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
