Respiratory Flashcards
(84 cards)
1
Q
inflammation of the nasal mucosa
most common cause?
A
rhinitis
adenovirus
*common cold: sneezing, congestion, runny nose
2
Q
allergic rhinitis
A
rhinitis due to type 1 hypersens
eosinophils
assoc w asthma/eczema
3
Q
most high yield complication of rhinitis? occurs when?
A
nasal polyp
repeated bouts
cystic fibrosis
Asprirn-intolerant asthma
4
Q
ASA-intolerant asthma
A
asthma
aspirin-induced bronchospasm
nasal polyps
5
Q
angiofibroma
see only in what population?
presentation?
A
benign
only adolescent males
profuse epistaxis
6
Q
nasopharyngeal carcinoma what virus? what patients? what nodes? what on biopsy?
A
malignant EBV-driven african kids/chinese young adult cervical nodes biopsy: "pleomorphic keratin-positive epithelial cells in a background of lymphocytes"
7
Q
acute epiglottitis
presentation?
A
H flu type b - most common in immunized and non-immunized
fever, sore throat, drooling w dysphagia, muffled voice, inspiratory stridor
8
Q
laryngotracheobronchitis (croup)
most common cause?
presentation?
A
inflammation of upper airway
parainfluenza virus most common
hoarse “barking” cough and inspiratory stridor
9
Q
vocal cord nodule
A
due to overuse
myxoid degeneration of connective tissue
hoarseness; resolved w rest
10
Q
laryngeal papilloma
what virus?
diff btw kids/adults?
presents w?
A
benign tumor on vocal cord HPV 6 and 11 SINGLE in adults MULTIPLE in kids hoarseness
11
Q
laryngeal carcinoma
A
low risk squamous cell on vocal cord
alcohol/tobacco
hoarseness, cough, stridor
12
Q
pneumonia is an infection of what part of the lung?
A
parenchyma
via mucus plugging, dmg to escalator, cough reflex etc
13
Q
characteristics of pneumonia
A
fever/chills yellow-green/rusty sputum tachypnea w pleuritis bradykinin/PGE2 are key mediators of PAIN dec breath sounds/dull to perc elevated WBC
14
Q
3 patterns of pneumonia
A
lobar (bacterial)
broncho (bacterial; runs along sm airways)
interstitial (increased markings on CxR; atypical/viral)
15
Q
lobar pneumonia
A
bacterial: 1) S. pneumo (older), 2) Klebsiella (enteric flora that is aspirated –> think risks); elderly, alcoholics, diabetics; currant jelly sputum, abcess
16
Q
4 phases of lobar pneumonia
A
congestion
red hepatization (blood)
grey hepatization
resolution
17
Q
stem cell of the lung
A
Type II pneumocyte
18
Q
“hepatization”
A
becomes dark and solid like liver
19
Q
bronchopneumonia
A
bacterial
scattered/patchy/multifocal/bilateral
surrounds bronchioles
20
Q
most common cause of secondary pneumonia - post-viral URI
A
S. aureus
often complicated by abscess/empyema
virus knocks out escalator
21
Q
bug causing pneumonia superimposed on COPD
A
H. influenzae
22
Q
bug causing pneumonia in CF pts
A
Pseudomonas
23
Q
bug causing CAP and superimposed on COPD
A
Moraxella
24
Q
CAP, COPD, immunocompromised, intracellular organism best seen on silver stain
A
Legionella
water source
25
interstitial pneumonia (aka?)
hallmark sign on CxR?
air sacs be like whaaat?
diffuse IS infiltrates (in wall; no major consolidation in air sacs)
ATYPICAL: upper resp i.e. minimal sputum, cough, low fever
increased lung markings
air sacs relatively clear
26
most common cause of atypical (IS) pneumonia
Mycoplasma (dorms/barracks)
| autoimmune hemolytic anemia (IgM v. I antigen on RBC's --> cold hemolytic anemia) and ERYTHEMA MULTIFORME
27
second most common cause of atypical pneumonia in young adults
Chlamydia pneumoniae
28
most common cause of atypical pneumonia in infants?
respiratory syncytial virus
29
bug causing atypical pneumonia w posttransplant immunosuppressive therapy?
CMV
30
bug causing atypical pneumonia in elderly, immunocompromised, preexisting lung disease?
Influenza virus
| risk for superimposed S. aureus or H influenzae
31
bug causing atypical pneumonia in farmers or vets?
```
Coxiella burnetii
high fever (Q fever)
```
32
what makes Coxiella different from other rickettsiae?
1) causes pneumonia
2) does NOT requires arthropod vector for tx (highly-heat resistant endospores)
3) does not produce skin rash
33
aspiration pneumonia
top 3 bugs?
classic location?
anaerobic bacteria in oropharynx
Bacteroides, Fuso, Pepto
RLL
34
Primary Tuburculosis
| symptomatic?
focal caseating necrosis in LOWER lobe and hilar nodes
fibrosis+calcification --> GHON complex
no; asymptomatic
35
miliary TB or bronchopneumonia due to which form of TB?
secondary reactivated TB
36
presentation of TB
fevers/night sweats
cough w hemoptysis
weight loss
run AFB stain to detect mycobacterium and r/o fungi
37
TB can spread to where?
any tissue
meninges w granulomas @ BASE
cervical nodes
KIDNEY (most common organ --> sterile pyuria)
lumbar vertebrae (Pott disease (when bone is involved))
38
to have chronic bronchitis, you need?
chronic productive cough lasting >3 months for >2 years
39
Reid Index?
ratio of mucinus glands in the lung
smokers >50%
defines chronic bronchitis
40
why does cyanosis occur in chronic bronchitis?
up PaCO2 so less PaO2 in alveolus so less partial pressure to push across capillaries
41
physiology of emphysema
destruction of alveolar air sacs --> loss of elastic recoil and collapse --> air trapping
42
inflammation in lung produces?
proteases --> our protection to this is antiproteases (antitrypsin) so to not allow for destruction
e.g. smokers --> debris and inflammation --> up proteases
43
smoker's emphysema
centriacinar most severe UPPER lobes
44
a1-antitrypsin deficiency emphysema
| may also present with?
panacinar
most severe in LOWER lobes
liver cirrhosis
the deficiency is that the protein is not IN THE BLOOD
still is produced in the liver but is misfolded and accum in ER of hepatocytes (PAS +)
45
most common clinical mutation of a1-AT deficiency?
PiM --> PiZ (misfolding and accum in ER)
hetero: PiMZ (asymptomatic but decreased circulating level of a1-AT) these pts at high risk for emphysema so DON'T SMOKE
homo: PiZZ (panacinar + cirrosis)
46
presentation of a1-AT?
```
dysnea
cough but NO SPUTUM
prolonged expiration w pursed lips
weight loss
inc AP diameter
```
47
pathogenesis of asthma
allergens --> TH2 phenotype in CD4 T cells of genetically susceptible individuals --> TH2s secrete IL-4 (IgE switch)/IL-5 (calls in EOS)/IL-10 (promotes TH2 cell production)
48
features of asthma: what do you find in the mucus?
Curschmann spirals admixed w Charcot-Leyden crystals
49
bronchiectasis pathogenesis?
occurs when?
unique complication?
necrotizing inflammation w damage to airway walls --> abnormal dilation --> loss of tone and air trapping (cannot accelerate/remove air)
CF/Kartagener/tumor/foreign body/necrotizing infection/allergic bronchopulmonary aspergillosis (asthmatics & CF)
secondary amyloidosis (AA deposition) ...primary is AL via plasma cell overproduction
50
what does fibrosis do to the elasticity of the lung? airways?
increases
| holds airways open
51
IPF
primary mediating factor?
where does fibrosis begin?
tx?
```
fibrosis of the lung interstitium
TGF-B from injured pneumocytes
r/o drugs (bleo/amio, radiation)
subpleural
tx: transplant
```
52
Pneumoconioses
| what cell mediates?
MP's engulf foreign particles and lay down fibrosis (to wall off the foreign material)
need chronic exposure to cause clinical sx
53
coal workers' pneumoconiosis
| assoc w?
carbon dust
massive exposure --> diffuse fibrosis (black lung)
assoc w RA (Caplan syndrome)
54
silicosis
| what professions?
silica; sandblasters/silica miners
nodules in upper lobes
inc TB risk (impaired phagolysosome formation by MP's) ONLY 'coniosis that inc TB risk
55
berylliosis
what professions?
inc risk for what?
beryllium; miners and aerospace
noncaseating granulomas, hilar nodes and systemic organs
inc risk for lung cancer
56
asbestosis
| fibrosis of lung/pleura, cancer of lung/pleura
construction/plumbers/shipyard
pleural plaques, ferruginous bodies
inc risk for carcinoma/mesothelioma
57
sarcoidosis
| common in what population?
noncaseating granulomas in lung and hilar nodes (epithelioid histiocytes w giant cells)
systemic disease
african-am females
CD4 helper T response
ASTEROID BODY (configuration of giant cells)
58
sarcoidosis can involve what other organs?
| tx?
uveitis
skin --> nodules or eryth. nodosum
salivary/lacrimal glands (mimics Sjogren's) but you know if you see N.C. granulomas
hypercalcemia bc N.C. granulomas have 1-a-hydroxylase activity and thus activate vit D
steroids or resolves spontaneously
59
hypersensitivity pneumonitis
granulomas with EOSINOPHILS
| e.g. pigeons
60
pulmonary HTN
characteristic lesion?
classic presenting sign?
>25mmHg
plexiform lesion (tuft of capillaries; indicate severe, long-standing disease)
exertional dyspnea
61
primary pulmonary HTN
young adult females
familial INACTIVATING MUT in BMPR2 --> proliferating mutations in vascular smooth muscle --> plexiform lesions and atherosclerosis of pulm artery
62
one unique way to get secondary pulmonary HTN?
recurrent PE
63
ARDS
| hallmark finding?
hyaline membrane formation --> inc surface tension (easy collapse) and thickened membrane w dec diffusion
"diffuse whiteout of the lung"
64
etiology of ARDS
| tx?
activation of NP's w protease and ROS damage of TYPE 1 & 2 pneumocytes --> repair (fibrosis) instead of regeneration bc type 2's gone
underlying cause + ventilation w PEEP
65
Neonatal RDS due to what?
findings?
3 main causes
due to inadequate surfactant --> excess E required to open air sacs
tachypnea, accessory muscle use, hypoxemia/cyanosis
1) prematurity (screen w L/S ratio*), 2) C-section delivery (steroids; cause surfactant release by type 2 pneumocytes (no stress assoc w delivery so no surfactant release) 3) maternal diabetes (high blood sugar --> baby's pancreas produces insulin, insulin inhibits surfactant production)
*Lecithin (phosphatidylcholine) is key component of surfactant and increases by week 48 of development
66
complications of neonatal ARDS?
hypoxemia inc risk for PDA and necrotizing enterocolitis (dec O2 to gut)
supplemental O2 --> ROS injury (retinal blindness)
67
most common cancers: incidence
most common cause of cancer mortality?
avg age of presentation?
key RF's
1) breast/prostate, 2) lung**, 3) colorectal
```
avg age of presentation = 60
cigarette smoke (polycyclic aromatic HC's), radon (generated from uranium decay), uranium miners, asbestos
```
68
classic CxR finding in lung cancer? next step?
"coin lesion" solitary nodule
next step?
past CxR's --> if new lesion --> biopsy
69
2 high-yield benign "coin-lesions"
```
granuloma (histoplasma e.g.)
bronchial hamartoma (tissue belongs there but is disorganized)
```
70
lung carcinoma
small cell (15%) not amenable to surgical resection, instead tx w chemo
non-small cell (85%) tx with surgical resection, no chemo
71
non-small cell e.g's
adenocarcinoma (40%): glands/mucus
squamous cell (30%): keratin pearls, IC bridges
large cell (10%): don't see any of the above chars
carcinoid tumor
72
small cell carcinoma
via poorly-differentiated neuroendocrine cells (Kulchitsky)
chromogranin positive
male smokers
central
paraneoplastic syndromes (Eaton-Lambert e.g.)
mitotic activity on histo
73
squamous cell
pink keratin pearls/IC bridges
most common in M smokers
central
PTHrP
74
adenocarcinoma
most common tumor in nonsmokers and female smokers
peripheral
no paraneoplastic syndromes
75
large cell carcinoma
if r/o others
smoking
central OR peripheral
poor prog
76
bronchioloalveolar carcinoma
arises from which cell?
prognosis?
```
columnar cells grow along preexisting bronchioles and alveoli
Clara cells
NOT related to smoking
peripheral
pneumonia-like on imaging
excellent prognosis
```
77
Carcinoid tumor
WELL-DIFFERENTIATED neuroendocrine cells
CHROMOGRANIN positive (as in all neuroendocrine tumors
not related to smoking
polyp-like mass in bronchus
can rarely cause carcinoid syndrome
histo: not mitotically active "nests" of cells
78
most common sources of lung metastasis?
| hallmark on imaging?
breast/colon
"cannon ball nodules"
more common than primary tumors
79
TNM staging
T: size/extension
N: spread to hilar/mediastinal nodes
M: spread (adrenal is unique to lung met)
overall 15% 5y survival
80
complications of lung cancer
pleural involvement (adenocarc)
SVC syndrome (vein distension, blue discoloration of arms/face)
hoarseness/diaphragmatic paralysis
Horner syndrome
81
parietal & visceral pleura lined by what type of cells?
mesothelial
82
spontaneous PTX due to?
| what age?
rupture of emphysematous bleb
young adults
trachea shifts to side of collapse
83
tension ptx trachea where?
trachea to opposite side
84
mesothelioma
assoc w?
presents w?
malignant neoplasm
assoc w asbestos
recurrent pleural effusions (bc mesothelium makes fluid)
dyspnea, chest pain
