Week 4 Flashcards
(129 cards)
1
Q
Squamous Cell Carcinoma
Location
Histology
Syndrom
A
Central
Keratin pearls, intracellular bridges
Parathyroid Hormone Related Peptide
2
Q
Symptoms of lung cancer
A
Cough
Hemoptysis
Chest Pain
Pneumonia
Brain Mets
3
Q
Lung metastasis destination
A
Brain, adrenal, liver, bone
4
Q
Lung cancers examples
A
Squamous cell carcinoma
Adenocarcinoma
Small cell carcinoma
Carcinoid tumor
Large cell carcinoma
5
Q
Symptoms of paraneoplastic syndrome
A
Hypercalcemia
Stones and bones
Short QT
Confusion, tired, coma
Muscle weakness
Nausaea and constipation
6
Q
Tumor in lung apex
A
Pancostal tumor
7
Q
Benign leasions of lungs
A
Granuloma (TB, fungus, sacro)
Bronchial harmatoma
8
Q
Another name for brochoalveolar carcinoma
A
Adenocarcinoma in-situ
9
Q
Adenocarcinoma
Most common in
Location
Histology
Cells
Mutations
A
Women / Non-smoker
Periphery
Epithelium with grandular
Type II and clara (peripheral)
KRAS, EGFR, ALK
10
Q
Adenocarcinoma
treatment:
ALK
EGFR
A
Gefitinb
Crizotinib
11
Q
Adenocarinoma
precurors
A
Adenocarcinoma in-situ (bronchoalveaolar)
Atypical adenomatous hyperplasia
12
Q
Small Cell Carcinoma
Treatment (general)
Characteristics
Location
Origin
Differentiation
Syndrome
A
Chemo
Most aggressive
Central
Neuroendocrine
Poorly differentiated
+ADH/+ACTH
13
Q
Carcinoid tumor
Histology
Orign
Differentiation
A
Unfirom cell size, round
Neuroendocrine
Well diff
14
Q
Large cell carcinoma
Diagnosis by
Gross
A
Diagnosis by exclusion
Large necrotic mass
15
Q
What lowers aspiration events
A
Increase in cricoid pressure
Rapid intubation
Use of rapid acting and paralytic meds
Subglottic suctioning
16
Q
Damage from aspiration
A
Gram negative bacteria
Acid
17
Q
How do intubated patients develop pneumonia?
A
The flora of intubated patient changes to organisms like pseudomonas
18
Q
Treatment for aspiration
A
Decontamination - Chlorhexidine - antiseptic esp. gram+
Gentamicin, colistin, vancomycin - europe (resistance??)
19
Q
The most common nosocomial infection in the ICU
Cause
Organisms
A
Ventilator-Associated Pneumonia (VAP)
Intubation
Gram (-) pseudomonas Gram (+) ORSA
20
Q
Diagnosis of Pneumonia (Kuhls)
A
CPIS Score (Clinical Pulmonary Infection Score)
Fever or hypothermia
Leukocytoses or leukopenia
Increased respiratory secretions
New or worsened infiltrate on chest x-ray
21
Q
Definition of ARDS
A
Bilateral infiltrate on CXR
Wedge less than 18 no hypetension
Hypoxemia regardless of PEEP
– PO2/iO2F ratio less than 200 (normal 100/0.21=500) (ALI 300 or less)
–
22
Q
Association with ARDS
A
Sepsis (most common)
Pancreatitis
Pneumonia
Aspiration
uRemia
Trauma
Amniotic fluid embolism
Shock
23
Q
Stages of ARDS
A
Prodrome (12-36h) - CXR mild increase in microvaculatrue, normal pO2, low pCO2, tachypnea, agitation (mediated by neutrophila)
Acute (exudative) phase (up to 7d) - hypoxema, CXR cardiac edema (like cardiogenic), capillary endothelial damage (edema); possible sepsis (lack of barrier) TYPE1, atelectesis (2/2 loss of surfactant) TYPE2
Proliferative (7-10d+) - Collagen deposition, hypercarbia
Fibrosis alveolitits (10+) - alveolar thick, hypercarbia, pul HTN, RHF
Recovery – M recovery PMN death
24
Q
ARDS treatment
A
Vasopressors (levophed)
Antibiotics
Increase PEEP to decrease FiO2 (decrease O2 toxcitit)
Low tidal volume ventilation
Rotational therapy
25
VAP
Occurence
Tests
Ventilator-Associated Pneumonia
Over 90% occur during mechanical ventilation; 50% begin within the first 4 days of being intubated.
26
What is it?
Harmatoma
27
What is it?
Squamous Cell Cariconoma
28
What is it?
Squamous cell carincoma
29
What is it?
Adenocaricoma
30
What is it?
Large Cell Carcinoma
31
What is it?
32
Paraneoplastic syndrome in SCC
33
What is it?
Pancoase tumor
34
What is it?
35
What it it?
Coins lesions -- harmatoma?
36
What is it?
Mesothelioma
37
Restrictive lung disease
Presentation
Dyspnea, tachypnea, end-inspiratory crackles, cyanosis
38
Restrictive lung disease
Progression
2o Pulm HTN, right heart failure/cor pulmonale
39
Respiratory volumes in resitrictive lung disease
low TLC
low DLCO
low FVC
normal to high FEV1
40
Causes of restrictive lung diseases
41
Restrictive: Fibrosing Diseases
Idiopathic Pulmonary Fibrosis
Nonspecific Interstitial Pneumonia
Cryptogenic Organizing Pneumoinia
–aka: bronchiolitis obliterans organizing pneumonia (BOOP)
Lung Disease from Connective Tissue Disorders
Pneumoconiosis
Drug Reactions
Radiation Pneumonitis
42
Restrictive: Idiopathic Pulmonary Fibrosis (IPF)
How diagnosed?
How path is referred?
Inflammation?
Onset?
Symptoms?
Treat?
Clinic-patholgic (clinical+x-ray+pathology)
Usual interstitial pneumonia (UIP) \* can be seen in other diseases
Not really
Insidout 40-70
Dyspnea, late hypoxemia&club
Steroids, immune supre, lung transplant
43
Clubbing
44
Restrictive: Nonspecific Interstitial Pneumonia
Diagnosis?
Symptoms?
Onset
Types?
Unknown etiology like IPF but fail to show diagnostic features
Dyspnea
46-55 yo
Cellular (mild/inflammatory/young) Efibrosi (worse/fibrosis/old)
45
Restrive: Cryptogenic Organizing Pneumonia
Bronchiolitis obliterans organizing pneumonia
Syptoms
Morphology
Cough and dyspnea
## Footnote
Polypoid plugs of loose organizing connective tissue (Masson bodies)
46
Restrictive: Organizing Pneumonia
What is it?
intra-alveolar fibrosis can occur as a secondary condition
–2nd to infections or inflammatory injury
–Viral and bacterial pneumonia
–Inhaled toxins
–Drugs
–Connective tissue disease
–GVHD
47
Restrictie: Pneumoconioses
Small particles result
Large particles result
Acute lung injury
Fibrosing colagenous pneumoconioses
48
What is it?
Asbestosis
49
How smoking affects pneumoconioses
Smoking reduces mucociliary clearance
50
Restrictie: Coal Workers’ Pneumoconiosis
Spectrum
Risk?
Anthrocosis, Simple CWP, Complicated CWP
No risk on tb or cancer
51
Restrictive: Silicosis
Work
Risk
Foundry work, sandblasting, mining, stone cutting
2x lung cancer, tb
52
What is it?
Silicosis
53
What is it?
Eggshell calcification in hilar LN
Silicosis
54
Restrictive: Asbestosis
General diseases assocaiated with
Forms of asbestos
What progression is asbestosis is similar to
Pleura
Serpentine (cruly) less harmful and amphibole (needle-like) ONLY associated with mesothelioma
IPF : honeycombing, UIP
55
What is it?
Asbestosis
Feruginouse (asbestos bodies)
56
What is it?
Calcified plaques
Asgestosis
57
Two types of restrictive granulomatous diseases
Sarcoidosis
Hypersensitivity Pneumonitis
58
Restrictive: Sarcoidosis
Cause
Presentation
Elevation of what
Immune regulation, genetic predisposition, env exposure
SOB, cough, chest pain, hemoptysis ++ fever, fatgiue, weight loss, anorexia, night swets
ACE and hypercalemia
59
What is it?
caseating / non granulomas
60
What is it?
Potato lymph nodes
61
Restrictive: Hypersensitivity Pneumonitis
ddx from asthma
examples
Acture presentation
Chronic presentation
It involves alveoli (asthma does not)
farmer's lung, pigeon breeder's lung, humidifier lung
Fever, dyspnea, cough, leukocytosis usually 4-6 hrs after exposure
From continuous exposure à respiratory failure, dyspnea, cyanosis
62
What is it?
Hypersensitivity Pneumonitis
cetered around bronchioles, interstitial pneumonitis, Interstitial fibrosis, honeycombing, obliterative bronchiolitis (late)
63
Restrictive: Pulmonary Eosinophilia
Respond to
Types
BAL
Acute Eosinophila (responds to steroids)
Simple Pulonary Eosinophilia (blood eosinophilia, transient)
Idiopathic
Secondary
64
Restrictive: Pulmonary Alveolar Proteinosis
What is it?
Symptoms?
Types
Treatment?
Cause?
Accumulation of acellular surfactant in the intra-alveolar and bronchiolar spaces
Cough with sputum (gelatinous chunks); progressive dyspnea, hypoxemia
Aquired, congential, secondary
Whole lung lavage
Likely due to antibody to granulocyte-macrophage colony stimulating factor (GM-CSF) - autoimmune
65
What it is?
66
Virchow’s Triad
Endothelial injury - trauma, vasculitis, HTN
Blood statsis / turbulent flow - immobility, venous compression
Hypercoagulability - genetic, cancer, immobilization, pregnancy
67
Pathology result of PE
V/Q mismatch
No blood to lungs
68
What is it?
PE
69
PE presetnation
Tachypnea, tachycardia, chestpainm dyspnea, hypoxemia
70
Pulmonary HT
sustained elevation of mean pulmonary arterial pressure to more than 25 mm Hg at rest or to more than 30 mm Hg with exercise
71
PAH classification
Pulmonary Arterial Hypertension
PH from left heart disease
PH from lung disease / hypoxemia
PH due to chronic thrombotic/embolic disease
Miscellaneous PH
72
Causes for PAH
Chronic Lung Disease
HF
Thromboemboli
Connective Tissue Disease
Obstructive Sleep Apnea
73
What is it?
Plexiform lesions
PAH
74
Cause for P HTN: Primary
Cause
Age
Presetnation
Progression
Treatment
BMPR2Mutation of BMPR2
20-40
Early: dyspnea, fatigue, angina ;; Late: respiratory distress, cyanosis
Death 5yr
O2, calcium channel blockers, digoxin, diuretics, lung transplant
75
Diffuse Pulmonary Hemorrhage Syndromes
**Goodpasture Syndrome**
**Idiopathic Pulmonary Hemosiderosis**
**Vasculitis Associated hemorrhage**
–Wegener Granulomatosis
–Hypersensitivity angiitis
Lupus erythematosus
76
Causes for DPHS: Goodpasture Syndrome
Cause
Histology
Diagnostic
Presentation
Treatment
Autoimmune a-basement membrane
necrosis, Hemosiderin laden M
IgG
Hemoptysis
Plasmapheresis, immunsuppr
77
DPHS cause: Idiopathic Pulmonary Hemosiderosis
What is it?
Presentationn
Dx from goodpature
Treatment
Intermittent, diffuse alveolar hemorrhage
productive cough, hemoptysis, anemia and weight loss
no anti-BM
Responds to immunsuppression
78
Causes for DPHS: Wegener Granulomatosis
What is it?
Necrotizing vasculitis
79
Pulmonary Edema causes
Cardiogenic
Non-Cardiogenic (ALI, ARDS, DAD),
80
Pulmonary Edema: Cardiogenic
Histology
Presetnation
Heart Failure cells
SOB, DOE, Orthopnea, PND, crackles
81
Pulmomary Edema: Diffuse Alveolar Damage
Histology
Hyaline membrane
Intersitial, intra-alveolar, inflammation, fibrin deposition
82
What is it?
ARDS/ALi
83
Causes for viral pneumonia
Influenza virus A and B
Respiratory syncytial virus
Human parainfluenza virus
84
Immunity in Orthomyxovirus virus
secretory IgA targeting HA in the respiratory tract
85
What distinguishes orthomyxoviruses type A, B, and C
nucleocapsid (NP) and matrix (M)
86
Most common casue of pneumonia and bronchiolitis in infants
Paramyxovirus
87
What is it?
Forming multinucleated giant cells (syncytia)
88
What is it?
Atelectasis
89
Atelectasis types
Resorption (secretions, foreign body, neoplasm)
Compression (fluid, tumor, blood, air)
Contraction - pulmonary fibrosis
90
Light’s Criteria
Sens/Spec
ProteinFluid/ProteinSerum \> 0.5
LDHFluid/LDHSerum \> 0.6
Fluid LDH \> 2/3
Sensitive but not specific
91
Empyema
What is it?
Cause?
Purulent pleural exudate
2nd to pneumonia
92
Non-inflammatory Effusions Pleura
Hydrothorax - pulmonary edema
Hemothora - trauma/vascular rupture
Chylothorax - obstruction/lymph node rupture
93
Pneumothorax
Association
Emphyseam, asthma, tuberculosis, traua, rupture of small peripheral blebs
94
Cysitc fibrosis
Sequale
Bronchiectasis w/ S. aureus and pseudomonas
95
Acute Bronchitis
What is it?
Casue
Another name
Symptoms
Self-limited inflammation of the large\* airways of the lung that is characterized by cough without pneumonia
Viral: Flu A/B
Chest cold
Cough \>5days (indistinguishable from mild URI for first few days)
96
Pneumonia types
Community-Acquired
Hospital-Acquired
Aspiration
Chronic
Necrotizing/Abscess
Immunocompromised
97
Pneumonia causes (general)
Bacteria and Viruses
98
What is it?
Pneumonia
99
Types of community acquired pneumonia
Lobar - lobe
Bronchopneumonia - patchy
100
Stages of Community Acquired Pneumonia
Congestion
Red Hepatization
Gray Hepatization
Resolution
101
Community Acquired Pneumonia
Symptoms
Abrupt onset of high fever, chills, cough, crackles
102
Community Acquired Pneumonia
Complications
Pulmonary abscess
Infected pleural
Bacteremic dissemination
103
Atypical Pneumonia
What is it
Location of pathology
Casues
Clinical presentation
"Atypical"?
ddx from Acute bronchitits
•Acute, febrile respiratory condition with patchy inflammatory changes in the lungs.
Alveolar septa and pulmonary interstitium
Mycoplasma, Influenza, Chlamydia, RSV, Adeno, Rhinovirus
Bad “chest cold” to severe illness with secondary infxn, Fever, headache, muscle aches
Symptoms out of proportion to minimal PE findings: Mild suptum, no symptom of consolidation, mild WBC up, no alveolar exudate
Site of infection
104
Typical vs. Aytpical pneumonia
105
106
Hospital-Acquired Pneumonia
Organisms
G- Pseudomonas, Enterobacterai G+ S. aureus
107
Aspiration Pneumonia
Population
When does it occur
Stroke, intoxication, altered mental status
When unconscious / vomiting
108
Lung Abscess
Causes
Aspiration
Pos-pneumonic )S. aureus/K. pneumoniae
Septic emboli
Obstructive
Trauma
109
Lung Abscess
Presentation
Cough, fever, copious foul-smelling purulent suptum
Clubbing
Radiologic diagnosis
110
Chronic Pneumonia
Location
Type of infection
Organisms
Localized
Granulomatous
M. tuberc ;; Histo, Blasto, Coccidi
111
Location of COPD vs. Asthma
Bronchi vs. Terminal
112
BRONCHODIL: b agonist
examples
mechanism
effect
use for athma / COPD
side effects
albuterol (s) salmeterol (l) formoterol (l)
increase in cAMP -\> vasoconstriction
prevent mediators release from mast, prevents leakage, increase mucous secretion and transport, bronchodilatation
asthma always with ICS / COPD can be without
muscle tremor, tachycardia, hypokalemia, restrlesness, hypoxemia,
113
BRONCHODIL: Methylxanthines
Examples
Mechanis
Side effects
Pharmacokinetis
Combined with
Theophylline
Inhibits PDE increa cAMP, inhibits adenosine binding
"caffeine" increased alertness, reduced fatigue tremor, insomia, anxiety CARDIO increased HR, peripheral resistance METABOLIC diuresis, increased BMR
Liver metabolism (clearance)
ICS
114
BRONCHODIL: anit-cholinergics
Examples
Describe each
Side effects
Atropine, ipratropium (atrovent), Titotropium (spiriva)
**Atropine** - nonselective, tertiary
**Ipratropium** - non seletive quaternary ammonium
**Tiotropium** - quick dissociation from M2, quaternanry
**Ipratropium** : bitter taste, glaucoma **Triotropium** : dry mouth
115
Inhaled Corticosteroids
Examples
First line for what
Inhibition
Side effects
Beclomethasone, Fluticasone, Budesonide
Allergic rhinitis
PLC and nk-kb
Cushinoid
116
Leukotriene Antagonists
Examples
Mechanism
Application
Side effects
Montelukast
Inhibits 5-lipoxygenase
Children, steroid phobia, aspirin-sensitive asthma, no responding to ICS
Hepatic ysfunctin, Churg-Strauss
117
Anti-IgE
Examples
Mechanism
Omalizumab
118
Cromolyn & Nedocromil
Mechanism
Use
Adverse
Stabilize Mast Cells
Prophylaxis
Sore throat, dry mouth
119
WHO Pulmonary HTN classification
Pulmonary Arterial Hypertension (PAH)
Associated with LH
Associated with lung disease
Thromboembolib PH
Miscellaneous
120
Three basic pathophysiological mechanisms involved in pulmonary arterial hypertension (PAH)
Enhanced vascontristion
Partial or complete luminal obstruction due to extensive and complex remodeling of the intimal
Propensity for thrombosis
121
PAH treatment
Prostanoids (e.g. PGI2 analogues)
Endothelin receptor blockers (e.g. Bosentan)
Phosphodiesterase inhibitors (PDE5 blockers such as Sildenafil)
122
What is rhinits
Most common cause of rhininits
Mechanism
Allergic disease of the upper airway characterized by nasal congestion, rhinorrhea (runny nose), postnasal drip, sneezing, and an itchy nose
most common form of rhinitis
IgE-mediated hypersensitivity
123
Symptoms of Allergic Rhinits
Allergic shiners (A)
The “allergic crease” (B)
Dennie-Morgan lines (linear creases underneath the lower eyelids) (C)
Pale nasal mucosa and turbinate hypertrophy (D)
Mouth breathing (E)
Cobblestoning of the oropharynx (F)
124
Diagnossi of allergic rhinitis
skin testing (prick or intradermal) or serum-specific IgE in vitro tests
skin are more sensitive but less specific
125
Lab tests for allergic rhinits
Skin tests
Radoallergosorbent test (measure IgE to allergens)
Total serum IgE
Total blood eosinophil count
Nasal cytology
126
Allergic rhinits
treatment options
antihistamines
decongestants
INC
leukotriente receptor antagonist
127
Allergic rhinits
antihistamines
examples
diphenhydramine 1st gen oral
loratadine 2nd gen oral
azelastine intranasal
not as effective as decongestnat
128
Allergic rhinits
decongestant
effect
mechanism
examples
extended use
Reduce nasal congestion but have no other significant effects on the symptoms of rhinitis
α-adrenergic stimulation vasoconstriction
imidazoline derivatives (oxymetazoline) or catecholamines (phenylephrine)
rebound rhinits -- rhinitis medicamentosa
129
