Exam I, lungs, Gomez Flashcards
(291 cards)
1
Q
how many lobes of the lung are there? bronchopulm segments?
A
lobes-5
segments- 19
2
Q
What size particle is most dangerous to inhale
A
0.5-5 micron
3
Q
how big are terminal bronchi
A
<2mm
4
Q
in lungs what type of specialized cells are only in trachea and bronchus
A
goblet cell, seromucous gland and cartiladge
5
Q
in lungs what type of specialized cells are only found in bronchioles
A
clara cells
6
Q
in lungs what type of specialized cells are only found in alveoli
A
type I pneumocyte and type II pneumocyte
7
Q
Majority of surface alveolar cells ware what type
A
Type I non-div
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
9
Q
what is a common congenital anomalie found in 10% neonatal autopsies
A
pulmonary hypoplasia
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
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
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
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
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
15
Q
What is most common cause of resp distress in newborn
A
hyaline membrane disease
16
Q
the rate of neonatal resp distress syndrome is inversely proportional to what
A
gestational age
17
Q
What factors are associ wtih neonatal resp distress syndrome
A
male, maternal DM, multiple gestation, C section before onset of labor
18
Q
What induce surfactant secretion
A
glucocorticoids and thyroxine
19
Q
At 20 weeks wat to alveoli look like? 30?
A
20-glandular
30- saccular
20
Q
what type cells secrete surfatant
A
type II pneumocytes
21
Q
If lecithin/sphingomyelin ratio is >2 what does this indicate in lungs?
<1?
A
> 2 lungs are mature
<1 lungs immature
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
23
Q
Atelectasis leads to what
A
uneven perfusion and hypoventilation
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
25
why is respiratory distress syndrome not seen in stillborns
need to exude protein rich fluid into alveolar space to make a hyaline membrane
26
what is risk of O2 therapy with infants with respiratory distress syndrome
retinopathy of prematurity
| bronchopulmonary dysplasia
27
What criteria for O2 therapy in cases of bronchopulmonary dysplasia
>28 days O2 therapy in infant>36 weeks post-menstrual age
28
What is deficit in infants with bronchopulmonary dysplasia
alveolar hypoplasia and thickened walls
| developmental arrest at saccular stages
29
what is defect in cycstic fibrosis (mucoviscidosis
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
30
What gene is CFTR on
7q31.2
31
What is Dx criteria for cycstic fibrosis
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)
32
How do you Tx pancreatic insufficiency from CF
oral pancrelipase
| may uncommonly need to Tx DM if islets destroyed
33
How do you Tx vitamin deficiency from CF
oral fat soluble vitamins ADEK
| parenterteal nutrition
34
how do you Tx pulmonary disease from CF
```
postural drainage and chest percussion
bronchodilators (albuterol)
mucolytic agents
antibiotics
hypertonic saline
high dose ibuprofen
```
35
What is dangerous about infants who have had an apparent life threatening event
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
36
How can atelectasis occur in an adult
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)
37
All atelectasis are at risk for what
infection
38
What are 2 main types pulm edema
hemodynamic and microvascular
39
describe hemodynamic PE
```
most common
increased hydrostatic P from Left HF
affects basal lower lobes
"ehart failure cells"
can lead to alveolar fibrosis (brown induration of lungs)
```
40
describe microvascular PE
increased permeability from infection or toxic injury etc
| if diffuse can lead to acute Resp distress syndrome
41
What is criteria for acute lung injury non-cardiogenic PE
acute onset dyspnea
hypoxemia
b/l infiltrates
absence of primary L HF !!
42
What type sof injuries can cause non-cardiogenic PE
congestion, surfactant disruption
| atelectasis
43
What mediators are related to non-cardiogenic PE
cytokines, oxidants, TNF, ILs, TGF-beta
44
non cardiogenic PE can lead to what
ARDS (DAD diffuse alveolar damage) or AIP(acute interstitial pneumonia
45
what occurs in diffuse alveolar damange
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)
46
what type of patients are more prone to diffuse alveolar damage
spesis, diffuse pulmonary infections, gastric aspiration, trauma
47
What infections can lead to aRDS
sepsis
diffuse pulm infection
gastric aspiration
48
what type of physical injuries can lead to ARDS
```
mechanical trauma and head injuries!
pulm contusions
near drowning
fractures with fat embolism
burns
ionizing radiation
```
49
more then 50% ARDS are assoc with what 4 conditions
sepsis, diffuse pulmonary infections, gastric aspiration, mechanical trauma including head injuries
50
reperfusion after lung injury can lead to what
ARDS because increase ROS
51
What is clinical presentation of ARDS
```
already ill
rapid onset, profound dyspnea and tachypnea
cyanosis and resp failure
diffuse b/l infiltrates on XR
high moratlity
```
52
What would you seen histologically in alveoli healing from ARDS
resorption of hyaline membranes with thickened albeolar septa with fibroblasts, collagen and many atypical type II pneumocytes
53
Describe acute interstitial pneumonia AIP
| Hamman-Rich syndrome
```
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
```
54
What are 2 types of chronic diffuse lung disease
obstructive and restrictive
55
describe obstructive airway disease characteristics, give examples
limit in rate of flow
FEV1/FVC reduced <0.7
R at any level
e.g: emphysema, chronic bronchitis, bronchiectasis, asthma
56
describe restrictive airway disease charactersitics, give examples
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
57
what are the major pathological changes in chronic bronchitis?
mucus gland hyperplasia, hypersecretion
58
what are the major pathological changes in emphysema
airspace enlargement, wall destruction
59
what are the major pathological changes in small-airway disease, bronchiolitis
inflammatory scarring/obliteration of bronchioles
60
What are the classifications of emphysema
centriacinar/centrilobular >95%
panacrinar/panlobular
distal acinar/paraseptal
irregular/paracicatrical
61
where is centriacinar emphysema found and what causes it
upper lobes and apices
| SMOKING
62
where is panacinar epmphysema and what causes it
lower lobes/anterior
| alpha 1 antitrypsin deficiency and SMOKING
63
where id distal acinar/paraseptal emphysema and wht caues it
subpleural and adjacent to septae
may be bullous and cause spontaneous pneumo in young adults
associated with previously damaged lung
64
which type of emphysema is usually asymptomatic
irregular/paracicatrical
65
how does panacinar emphysema progress
initial distention of albeolus and duct then involves entire pulmonary lobule
66
what is etiology of emphysema
proteolytic digestion of alveolar walls
| neutrophil secreted elastase is primary villain (inhibited by alpha1 antitrypsin
67
What deficiency leads to early life emphysema
chrom 14 alpha 1 antitrypsin deficiency
68
When do Sx of emphysema develop
after 1/3 lung damaged
69
what are respiratory levels in emphysema
low FEV1, high TLC and RV
| low FEV1 due to bronchiole collapse and fibrosis
70
what is Tx of emphysema
bronchodilators, steroids, bullectomy,transplant
71
what is obstructive overinflation
overexpansion by trapped air
1-ball valve obstruction by object
2-collaterals feeding around obstruction
3- congenital lobar overinflation from lack of bronchial cartilage
72
is there wall destruction in compensatory hyperinflation
no
| ovvurs from loss of adjacent tissue
73
What is clinical definition of chronic bronchitis
3 mo productive cough/yr for 2 consecutive yeras
74
what are causes of chronic bronchitis
smoking
| hypersecretion mucus from stimulation by protesases
75
and increased Reid index >0.4 is indicative of what
chronic bronchitis
76
What type of vasulities can occur in chronic bronchitis
bronchiolitis obliterans in small airways
77
who are the blue bloaters
chronic bronchitis
78
who are the pink puffers
COPD
79
Redi index is a measurement of what
thickness of glands/thickness of wall
80
What is age of onset with predominant bronchitis vs predominant emphysema
bronchitis- 40-45
| emphysema 50-75
81
what are the characterisitics of bronchitis that do not occur in emphysema
```
cor pulmonale
infections
elastic revoil is normal
increased airway resistance
large heart
blue bloater
```
82
what are characteristics of emphysema not seen with bronchitis
terminal resp insuficiency
low elastic recoil
small heart
pink puffer
83
What is asthma
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
84
what can asthma evolve into
acute severe asthma
85
What is atopic asthma
type I HS
IgE Antibodies to inhaled allergens
mast cells
stimulation of subepithelial vagal R
86
what are Dx testing for atopic asthma
```
skin allergen testing for confirmation
RAST testing (radioallergosorbent test)
```
87
What molecules induce bronchoconstriction
Ach from nerves, Leukotrienes C4 D4 E4 from mast cells
| histmine and PGD2
88
What is nonatopic asthma
```
pulmonary infections (viral) and air pollutants
no allergic indicators
```
89
What is drug induced asthma
uncommon form of disease
| aspirin is the classic cause because inhibit COX pathway
90
What is morphology of asthma
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
91
What are charco-leyden crystals
crystalloids with eosinphil lysophospholipase binding protein
92
what are curshcmann spirals in alveoli
from shed epithelium
93
What is bronchiectasis
permanent dilation of bronchi and bronchioles
| tissue destruction secondary to infection
94
What are Sx of bronchiectasis
dyspnea, orthopnea, and rarley severe hemoptosis that is fould semlling
may develop brain abscesses and amyloidosis
95
What is bronchiectasis assoc with
```
CF, primary ciliary dyskinesia
obstruction
many infections
autoimmune
pulm sequestration
allergic bronchopulmonary apsergiloosis
```
96
What syndrome is assoc with primary ciliary dyskinesia
kartagener syndrome:
| male infertility, sinusitis, situs inverus of partial lateralizing abnormality
97
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
chronic diffuse interstitial lung disease
98
What are the fibrosing chronic intersitial lung diseases
```
idiopathic pulm fibrosis
nonsepcific interstitial pneumonia
cryptogenic organizing pneumonia
CT disease associated
pneumoconioses
drug reactions
radiation pneumonitis
```
99
what are the granulomatous chronic interstitial lung diseases
sarcoidosis
HS pneumonitis
eosinphilic pneumonias!!!
100
what are the smoking related chronic interstitial lung diseases
desqaumative interstitial pneumonia
| respiratory bronchiolitis-assoc interstitial ung disease
101
what are the other types of chronic interstitial lung diseases
pulmonary langerhans cell histiocytosis
pulmonary albeolar proteinosis
lymphoid interstitial pneumonia
102
What occurs in idiopathic pulm fibrosis (usual interstitial pneumonia) "crytptogenic fibrosing aleolitis"
type I pneumocyt death
type II hyperplasia
inflammation with TH2 , cytokines, macrophages, fibroblasts driven by TGF-b, colagen deposition
103
What environmental factors contribute to idiopathic pulm fibrosis
smoking smoking
work related exposures
reflux esophagus
104
What are the effects of TGF-b on respiratory epithelium
inhibits caveolin in fibroblasts
ceveolin usually inhibits deposition of collagen and ECM so TGF-b promotes this
reduces telomerase and induces fibroblasts and myofibroblasts
105
What is clinical presentation of idiopathic pulm fibrosis
insidious unpredictable disease in middle aged >50
dyspnea, dry cough, hypoxemia with cyanosis, digital clubbing
mean survival is <3 yrs
106
describe patholody of idiopathic pulmonary fibrosis
repeated cycles of alveolitis
healing/scarring leads to patchy interstitial fibrosis
end stage looks like honeycomb lung
107
What is Tx for idiopathic pulm fibrosis
lung transplant
108
clinical presentaion non sepcific interstitial pneumonia
dyspnea and cough for months
| middle age with milder Sx
109
Histo presentation of nonsepcific interstitial pneumonia
mild patchy or diffuse interstitial fibrosis
| no fibroblastic foci or honeycombing
110
What does crytopgenic organizing pneumonia look like?
| also called bronchiolitis obliterans organizing pneumonia (boop)
all CT of same ange and no interstitial fibrosis
| does not progress to honeycomb lung
111
What is Tx for cryptogenic organizing pneumonia
oral steroids for > 6 mo
112
What are the collagen vascular disorder-related intersitial lung diseases
```
rheumatoid arthritis
scleroderma
SLE
sjogren syndrome
polymyositis/dermatomyositis
mixed CT disorder
```
113
what is caplan syndrome
combination of rheumatoid arthritis and pneumoconiosis
114
What is most dangerous particle size and shwy
```
1-5 micron
amount/volume
size shape buyoncy
solubility
cytotoxicity
concomitant irritants
```
115
what mineral inhalants can lead to caplan syndrome
coal dust
silica
asbestos
116
What chemical fumes can lead to asthma
NO, SO2, NH4, benzene
117
What are the types of coal workers pneumonconiosis
asymptomatic anthracosis
| simple and complicated
118
describe simple coal workers pneumoconiosis
coal macules and nodules +/- centrilobular emphysema
119
describe complicated coal workers pneumoconiosis
scars >2cm
<10% progress to Comp. CWP with progressive massive fibrosis
pulmonary dysfunction, pulm HTN, cor pulmonale
120
What is the most prevalent chronic occupational disease in the world
silicosis
121
How does silica cause silicosis
silica is ingested by macrophages that lead to inflammation with release of TNF and thus increase in fibroblasts
potentiates carcinogenesis
122
patients with silicosis are more prone to what infection
TB
123
Silicosis can have what characterisitic sign on CXR
egg shell
124
What are asbestos related diseases
```
pleural effusions
pleural plaques or diffuse pleural fibrosis
asbestosis
lung cancer
laryngeal carcinoma
mesotheliuma
```
125
What is asbestosis
fibrotic lung disease begining at lower lobes and subpleurally
dyspnea with productive cough
126
What is more harmgul serpentine chrysotile of amphiboles
amphiboles, seen with mesothelioma
127
What is seen histologically with asbestos
iron/ferruginous bodies
| beading with knobbed ends
128
What drugs can cause Hypersensitivity pneumonitis
methotrexate and nitrofurantoin
129
what drugs can cause bronchospasms
aspirin and Beta antagonists
130
what drugs cause pneumonitis and fibrosis
amiodarone, bleomycin
131
what occurs with acute radiation pneumonitis
alveolitis of HS pneumonitis, pleural effusions and infiltrates on XR withing 6 mo of radiation
132
what occurs with chronic radiation pneumonitis
pulmonary fibrosis (looks like diffuse alveolar damage)
133
what is sarcoidosis
systemic disease of unknown origin characterized by formation of numerous non-caseating granulomas
inc CD4 and IL2 and cytokines
134
how can you Dx sarcoidosis
by exclusion
135
where are common places in body for sarcoidosis to occur
pulmonary>eye>skin
usually b/l lungs
spleen and liver involved in about 3/4
136
what is demographic distribution of sarcoidosis
women>men US black>whites
137
patients with sarcoidosis can have anergy to what
PPD or candida antigens
138
What is relation of ACE with sarcoidosis
levels are elevated because the endothelial cells of lungs produce ACE
139
What diseases have elevated ACE levels
sarcoidosis, leprosy, gaucher, primary biliary cirrhosis and amyloidosis
140
asteroid bodies and schaumann bodies in lung histo is characterisitic of what
sarcoidosis
141
What are types of extrinsic allergic alveolitis
```
farmers lung (actinomyces in hay)
brid fanciers lung (reaction to sera, feces)
humidifier lung (thermophilic bacteria)
```
142
Where in lungs does the hypersensitivity reaction occur
alveoli
143
what are Sx of hypersensitivity pneumonitis
fever, cough, dyspnea, leukocytosis hours after exposure
144
hypersenstivity pneumonitis can have noncaseating granulomas in what part of lung
distal
145
what are the intersitial lung diseases that are associated with cigarette smoking
desquamative interstitial pneumonia
respiratory bronchiolitis associated interstitial lung disease
+/- pulmonary langerhands cell histiocytosis (eosinophilic granuloma)
146
What occurs with desquamtaive interstitial pneumonia
macrophages in alveoli
minimal fibrosis
>50 and in males
dyspnea
147
what is Tx for desquamative interstitial pneumonia
steroids and cessation of smoking curative
148
What is characterisitc of respiratory bronchiolitis associated interstitial lung disease
pigmented macrophages in bronchioles
| peribronchiolar fibrosis
149
What interstitial disease has proliferation of dendritic cells in response to smoking
pulmonary langerhans cell histiocytosis (eosinophilic granuloma)
150
What molecules are expressed in pulmonary langerhans cell histiocytosis
CD1a, S-100, CD207 (langerin)
151
what is the distinctive histo finding for pulmonary alveolar proteinosis
accumulation of acellular surfactant in the intraalveolar and bronchiolar spaces
152
what are the 3 classes of pulmonary alveolar proteinosis
autoimmune (acquired)
secondary
hereditaroy (congenital)
153
what is the most common type of pulmonary alveolar proteinosis
autoimmune
Ab to GM-CSF
defective phagocytosis of surfactant
154
what is the fatal form of pulmonary alveolar proteinosis
hereditaroy
| mutliple genes involved in GM-CSF signaling
155
secondary pulmonary alveolar proteinosis is secondary to what
many lung disorders like acute silicosis, immunodeficiency syndrome, malignancy, blood disorders
156
What is Tx for pulmonary alveolar proteinosis
pulmonary lavage and GM-CSF therapy or transplant in congenital
157
What are the Pulmonary Diseases of vascular origin
Pulmonary embolism, hemorrhage and infarction
pulmonary HTN
diffuse pulmonary hemorrhage syndromes
158
what are the diffuse pulmonary hemorrhage syndromes
goodpasture
wegener granulomatosis
idiopathic pulmonary hemosiderosis
159
PE usually occur in what lobes of lungs
lower
160
What serum levels are elevated in PE
lactate dehydrogenase
161
How do you perform lung V/Q scan
inhale radioactive compoung then inject radiocactive compund in vein
162
What are other forms of emboli besides blood
fat, bone marrow, tumor, air Nitrogen, talc and metal oxides, bullets, amniotic fluid
163
pulmonary P is abnromal when it reaches what percentage of systemic P
1/4
164
What are Sx of pulm HTN
dyspnea, fatigue, anginal chest pain, cyanosis
165
descirbe primary pulmonary HTN
idiopathic is mostly females 20-40 y.o
| rare is the familial, auto dominant (mutaiton in BMPR2)
166
What is the role of bone morphogenic protein R type 2
in vasc sm muscles cells it inhibits proliferation and favors apoptosis
167
What is secondary pulm HTN
endothelial dysfunction and normal reaction of pulm aa to increased P
168
Describe goodpastures
autoimmmune
anti-basement membrane Ab for alpha 3 chain of collagen IV
proliferative rapidly progressive glomberulonephritis
necrotizing hemorrhagic interstitial pneumonitis
M>F
169
What is most common cause of death in goodpastures?
| what is Tx?
renal failure causes deeath
| Tx- plasmapheresis and immunosuppressants
170
What syndrome has liniear anti-BM Ab
goodpasture
171
describe idiopathic pulm hemosiderosis
rare condition usually of children
episodes of diffuse hemorrhage
diffuse hemosiderin deposition in macrophages and alveolar walls
172
what are Sx of idiopathic pulm hemosiderosis
productive cough, hemoptysis, anemia and weight loss
173
Describe wegener granulomatosis
```
necrotizing granulomatous arteritis of lungs
capillaritis
necrotizing inflammation of URtract
hard to diagnose
crescenteric glomerulonephritis
M>F 5th decade, immuno Rx
```
174
What Ab do you stain for in wegeners
anti neutrophil Ab
| PR3/c-ANCA
175
what are the host defense mechanisms of upper airways
nasal hair. turbinates, mucociliary apparatus, immunoglobulin A
saliva
sloughing of epithelial cells
local complement production
176
what are the host defenses of the conducting airways
cough, epiglottic reflexes, sharp angled branching of airways
mucociliary apparatus
Ig production
177
what are the predisposing ocnditions with conducting airways
accumulation of secretions, loss or suppression of normal cough reflex, injury to mucociliary apparatus
178
What are the host defense mechanisms of lower resp tract
alveolar linging fluid
cytokings (IL1 TNF)
alveolar macrophages , polymorphonuclear leukocytes
cell mediated immunity
179
what are major predisposing conditions in lower resp tract for infection
abnormalities of phagocytosis or bactericidal activities
180
what are major predisposing conditions for infection of lymphoid tissue in lungs
splenectomy (encapsulated pneumococcus)
181
What are common causes of community acquired Acute Pneumonia
```
strep pneumonia (most common)
H influenzae
M catarrhalis
Staph aureus
legionalla pneumophila
enterobacteria
```
182
What are the 2 most commin infectious causes of penumonia in COPD patients
H influenze
| moraxella catarrhalis
183
What is the most common post viral pneumonia
staph aureus
184
what is common cause of penumonia if patients with CD and neutropenia
pseudomonas aeruginosa
185
What are the common causes of commonuty acquired atypical pneumonia (patchy or interstitial inflammation)
mycoplasma pneumoniase (cold agglutins)
chlamydia spp
Coxiella burnetti
viruses
186
What are the common causes of health care associated and hospital acquired pneumonia (nosocomial)
gream - rods
enterobacteria: klebsiella, serratia, e coli, pseudomonas
staph aureus
187
What bacteria cause aspiration penumonia
anaerobic oral flora: bacteroides, prevotella, fusobacterium, peptostrep
with aerobic bacteria: step pneumonia, staph aureus, H influenzae, pseudo aeruginosa
188
What are causes of chronic pneumonia
nocardia, actinomyces
| granulomatous: mycobacterium TB, atypical mycobacteria, histo capsulatum, coccidoides immitis, blastomyces dermatitidis
189
What are the opportunistic causes of peumonia
CMV, pneumocystis jirovecii
mycobacterium avium intracell
invasive aspergillosis
invasive candidiasis
190
What are the 2 basic types of bacterial penumonia
bronchopneumonia(predominant) and lobar pneumonia
191
What is typical of viral pneumonias
"chest cold" with co existing laryngobronchitis, bronchiolitis, tonsilitis
can be pandemiz like H1N1
192
what is difference of drift vs shift of viruses
drift is minor N neurominidase or H hemagglutinin mutations
| shift is with animal virus RNA recombination/replacement of both
193
What organisms can cause pulmonary abscesses
staph aureus
| mixed anaerobic organisms
194
what are complications with pulm abscesses
empyema, hemorrhage, brain abscess/meningitis, amyloidosis
195
what are Sx of pulmonary abscess
cough, fever, fould smelling purulent/bloody sputum, chest pain, weight loss
196
pulmonary abscess most commonly arises from what and found where
right lower lobe from aspiration
197
What infections are comon in lungs of infant that is 0/7 days old
group B strep, E coli
198
what infections are common in lungs of infant 7-90 days old
listeria, candida
199
What can lead to transcervical ifnections (ascending)
inhalation of infected amniotic fluid (in utero) or infected passing through birth canal
200
What are the infections that occur transplacentally (hematologic)
parastitic: toxo and malaria
viral: Hep B and HIV
bacterial : listeria and treponema
TORCH
201
What is the most common cause of bronchiolitis and pneumonia in children <12 mo
respiratory sysncytial virus
202
What is progression of RSV in children
URI but spreads to lower from fusion of membranes (syncytia)
associated with otitis media in many children
can cause pneumonia in elderly
203
What to CXR show with RSV
entrapped air in bronchioles that are blocked by inflammation and secretions "hyperinflated lung fileds"
204
What is Tx for RSV
supportive
205
What are the granulomatous chronic pneumonias
TB
| leoprosy and fungal
206
what are people with chronic pneumonia d/t TB at high risk for
hodgkin lymphoma, chronic lung disease (silicosis), chronic renal failure, malnutrition, alcoholism and immunosuppresion
207
what type of fungi cause chronic pneumonia
termally dimorphic (hyphae and spores in envrionment, yeast in body)
208
What occurs with a primary TB infection
```
ghon complex(parenchymal lesion with involved lymph node)
granulomatous response, asymptomatci and self limiting
```
209
describe secondary infeciton of TB
reactivaition of old walled off lesion, usually apical because there is high pp of O2
variable course with cavitary caseous necrosis and scarring
210
What is miliary TB
when tubercle erodes into vessel
211
What cases do you see TB without granulomas
dissemination in 10-15% mildly immunosuppressed
| dissemination in >50% severely immunosuppressed
212
What are the specific dimorphic fungi that can cause penumonias
histoplasma capsulatum
blastomyces dermatidis
coccidioides immitis
cryptococcus gattii, C neofromans var gattii
213
where is histo capsulatum found
ohio and Miss river valleys and caribbean
214
where is blastomyces dermatidis found
central and SE USA, canada, mexico, middle east africa and india
215
where is coccidioides immitis foun
SW (San juaquin valley), far west and mexico
216
What is characteristic histologically of blastomycosis
thick wall and nuclei
217
which fungi have spherules histologically
coccidioides
218
If CD4 count is <200 what is most common infection to cause pneumonia in HIV patients
pneumocystis carinii
| jirovecii
219
If CD4 count is <50 what is most common infection to cause pneumonia in HIV patients
CMV and MAC
220
What are common focal pneumonias caused by
aspergillus sp.
| candida albicans
221
When do we use lung transplants
emphysema, idiopathic pulmonary fibrosis
cystic fibrosis
idiopathic/familal pulm HTN
(end stage)
222
What are complications with lung transplants
infections
acute rejection
chronic rejection
223
What is the histo presentation of pneumocystis pneumonia
foamy cotton candy exudate with the cup and saucer shaped organisms
224
What are the benign neoplasms of lung (uncommon)
hamartoma
| inflammatory myofibroblastic tumor
225
what is the most comon cause of cancer death in US and worldwide
primary lung malignancies
226
majority of lung malignancies are what type
carcinomas
227
What cancer in lung has popcorn calcifications
pulmonary hamartoma
228
what are the types of squamous cell carcinomas in lung
papillary, clear cell, small cell and basaloid
229
what are the types of adenocarcinomas in lung
in situ
minimally invasice
lepidic, acinar, papillary and solid
mucinous
230
What cancers collectively are referred to as non-small-cell lung carincoma
squamous, adeno and large cell
231
what types of cancers can smoking lead to
```
lung
oral
pharyngeal
laryngeal
esophageal
pancreatic
cervical
renal and bladder
```
232
what aspects of smoking are taken in account to cause cancer
inhaltion
amount
duration and/or cessation
gender F>M
233
What are the dangerous substances in cigarette smoke
polycyclic aromatic hydrocarbons*** affect lungs the most
| nitrosamine
234
The bladder cancer from smoking is from what particle
4-aminobiphenyl, 2 naphthylamine
235
What does phenol in cigarette smoke promote
tumor promotion
236
where in lungs are small cell carcinomas gound
central
237
where are squamous non cell cancers found
central
238
where are adenocarcinoma cancers found
peripheral
239
where are large cell carcinomas found
anywhere
240
What are the 3 most common lung cancers d/t smoking in order of most prevalent
small cell
squamous non small cell
large cell
241
EGFR inhibitors are useful in what
adenocarcinomas with EGFR mutations
242
What two mutations appear to be mutually exclusive in lung cancer
KRAS and EGFR
243
What are signs and Sx of lung cancer
pain, hemoptysis, weight loss, underlying chronic lung disease Sx
local direct effects related to endobronchial growth
direct expansion into mediastinum
metatstaic disease Sx
244
What are the most common local effects of lung cancer tumor spread
cough
hemoptysis
chest pain
245
What is a pancoast tumor
apical lung tumor with pain in distribution of ulnar nerve and horner syndrome (enophtalmos, ptosis, miosis and anhydrosis)
246
What paraneoplastic syndromes can lead to lung cacner
```
ADH
ACTH
PTHrp
Calcitonin
Gonadotropins
Serotonin, VIP, bradkinin
lambert-eaton myasthenic synfrome
peripheral neuropathy
dermopathies
hypertrophic pulm osteoarthropathy
hematologic abnormalities
```
247
What type of lung cancer is seen with PTHrp
squamous cell
248
What are the precursor lesions of squamous cell carcinomas
non neoplastic: goblet cell hyperplasia, basal cell hyperplasia and squamous metaplasia
neoplastic: squamous dysplasia, carcinoma in situ, invasive squamous carcinoma
249
What are the cytologic hallmarks to dx lung cancer
strap cells and squamous pearl
250
what is the most comon cancer in women and nonsmokers of lungs
adenocarcinomas
251
what are the precursor leasions to adenocarcinomas of lung
atypical adenomatous hyperplasia
252
what is characteristic of adenocarcinomas of lung
```
mucin production
TTF1 positive (thyroid transcription factor 1)
```
253
what does atypical adenomatous hyperplasia look like
epithelium is cuboidal and there is mild interstitial fibrosis
254
What is the histo grading of adenocarcinomas
well differentiated- low grade
moderatley differentiated- intm grade
poorly differentiated- high grade
peripheral with cuboidal differentiation- grade 3/3
255
zellballen with vacuoles on cytology is indicative of what process
adenocarcinoma
256
What is criteria for bronchioloalveolar carcinoma (adenocarcinoma in situ)
<3 cm iwth growth along alveolar septa, no invasion
257
what is criteria for microinvasice carcinoma
<5 mm invasive component
258
What type of bronchioalveolar CIS and microinvasive carincoma spread
mucinous (solitary or multiple nodules)
| the non-mucinous rarley spread and are solitary nodules
259
What is a precurosr for neuroendocrine proliferations and tumors
diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
260
what are types of neuroendocrine proliferations
```
tumorlets
carcinoids (MEN1)
atypical carcinoides (MEN1)
small cell neuroendocrine carcinoma
large cell neuroendocrine carcinoma
```
261
What is carcinoid syndrome
diarrhea, flushing, cyanosis
262
What neuroendocrine proliferation is assoc with p53, BCL2 and BAX abnormalities
MEN1 atypical carcinoids
263
What is Tx for small cell carcinoma
aggressive chemoRx
264
what is origin of small cell carcinoma
neuroendocrine
265
what gene expression is common in small cell carcinoma
BCL-2 expression
266
what are common mutations with small cell carcinoma
```
p53
RB 1 (80-100%)
```
267
What is the azopardie effect and what is it seen in
blue staining of vessels by tumor DNA
| seen in small cell carcinoma
268
What is more common in small cell carcinoma vs non small cell
neuroendocrine markers
RB mutations
p53 mutations
often complete response to chemoRx but may recur
269
What is T1 stage lung cancer
tumor is <3 cm without pleural or mainstem bronchus involvement
270
What is T2 stage lung cancer
tumor 3-7 cm or involvement of mainstem bronchus 2 cm from carina, visceral pleura involvement or lobar atelectasis
271
what is T3 stage lung cancer
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
What is T4 stage lung cancer
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
What is N0 lung cancer
no metastasis to regional lymph nodes
274
what is N1 lung cancer
ipsi hilar or peribronchial nodal involvement
275
What is N2 lung cancer
metastatis to ipsi mediastinal or subcarinal lymph
276
what is N3 lung cancer
metastasis to contra mediastinal or hilar lymph, ispi or contra scalene or supraclavicular lymph
277
what is M0 lung cancer
no distant metastasis
278
What is M1 lung cancer
distant metastasis
a- separate tumor nodules in contra lobe or pleural nodules
b- distant metastasis
279
What classifies stage IV lung cancer
any T any N and M1a or M1b
280
an N3 of lung cancer signifies what stage
IIIB
281
A T3 signifies what stage lung cancer
IIB, IIIA or IIIB
282
What criteria must be met to have stage IB or stage II lung cancer
T2
283
What is 5 yr survival rate of non small cell carcinoma based on stages
1-48%
2-36%
3-8%
4- 2%
284
what is 2 yr survival of small cell carcinoma
stage 1/2 25-35%
| stage 3/4 1%
285
where does metastasis usually occur in lung
regional: adrenals, liver, brain, bone
286
The lungs receive metastasis from what organs
breast, GI, sarcomas, melanoma
287
What are the most common types of pleural nepplasms
lung and breast metastatic
288
What is used to Dx malignant mesothelioma
hyaloronidase sensitive acid mucopolysaccharides, calretenin, mesothelin, WT-1, cytokeratin 5/6, D2-40 and predominantly perinuclear staining with pan-keratins
289
What is mutation seen with pleural solitary fiborus tumor
NAB2-STAT6 fusion
| CD34+ and keratin -
290
what is most common type of malignant mesothelioma
epithelioid
291
What is appearance of microvilli in mesothelioma
numerous long and slender
