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Flashcards in Pulmonary Deck (106)
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1

Define chronic bronchitis

Chronic cough and production sputum for a minimum of 3 months a year for at least two consecutive years

2

Microscopic features of chronic bronchitis

1. Increase in glands
2. Patches of inflammatory cells (WBCs)
3. Damaged lining with increase goblet cells

3

What does increased mucus production lead to in chronic bronchitis?

1. Prolonged coughing
2. Expectoration of purulent sputum
3. Dyspnea

4

Blue bloaters

Chronic bronchitis
Hypoxia during coughing

5

Chronic Cor Pulmonale

Right heart failure due to pulmonary hypertension

6

CXR findings in chronic bronchitis

1. Increase in bronchovascular markings
2. Enlarged heart

7

Define emphysema

Enlargement of the airspaces distal to the terminal bronchioles with destruction of the alveolar walls

8

What is the genetic deficiency in non-smokers who get emphysema?

Alpha-1-Antitrypsin

9

Gross pathology of emphysema

1. Enlarged lungs
2. Lungs remain filled with air and do no collapse
3. Lungs are whiter than normal, billowy and touch in teh chest midline

10

Define blebs

Subpleural air-filled spaces formed by ruptured alveoli which can rupture into the pleural cavity

11

What is the main complication we are worried about with blebs?

Pneumothorax

12

Define bullae

Parenchymal (interstitial of the lung) air-filled spaces >1 cm in diameter

13

Clinical features of emphysema

1. Tacyhpnea
2. Barrel-shaped chest
3. Hyperventilate="Pink puffers"
4. NOT cyanotic
5. No cough

14

CXR findings in emphysema

1. Increased interstitial markings
2. Flattened diaphragm
3. Long AP diameter
4. Over-inflation, a lot of space between ICS

15

Etiology of bronchial asthma

Hypersensitivity reaction (IgE)

16

Bronchial asthma attacks are marked by what?

1. Wheezing during expiration
2. Cough
3. Dyspnea

17

What are the two major forms of asthma?

1. Extrinsic asthma
2. Intrinsic asthma

18

What is extrinsic asthma mediated by?

-Exposure to exogenous allergens
-->pollen, dander, feather, mold, dust
-Typically affects children

19

What is intrinsic asthma precipitated by?

Non-immune mechanism:
-Physical factors (heat or cold)
-Exercise
-Psychological stress
-Chemical irritants
-Air pollution
-Bronchial infection

20

Vasoactive substances

-Histamine
-Bradykinins
-PGs

21

What do the inflammatory mediators cause?

1. Bronchoconstriction
2. Edema
3. Mucus hypersecretion

22

Histological findings in bronchial asthma

1. Bronchial wall hyperplasia
2. Overproduction of mucus in lumen
3. Curschmann spirals
4. Thickening of basement membrane
5. Thick smooth muscle cells

23

Define bronchiectasis

Permanent dilation of the bronchi

24

What is the most common complication of chronic bronchitis?

Bronchiectasis

25

What is hallatosis (bad breath) associated with?

Bronchiectasis
Due to stagnant mucopurulent material

26

CXR findings in bronchiectasis

1. Dilated bronchioles
2. Increased vascular markings

27

What are the two major forms of pneumonia and what is the main etiology of each?

1. Alveolar Pneumonia (idntraalveolar inflammation)- Bacteria=neutrophils
2. Interstitial Pneumonia (interstitial thickening)- Viral=mononucleal cells

28

What are the two subgroups of alveolar pneumonia

1. Bronchopneumonia- Limited to segmental bronchi and surrounding parenchyma=patchy in it's distribution
2. Lobar pneumonia- diffuse= "white out"

29

What population is alveolar pneumonia most common in?

Debilitated elderly confined to bed

30

What is the result of unresolved pneumonia?

Bronchiectasis

31

Hepatization

The lung tissue cuts like liver tissue= lobar pneumonia

32

What does chronic pneumonia lead to?

Interstitial fibrosis

33

What is the most common bacterial pneumonia infection?

Streptococcus pneumococcus (pneumococcus)

34

What are the other two most common bacterial infections in pneumonia?

1. Staphylococcus aureus: Gram (+) dipploccoci
2. H. Influenza: Gram (-) respiratory rod

35

Classifications for aspiration pneumonia

1. Food particles in the lungs
2. Surrounded by bacteria colonization
3. Tons of neutrophils

36

Who is aspiration pneumonia the most prevalent in?

1. Alcoholics
2. Neurologic dysfunction
3. High opioids

37

Legionella Pneumophilia

Gram (-) respiratory rod
Humidifiers or AC systems
Story of legionnaires getting sick in Philadelphia

38

Etiology of viral infections

close contact with an infected person

39

What viruses may be latent in the human body and cause pneumonias by reactivation in immunocompromised persons?

Herpes and CMV (cytomegalovirus)

40

How are viruses and TB typically spread in pneumonia?

Inhalation in air droplets

41

What bacteria are typical of infected secretions from the upper respiratory tract? What infections?

-Streptococcus and Staphylococcal
-Sinusitis, laryngitis, pharyngitis

42

Hematogenous spread

Bacteria transported from the blood to the lungs (septsemia)
-UTI's
-GI infections (ruptured appendix)

43

What is the best example of an infection that gets into bloodstream and goes to the lungs?

UTI: E.coli

44

What population does pneumonia most often occur in?

Children <5 y.o.
Elderly >70 y.o

45

The two classifications of pneumonia

1. Primary or Community-Acquired: Infects previously healthy people
2. Secondary or Hospital-Acquired (nosocomial): infects those with pre-existing illnesses

46

Who are the biggest offenders of hospital-acquired pneumonia infections?

Physicians

47

CXR findings in pneumonia

Pulmonary infiltrates/consolidations

48

What are the clinical features of Streptococcus pneumonia/pneumococcus

1. Sudden onset
2. Chills
3. Fever
4. Pleuritic CP
5. Cough
6. Rust-colored sputum

49

How effective is the pneumococcal vaccine?

80-90%

50

Who do we give the pneumococcal vaccine to?

High risk patients:
-Elderly
-Splenectomy pt's
-Sick cell
-multiple myeloma
-DM
-CA
-Alcoholics

51

What bacteria produces abscess?

S. aureus:
-Virulent form
-High mortality rate >50%

52

What is the most common hospital acquired pneumonia

Pseudomonas

53

What is characteristic of pseudomonas?

Vascular lesions that cause infarcts and necrosis

54

What is the most common cause of lung infections in cystic fibrosis?

Pseudomonas-->contaminated ventilatory equipment

55

What bacteria causes a thick, current red colored jelly sputum?

Klebsiella pneumoniae

56

What causes "walking pneumonia"

Mycoplasma pneumoniae
-Causes Interstital pneumonia
-Bacteria-like
-Acts like a virus, no cell well

57

What is the number one cause of meningitis in AIDs pt's?

Cryptococcus Neoformans

58

What is diagnostic of Cryptococcus Neoformans

oval budding yeast surrounded by a wide polysaccharide capsule

59

What is the main reservoir of Cryptococcus Neoformans

Pigeon dropping in the soil
-No human-to-human infection
-Inhalation of organism

60

Define Coccidioidomycosis

-"Valley Fever"
-Chronic, necrotizing fungal infection

61

Spherules

-Formed from arthrospores in the lungs
-Filled with endospores
-Coccidioidomycosis infection

62

Endospores

upon rupture of the spherule walls the endospores are released and differentiate to form new spherules
-Spread either blood or by direct extension

63

What else forms caseating, cheesy like granulomas other than TB?

Coccidioidomycosis

64

What organs does Coccidioidomycosis spread to?

1. Bones
2. Skin
3. Liver
4. Spleen
5. CNS (meningitis)

65

Whats characteristic of both a fungus and protozoa parasite

Pneumocystis carinii pneumonia

66

What is a common cause of diffuse interstitial pneumonia in AIDs patients and one of the leading causes of death in AIDs its?

Pneumocystis carinii pneumonia

67

CXR findings in Pneumocystis carinii pneumonia

1. Diffuse interstitial pneumonia
2. Likely to isolate to lungs only

68

Characteristics of TB

-Mycotic acid-fast, beaded bacilli with a waxy capsule
-Obligate aerobe

69

How is TB transmitted?

Person-to-person via respiratory aerosoles

70

Ghon complex

- A peripheral parenchymal granuloma and a prominent infected draining mediastinal (hilar) lymph node
-Well-circumscribed with caseating necrosis

71

What is the main clinical presentation of primary TB infection?

Asymptomatic

72

Progressive Primary TB

-Uncommon=5% of primary TB
- Does not go through a Ghon complex
-Initial lesion enlarges rapidly and spreads to other parts of the lungs

73

Who is progressive primary TB common in?

Children and immunocompromised

74

Secondary TB infection

-Reactivation of a dormant primary infection
-Cavitary TB
-Hemoptysis

75

What is the main complication of secondary TB infection?

Miliary spread

76

Define Scrofula

Unilateral cervical adenitits with swollen, non-tender nodules

77

Define Potss disease

Osteoarthritis of the vertebral column that causes contractors
-Due to military spread from. TB

78

Secondary TB sx's

-Low grade fever
-Loss of appetite
-Minor hemoptysis

79

How do you diagnose TB?

Acid-fast bacilli (AFB)
Stains magenta

80

What lung cancer has the strongest association with smoking?

Small cell carcinoma

81

What lung cancer has the least association with smoking?

Adenocarcinoma

82

Name the two mutated oncogenes in lung cancer

1. K-Ras oncogenes: Adenocarcinomas, large cell carcinoma, squamous cells

2. Myc Oncogen overexpression: small cell carcinomas

83

Name the tumor suppressor genes in lung cancer

1. Mutation in p53 gene: small cell and non-small cell

2. Retinoblastoma gene (Rb):small cell and non-small cell

84

Chromosome abnormality in lung cancer

deletion in short arm of chromosome 3 (3p)

85

Define "undifferentiated large cell carcinoma"

anaplasia of stem cells before they differentiate

86

what lung cancer involves the neuroendocrine cells

small or oat-cell carcinomas

87

What lung cancer does this gross appearance describe?
-irregular masses
-gray-white in color
-soft and glistening (depends on amount of mucus)

adenocarcinomas

88

What cancer is the only one sensitive to radiotherapy

small cell carcinoma

89

what cancer is the only one that produces a variety of paraneoplastic syndromes? What are these syndromes?

Small cell carcinoma
1. ADH production- Diabetes insipidus
2. ACTH- Graves dz
3. PTH

90

What lung cancer does this gross appearance describe?
-Firm
-Gray-white in color
-Ulcerative masses: hemorrhage and necrosis

Small cell carcinoma

91

How do you diagnose squamous cell carcinoma?

Cytology from bronchial washings/brushing during bronchoscopy

92

Clinical presentation of squamous cell carcinoma

-cough
-dyspnea
-hemoptysis
-CP
-Possible pneumonia with pleural effusion

93

What is a distinctive subtype of adenocarcinoma?

Bronchioalveolar carcinoma (BAC)

94

What is a distinctive sign of Bronchioalveolar carcinoma (BAC)

Copious amounts of frothy mucous in sputum

95

Gross appearance of Bronchioalveolar carcinoma (BAC)

-Single peripheral nodule/coin lesion (>50% of cases)
-Multiple nodules
-Diffuse infiltrate

96

What lung cancer is indistinguishable from lobar pneumonia due to it's "white out" appearance

Bronchioalveolar carcinoma (BAC)- diffuse appearance

97

Histological appearance of Bronchioalveolar carcinoma (BAC)

1. 2/3 nonmucinous
2. 1/3 mucinous tumors with increased number of goblet cells

98

What lung cancer does this histology describe?
-Large nuclei
-Hyperchromatic
-Secretory neuroendocrine granules

Small cell carcinoma

99

What lung cancer does this histology describe?
-Large, irregular cells that exhibit ample cytoplasm
-Nuclei show prominent nucleoli and vesicular chromatin

Large cell carcinoma

100

Where do lung cancers most commonly metastasize to?

Regional lymph nodes
-Mediastinal and hilar lymph nodes

101

Most frequent extra nodal metastasis in lung cancer

Adrenal gland

102

What disease can adrenal metastasis cause?

Addison's disease

103

What diagnostic yields the highest result without an invasive thoracic procedure?

Fine needle aspiration (FNA) with cytology

104

What is the most successful technique in making the diagnosis of squamous cell carcinoma

Bronchoscopy with cytology from bronchial washing/brushing

105

What is a rind tumor?

Malignant mesothelioma

106

What exposure are 80% of Malignant mesothelioma caused by?

asbestos