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lung path II Flashcards

1
Q

PE

A

10% of acute hospital deaths
underdiagnosed
elevated LDH

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2
Q

PHTN

A

abnormal when pressurs reaches 1/4 of systemic

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3
Q

pulmonary arterial HTN

A

primary idiopathic arterial HTN
autoimmune CT disorder
drugs

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4
Q

idopathic primary pulmonary HTN

A

adults mostly females 20-40

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5
Q

rare familiar primary PHTN

A

autosomal dominant with only 10-20%
mutation in BMPR2
in vascular smooth m cells BMPR2 inhibits proliferation and favors apoptosis
mutation inactivated inhibition

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6
Q

secondary PHTN

A

endothelium dysfunction and normal reduction of pulmonary aa to increased pressure

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7
Q

diffuse alveolar hemorrhage syndrome

A

goodpasture syndrome
idiopathic pulmonary hemosiderosis
vasculitis (wegners, hypersensativity pneumonitis, SLE)

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8
Q

goodpastures

A

autoimmune, anti-basement membrane Abs
alpha 3 chain of collagen IV
proliferative rapidly progressive glomerulonephritis
necortizing hemorrhagic interstitial pneumonitits
M>F, young smokers
renal failure usually COD

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9
Q

idiopathic pulmonary hemosiderosis

A

rare condition usually in children
episodes of diffuse hemorrhage
no antivascular Abs have been found, but immunosupression works
diffuse hemosiderin deposistion in macrophages and alveolar walls

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10
Q

symptoms of idiopathic pulmonary hemosiderosis

A

productive cough, hemoptysis, anemia, weight loss

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11
Q

polyangitis w/granulomatosis

A

necrotizing granulomatous arteritis of lungs and URT
necrotizing crescentic glomerulonephritis
hard to diagnose
M>F 5th decade
immunoRx
variable prognosis
cytoplasmic pattern anti-neutrophil Abs (PR3/c-ANCA)

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12
Q

nasopharynx defenses

A

nasal hair
turbinates
mucociliary apparatus
IgA

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13
Q

oropharynx defenses

A

saliva
sloughing of epi
local complement production
interference from resident flora

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14
Q

trachea and bronchi defenses

A

cough, epiglottic reflexes
sharp angled branching of airways
mucocilliary apparatus
IgM, IgG, IgA

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15
Q

lower respiratory tract defenses

A 
alveolar lining fluid
cytokines
alveolar macros
polymorphonuclear leukocytes
cell-mediated immunity
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16
Q

community acquired acute penumonia

A 
alveolar exudates
strep pneumoniae
H. influenza
M. catarrhalis
Staph aureus
legionella penumophilia
enterbacteriaceae
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17
Q

strep pneumonaie

A

community acquired
G+ diplococci
most common
increased risk w/splenectomy/sickle cell -> need vaccine

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18
Q

H. influenza

A 
community acquired
also meningitis and pink eye
G- pleomorphic 
vaccine for encapsulated form 
#1 in COPD
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19
Q

M. catarrhalis

A

community acquired
G- diplococci
#2 in COPD

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20
Q

Staph aureus

A

community acquired
G+ cocci
common in post viral pneumonia w/IVDA

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21
Q

legionella pneumophilia

A

community acquired
gram - rod
macrophages in small bronchioles
legionellas disease and pontiac fever

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22
Q

enterobacteriaceae

A

community acquired
klebsiella pneumoniae
pseudomonas aerginosa

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23
Q

klebsiella pneumoniae

A

community acquired
Gram - rod
seen in debilitated/malnourished (alcoholics) with bloody thick sputum

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24
Q

pseudomonas aeruginosa

A

community acquired
gram neg coccobacilli
CF and neutropenia
angioinvasive

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25
community acquired atypical pneumonia
``` patchy or interstitial inflammation mycoplasma pneumoniae chlamydia coxiella burnetti viruses ```
26
mycoplasma
community acquired atypical sperhical to filimentoud w/o cell wall gram - have cold agglutinins
27
viruses w/atypical pneumoniae
``` respiratory synctial virus parainfluenza human metapneuomia virus influenza A and B adenovirus rhinoiviruses rubeola varicella SARS ```
28
health care associated and hospital acquired pneumonia
gram neg rods enterobacteriae psudomonas staph aureus (MRSA)
29
aspiration pneumonia
anaerobic and aerobic bacteria
30
necrotizing pneumonia and lung abscesses
anaerobic bacteria staph aureus klebsiella strep pyogenes
31
chronic pneumonia
nocardia | actinomyces
32
granulomatous chronic pneumonia
``` TB atypical myobacterium histoplasma capsulatum coccidodes immitis blastomyces dermatitdis ```
33
pneumonia in immunocompromised host
``` CMV pneumocytis jirovecci myocobacterium avium-intracellulare invasive aspergillosis invasive candidiasis ```
34
lobar pneumonia
mostly caused by strep pneumonia
35
stages of bacterial pneumonia
acute- early red hepatization early organization- streams thru the pore of kohn advanced organizing pneumonia
36
viral pneumonias
usually self-limiting 'chest cold', but can be lethal co-exist with bronchitis can be epidemic
37
pulmonary abscess organisms
``` staph aureus and other gram neg mixed, including anaerobic: bacteriodies fragilis fusobacterium peptococcus ```
38
complications of pulmonary abscesses
empysema hemorrhage brain abscess/meningitis amyloidosis
39
symptoms of pulmonary abscesses
``` cough fever fould smelling, purulent and/or bloody sputum chest pain weight loss ```
40
pulmonary abscess sources
``` #1- aspiration antecedent lung bacterial infection septic emboli neoplasia penetrating wounds infection from adjacent organ hematogenous spread of infection ```
41
perinatal infections timing
early onset 0-7 days: group B strep and E. coli | late onset 7-90 days: listeria, candida
42
transcervical/ascending perinatial infections
inhalation of infected amniotic fluid in utero or infected passing thru birth canal most bacterial, some viral pneumonia, sepsis, and meningitis common
43
tranplacental infections
most parasitic (malaria, toxoplasma) or viral (hep B, HIV) few bacterial TORCH pneumonia, encephalitis, chorioretinitis, myocarditis, dermatitis
44
TORCH
``` Toxoplama Rubella CMV Herpes other (treponema palllidum) ```
45
Respiratory synyctial virus (RSV) bronchiolitis
most common cause of bronchiolitis and pneumonia in children <12months initial URT infection but in 1-2days spread to lower airways moving cell-cell associated otitis media can cause pneumonia in elderly xray shows areas w/entrapped air supportive Tx
46
chronic penumonias
frequently a localized lesion immunocompetent patients | many are granulomatous processes: TB, leprosy, fungal
47
TB primary infection
Ghon complex | granulomatous response, usually asymptomatic and self limiting but clinically symptomatic in 5%
48
Ghon complex
parenchymal lesion and involved lymph nodes
49
secondary TB
reactivation of old walled off lesions, usually apical | cavitary caseous necrosis w/subsequent scarring or progressive disease
50
miliary TB
occurs when tubercle erodes into a vessel
51
immunosupressed TB
may see w/o granulomas | at risk for dissemination
52
dimorphic fungal pneumonias
fungal spores ubiquitous induce localized granulomatous response OR may be disseminated can have angioinvasion, thrombosis, and septic infarcts
53
histoplasma capsulatum
ohio and miss river and carribean soil spores from birds or bat feces microcondia and macorcondia
54
blastomyces dermatidis
central and SE USA, canada, mexico, middle east, africa, india soil spores microconidia
55
coccidioides
SW, far west, and mexico soil spores arthroconidia
56
pulmonary diffuse pneumonias HIV
pneumocystis hirovecii CMV mycobacterium avium complex
57
pulmonary focal pneumonias HIV
aspergillus | cnadida albicans
58
diseases that warrant lung transplant
emphysema idiopathic pulmonary fibrosis CF idiopathic/familial PHTN
59
complications of lung transport
infections acute regjection chronic rejections 79% 1yr, 53% 5yr, 30%10yr survival rates
60
pneumocystis pneumonia
foamy cotton candy exudate and cup and saucer- shaped organisms

Resp II (15 decks)

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