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Flashcards in Respiratory Deck (161):
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COPD changes in FEV, FVC, TLC (spirometry)

Decrease FVC, MORE decrease in FEV1, decrease in FEV1/FVC ratio, increase in TLC

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Chronic bronchitis Dx requirements

Chronic productive cough lasting 3 months over a minimum of 2 years

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Chronic bronchitis is associated with

Smoking

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% of wall is mucous glands in CHronic bronchitis

>50%, measures in Reid index, hypertrophy of bronchial mucinous glands

4

The excess mucous goes where in chronic bronchitis

Coughed up or can plug parts of lung

5

What is Reid index?

Measure of the thickness of the glands in the bronchial wall

7

Clinical features of chronic bronchitis

Productive cough, cyanosis, inc. PaCO2, dec. PaO2, inc. risk of infection and cor pulmonale

8

Emphysema mechanism of disease

loss of elasticity, destruction of the alveolar air sacs, the many air sacs now act as one (one reason for obstructive disease), air drag and loss of elasticity allows for some "collapse" of the walls of bronchioles (second reason for obstruction)

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EMphysema cause

imbalance of proteases and anti-proteases; smokers cause the increase in protease activity; alpha 1 anti trypsin def. leads to less antiprotease protection

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what is most common cause of emphysema

smoking

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2 categories of emphysema

panacinar and centriacinar

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smoking causes which kind of emphysema

centriacinar, mainly upper lobes

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alpha 1 anti trypsin def causes which emphysema

pan-acinar, lower lobes mainly

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A1AT def also involves

liver, causing cirrhosis

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most clinically relevent allele muattions for A1AT

PiZ allele, now protein accumulates in ER

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PiMZ heterozygotes

higher risk for emphysema with smoking but otherwise assyptomatic

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clinical features of emphysema

dyspnea, cough, no sputum, pursed lips with prolonged expiration, lbs loss, inc. AP diameter (barrel chest)

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functional residual capacity is what in empysema

increased and in a fibrosis of lung then the FRC will decrease

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late complications of emphysema

hypoxemia, cor pulmonale

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Asthma descript

revrsible airway bronchoconstrict, usually from a type 1 hypersensitivity rxn

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Asthma pathogenesis

allergins induce TH2 phenotype CD4 t cells of genetically susceptible individuals, the TH2 cells secrete IL-4,5,10

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IL 4 important for what

IgE shift

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IL5 important for

eosinphil

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IL10 important for

Th2 dif and block Th1 form

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early phase of asthma

mast cell activation leading to contriction, from the leukotrienes

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late phase of asthma

inflammation and major basic protein potentiate the bronchoconstriction

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clinical features of asthma

dyspnea, wheezing, productive cough with curschmann spirals with charcot leyden crystals, severe unrelenting attack can lead to status asthmaticus and death

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non allergic causes of asthma

exercise, viral infection, aspirin (aspirin intolerant asthma), occupational exposure

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nasal polyps associations

chronic rhinitis
adults+asthma + polyps = aspirin intolerant asthma
child + polyps = CF

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Bronchiectasis definition

permant dilation of bronchioles and bronchi causing loss of airway tone and results in air trapping

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Bronchiectasis causes

CF, kartagener syndrome, tumor or foreign body, nectrotizing infection, allergic bronchopulmonary aspergillosis-----all in all its due to inflammation eith damage to the air way walls

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clinical features of bronchiectasis

cough, dyspnea, foul smelling sputum, with complications of hypoxemia with cor pulmonale and 2ndary amyloidosis

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restrictive diseases spirometry findings

cant fill lung thus dec. TLC, decreased more FVC, decreased FEV1, increased FEV1/FVC ratio

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causes of restrictive diseases

interstital diseases causing fibrosis of the interstitium or even a chest wall issue (ex obesity)

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Idiopathic pulmonary fibrosis is what kind of disease

restrictive disease with fibrosis of the lung interstitium

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etiology of idiopathic pulm. fibrosis

cyclical lung injury, TGF-Beta thought to be agent causing the fibrosis....must exclude other causes to be able to give this Dx

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clinical features of IPF

progressive dyspnea, cough, fibrosis seen on lung CT leads to a honey comb lung, Tx is lung transplant

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Pneumoconioses def.

interstitial fibrosis due to occupational exposure, requires chronic exposure to fibrogenic small particles

39

Coal workers pneumoconiosis

carbon dust is the causeitive agent

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Coal workers pneumoconiosis pathologic findings

diffuse fibrosis (black lung), assoc. with RA (Caplan syndrome)

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Anthracosis def.

mild exposure to carbon from pollution, not clinically relevant

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Silicosis

exposure to silica, as in using a sandblaster or working in a silica mine

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silicosis pathologic findings

fibrotic nodules in upper lobes of lungs

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which pneumocosis inc. risk for TB?

silicosis, the silica impairs the phagolysosome formation by macrophages

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Berylliosis

beryllium, miners and also from the aerospace industry

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berylliosis path. finsdings

non-caseating granulomas in lung, hilar nodes, systemic organs

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berylliosis increases risk for what

lung cancer

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Asbestosis

asbestos fibers, seen in construct workers, plumbers, shipyard workers

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asbestosis path. findings

fibrosis of lung and pleura with inc. risk for lung cancers and mesothelioma. lung cancer has higher incidence

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asbestosis lesions characteristics

lesions has long golden brown fibers with associated iron (asbestos bodies)

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WHat pneumoconiosis is similar to sarcoidosis

berylliosis

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Sarcoidosis is what type of lung issue

restrictive disease

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Sarcoidosis def

systemic disease characterized by non-caseating granulomas in multiple organs

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Sarcoidosis most common population

african american females

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sarcoidosis etiology

unknown, likely due to CD4 T-helper response

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characteristic findsing in sarcoidosis

asteroid bodies

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granulomas from sarcoidosis generally involve

hilar nodes and lung

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other tissues involved in sarcoidosis

Uveitis, cutaneous nodules or erythema nodosum, salivary/lacrimal glands (may mimic sjogren syndrome),

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clinical features of sarcoidosis

dyspnea, cough, elvated serum ACE, hypercalcemia, Tx is steroids, but can spontaneously regress

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non-caseating granulomas have what activity

1 alpha hydroxylase activity

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Hypersensitivity pneumonitis is what class

restrictive disease

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hypersensitivity pneumonitis has what patholgy

granulomatous rxn to inhaled oragnic antigens

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hypersensitivity oneumonitis clinical features

fever, cough, dyspnea that resolves with removal of exposure...chronic exposure can lead to interstitial fibrosis, remember also there will be eosinophils also

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pulmonary mean arterial P, normal and what dictatses pulm. HTN

10 is normal and over 25 is HTN

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pulm htn characterized by

atherosclerosis of pulm trunk, smooth muscle hypertrophy of pulm arteries, intimal fibrosis, plexiform lesions in longstanding disease

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pulm htn leads to

RV hypertrohpy and corpulmonale

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pulm htn clinical features

exertional dyspnea and right sided heart failure

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primary pulm htn details

classically in young adult females, unknown etiology, familial forms related to BMPR2 mutations inactivating kind (leads to proliferation of vascular smooth muscle)

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secondary pulm htn causes

due to hypoxemia (COPD), or inc. volume in pulm. circuit (congenital heart disease), recurrent pulm. embolism can be a cause also

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acute respiratory distress syndrome

leakage of protein fluid into air sac leading to a hyaline membrane in the air sacs

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ARDS clinical features

hypoxemia and cyanosis (due to the fact the diffusion of air is limited from thicker air sac now from hyaline membrane), white out on CXR, respiratory distress

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ARDS etiology

sepsis, infection, shock, trauma, aspiration, pancreatitis, DIC, hypersensitivity rxns, drugs.....neutros are activiated causing free radical damage and protease damage (type I and II pneumocytes are damaged)

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ARDS Tx

address underlying cause, ventilation with positive end expiratory pressure, recovery may be complicated by interstitial fibrosis

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neonatal resp. distress syndrome

due to inadequate surfactant levels (surfactant from type II pneumocytes)

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neonatal resp. distress syndrome clinical features

increasing resp. effot after birth, tachypnea with accessory use, grunts, hypoxemia with cyanosis, diffuse granularity of lung on x-ray

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neonatal resp. distress syndrome associations

prematurity (L:S ratio for screening), C-section delivery, maternal diabetes

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L:S ratio meaning

higher L = more surfactant, ratio wants to be >2 then lung is mature, L = lecicin which is phosphatidylcholine

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steroids do what to surfactant levels

increase them which is why when C section there is less stress thus less steroids thus less surfactant

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high insulin from fetus does what to surfactant

inhibits it

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complications of neonatal resp. distress syndrome

hypoxemia increases risk for persistence of PDA and necrotizing enterocolitis and the supplement O2 cna inc. risk for free radical injury

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carcinogenic in smoke from tobacco

polycyclicaromatic hydrocarbons

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key risk factors for lung cancer

cig. smoke, radon, asbestos

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lung cancer presentation

non specific Sx, solitary nodule usually (coin lesion)

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benign lung lesions more common in

young...they usually are granulomas or a bronchial hamartoma (lung tissue + cartilage) and is usually calcified

85

small cell carcinomas usually cannot be what

resected

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subtypes of non small cell carcinoma

adenocarcinoma, squamous cell carcinoma, large cell carcinoma, carcinoid tumor

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mucous or gland secretions

adenocarcinoma

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keratin pearls are part of what aling with intercellular bridges

squamous cell carcinoma

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no glands, no secretions, no intercellular bridges

large cell carcinoma

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small cell carcinoma characteristics

poorly diff. small cells, arise from neuroendocrine cells (Kulchitsky cells), high mitotic activity

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small cell carcinoma association

male smokers

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small cell carcinoma location

Central

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small cell carcinoma comments

rapid growth and early metastasis; may produce ADH, ACTH, or cause eaton lambert syndrome...(paraneoplastic syndromes)

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squamous cell carcinoma characteristics

keratin pearls, intercellular bridges

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if tumor starts with S

smoking assoc., central location, paraneoplastic syndromes

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squamous cell carcinoma association

smoking

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squamous cell carcinoma location

central

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squamous cell carcinoma comments

paraneoplastic syndrome of PTHrP

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adenocarcinoma characteristics

glands or mucin

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adenocarcinoma associations

most common in non smokers and females

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adenocarcinoma location

peripheral

102

large cell carcinoma characteristics

poorly diff. large cells, NO keratin pearls, NO intecellular bridges, NO glands or mucin

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large cell carcinoma association

smoking

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large cell carcinoma location

central or peripheral

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large cell carcinoma comments

poor prognosis

106

bronchioloalverolar carcinoma characteristics

columnar cells that grow along preexisting bronchioles and alveoli; arise from clara cells

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bronchioloalveolar carcinoma association

not related to smoking

108

bronchioloalveolar carcinoma location

peripheral

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bronchioloalveolar carcinoma comment

may present with pneumonia-like consolidation on imaging; excellent prognosis

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carcinoid tumor characteristics

well diff. neuroendocrine cells; chromogranin +

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carcinoid tumor associations

not related to smoking

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carcinoid tumors location

central or peri; classically forms a polyp like mass in bronchus

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carcinoid tumor comments

low grade malignancy; rarely causes carcinoid syndrome

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metastasis to lung characteristics

most common from breast and colon carcinoma

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metastasis to lung location

multiple cannon ball nodules on imaging

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metastasis to lung comments

more common than primary tumors

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unique site of distant spread from lung cancer

adrenal gland

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local complications of lung cancers

pleural involvement, obstruction of SVC (SVC syndrome..dilated veins in head and neck, edema in arms, blue discorloation of arms and face), involvement of recurrent laryngeal or phrenic nerve, compression of the sympathetic chain (can cause horners)

119

what lines the pleuras

meso cells

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pneumothorax def

air in the pleural space

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spontaneous pneumothorax characteristics

rupture of emphysematous bleb, seen in young adults, results in collapse of portion of lung, trachea shifts to side of collapse

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tension pneumothorax chatracterisitcs

arise from a penetrating chest wall injury, trachea pushed to opp. side of injury, medical emergency, Tx with insertion of chest tube

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mesothilioma characteristics

malignant neoplasm of mesothelial cells, highly assoc. with occupational exposure to asbestos, presents with recurrent pleural effusions, dyspnea, chest pain, tumor encases the lung

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pneumonia occurs when

normal lung defenses are impaired

125

clinical features of pneumonia

fever, chills, cough with eyllow green or rusty sputum, pleuritic chest pain, dec. breath sounds with dullness to percussion, elevated WBC

126

3 patterns seen on CXR for pneumonia

lobar, bronchopneumonia, interstitial

127

lobar pneumonia look on CXR

1 lobe

128

bronchopneumonia look on CXR

patchy spots

129

interstitial pneumonia look on CXR

interstiium involved leading an increase in the lung markings

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lobar and broncho pneumonia most common caustive agents

bacteria

131

interstitial pneumonia causitive agents

viral mainly

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most common cause of lobar pneumonia

Strept. pneumoniae, klebsiella pneumoniae

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most common cause of community acquired pneumonia

S. pneumoniae, usually seen in middle aged adults and elderly

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klebsiella pneumoniae characterisitcs

affects malnourished and debilitated individuals, especially elderly, alcoholics, diabetics. thick mucoid capsule results in gelatinous sputum (currant jelly)

135

4 classic phases of lobar pneumonia

Congestion then Red Hepatization then Grey Hepatization then Resolution

136

Congestion phase of lobar pneumonia

congestion or blood, edema

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Red hepatization phase of lobar pneumonia

exudate in lung, includes RBC

138

Grey hepatization phase in lobar pneumonia

the RBC exudate breaks down

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Type I or II is the stem cell for lung

type II

140

Bronchopneumonia characteristics

scattered patchy consolidation centered around bronchioles; often multifocal and B/L

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Key causes of Bronchopneumonia

S. aureus, H. influenzae, P. aeruginosa, M. catarrhalis, Legionella

142

S. aureus with lung

most common cause of secondary pneumonia (bacterial on top of viral pneumonia); often complicated by abscess or empyema

143

H. flu with the lung

common cause of secondary pneumonia and pneumonia superimposed on COPD

144

Pseudomonas on lung

pneumonia in CF pt

145

Moraxella catarrhalis on lung

CAP and pneumonia super imposed on COPD levels

146

Legionella on lung

CAP, pneumonia superimposed on COPD, pneumonia in immunocomprimised; xmitted from H2O source; intracellular organism

147

interstitial pneumonia differences with Sx

they are more mild than the others, inflammation seen in the walls of air sacs

148

causes of interstitial pneumonia

mycoplasma pneumoniae, chlamydia, RSV, CMV, influenza, coxiella burnetii

149

mycoplasma pneumoniae on lung

most common atypical, young adults (dormatories), can produce cold agglutinin hemolytic anemia, not visible on gram stain

150

chlamydia on lung

2nd most common atypical pneumonia in young adults

151

RSV on lung

most common atypical in infants

152

CMV on lung

post transplant surgury most common, atypical

153

influenza on lung

atypical in elderly, immunocompromiesed, pre-exist lung disease

154

coxiella B. on lung

Q fever, farmers and vets, atypical pneumonia, HAVE A HIGH FEVER UNLIKE OTHERS

155

Aspiration pneumonia causes

bacteriodies, fusobacterium, peptococcus

156

primary TB characteristics

focal caseating necrosis in lower lobe of lung and hilar nodes, foci undergo fibrosis and calcification (Ghon complex)

157

secondary TB characterisitcs

due to reactivation, occurs at apex of lung, caseous necrosis and may lead to miliary TB (scattered all over lung) or TB bronchopneumonia

158

clinical features of secondary TB

fever, night sweats, cough, hemoptysis, lbs loss, Bx show caseating granulomas with acid fast bacilli

159

systemic spread of TB where

meningies (base of brain), cervical nodes, kidney (sterile pyuria, most common organ), lumbar vertebrase (Pott disease)

160

Obstructive diseases

Emphysema, chronic bronchitis, asthma, bronchi ecstasies

161

Restrictive diseases

Fibrosing, grabulomas etc