RR 2024 Respiratory Flashcards
Terminal bar
Using light microscopy, the terminal bar appears as a bar or spot at the apical surface of the cell, wherein the structures listed cannot be resolved. Dense band-like region in the luminal aspect of the cell.
Dark blue colour on Pap stain.
Typically seen together with cilia.
Brush border
Microvilli (GI)
Stereocilia
Large cilia found in the epididymis and in the piliform cells, the sensor cells of the cochlea and otolithic organs and the semicircular canals (vestibular system) in the inner ear.
Physical finding in bronchial obstruction
Chronic obstruction (brochiectasis, COPD): General findings may include digital clubbing (2% to 3%), cyanosis, plethora, wasting, and weight loss. Local chest examination: Most commonly crackles and wheezes on auscultation. Crackles: 75%, usually bi-basal. Wheezing: 22% (wheezing may be due to airflow obstruction from secretions)
Physical findings in pneumothorax
On lung examination, hyperresonance to percussion, decreased tactile fremitus, and diminished breath sounds are present on the affected side. In a tension pneumothorax, findings may include a displaced point of maximal impulse, tracheal deviation, mediastinal shift, and hemodynamic instability.
Clinical finding with foreign body (FB) aspiration
In adults, approximately 40% of FBs are found in the left bronchial tree and only 5–11% remain in the trachea. Physical examination in a patient with suspected FB aspiration may be normal or may reveal nonspecific findings such as cough and hoarseness, especially if the FB is small. A patient with a FB lodged in the trachea or mainstem bronchi may present with stridor, persistent cough, significant dyspnea, loud wheezing localized to the side of the FB impaction, or absence of breath sounds on the affected side. Auscultation with the patient in the lateral decubitus positions may bring out wheezing on the dependent side. Hyperinflation on the side of the FB impaction, due to the ball-valve phenomenon, may lead to a larger appearing chest cage on that side. Conversely, complete airway obstruction by a FB with resultant atelectasis can present with absent breath sounds on the affected side.
Major Categories of Chronic Interstitial Lung Disease
Fibrosing
Granulomatous
Eosinophilic
Smoking-Related
Causes of fibrosing Chronic Interstitial Lung Disease
Usual interstitial pneumonia (idiopathic pulmonary fibrosis)
Nonspecific interstitial pneumonia
Cryptogenic organizing pneumonia
Collagen vascular disease-associated
Pneumoconiosis
Therapy-associated (drugs, radiation)
Causes of granulomatous Chronic Interstitial Lung Disease
Sarcoidosis
Hypersensitivity pneumonia
Causes of eosinophilic Chronic Interstitial Lung Disease
Loeffler syndrome
Drug allergy–related
Idiopathic chronic eosinophilic pneumonia
Löffler syndrome
a transient respiratory illness associated with blood eosinophilia and radiographic shadowing. (See the image below.) It was initially described by Löffler in 1932. In 1952, Crofton included Löffler syndrome as one of the 5 categories for conditions that cause pulmonary infiltrates with eosinophilia. The original description of Löffler syndrome listed parasitic infection with Ascaris lumbricoides as its most common cause; however, other parasitic infections and acute hypersensitivity reactions to drugs are included as etiologies for simple pulmonary eosinophilia.
Löffler syndrome has classically been related to
has classically been related to the transit of parasitic organisms through the lungs during their life cycle in the human host. After ingestion of Ascaris lumbricoides eggs, larvae hatch in the intestine and penetrate the mesenteric lymphatics and venules to enter the pulmonary circulation. They lodge in the pulmonary capillaries and continue the cycle by migrating through the alveolar walls. Finally, they move up the bronchial tree and are swallowed, returning to the intestine and maturing into adult forms. This process takes approximately 10-16 days after ingestion of the eggs. Other parasites, such as Necator americanus, Ancylostoma duodenale, and Strongyloides stercoralis, have a similar cycle to Ascaris, with passage of larval forms through the alveolar walls. These parasites are not orally ingested but enter the human host through the skin.
Agents in drug-induced eosinophilia
Antimicrobials - Dapsone, ethambutol, isoniazid, nitrofurantoin, penicillins, tetracyclines, clarithromycin, pyrimethamine, daptomycin [2]
Anticonvulsants - Carbamazepines, phenytoin, valproic acid, ethambutol
Anti-inflammatories and immunomodulators - Aspirin, azathioprine, beclomethasone, cromolyn, gold, methotrexate, naproxen, diclofenac, fenbufen, ibuprofen, phenylbutazone, piroxicam, tolfenamic acid
Other agents - Bleomycin, captopril, chlorpromazine, granulocyte-macrophage colony-stimulating factor, imipramine, methylphenidate, sulfasalazine, sulfonamides
Prognosis of Loffler Syndrome
Prognosis
Prognosis is excellent.
Morbidity/mortality
No deaths due to Löffler syndrome have been reported. Löffler syndrome is considered a benign, self-limiting disease without significant morbidity. Symptoms usually subside within 3-4 weeks or shortly after the offending medication is withdrawn in drug-induced pulmonary eosinophilia.
Causes of smoking related Chronic Interstitial Lung Disease
Desquamative interstitial pneumonia
Respiratory bronchiolitis
