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Year 2 Respiratory > Exam I, lungs, Gomez > Flashcards

Exam I, lungs, Gomez Flashcards

1
Q

how many lobes of the lung are there? bronchopulm segments?

A

lobes-5

segments- 19

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2
Q

What size particle is most dangerous to inhale

A

0.5-5 micron

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3
Q

how big are terminal bronchi

A

<2mm

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4
Q

in lungs what type of specialized cells are only in trachea and bronchus

A

goblet cell, seromucous gland and cartiladge

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5
Q

in lungs what type of specialized cells are only found in bronchioles

A

clara cells

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6
Q

in lungs what type of specialized cells are only found in alveoli

A

type I pneumocyte and type II pneumocyte

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7
Q

Majority of surface alveolar cells ware what type

A

Type I non-div

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8
Q

What is a lobule? acinus?

A

lobule- cluster of terminal bronchioles with attached acini

acinus- respiratory bronchiole and all attached alveolar ducts and sacs

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9
Q

what is a common congenital anomalie found in 10% neonatal autopsies

A

pulmonary hypoplasia

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10
Q

What is the most common type of tracheoesophageal fistula

A

the dista part of esophagus comes off trachea, proximal part is a blind ending pouch

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11
Q

describe congenital foregut cysts

A 
detached section of maldeveloped foregut
mediastinal and hilar locations
usually bronchogenic with resp epithelium
some esophageal- squamous mucosa
enteric- intestinal mucosa
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12
Q

What are congenital cystic adenomatoid malformations and the types?

A

hamartomatous lesion with abnormal bronchiolar tissue
type I- large cysts, good prognosis
type II- medium cysts with other malformations

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13
Q

what are bronchopulmonary sequestrations and types?

A

areas of lung without normal connection to airways
blood supply is from systemic aa
Extralobular- external to lung(have other anomalies)
intralobular- within lung have recurrent local infections, most likely an acquired lesion

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14
Q

What are causes of resp distress in newborn

A 
excessive maternal sedation
fetal head injury
blood or amniotic fluid aspiration
intrauterine hypoxia from nuchal cord
hyaline membrane disease
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15
Q

What is most common cause of resp distress in newborn

A

hyaline membrane disease

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16
Q

the rate of neonatal resp distress syndrome is inversely proportional to what

A

gestational age

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17
Q

What factors are associ wtih neonatal resp distress syndrome

A

male, maternal DM, multiple gestation, C section before onset of labor

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18
Q

What induce surfactant secretion

A

glucocorticoids and thyroxine

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19
Q

At 20 weeks wat to alveoli look like? 30?

A

20-glandular

30- saccular

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20
Q

what type cells secrete surfatant

A

type II pneumocytes

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21
Q

If lecithin/sphingomyelin ratio is >2 what does this indicate in lungs?
<1?

A

> 2 lungs are mature

<1 lungs immature

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22
Q

How do you obtain the L/S ratio for lung development

A

thin layer chromotogrpahy
gluorescence polarization
foam stability index
lamellar body count

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23
Q

Atelectasis leads to what

A

uneven perfusion and hypoventilation

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24
Q

What is clinical presentation of respiratory distress syndrome?

A 
preterm and AGA
male sex, maternal DM, C section
low 1 min Apgar score
may need resuscitation
become cyanotic
fine pulm rales
reticulonodular/groun glass CXR
O2 Therapy
death or recovery in 3-4 days
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25
Q

why is respiratory distress syndrome not seen in stillborns

A

need to exude protein rich fluid into alveolar space to make a hyaline membrane

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26
Q

what is risk of O2 therapy with infants with respiratory distress syndrome

A

retinopathy of prematurity

bronchopulmonary dysplasia

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27
Q

What criteria for O2 therapy in cases of bronchopulmonary dysplasia

A

> 28 days O2 therapy in infant>36 weeks post-menstrual age

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28
Q

What is deficit in infants with bronchopulmonary dysplasia

A

alveolar hypoplasia and thickened walls

developmental arrest at saccular stages

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29
Q

what is defect in cycstic fibrosis (mucoviscidosis

A

disorder of epithelial transport of cystic fibrosis transmembrane conductance regulator (epithelial Cl Ch)
affects fluid secretion in exocrine glands and epithelial linging of resp, GI and repro tracts

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30
Q

What gene is CFTR on

A

7q31.2

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31
Q

What is Dx criteria for cycstic fibrosis

A

one or more characteristic phenotypic features(or Hx of CF in sibling) (or +newborn screening test)
AND
Increased sweat Cl [ ] on 2+ occasions (or 2 CFTR mutations)(or abrnomral epithelial nasal ion transport)

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32
Q

How do you Tx pancreatic insufficiency from CF

A

oral pancrelipase

may uncommonly need to Tx DM if islets destroyed

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33
Q

How do you Tx vitamin deficiency from CF

A

oral fat soluble vitamins ADEK

parenterteal nutrition

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34
Q

how do you Tx pulmonary disease from CF

A 
postural drainage and chest percussion
bronchodilators (albuterol)
mucolytic agents
antibiotics
hypertonic saline
high dose ibuprofen
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35
Q

What is dangerous about infants who have had an apparent life threatening event

A

if they have been resuscitated they are now at increase risk of future respiratory death
have prolonged apnea, dminished responses to hypercarbia or hypoxia
often premature or have mechanical disorders leading to compromise

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36
Q

How can atelectasis occur in an adult

A

resportion (obstruction of airways and the mediastinum shifts toward involved lung)
compression from external Pressure(mediastinum shifts away from involved lung)
contraction (secondary to fibrosis of lung or pleura, irreversible)

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37
Q

All atelectasis are at risk for what

A

infection

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38
Q

What are 2 main types pulm edema

A

hemodynamic and microvascular

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39
Q

describe hemodynamic PE

A 
most common
increased hydrostatic P from Left HF
affects basal lower lobes
"ehart failure cells"
can lead to alveolar fibrosis (brown induration of lungs)
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40
Q

describe microvascular PE

A

increased permeability from infection or toxic injury etc

if diffuse can lead to acute Resp distress syndrome

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41
Q

What is criteria for acute lung injury non-cardiogenic PE

A

acute onset dyspnea
hypoxemia
b/l infiltrates
absence of primary L HF !!

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42
Q

What type sof injuries can cause non-cardiogenic PE

A

congestion, surfactant disruption

atelectasis

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43
Q

What mediators are related to non-cardiogenic PE

A

cytokines, oxidants, TNF, ILs, TGF-beta

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44
Q

non cardiogenic PE can lead to what

A

ARDS (DAD diffuse alveolar damage) or AIP(acute interstitial pneumonia

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45
Q

what occurs in diffuse alveolar damange

A

damage to alveolar capillary walls(involvess neutrophilic migration)
have vascular injury and secondary loss of surfactant
can develop prothromnotic milieu (increased TF and dec Protein C)

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46
Q

what type of patients are more prone to diffuse alveolar damage

A

spesis, diffuse pulmonary infections, gastric aspiration, trauma

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47
Q

What infections can lead to aRDS

A

sepsis
diffuse pulm infection
gastric aspiration

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48
Q

what type of physical injuries can lead to ARDS

A 
mechanical trauma and head injuries!
pulm contusions
near drowning
fractures with fat embolism
burns
ionizing radiation
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49
Q

more then 50% ARDS are assoc with what 4 conditions

A

sepsis, diffuse pulmonary infections, gastric aspiration, mechanical trauma including head injuries

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50
Q

reperfusion after lung injury can lead to what

A

ARDS because increase ROS

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51
Q

What is clinical presentation of ARDS

A 
already ill
rapid onset, profound dyspnea and tachypnea
cyanosis and resp failure
diffuse b/l infiltrates on XR
high moratlity
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52
Q

What would you seen histologically in alveoli healing from ARDS

A

resorption of hyaline membranes with thickened albeolar septa with fibroblasts, collagen and many atypical type II pneumocytes

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53
Q

Describe acute interstitial pneumonia AIP

Hamman-Rich syndrome

A 
Sx similar to ARDS
no associated causative disorder
~59 y.o M=F
acute respi failure follwoing illness
33-74% mortalitiy rate within 2 mo
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54
Q

What are 2 types of chronic diffuse lung disease

A

obstructive and restrictive

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55
Q

describe obstructive airway disease characteristics, give examples

A

limit in rate of flow
FEV1/FVC reduced <0.7
R at any level
e.g: emphysema, chronic bronchitis, bronchiectasis, asthma

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56
Q

describe restrictive airway disease charactersitics, give examples

A

limit total lung capcity and residual volume
near normal flow rates (FEV1 may be mildy reduced due to dec TLC but FEV1/FVC near normal)
e.g: ches wall disorders, obesity, ARDS, interstitial fibrosis, penumoconioses

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57
Q

what are the major pathological changes in chronic bronchitis?

A

mucus gland hyperplasia, hypersecretion

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58
Q

what are the major pathological changes in emphysema

A

airspace enlargement, wall destruction

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59
Q

what are the major pathological changes in small-airway disease, bronchiolitis

A

inflammatory scarring/obliteration of bronchioles

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60
Q

What are the classifications of emphysema

A

centriacinar/centrilobular >95%
panacrinar/panlobular
distal acinar/paraseptal
irregular/paracicatrical

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61
Q

where is centriacinar emphysema found and what causes it

A

upper lobes and apices

SMOKING

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62
Q

where is panacinar epmphysema and what causes it

A

lower lobes/anterior

alpha 1 antitrypsin deficiency and SMOKING

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63
Q

where id distal acinar/paraseptal emphysema and wht caues it

A

subpleural and adjacent to septae
may be bullous and cause spontaneous pneumo in young adults
associated with previously damaged lung

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64
Q

which type of emphysema is usually asymptomatic

A

irregular/paracicatrical

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65
Q

how does panacinar emphysema progress

A

initial distention of albeolus and duct then involves entire pulmonary lobule

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66
Q

what is etiology of emphysema

A

proteolytic digestion of alveolar walls

neutrophil secreted elastase is primary villain (inhibited by alpha1 antitrypsin

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67
Q

What deficiency leads to early life emphysema

A

chrom 14 alpha 1 antitrypsin deficiency

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68
Q

When do Sx of emphysema develop

A

after 1/3 lung damaged

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69
Q

what are respiratory levels in emphysema

A

low FEV1, high TLC and RV

low FEV1 due to bronchiole collapse and fibrosis

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70
Q

what is Tx of emphysema

A

bronchodilators, steroids, bullectomy,transplant

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71
Q

what is obstructive overinflation

A

overexpansion by trapped air
1-ball valve obstruction by object
2-collaterals feeding around obstruction
3- congenital lobar overinflation from lack of bronchial cartilage

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72
Q

is there wall destruction in compensatory hyperinflation

A

no

ovvurs from loss of adjacent tissue

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73
Q

What is clinical definition of chronic bronchitis

A

3 mo productive cough/yr for 2 consecutive yeras

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74
Q

what are causes of chronic bronchitis

A

smoking

hypersecretion mucus from stimulation by protesases

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75
Q

and increased Reid index >0.4 is indicative of what

A

chronic bronchitis

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76
Q

What type of vasulities can occur in chronic bronchitis

A

bronchiolitis obliterans in small airways

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77
Q

who are the blue bloaters

A

chronic bronchitis

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78
Q

who are the pink puffers

A

COPD

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79
Q

Redi index is a measurement of what

A

thickness of glands/thickness of wall

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80
Q

What is age of onset with predominant bronchitis vs predominant emphysema

A

bronchitis- 40-45

emphysema 50-75

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81
Q

what are the characterisitics of bronchitis that do not occur in emphysema

A 
cor pulmonale
infections
elastic revoil is normal
increased airway resistance
large heart
blue bloater
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82
Q

what are characteristics of emphysema not seen with bronchitis

A

terminal resp insuficiency
low elastic recoil
small heart
pink puffer

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83
Q

What is asthma

A

chronic inflammarotyr disorder
reactive airspace disease with episodic partially reversible bronchoconstriction
most often at night and early morning
extrinsic is allergecns, exercise cold is intrinsic

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84
Q

what can asthma evolve into

A

acute severe asthma

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85
Q

What is atopic asthma

A

type I HS
IgE Antibodies to inhaled allergens
mast cells
stimulation of subepithelial vagal R

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86
Q

what are Dx testing for atopic asthma

A 
skin allergen testing for confirmation
RAST testing (radioallergosorbent test)
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87
Q

What molecules induce bronchoconstriction

A

Ach from nerves, Leukotrienes C4 D4 E4 from mast cells

histmine and PGD2

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88
Q

What is nonatopic asthma

A 
pulmonary infections (viral) and air pollutants
no allergic indicators
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89
Q

What is drug induced asthma

A

uncommon form of disease

aspirin is the classic cause because inhibit COX pathway

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90
Q

What is morphology of asthma

A

overinflated lungs
with airway remodeling like eosinophilia, subBM fibrosis, hypertrophy and hyperplasia of submucosal glands and goblet cell metaplasia
hypertrophy and hyperplasia of smooth muscle
increased vascularity

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91
Q

What are charco-leyden crystals

A

crystalloids with eosinphil lysophospholipase binding protein

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92
Q

what are curshcmann spirals in alveoli

A

from shed epithelium

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93
Q

What is bronchiectasis

A

permanent dilation of bronchi and bronchioles

tissue destruction secondary to infection

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94
Q

What are Sx of bronchiectasis

A

dyspnea, orthopnea, and rarley severe hemoptosis that is fould semlling
may develop brain abscesses and amyloidosis

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95
Q

What is bronchiectasis assoc with

A 
CF, primary ciliary dyskinesia
obstruction
many infections
autoimmune
pulm sequestration
allergic bronchopulmonary apsergiloosis
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96
Q

What syndrome is assoc with primary ciliary dyskinesia

A

kartagener syndrome:

male infertility, sinusitis, situs inverus of partial lateralizing abnormality

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97
Q

Xray shows reticulonodular or gournd glass appearance involeing intersitium and alveolar walls
patint has dec TLC RV
dyspnea tachypnea, cyanosis, end-inspiratory crackles
end-stage honeybomc lung

A

chronic diffuse interstitial lung disease

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98
Q

What are the fibrosing chronic intersitial lung diseases

A 
idiopathic pulm fibrosis
nonsepcific interstitial pneumonia
cryptogenic organizing pneumonia
CT disease associated
pneumoconioses
drug reactions
radiation pneumonitis
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99
Q

what are the granulomatous chronic interstitial lung diseases

A

sarcoidosis
HS pneumonitis
eosinphilic pneumonias!!!

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100
Q

what are the smoking related chronic interstitial lung diseases

A

desqaumative interstitial pneumonia

respiratory bronchiolitis-assoc interstitial ung disease

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101
Q

what are the other types of chronic interstitial lung diseases

A

pulmonary langerhans cell histiocytosis
pulmonary albeolar proteinosis
lymphoid interstitial pneumonia

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102
Q

What occurs in idiopathic pulm fibrosis (usual interstitial pneumonia) “crytptogenic fibrosing aleolitis”

A

type I pneumocyt death
type II hyperplasia
inflammation with TH2 , cytokines, macrophages, fibroblasts driven by TGF-b, colagen deposition

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103
Q

What environmental factors contribute to idiopathic pulm fibrosis

A

smoking smoking
work related exposures
reflux esophagus

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104
Q

What are the effects of TGF-b on respiratory epithelium

A

inhibits caveolin in fibroblasts
ceveolin usually inhibits deposition of collagen and ECM so TGF-b promotes this
reduces telomerase and induces fibroblasts and myofibroblasts

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105
Q

What is clinical presentation of idiopathic pulm fibrosis

A

insidious unpredictable disease in middle aged >50
dyspnea, dry cough, hypoxemia with cyanosis, digital clubbing
mean survival is <3 yrs

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106
Q

describe patholody of idiopathic pulmonary fibrosis

A

repeated cycles of alveolitis
healing/scarring leads to patchy interstitial fibrosis
end stage looks like honeycomb lung

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107
Q

What is Tx for idiopathic pulm fibrosis

A

lung transplant

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108
Q

clinical presentaion non sepcific interstitial pneumonia

A

dyspnea and cough for months

middle age with milder Sx

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109
Q

Histo presentation of nonsepcific interstitial pneumonia

A

mild patchy or diffuse interstitial fibrosis

no fibroblastic foci or honeycombing

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110
Q

What does crytopgenic organizing pneumonia look like?

also called bronchiolitis obliterans organizing pneumonia (boop)

A

all CT of same ange and no interstitial fibrosis

does not progress to honeycomb lung

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111
Q

What is Tx for cryptogenic organizing pneumonia

A

oral steroids for > 6 mo

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112
Q

What are the collagen vascular disorder-related intersitial lung diseases

A 
rheumatoid arthritis
scleroderma
SLE
sjogren syndrome
polymyositis/dermatomyositis
mixed CT disorder
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113
Q

what is caplan syndrome

A

combination of rheumatoid arthritis and pneumoconiosis

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114
Q

What is most dangerous particle size and shwy

A 
1-5 micron
amount/volume
size shape buyoncy
solubility
cytotoxicity
concomitant irritants
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115
Q

what mineral inhalants can lead to caplan syndrome

A

coal dust
silica
asbestos

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116
Q

What chemical fumes can lead to asthma

A

NO, SO2, NH4, benzene

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117
Q

What are the types of coal workers pneumonconiosis

A

asymptomatic anthracosis

simple and complicated

118
Q

describe simple coal workers pneumoconiosis

A

coal macules and nodules +/- centrilobular emphysema

119
Q

describe complicated coal workers pneumoconiosis

A

scars >2cm
<10% progress to Comp. CWP with progressive massive fibrosis
pulmonary dysfunction, pulm HTN, cor pulmonale

120
Q

What is the most prevalent chronic occupational disease in the world

A

silicosis

121
Q

How does silica cause silicosis

A

silica is ingested by macrophages that lead to inflammation with release of TNF and thus increase in fibroblasts
potentiates carcinogenesis

122
Q

patients with silicosis are more prone to what infection

A

TB

123
Q

Silicosis can have what characterisitic sign on CXR

A

egg shell

124
Q

What are asbestos related diseases

A 
pleural effusions
pleural plaques or diffuse pleural fibrosis
asbestosis
lung cancer
laryngeal carcinoma
mesotheliuma
125
Q

What is asbestosis

A

fibrotic lung disease begining at lower lobes and subpleurally
dyspnea with productive cough

126
Q

What is more harmgul serpentine chrysotile of amphiboles

A

amphiboles, seen with mesothelioma

127
Q

What is seen histologically with asbestos

A

iron/ferruginous bodies

beading with knobbed ends

128
Q

What drugs can cause Hypersensitivity pneumonitis

A

methotrexate and nitrofurantoin

129
Q

what drugs can cause bronchospasms

A

aspirin and Beta antagonists

130
Q

what drugs cause pneumonitis and fibrosis

A

amiodarone, bleomycin

131
Q

what occurs with acute radiation pneumonitis

A

alveolitis of HS pneumonitis, pleural effusions and infiltrates on XR withing 6 mo of radiation

132
Q

what occurs with chronic radiation pneumonitis

A

pulmonary fibrosis (looks like diffuse alveolar damage)

133
Q

what is sarcoidosis

A

systemic disease of unknown origin characterized by formation of numerous non-caseating granulomas
inc CD4 and IL2 and cytokines

134
Q

how can you Dx sarcoidosis

A

by exclusion

135
Q

where are common places in body for sarcoidosis to occur

A

pulmonary>eye>skin
usually b/l lungs
spleen and liver involved in about 3/4

136
Q

what is demographic distribution of sarcoidosis

A

women>men US black>whites

137
Q

patients with sarcoidosis can have anergy to what

A

PPD or candida antigens

138
Q

What is relation of ACE with sarcoidosis

A

levels are elevated because the endothelial cells of lungs produce ACE

139
Q

What diseases have elevated ACE levels

A

sarcoidosis, leprosy, gaucher, primary biliary cirrhosis and amyloidosis

140
Q

asteroid bodies and schaumann bodies in lung histo is characterisitic of what

A

sarcoidosis

141
Q

What are types of extrinsic allergic alveolitis

A 
farmers lung (actinomyces in hay)
brid fanciers lung (reaction to sera, feces)
humidifier lung (thermophilic bacteria)
142
Q

Where in lungs does the hypersensitivity reaction occur

A

alveoli

143
Q

what are Sx of hypersensitivity pneumonitis

A

fever, cough, dyspnea, leukocytosis hours after exposure

144
Q

hypersenstivity pneumonitis can have noncaseating granulomas in what part of lung

A

distal

145
Q

what are the intersitial lung diseases that are associated with cigarette smoking

A

desquamative interstitial pneumonia
respiratory bronchiolitis associated interstitial lung disease
+/- pulmonary langerhands cell histiocytosis (eosinophilic granuloma)

146
Q

What occurs with desquamtaive interstitial pneumonia

A

macrophages in alveoli
minimal fibrosis
>50 and in males
dyspnea

147
Q

what is Tx for desquamative interstitial pneumonia

A

steroids and cessation of smoking curative

148
Q

What is characterisitc of respiratory bronchiolitis associated interstitial lung disease

A

pigmented macrophages in bronchioles

peribronchiolar fibrosis

149
Q

What interstitial disease has proliferation of dendritic cells in response to smoking

A

pulmonary langerhans cell histiocytosis (eosinophilic granuloma)

150
Q

What molecules are expressed in pulmonary langerhans cell histiocytosis

A

CD1a, S-100, CD207 (langerin)

151
Q

what is the distinctive histo finding for pulmonary alveolar proteinosis

A

accumulation of acellular surfactant in the intraalveolar and bronchiolar spaces

152
Q

what are the 3 classes of pulmonary alveolar proteinosis

A

autoimmune (acquired)
secondary
hereditaroy (congenital)

153
Q

what is the most common type of pulmonary alveolar proteinosis

A

autoimmune
Ab to GM-CSF
defective phagocytosis of surfactant

154
Q

what is the fatal form of pulmonary alveolar proteinosis

A

hereditaroy

mutliple genes involved in GM-CSF signaling

155
Q

secondary pulmonary alveolar proteinosis is secondary to what

A

many lung disorders like acute silicosis, immunodeficiency syndrome, malignancy, blood disorders

156
Q

What is Tx for pulmonary alveolar proteinosis

A

pulmonary lavage and GM-CSF therapy or transplant in congenital

157
Q

What are the Pulmonary Diseases of vascular origin

A

Pulmonary embolism, hemorrhage and infarction
pulmonary HTN
diffuse pulmonary hemorrhage syndromes

158
Q

what are the diffuse pulmonary hemorrhage syndromes

A

goodpasture
wegener granulomatosis
idiopathic pulmonary hemosiderosis

159
Q

PE usually occur in what lobes of lungs

A

lower

160
Q

What serum levels are elevated in PE

A

lactate dehydrogenase

161
Q

How do you perform lung V/Q scan

A

inhale radioactive compoung then inject radiocactive compund in vein

162
Q

What are other forms of emboli besides blood

A

fat, bone marrow, tumor, air Nitrogen, talc and metal oxides, bullets, amniotic fluid

163
Q

pulmonary P is abnromal when it reaches what percentage of systemic P

A

1/4

164
Q

What are Sx of pulm HTN

A

dyspnea, fatigue, anginal chest pain, cyanosis

165
Q

descirbe primary pulmonary HTN

A

idiopathic is mostly females 20-40 y.o

rare is the familial, auto dominant (mutaiton in BMPR2)

166
Q

What is the role of bone morphogenic protein R type 2

A

in vasc sm muscles cells it inhibits proliferation and favors apoptosis

167
Q

What is secondary pulm HTN

A

endothelial dysfunction and normal reaction of pulm aa to increased P

168
Q

Describe goodpastures

A

autoimmmune
anti-basement membrane Ab for alpha 3 chain of collagen IV
proliferative rapidly progressive glomberulonephritis
necrotizing hemorrhagic interstitial pneumonitis
M>F

169
Q

What is most common cause of death in goodpastures?

what is Tx?

A

renal failure causes deeath

Tx- plasmapheresis and immunosuppressants

170
Q

What syndrome has liniear anti-BM Ab

A

goodpasture

171
Q

describe idiopathic pulm hemosiderosis

A

rare condition usually of children
episodes of diffuse hemorrhage
diffuse hemosiderin deposition in macrophages and alveolar walls

172
Q

what are Sx of idiopathic pulm hemosiderosis

A

productive cough, hemoptysis, anemia and weight loss

173
Q

Describe wegener granulomatosis

A 
necrotizing granulomatous arteritis of lungs
capillaritis
necrotizing inflammation of URtract
hard to diagnose
crescenteric glomerulonephritis
M>F 5th decade, immuno Rx
174
Q

What Ab do you stain for in wegeners

A

anti neutrophil Ab

PR3/c-ANCA

175
Q

what are the host defense mechanisms of upper airways

A

nasal hair. turbinates, mucociliary apparatus, immunoglobulin A
saliva
sloughing of epithelial cells
local complement production

176
Q

what are the host defenses of the conducting airways

A

cough, epiglottic reflexes, sharp angled branching of airways
mucociliary apparatus
Ig production

177
Q

what are the predisposing ocnditions with conducting airways

A

accumulation of secretions, loss or suppression of normal cough reflex, injury to mucociliary apparatus

178
Q

What are the host defense mechanisms of lower resp tract

A

alveolar linging fluid
cytokings (IL1 TNF)
alveolar macrophages , polymorphonuclear leukocytes
cell mediated immunity

179
Q

what are major predisposing conditions in lower resp tract for infection

A

abnormalities of phagocytosis or bactericidal activities

180
Q

what are major predisposing conditions for infection of lymphoid tissue in lungs

A

splenectomy (encapsulated pneumococcus)

181
Q

What are common causes of community acquired Acute Pneumonia

A 
strep pneumonia (most common)
H influenzae
M catarrhalis
Staph aureus
legionalla pneumophila
enterobacteria
182
Q

What are the 2 most commin infectious causes of penumonia in COPD patients

A

H influenze

moraxella catarrhalis

183
Q

What is the most common post viral pneumonia

A

staph aureus

184
Q

what is common cause of penumonia if patients with CD and neutropenia

A

pseudomonas aeruginosa

185
Q

What are the common causes of commonuty acquired atypical pneumonia (patchy or interstitial inflammation)

A

mycoplasma pneumoniase (cold agglutins)
chlamydia spp
Coxiella burnetti
viruses

186
Q

What are the common causes of health care associated and hospital acquired pneumonia (nosocomial)

A

gream - rods
enterobacteria: klebsiella, serratia, e coli, pseudomonas
staph aureus

187
Q

What bacteria cause aspiration penumonia

A

anaerobic oral flora: bacteroides, prevotella, fusobacterium, peptostrep
with aerobic bacteria: step pneumonia, staph aureus, H influenzae, pseudo aeruginosa

188
Q

What are causes of chronic pneumonia

A

nocardia, actinomyces

granulomatous: mycobacterium TB, atypical mycobacteria, histo capsulatum, coccidoides immitis, blastomyces dermatitidis

189
Q

What are the opportunistic causes of peumonia

A

CMV, pneumocystis jirovecii
mycobacterium avium intracell
invasive aspergillosis
invasive candidiasis

190
Q

What are the 2 basic types of bacterial penumonia

A

bronchopneumonia(predominant) and lobar pneumonia

191
Q

What is typical of viral pneumonias

A

“chest cold” with co existing laryngobronchitis, bronchiolitis, tonsilitis
can be pandemiz like H1N1

192
Q

what is difference of drift vs shift of viruses

A

drift is minor N neurominidase or H hemagglutinin mutations

shift is with animal virus RNA recombination/replacement of both

193
Q

What organisms can cause pulmonary abscesses

A

staph aureus

mixed anaerobic organisms

194
Q

what are complications with pulm abscesses

A

empyema, hemorrhage, brain abscess/meningitis, amyloidosis

195
Q

what are Sx of pulmonary abscess

A

cough, fever, fould smelling purulent/bloody sputum, chest pain, weight loss

196
Q

pulmonary abscess most commonly arises from what and found where

A

right lower lobe from aspiration

197
Q

What infections are comon in lungs of infant that is 0/7 days old

A

group B strep, E coli

198
Q

what infections are common in lungs of infant 7-90 days old

A

listeria, candida

199
Q

What can lead to transcervical ifnections (ascending)

A

inhalation of infected amniotic fluid (in utero) or infected passing through birth canal

200
Q

What are the infections that occur transplacentally (hematologic)

A

parastitic: toxo and malaria
viral: Hep B and HIV
bacterial : listeria and treponema
TORCH

201
Q

What is the most common cause of bronchiolitis and pneumonia in children <12 mo

A

respiratory sysncytial virus

202
Q

What is progression of RSV in children

A

URI but spreads to lower from fusion of membranes (syncytia)
associated with otitis media in many children
can cause pneumonia in elderly

203
Q

What to CXR show with RSV

A

entrapped air in bronchioles that are blocked by inflammation and secretions “hyperinflated lung fileds”

204
Q

What is Tx for RSV

A

supportive

205
Q

What are the granulomatous chronic pneumonias

A

TB

leoprosy and fungal

206
Q

what are people with chronic pneumonia d/t TB at high risk for

A

hodgkin lymphoma, chronic lung disease (silicosis), chronic renal failure, malnutrition, alcoholism and immunosuppresion

207
Q

what type of fungi cause chronic pneumonia

A

termally dimorphic (hyphae and spores in envrionment, yeast in body)

208
Q

What occurs with a primary TB infection

A 
ghon complex(parenchymal lesion with involved lymph node)
granulomatous response, asymptomatci and self limiting
209
Q

describe secondary infeciton of TB

A

reactivaition of old walled off lesion, usually apical because there is high pp of O2
variable course with cavitary caseous necrosis and scarring

210
Q

What is miliary TB

A

when tubercle erodes into vessel

211
Q

What cases do you see TB without granulomas

A

dissemination in 10-15% mildly immunosuppressed

dissemination in >50% severely immunosuppressed

212
Q

What are the specific dimorphic fungi that can cause penumonias

A

histoplasma capsulatum
blastomyces dermatidis
coccidioides immitis
cryptococcus gattii, C neofromans var gattii

213
Q

where is histo capsulatum found

A

ohio and Miss river valleys and caribbean

214
Q

where is blastomyces dermatidis found

A

central and SE USA, canada, mexico, middle east africa and india

215
Q

where is coccidioides immitis foun

A

SW (San juaquin valley), far west and mexico

216
Q

What is characteristic histologically of blastomycosis

A

thick wall and nuclei

217
Q

which fungi have spherules histologically

A

coccidioides

218
Q

If CD4 count is <200 what is most common infection to cause pneumonia in HIV patients

A

pneumocystis carinii

jirovecii

219
Q

If CD4 count is <50 what is most common infection to cause pneumonia in HIV patients

A

CMV and MAC

220
Q

What are common focal pneumonias caused by

A

aspergillus sp.

candida albicans

221
Q

When do we use lung transplants

A

emphysema, idiopathic pulmonary fibrosis
cystic fibrosis
idiopathic/familal pulm HTN
(end stage)

222
Q

What are complications with lung transplants

A

infections
acute rejection
chronic rejection

223
Q

What is the histo presentation of pneumocystis pneumonia

A

foamy cotton candy exudate with the cup and saucer shaped organisms

224
Q

What are the benign neoplasms of lung (uncommon)

A

hamartoma

inflammatory myofibroblastic tumor

225
Q

what is the most comon cause of cancer death in US and worldwide

A

primary lung malignancies

226
Q

majority of lung malignancies are what type

A

carcinomas

227
Q

What cancer in lung has popcorn calcifications

A

pulmonary hamartoma

228
Q

what are the types of squamous cell carcinomas in lung

A

papillary, clear cell, small cell and basaloid

229
Q

what are the types of adenocarcinomas in lung

A

in situ
minimally invasice
lepidic, acinar, papillary and solid
mucinous

230
Q

What cancers collectively are referred to as non-small-cell lung carincoma

A

squamous, adeno and large cell

231
Q

what types of cancers can smoking lead to

A 
lung
oral
pharyngeal
laryngeal
esophageal
pancreatic
cervical
renal and bladder
232
Q

what aspects of smoking are taken in account to cause cancer

A

inhaltion
amount
duration and/or cessation
gender F>M

233
Q

What are the dangerous substances in cigarette smoke

A

polycyclic aromatic hydrocarbons*** affect lungs the most

nitrosamine

234
Q

The bladder cancer from smoking is from what particle

A

4-aminobiphenyl, 2 naphthylamine

235
Q

What does phenol in cigarette smoke promote

A

tumor promotion

236
Q

where in lungs are small cell carcinomas gound

A

central

237
Q

where are squamous non cell cancers found

A

central

238
Q

where are adenocarcinoma cancers found

A

peripheral

239
Q

where are large cell carcinomas found

A

anywhere

240
Q

What are the 3 most common lung cancers d/t smoking in order of most prevalent

A

small cell
squamous non small cell
large cell

241
Q

EGFR inhibitors are useful in what

A

adenocarcinomas with EGFR mutations

242
Q

What two mutations appear to be mutually exclusive in lung cancer

A

KRAS and EGFR

243
Q

What are signs and Sx of lung cancer

A

pain, hemoptysis, weight loss, underlying chronic lung disease Sx
local direct effects related to endobronchial growth
direct expansion into mediastinum
metatstaic disease Sx

244
Q

What are the most common local effects of lung cancer tumor spread

A

cough
hemoptysis
chest pain

245
Q

What is a pancoast tumor

A

apical lung tumor with pain in distribution of ulnar nerve and horner syndrome (enophtalmos, ptosis, miosis and anhydrosis)

246
Q

What paraneoplastic syndromes can lead to lung cacner

A 
ADH
ACTH
PTHrp
Calcitonin
Gonadotropins
Serotonin, VIP, bradkinin
lambert-eaton myasthenic synfrome
peripheral neuropathy
dermopathies
hypertrophic pulm osteoarthropathy
hematologic abnormalities
247
Q

What type of lung cancer is seen with PTHrp

A

squamous cell

248
Q

What are the precursor lesions of squamous cell carcinomas

A

non neoplastic: goblet cell hyperplasia, basal cell hyperplasia and squamous metaplasia
neoplastic: squamous dysplasia, carcinoma in situ, invasive squamous carcinoma

249
Q

What are the cytologic hallmarks to dx lung cancer

A

strap cells and squamous pearl

250
Q

what is the most comon cancer in women and nonsmokers of lungs

A

adenocarcinomas

251
Q

what are the precursor leasions to adenocarcinomas of lung

A

atypical adenomatous hyperplasia

252
Q

what is characteristic of adenocarcinomas of lung

A 
mucin production
TTF1 positive (thyroid transcription factor 1)
253
Q

what does atypical adenomatous hyperplasia look like

A

epithelium is cuboidal and there is mild interstitial fibrosis

254
Q

What is the histo grading of adenocarcinomas

A

well differentiated- low grade
moderatley differentiated- intm grade
poorly differentiated- high grade
peripheral with cuboidal differentiation- grade 3/3

255
Q

zellballen with vacuoles on cytology is indicative of what process

A

adenocarcinoma

256
Q

What is criteria for bronchioloalveolar carcinoma (adenocarcinoma in situ)

A

<3 cm iwth growth along alveolar septa, no invasion

257
Q

what is criteria for microinvasice carcinoma

A

<5 mm invasive component

258
Q

What type of bronchioalveolar CIS and microinvasive carincoma spread

A

mucinous (solitary or multiple nodules)

the non-mucinous rarley spread and are solitary nodules

259
Q

What is a precurosr for neuroendocrine proliferations and tumors

A

diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

260
Q

what are types of neuroendocrine proliferations

A 
tumorlets
carcinoids (MEN1)
atypical carcinoides (MEN1)
small cell neuroendocrine carcinoma
large cell neuroendocrine carcinoma
261
Q

What is carcinoid syndrome

A

diarrhea, flushing, cyanosis

262
Q

What neuroendocrine proliferation is assoc with p53, BCL2 and BAX abnormalities

A

MEN1 atypical carcinoids

263
Q

What is Tx for small cell carcinoma

A

aggressive chemoRx

264
Q

what is origin of small cell carcinoma

A

neuroendocrine

265
Q

what gene expression is common in small cell carcinoma

A

BCL-2 expression

266
Q

what are common mutations with small cell carcinoma

A 
p53
RB 1 (80-100%)
267
Q

What is the azopardie effect and what is it seen in

A

blue staining of vessels by tumor DNA

seen in small cell carcinoma

268
Q

What is more common in small cell carcinoma vs non small cell

A

neuroendocrine markers
RB mutations
p53 mutations
often complete response to chemoRx but may recur

269
Q

What is T1 stage lung cancer

A

tumor is <3 cm without pleural or mainstem bronchus involvement

270
Q

What is T2 stage lung cancer

A

tumor 3-7 cm or involvement of mainstem bronchus 2 cm from carina, visceral pleura involvement or lobar atelectasis

271
Q

what is T3 stage lung cancer

A

tumor >7 cm or one with involvement parietal pleura, chest wall, diaphragm, phrenic, mediastinal pleura, parietal pericardium, mainstem bronchus <2 cm from carina, entire lung atelectasis, separate tumor loduesl in same love

272
Q

What is T4 stage lung cancer

A

any tumor with invasion of mediastinum, heart, great vessels, trachea, recurren laryngeal nerve, esophagus, vertebral body or carina or separte tumor nodules in different ipsi lobe

273
Q

What is N0 lung cancer

A

no metastasis to regional lymph nodes

274
Q

what is N1 lung cancer

A

ipsi hilar or peribronchial nodal involvement

275
Q

What is N2 lung cancer

A

metastatis to ipsi mediastinal or subcarinal lymph

276
Q

what is N3 lung cancer

A

metastasis to contra mediastinal or hilar lymph, ispi or contra scalene or supraclavicular lymph

277
Q

what is M0 lung cancer

A

no distant metastasis

278
Q

What is M1 lung cancer

A

distant metastasis
a- separate tumor nodules in contra lobe or pleural nodules
b- distant metastasis

279
Q

What classifies stage IV lung cancer

A

any T any N and M1a or M1b

280
Q

an N3 of lung cancer signifies what stage

A

IIIB

281
Q

A T3 signifies what stage lung cancer

A

IIB, IIIA or IIIB

282
Q

What criteria must be met to have stage IB or stage II lung cancer

A

T2

283
Q

What is 5 yr survival rate of non small cell carcinoma based on stages

A

1-48%
2-36%
3-8%
4- 2%

284
Q

what is 2 yr survival of small cell carcinoma

A

stage 1/2 25-35%

stage 3/4 1%

285
Q

where does metastasis usually occur in lung

A

regional: adrenals, liver, brain, bone

286
Q

The lungs receive metastasis from what organs

A

breast, GI, sarcomas, melanoma

287
Q

What are the most common types of pleural nepplasms

A

lung and breast metastatic

288
Q

What is used to Dx malignant mesothelioma

A

hyaloronidase sensitive acid mucopolysaccharides, calretenin, mesothelin, WT-1, cytokeratin 5/6, D2-40 and predominantly perinuclear staining with pan-keratins

289
Q

What is mutation seen with pleural solitary fiborus tumor

A

NAB2-STAT6 fusion

CD34+ and keratin -

290
Q

what is most common type of malignant mesothelioma

A

epithelioid

291
Q

What is appearance of microvilli in mesothelioma

A

numerous long and slender

Year 2 Respiratory (5 decks)

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