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32 respa Flashcards

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1
Q

congenital anomalies

A
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2
Q

acute lung injury
manifest as

A

congestion edema surfactant disruption atelactasis and progress to ards

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3
Q

pulm. edema
define
causes

A

accumulation of fluid in lungs

hemodynamic edema
edema due to microvascukar injury
edema of undetermined origin

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4
Q

hemodynamic edema
define due to
example cause
histology
lung appearance

A

due to hydrostatic pressure
left sided chf
hemosiderin laden macrophages prsent
chronic firm and brown induration

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5
Q

ARDS is caused by

A

diffuse alveolar capillary damage

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6
Q

Clinical features

A

Hypoxemia and cyanosis with respiratory distress—due to thickened diffusion
barrier and collapse of air sacs (increased surface tension)
‘White-out’ on chest x-ray (Fig. 9.I7B)

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7
Q

alveloar wall become…………. in ARDS

A

hyalinized

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8
Q

injury is to………..in ARDS
pathogenesis

A

endothelial and alveolar epi injury
il1
il8 and TNF increase
neutrophil activated

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9
Q

phases of ARDS

A

EXUDATIVE
proliferative
fibrotic

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10
Q

NEONATAL RESPIRATORY DISTRESS SYNDROME
due to
what cell
associtaed with

A

Respiratory distress due to inadequate surfactant levels
1. Surfactant is made by type II pneumocytes; phosphatidylcholine (lecithin) is the
major component.
2. Surfactant decreases surface tension in the lung, preventing collapse of alveolar
air sacs after expiration.
3. Lack of surfactant leads to collapse of air sacs and formation of hyaline
membranes.

prematurty
cesarian section
maternal diabetes

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11
Q

why prematurity affect

A

—Surfactant production begins at 28 weeks; adequate levels are not
reached until 34 weeks.
i. Amniotic fluid lecithin to sphingomyelin ratio is used to screen for lung
maturity.
ii. Phosphatidylcholine (lecithin) levels increase as surfactant is produced;
sphingomyelin remains constant.
iii. A ratio > 2 indicates adequate surfactant production.

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12
Q

why cesearian section cause NARDS

A

—due to lack of stress-induced steroids; steroids
increase synthesis of surfactant,

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13
Q

why maternal DM causes NARDS

A

—Insulin decreases surfactant production,

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14
Q

Clinical features OF NARDS
3

A
  1. Increasing respiratory effort after birth, tachypnea with use of accessory muscles,
    and grunting
  2. Hypoxemia with cyanosis
  3. Diffuse granularity of the lung (‘ground-glass’ appearance) on x-ray
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15
Q

acute interstitial pneumonia

A

like ARDS but unknown etiology

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16
Q

Obstructive versus restrictive pulmonary diseases

A

Obstructive characterized by an increase in resistance to airflow, owing to partial or complete obstruction at any level from the trachea and large bronchi to the terminal and respiratory bronchi restrictive disease characterized by reduced expansion of lung Panka, which is decreases total lung capacity

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17
Q

COPD diseases list

A

Chronic bronchitis, bronchiectasis , asthma, emphysema

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18
Q

Emphysema

A

Is characterized by abnormal, permanent enlargement of airspace distal to the terminal bronchioles, accompanied by destruction of their walls , without obvious fibrosis

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19
Q

Types of emphysema

A

Central Panacinar paraseptal, irregular

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20
Q

From the types of emphysema, which are clinically significant

A

Central and panacinar

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21
Q

Central or centri acinar emphysema affects
lesions are
What is seen in the walls occurs predominantly in?

A

Proximal parts of the acinar are affected and distal parts are spared. Lesions are more common in the upper lobe
wall often contain large amounts of black pigments.
Predominantly in heavy smokers

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22
Q

Panacinar emphysema

A

Involves both proximal and distal bronchioles
it’s more common in the lower lobe and
is associated with alpha 1 anti-trypsine deficiency

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23
Q

Distal or paraseptal emphysema

A

Spares the proximal acinus

Emphysema is adjacent to the plural along the lobular connective tissue septa, and the margins of the lobules
Occurs adjacent to areas of fibrosis and scarring
More severe in the upper half of the lung
Under lies many cases of spontaneous pneumothorax in adults
Forms blebs and bullous

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24
Q

Most plausible hypothesis to account for the destruction of Alveolar walls

A

Protease anti-protease mechanism

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25
Can you call manifestations of emphysema do not appear until
1/3 of functioning, pulmonary paranchyma is damaged
26
Clinical features of emphysema include
1. Dyspnea and cough with minimal sputum 2. Prolonged expiration with pursed lips ('pink-puffers') 3. Weight loss 4. Increased anterior-posterior diameter of chest {'barrel-chest,' ) 5. Hypoxemia (due to destruction of capillaries in the alveolar sac) and cor pulmonale are late complications.
27
Other types of emphysema list
Compensatory hyper inflation, emphysema obstructive over inflation, bullous emphysema interstitial emphysema
28
Compensatory hyperinflation emphysema
Hyper inflation of the residual lung parenchyma that follow surgical removal of a diseased lung or lobe
29
Obstructive over inflation, define and give example
Refers to the condition in which the lung expands because air is trapped within it. Common cause is obstruction by tumor or foreign object. Example is congenital labor over inflation in infants.
30
Interstitial emphysema
Presence of air or gas within the interstitial space of the lung
31
CHRONIC BRONCHITIS
Chronic productive cough lasting at least 3 months over a minimum of 2 years; highly associated with smoking
32
c. bronchitis Characterized by
hypertrophy of bronchial mucinous glands 1. Leads to increased thickness of mucus glands relative to overall bronchial wall thickness (Reid index increases to > 50%; normal is < 40%) reurrent infection because of of mucus plus and smoking metaplasia of brochiol epithelium follows
33
Chronic bronchitis patients known as
blue bloaters
34
asthma define and types
Reversible airway broncho constrict ion, most often due to allergic stimuli (type I hypersensitivity) Atopic non atopic drug induced occupational
35
atopic asthma define pathogenesis
Presents in childhood; often associated with allergic rhinitis, eczema, and a family history of atopy Pathogenesis 1. Allergens induce TH2 2. TH2 cells secrete IL-4 (mediates class switch to IgE), IL-5 (attracts eosinophils), and IL-10 (stimulates T|}2 cells and inhibits T^l). 3. Reexposure to allergen leads to lgE-mediated activation of mast cells.
36
IL4 IL5 IL10 functions
TH2 cells secrete IL-4 (mediates class switch to IgE), IL-5 (attracts eosinophils), and IL-10 (stimulates TH2 cells and inhibits TH1).
37
early phase rxn and late phase rxn in asthma
i. Release of preformed histamine granules and generation of leukotrienes C4, D4, and E4 lead to broncho constrict ion, inflammation, and edema (earlyphase reaction), ii. Inflammation, especially major basic protein derived from eosinophils, damages cells and perpetuates bronchoconstrict ion (late-phase reaction).
38
clinical triads in asthma
cough wheezing dyspnea
39
macroscopic and microscopic finding of asthma
tnecious mucus crushman spirals and charcot leydon crystals made of eosinophil membrane proteins
40
if asthma persists
status athmaticus
41
BRONCHIECTASIS define due to
Permanent dilatation of bronchioles and bronchi ; loss of airway tone results in air trapping. 1. Cystic fibrosis 2. Kartagener syndrome 3. Tumor or foreign body 4. Necrotizing infection 5. Allergic bronchopulmonary aspergillosis
42
kartagener syndrome
inherited defect of the dynein arm, which is necessary for ciliary movement. Associated with sinusitis, infertility (poor motility of sperm), and situs inversus (position of major organs is reversed, e.g., heart is on right side of thorax)
43
etiology and pathogenesis of BRONCHECTASIS
obstruction and infection bronchial obstruction normal clearing mechanism impaired pooling of secretion distal to obstruction inflammation
44
bronchoectasis usually affects the
lower lobes bilaterally
45
Clinical features of bronchoectasis
1. Cough, dyspnea, and tbul-smelling sputum 2. Complications include hypoxemia with cor pulmonale and secondary (AA) amyloidosis.
46
diffuse pulmonary hemorhage syndromes 3
goodpastures sydrome idiopathic pulmonary hemosiderosis vasculitis associated hemorehage
47
PNEUMONIA
A. Infection of the lung parenchyma B. Occurs when normal defenses are impaired (e.g.. impaired cough reflex, damage to mucociliary escalator, or mucus plugging)
48
loss of clearin mechanism interfered by
loss of cough reflex injury to mucociliary apparatus interference with phagocytic action of alveolar pulm congestion and edema accumulation of secretions
49
2 patterns are classically seen on chest x-ray in pneumonia
lobar lobular
50
lobar pneumonia DEFINE usually what
A. Characterized by consolidation of an entire lobe of the lung B. Usually bacterial; most common causes are Streptococcus pneumoniae (95%) and Klebsiella pneumoniae
51
Classic gross phases of lobar pneumonia
1. Congestion—due to congested vessels and edema 2. Red hepatization—due to exudate, neutrophils, and hemorrhage tilling the alveolar air spaces, giving the normally spongy lung a solid consistency (Fig. 9.3B,C) 3. Gray hepatization—due to degradation of red cells within the exudate 4. Resolution
52
BRONCHOPNEUMONIA define where cause age
A, Characterized by scattered patchy consolidation centered around bronchioles; often multifocal and bilateral and basal B. Caused by a variety of bacterial organisms viral benzene in extreme of ages difficulty in resolution
53
the 7 pneumonia syndromes or pneumonia can arise in 7 clinical settings
community acquired acute communiy acquired atypical nosocomial aspiration chronic necrotizing pneomnia and abcsess pneumonia in immunocom.
54
community acquired acute pneumonia cause organism specific risk factors
bacterial or viral bacterial infection follows viral risk factors extreme ages chronic diseases immunodeficiency absent spleen - encapsulated infection organism strep pneumonea H. influenza Moraxella catarhalis staph aures follow viral klebsella pseudomonas legionella organ transplant
55
complications of community acquired pneumonia
abscess formation empyma acc. of pus in pleural space organization of exudate then solid tissue bacteria dissemination
56
community acquired atypical define present as organisms
A. Characterized by diffuse interstitial infiltrates B. Presents with relatively mild upper respiratory symptoms (minimal sputum and low fever); 'atypical' presentation lack of alveolar exudate C. Caused by bacteria or viruses org. mycoplasma coxiella chlamydia influenza virus adeno rhino rubeola varcilla
57
influenza infectios cause epidemics and pandemics how
epidemics mutations of hemaglutinin and neuramindase virus escape host antibody antigenic drift pandemics both agglutinin and neuraminidase are replaced through recombination of rna of animal viruses antigenic shift
58
nosocomial pneumonia org
gram negative rods staph aures not strep pneumoniea
59
aspiration pnemonia seen in common org and often causes which lung
Seen in patients at risk tor aspiration (e.g., alcoholics and comatose patients) Most often due to anaerobic bacteria in the oropharynx (e.g., Bacteroides, Fusobacterium, and Peptococcus) necrotizing pneumonia with abcsess right lung
60
lung abscess define organism
A lung abscess is a localized collection of pus within the lung tissue characterized by necrosis of lungs mixed
61
causative organisms of lung abscess are introduced by
aspiration primary bacterial infection septic emboli neoplasia miscellaneous trauma , from other organs
62
primary cryptogenic pneumonia
when all causative agents are excluded and no reason for abscess formation
63
pulm. abscess due to aspiration are place and bi or uni
right lung single
64
pulm. abscess that develop in course of pneumonia or bronchoectasis are
multiple basal scattered
65
when abscess and other communication exists it creates
air filled cavity
66
superimposed saprophytic infections are prone to develop
gangrene of lung
67
pulm. abcsess manifestations are like
bronchoectasis
68
complication of lung abscess
extension to pluera hemorrhage brain abscess or meningitis secondary amyloidosis
69
chronic pnemonia
granulomatous inflamation by bacteria or fungi tb histoplasmosis blastomycosis coccidomycosis
70
HBC fungi discussed togethere because 2
granulomatous disease like tb dimorphic hyphae at envrt temp and spore at body temp.
71
pnuemonia in immunocompromised orgnaism include
bacteria pseudomonas mycobacterium legionella listeria virus CMV herpes fungi candida aspergillus cryptococcus pneumocytis carni
72
in HIV CD4 counts >200 <200 <50
bacterial pneumocystis pneumoniea CMV M. avium
73
lung cancer classification anatomically
central arise from main bronchi peripheral in the parenchyma solitary pulm. nodule
74
4 type of precursor cancerous lesions recognized
Squamous dysplasia and CIS aatypical adenomatous hyperplasia adenocarcinoma in situ diffuse idiopathic pulm. neuroendocrine cell hyperplasia
75
lung cancers arise mostly in and also which type
hilus of lung cental 2/3rd
76
small number arise in the peripheral lung and are predominantly
adenocarcinomas
77
lung tumors have habit of spreading except ...................which metastasis outside of thorax late
SCC
78
Most organ involved in the metastasis of lung cancers
adrenals
79
SCC risk factor sex frequency of mutation
assoc. with smoking male high frequency of p53 mutation
80
adenocarcinoma sex and risk factor precursor lesion mutation different from SCC
women and non smokers atypycal adenomatous hyperplasia adenomatous CIS K-RAS mutation lower in non smokers
81
adenomatous grow ......... and metastasize ................. compared to SCC
grow slowly metastasize rapidly
82
small cell carcinoma define characterize epithelial cells complications derived from
epithelial cells are small with scant cytoplasm ill defined cell borders finely granular nuclear chromatin and absent nucleoli necrosis is common neuroendocrine progenitor cells of linig of bronchial epithelium
83
.............. staining of vascular walls due to encrustation by ...... from necrotic tumor cells present
basophilic DNA
84
characteristics of small cell carcinoma 7
ectopic hormone production strong relationship with smoking occur both in central and peripheral bronchus no preinvasive lesion most aggressive metastasize widely incurable by surgical resection p53 and RB mutation
85
large cell carcinoma
undefferentiated epithelial cell tumours that lack cytologic features of small cell carcinoma , adenocarcinoma and squamous cell carcinoma probably represent SCC and adenocarcinoma that are so undefferentiated that they can no longer be recognized
86
local effects of lung tumor
lipid pnemonia pneumonia svc syndrome diaphgram paralysis horner syndrome
87
which tumors have better prognosis and which have bad
adenocarcinoma and aquamous cell better prognosis
88
systemic manifestations of lung cancer
lambeert eaton peripheral neuropathy acanthosis niagrans leukmoid reaction hypertrophic pulm. osteoarthritis
89
apical lung cancer (aka) tend to invade ............... and produce...........
pancoast tumors neural structures around trachea horner syndrome
90
carcinoid tumors age types and grade
low grade malignant tumor younger than 40 typical and atypical
91
typical carcinoid tumors and atypical
no p53 mutation
92
central carcinoid tumors characteristics
polypoid mass that projects into lumen covered by intact mucosa
93
peripheral carcinoid tumor chrxts specific name (like what)
intaluminal masses that penetrate bronchial wall and fan out collarbutton lesion
94
classic carcinoid syndrome
diarrhea flushing cyanosis
95
most carcinoid tumors ....................... (secretory activity ) and .................. metastasis
dont have secretory activity donot metastasize
96
among the miscellenous tumors of lung which one is common in children
inflammatory myofibroblastic tumor
97
normal pleural fluid volume and content
15 ml acellular clear lubricating fluid
98
inflammatory pleural effusion types
serous serofibrous fibrous suppurative (empyma) hemmorhagic pleritis
99
empyma most common cause
contigous spread from intrapulmonary infection
100
hemmorhagic pleuritis is found in or caused by
hemorhagic diatheses ricketssial disease neoplastic involvement
101
serofibrous pleural effusion most common cause
radiation
102
non inflammatory pleural effusion list
hydrothorax hemothorax chylothorax
103
chylothorax where difference b/n true and pseudochyle
more on left bc thoracic duct true chyle contain fat
104
ascites assoc.ted pleral effusion which lung
right lung
105
types/ causes of pneumothorax
traumatic/ tension pneumothrax spontanous idiopathic
106
tension pneumothorax manifestation
pushed trachea to opposite side
107
spontaneous idiopathic pneumothotax manifestation
rupture of blebs subsides spontaneously trachea pushed towards the lesion
108
MESOTHELIOMA
Malignant neoplasm of mesotheiial cells; highly associated with occupational exposure to asbestos Presents with recurrent pleural effusions, dyspnea, and chest pain; tumor encases the lung
109

Patho (33 decks)

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