Week 6

Question 1

Atelectasis

Answer 1

inadequate expansion of airspaces: aspiration, pneumothorax, pleural fibrosis

Question 2

Acute Respiratory Distress Syndrome (ARDS)

Answer 2

progression of acute injury and damage from activated neutrophils

Question 3

COPD congestive obstructive pulmonary disease:

Answer 3

emphysema, asthma, bronchietasis-very common
• Associated with emphysema, chronic bronchitis, asthma
• Main cause is cigarette smoke

Question 4

Emphysema

Answer 4

destruction of alveolar walls and permanent enlargement of airspaces: smoking, alpha-1 antitrypsin deficiency (imbalance of proteases and antiproteases), air pollution
-barrel chest with hyperinflation

Question 5

Chronic bronchitis

Answer 5

persistent cough > 3 months in 2 consecutive years: smoking, air pollution. Hypersecretion of mucus by airways: infection often present

Question 6

Bronchiectasis

Answer 6

obstruction of bronchi and persistent necrotizing infections: destruction of elastin and muscles in bronchial walls-congenital expression often caused by cystic fibrosis

Question 7

Asthma

Answer 7

reactive airway disease and narrowing of airways-hyperreactivity: hyperinflated lungs, thick mucus plugs in airways, smooth muscle hypertrophy
• Types:
Atopic- childhood onset often with allergic rhinitis
Non-atopic- non-immune, occupational exposures

Question 8

Fibrosing lung diseases

Answer 8

e.g., associated with collagen vascular diseases such as rheumatoid arthritis-restrictive lung disease: stiff lung and hard to expand lungs

Question 9

Occupational lung diseases

Answer 9

restrictive, e.g., mineral dust-induced, silicosis, asbestosis [mesothelioma]

Question 10

Sarcoidosis

Answer 10

restrictive disease-abnormal connective tissue and reduced elastic properties; multi-organ involvement

Question 11

Pulmonary embolus

Answer 11

• Can cause sudden death if in pulmonary artery
• Origin from deep veins in legs
• Cause: prolonged bed rest, surgery, congestive heart failure

Question 12

Pulmonary hypertension

Answer 12

• Causes: heart disease, recurrent thromboemboli

* Cor pulmonale- right ventricular failure

Question 13

What are the 3 types of lung diseases?

Answer 13

1. Restrictive: caused by fibrosis or chest wall abnormalities; gas exchange impaired; difficulty inhaling and expanding lungs
2. Vascular: gas exchange impaired by obstruction or hemorrhage; may be abrupt or insidious
3. Obstruction: blocked airways; gas exchange through septal walls not impaired; unable to exhale

Question 14

Tuberculosis

Answer 14

• caused by mycobacterium tuberculosis
  1. Usually lungs but can affect other organs
  2. Flourishes in crowded, impoverished areas
  3. Non-contagious during long periods of dormancy
  4. Problems with multidrug antibiotic resistance
  5. Forms necrotizing granulomas

Question 15

Fungal infections-

Answer 15

histoplasmosis

Question 16

Pneumonia in immunocompromised (e.g., AIDS)

Answer 16

⎫ Can be caused by micro-organisms including from normal flora
⎫ CMV (cytomegalo virus-common infection) causes ‘owl’s eye’ histology

Question 17

Lung tumors-

Answer 17

leading cause of cancer deaths in the world in men and women

1. 95% primary lung cancers are carcinomas (adeno and squamous cell [contains keratin] types most common)
2. Smokers 10-55X more likely to develop than general population

Question 18

2 “relievers” of asthma?

Answer 18

albuterol is the only true reliever

salmeterol

Question 19

Inhaled corticosteroid

Answer 19

fluticasone, nose bleeds, thrush, interfere with growth

Question 20

Theophylline

Answer 20

a methylxanthine, increase CAMP, phosphodiesterase inhibitor, combined with steroids to reduce the amount of steroid needed

Question 21

ipratropium

Answer 21

reverses contraction of smooth muscle from vagal activity-usually backup for beta 2 agonists-sometimes combine antimuscrinics with beta 2 agonists, dry mouth

Question 22

montelukast

Answer 22

leukotriene modifier
prophylaxis or chronic treatment for pt who have had trouble with inhaled treatments
aspirin induced asthma
block leukotriene binding to receptor

Question 23

cromolyn

Answer 23

mast cell stabilizer
inhibits the release of histamine
prophylactic (before exercise)

Question 24

omalizumab

Answer 24

inhibits IgE binding to mast cells-very expensive, only for severe non-responsive asthma

Question 25

COPD (Congestive Obstructive Pulmonary Disease) 1. Causes: 2. Treatment:

Answer 25

* Long smoking hx, or exposure to environmental irritants * Airflow limitations-due to progressive, irreversible airway remodeling * Not fully reversible in contrast to asthma which can be at least partially reversible * Longer acting bronchodilators such as tiotropium bromide (Spireva) * Longer acting beta 2 agonists such as salmeterol * Theophylline with glucocorticoids (glucocorticoids alone not very effective) * Typically responses not as good as with asthma

Question 26

Oseltamivir (Tamiflu)-

Answer 26

prevents separation of virus particle from cell receptors, stopping viral spread—earlier treatment essential (can decrease the duration of flu 1-2 days) -works against type A and B flus

Question 27

Antismoking medication

Answer 27

1. Nicotine replacement—gum or patch | 2. Bupropion (not buproprion) –it is an antidepressant (smoking cessation name is Zyban)

Question 28

Chronic renal disease

Answer 28

Main cause is hypertension -aterionephrosclerosis caused by hypertension or diabetes -hyaline thickening of arterioles • Diabetes • Chronic glomerulonephritis—can be acute or chronic

Question 29

Renal diseases

Answer 29

``` Single or fused kidney Renal dysplasia Adult polycystic kidneys –genetic • Renal insufficiency • Linked to intracranial aneurysm • Other organs also have cysts • Enlarged kidneys ```

Question 30

Urinary obstruction

Answer 30

* more than 3 weeks causes permanent damage * Get dilated ureter and hydronephrosis * If distal to bladder can get dilated bladder with a thickening of the bladder wall

Question 31

Hydronephrosis

Answer 31

``` unable to concentrate the urine Identify symptoms: • Anuria • Polyuria • Bladder distention • Sometimes asymptomatic ```

Question 32

Signs of kidney stones

Answer 32

* Renal colic * Hematuria * Pyelonephritis * Sometimes asymptomatic

Question 33

What are the 4 types of kidney stones?

Answer 33

calcium/calcium oxalate struvite uric acid cystine

Question 34

Pyelonephritis (10-20% kidney failure) 1. Define 2. Cause 3. Consequences 4. Can have acute or chronic (more scarring) types

Answer 34

* Retrograde spread from cystitis * Common with urinary obstruction, stenosis * Diabetes and immunocompromised (diabetes is the most common cause) * Flank pain * Fever * 10-20% chronic renal failure * Kidney scarring

Question 35

Renal cell carcinomas

Answer 35

80-90% of renal malignancies—most frequent Often asymptomatic (and not discovered until large) Most likely metastasizes to lungs or bone, sometimes to regional lymph nodes

Question 36

Wilms tumor (nephroblastoma)

Answer 36

1. Most common in first 3 years of life | 2. Most common congenital renal tumor

Question 37

Shistosomoiasis

Answer 37

- infection from snails - leading cause of squamous cell carcinoma in bladder - primarily from middle east - shitosomoiasis eggs deposited in bladder