral presents with hoarseness and resolves with rest

41
Q

atopic means hypersensitivity type….?

A

1/allergic

41
Q

loss of elastic recoil and collapse of airways in exhalation?

A

emphysema

42
Q

histology of sarcoidosis

A

stellate inclusions (asteroid bodies) seen within giant cells

43
Q

inflammation of nasal mucosa?

A

rhinitis

44
Q

columnar cells that grow along preexisting bronchioles and alveoli arise from clara cells

A

bronchioloalveolar carcinoma

45
Q

what causes laryngeal papilloma?

A

HPV 6 and 11

46
Q

symptoms of ideopathic pulmonary fibrosis

A

cough, dyspnea, fibrosis on lung CT (subpleural patches diffuse with honeycomb lung)

47
Q

presents with fever, cough and dyspnea hours after exposure and resolves with removal of exposure

A

hypersensitivity pneumonitis

49
Q

symptoms of secondary TB

A

fevers, night sweats, cough w hemoptysis, weight loss

49
Q

4 types of obstructive diseases

A

chronic bronchitis emphysema asthma bronchiectasis

51
Q

what commonly causes acute epiglottitis? and who gets it?

A

H influenzae non immunized children

52
Q

risk of supplemental oxygen with neonatal respiratory distress syndrome

A

free radical injury

54
Q

in general, restrictive diseases are…

A

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
Q

what anaerobic bacteria cause aspiration pneumonia?

A

bacteroides fusobacterium peptococcus

57
Q

primary TB

A

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
Q

laryngeal carcinoma

A

squamous cell carcinoma usually from epithelial lining of vocal cord hoarseness, cough, and stridor

59
Q

primary TB usually occurs where? and secondary TB?

A

primary - lower lobes of lung and hilar lymph nodes secondary - apex of lungs (poor drainage and high oxygen tension)

60
Q

what makes up an angiofibroma? who typically gets them?

A

large blood vessels and fibrous tissue adolescent males with nosebleed

61
Q

how do you get acute respiratory distress syndrome?

A

usually secondary to sepsis, infection, shock, DIC, aspiration, drugs, etc activation of neutrophils induces protease and free radical damage to pneumocytes

63
Q

emphysema

A

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
Q

benign tumor of nasal mucosa?

A

angiofibroma

67
Q

what does parainfluenza virus cause?

A

laryngotracheobronchitis/croup

68
Q

bronchopneumonia

A

scattered patchy consolidation centered around bronchioles; usually multifocal and bilateral

69
Q

what do you see in acute respiratory distress syndrome CXR?

A

lung white out

71
Q

symptoms of emphysema

A

dyspnea, cough, minimal sputum, prolonged expiration w pursed lips (pink puffer), weight loss, barrel chest, complications=hypoxemia/cor pulmonale

73
Q

symptoms of asthma

A

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
Q

ghon complex

A

calcified focal TB lesion involving lymph node source of long term infection and viable bacteria

76
Q

tuberculosis is caused by

A

inhalation of aerosolized mycobacterium tuberculosis

78
Q

in secondary TB, AFB stain reveals…

A

acid fast bacilli

79
Q

if coin lesion is benign, it could be

A

NOT lung cancer 1) granuloma (TB or fungus) 2) bronchial hamartoma (benign tumor of lung tissue and cartilage)

80
Q

where does TB commonly spread?

A

mininges cervical lymph nodes kidneys lumbar vertebra

81
Q

how to treat ideopathic pulmonary fibrosis?

A

lung transpantation

83
Q

bronchiectasis can be caused by

A

cystic fibrosis kartagener syndrome (defect in dynein arm associated with ciliary movement) tumor allergic bronchopulmonary aspergillosis (aspergillus fungus)

84
Q

damage to alveolar-capillary interface

A

acute respiratory distress syndrome

85
Q

most common tumor in male smokers

A

squamous cell carcinoma

86
Q

what cancer is rapid with early metastasis may release ADH or ACTH

A

small cell carcinoma

88
Q

acute epiglottitis

A

inflammation of epiglottis presents with: fever, sore throat, drooling and dysphagia, muffled voice, inspiratory stridor, risk of airway obstruction

89
Q

surfactant is made by.. when?

A

type 2 pneumocytes from lecithin begins week 28 but not adequate until 34th

89
Q

causes of neonatal respiratory distress syndrome

A

premature births (before week 34), c section delivery (lack of steroids decrease surfactant synthesis), and maternal diabetes (insulin decreases surfactant production)

90
Q

COPD and interstitial lung diseases both cause

A

hypoxemia –> secondary pulmonary hypertension

91
Q

pleural effusions, dyspnea, and chest pain tumor encases the lung

A

mesothelioma

92
Q

hypersensitivity pneumonitis

A

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
Q

A1AT deficiency severity

A

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
Q

well differentiated neuroendocrine cells; chromogranin +

A

carcinoid tumor

95
Q

lung cancer

A

average age = 60 often a solitary coin lesion biopsy essential for diagnosis risk factors: smoking, radon, asbestos

96
Q

nasopharyngeal carcinoma is associated with ____? presents with —–? and typically affects?

A

EBV; cervical lymph node involvement; african children and chinese adults

97
Q

ground glass appearrance of infant lung

A

neonatal respiratory distress syndrome

98
Q

multiple cannonball nodules on imaging

A

metastasis to lung commonly from breast and colon carcinoma

99
Q

what two cancers are not related to smoking?

A

bronchioloalveolar carcinoma carcinoid tumor

101
Q

what composes a vocal cord nodule?

A

myxoid degenerative CT

102
Q

what can cause nasal polyps?

A

repeated rhinitis cystic fibrosis aspirin intolerant asthma

103
Q

malignant tumor of nasopharyngeal epithelium?

A

nasopharyngeal carcinoma

105
Q

4 types of NON small cell carcinomas

A

adenocarcinoma, squamous cell carcinoma, large cell carcinoma, carcinoid tumor

106
Q

ideopathic pulmonary fibrosis

A

fibrosis of lung interstitium, possibly due to TGF-beta from injured pneumocytes that induces fibrosis

107
Q

adenocarcinoma

A

glands or mucin; peripheral, plurae involvement most common tumor in nonsmokers and female smokers

108
Q

4 restrictive diseases

A

ideopathic pulmonary fibrosis pneumoconioses sarcoidosis hypersensitivity pneumonitis

109
Q

trachea shifted to side of injury? trachea shifted to opposite side?

A

same side = spontaneous pneumothorax opposite = tension pneumothorax

110
Q

allergic rhinitis

A

type 1 hypersensitivity rxn, inflammatory infiltrate with eosinophils associated with asthma and eczema

CPR 2nd half (6 decks)

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