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66 Cards in this Set
- Front
- Back
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rhinovirus
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most common cause of the common cold
transmitted by hand to eye-nose contact |
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RSV
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most common viral cause of atypical pneumonia and bronchiolitis in children
late fall or winter |
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Parainfluenza
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most common cause of CROUP in infants
inspiratory stridor due to submucosal edema in the trachea Anterior X-ray shows "steeple sign" representing mucosal edema in trachea |
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CMV
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common pneumonia in immunocompromised(bone marrow transplants, AIDS)
Enlarged alveolar macrophages/pneumocytes, contain basophilic intranuclear inclusions surrounded by a halo |
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Influenza virus
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Type A most often involved
Hemagglutinins bind virus to cell receptors in the nasal passages Neuroaminidase dissolves mucus and facilitates release of viral particles Influenza A pneumonia may be complicated by a superimposed bacterial pneumonia(usually staph aureus) |
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Rubeola
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Fever, cough, conjunctivitis, and excessive nasal mucus production
Koplik spots in the mouth precede the onset of rash Warthin-Finkeldey multinucleated giant cells are a characteristic finding |
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ARDS
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infects lower respiratory tract and then spreads systemically to produce severe respiratory infection
1st transmitted to humans through contact with masked palm civets and then from human-to-human contact through respiratory secretions(hospitals, families) Dx with viral detection by PCR or detection of Abs |
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Chlamydia pneumonia
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2nd most common cause of atypical pneumonia
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Chlamydia trachomatis
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newborn pneumonia(passage through birth canal
afebrile, staccato cough(choppy cough), conjunctivitis, wheezing |
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Rickettsia: Coxiella burnetii
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only rickettsia transmitted without a vector
contracted by dairy farmers, veterinarians assoc with birthing process of infected sheep, cattle, and goats, and handling of milk or excrement Atypical pneumonia, myocarditis, granulomatous hepatitis |
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Mycoplasma: M. pneumoniae
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most common cause of atypical pneumonia
common in adolescents and military recruits (closed spaces) insidious onset and with low grade fever complications: bullous myringitis, cold autoimmune hemolytic anemia due to anti-IgM Abs Cold agglutinins in blood |
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Bacteria
Streptococcus pneumoniae |
gram positive lancet shaped diplococcus
most common cause of typical community acquired pneumonia rapid onset, productive cough, signs of consolidation |
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Bacteria
Staphylococcus aureus |
gram positive coccus in clumps
yellow sputum commonly superimposed on influenza pneumonia and measles pneumonia major lung pathogen in CF and iv drug users hemorrhagic pulm edema, abscess formation, and tension pneumatocysts(intrapleural blebs), which may rupture and cause a tension pneumothorax |
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Bacteria
Corynebacterium diptheriae |
gram positive rod
toxin inhibits protein synthesis by ADP ribosylation of elongation factor 2 involved in protein synthesis; toxin also impairs Beta-oxidation of fatty acids in the heart Toxin induced pseudomembranous inflammation produces shaggy gray membranes in the oropharynx and trachea |
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Bacteria
Haemophilus influenzae |
gram negative rod
common cause of sinusitis, otitis media, conjunctivitis(pink eye) inspiratory stridor may be due to acute epiglottitis; swelling of epiglottis produces thumbprint sign on lateral xray of neck most common bacterial cause of acute exacerbation in COPD |
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Bacteria
Moraxella catarrhalis |
gram negative diplococcus
common cause of typical pneumonia, especially in the elderly 2nd most common pathogen causing acute exacerbation of COPD Common cause of chronic bronchitis, sinusitis, otitis media |
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Bacteria
Pseudomonas aeruginosa |
gram negative rod
green sputum(pyocyanin) water loving bacterium most often transmitted by respirators most common cause of nosocomial pneumonia and death due to pneumonia in CF; pneumonia often assoc with infarction due to vessel invasion |
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Bacteria
Klebsiella pneumoniae |
gram negative fat rod surrounded by a mucoid capsule
most common gram negative organism causing lobar pneumonia and typical pneumonia and typical pneumonia in elderly pts in nursing homes common cause of pneumonia in alcoholics; however S. pneumonia is still the most common pneumonia Pneumonia assoc with blood-tinged, thick, mucoid sputum; lobar consolidation and abscess formation are common |
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Legionella pneumophilia
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gram negative rod(requires IF stain or Dieterle silver stain to ID in tissue); antigens detected in urine
Water loving bacteria(water coolers; mists in produce section of grocery stores; outdoor restaurants in summer; rain forests in zoos) Pneumonia assoc with high fever, dry cough, flu-like symp May produce tubulointerstitial disease with destruction of juxtaglomerular apparatus leading to hyporeninemic hypoaldosteronism (type IV renal tubular acidosis: hyponatremia, hyperkalemia, metabolic acidosis) |
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Systemic fungi
Cryptococcus neoforms |
budding in yeast with narrow based buds; surrounded by a thick capsule
Found in Pigeon excreta(buildings, outside office windows, under bridges) Most common opportunistic fungal infection Primary lung disease(40%): granulomatous inflammation with caseation |
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Systemic fungi
Aspergillus fumigatus |
fruiting body and narrow-angled(<45 degrees), branching septate hyphae
Aspergilloma: fungus ball(visible on X-ray) that develops in a pre-existing cavity in the lung(old TB site); cause of massive hemoptysis Allergic bronchopulmonary aspergillosis: type 1 and 3 hypersensitivity reactions; IgE levels increased ; eosinophilia; intense inflammation of airways and mucus plugs in terminal bronchioles; repeated attacks may lead to bronchiectasis and interstitial lung disease Vessel invader with hemorrhagic infarctions and a necrotizing bronchopneumonia |
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Systemic fungi
Mucor species |
Wide angled hyphae(>45 degrees) without septae
clinical setting: diabetes, immunosuppressed pts vessel invader and produces hemorrhagic infarcts in the lung Invades the frontal lobes in pts with DKA(rhinocerebral mucormycosis) |
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Systemic fungi
Coccidioides immitis |
Spherules with endospores in tissues; contracted by INHALING arthrospores in dust while living or passing through arid desert areas in southwestern US("valley fever"); increased after earthquakes(increased dust)
Flu like symptoms and erythema nodosum(painful nodules on lower legs; inflammation of subcutaneous fat) Granulomatous inflammation with caseous necrosis |
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Systemic fungi
Histoplasma capsulatum |
most common systemic fungal infection; endemic in Ohio and central Mississippi River valleys; inhalation of of microconidia in dust contaminated with excreta from bats(increased incidence in cave explorers, spelunkers), starlings or chickens(common in chicken farmers.
Granulomatous inflammation with caseous necrosis yeast forms are present in macrophages stimulates TB lung disease; produces coin lesions, consolidations, miliary spread and cavitation Marked dystrophic calcification of granulomas; most common cause of multiple calcifications in the spleen |
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Systemic fungi
Blastomyces dermatitidis |
yeasts have broad based buds and nuclei; occurs in great lakes area and central and southwestern US
Male dominate disease produces skin and lung disease; skin lesions stimulate squamous cell carcinoma granulomatous inflammation with caseous necrosis |
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Systemic fungi
Pneumocystis jiroveci |
cysts and trophozoites present
cysts attach to type 1 pneumocytes primarily an opportunistic infection occurs when CD4 TH count <200 Most common initial AIDS defining infection Pts develop fever, dyspnea, and severe hypoxemia Diffuse intra-alveolar foamy exudates with cup shaped cysts best visualized with silver or giesma stains CXR: diffuse alveolar and interstitial infiltrates Rx: TMP/SMX given prophylactically when CD4 counts <200 |
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pulmonary vascular resistance
(PVR) |
PVR = (Ppulm artery-PLatrium)/Cardiac Output
R=8nl/pi r^4 n=viscosity of inspired air l = airway length r = airway radius |
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oxygen content of blood
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O2 content = (O2 binding capacity x %saturation) + dissolved O2
nl: 1 g Hb bind 1.34 mL O2 nl HB 15g/dL cyanosis when deoxgenated Hb >5g/dL |
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relation of O2 content with amount of Hemoglobin
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O2 content of arterial blood falls as H falls, BUT O2 saturation and arterial PO2 DOES NOT
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Arterial PO2 and chronic lung disease
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Arterial PO2 falls with chronic lung disease because the physiological shunt decreases O2 oxygen extraction ratio
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Oxygen delivery to tissues
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Oxygen delivery to tissues = cardiac output x oxygen content of blood
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Alveolar Gas Equation
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PAO2 = PIO2-(PACO2/R)
can be approx as PA)2 = 150-PaCO2/0.8 PAO2 - alveolar PO2 PIO2 - PO2 inspired air PACO2 - alveolar PCO2 R - respiratory quotient A-a gradient = PAO2 - PaO2 - 10-15 mmHg |
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Causes of Increased A-a gradient in Hypoxemia
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Shunting, V/Q mismatch, fibrosis(diffusion block)
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Lung Zones and Ventilation
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Lung Zones:
1. APEX of lung: V/Q=3(wasted perfusion) 2. BASE of lung: V/Q=0.6(wasted perfusion) |
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Where are ventilation and perfusion the greatest?
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BASE of the lung
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Exercise and V/Q mismatch
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With exercise(Increased CO), there is a vasodilation of apical capillaries, resulting in a V/Q ratio that approaches 1
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what O2 thriving organism flourish in the apex
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TB
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V/Q approaches 0 = OBSTRUCTION (shunt)
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In a shunt, 100% O2 will not improve PO2
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V/Q approaches infinite - blood flow obstruction(physiological dead space)
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Assuming that <100% dead space, 100% O2 improves PO2
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chronic bronchitis: "Blue Bloater"
pathology Obstructive |
hypertropy of mucus secreting glands in bronchioles, high reid index(COPD, >50%)
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chronic bronchitis: "Blue Bloater"
clinical manifestations obstructive |
productive cough for > 3 months consecutively in > 2 yr period
disease of small airways |
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Obstructive Ling Disease
COPD |
obstruction of air flow results in air trapping in the lungs
Airways close prematurely at high lung volumes Increased RV, Decreased FVC PFTs: decreased FEV1, decreased FEV: lead to decreased FEV1/FEV ratio (hallmark) V/Q mismatch Wheezing, Crackles, Cyanosis |
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Emphysema
Pink Puffer: barrel shaped chest |
Enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls
Increased elastase activity Increased lung compliance because loss of elastic fibers EXHALE through pursed lips to Increase Airway pressure and prevent airway collapse during exhalation Findings: Dyspnea, Decreased breath sounds, tachycardia, Decreased I/E ratio |
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Emphysema: classification
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Centriacinar: caused by smoking
Panacinar: alpha1-antitrypsin deficiency(also liver cirrhosis) Paraseptal emphysema: assoc with bullae, can rupture, spontaneous pneumothorax, often in young otherwise healthy men |
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Asthma
Obstructive |
Bronchial Hypersensitivity causes reversible bronchoconstriction
Smooth muscle hypertrophy andCurschmann's spirals(shed epithelium from mucous plugs) |
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Asthma: trigger and clinical manifestations
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Asthma can be triggered by: viral URIs, allergens, and stress
Findings: cough, wheezing, dyspnea, tachypnea, hypoxemia, Decreased I/E ratio, pulsus paradocus, mucous plugging |
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squamous cell carcinoma
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Squamous Sentral Smoking
Central Hilar Mass arising from bronchus Cavitation, Clearly linked to Smoking PTHrP Keratin Pearls and Intercellular bridges |
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Lung Cancer: complications
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SPHERE
SVC Syndrome Pancoast's Tumor Horner's Syndrome Endocrine(paraneoplastic) Recurrent Laryngeal Symptoms(hoarseness) Effusions(pleural or pericardial) |
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PE: Bronchial Obstruction
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Breath sounds: absent/decreased over affected area
Resonance: decreased Fremitus: decreased Tracheal Deviation: toward side of lesion |
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PE: Pleural Effusion
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Breath Sounds: Decreased over effusion
Resonance: dullness Fremitus: decreased |
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PE: Pneumonia(lobar)
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Breath sounds: May have bronchial breath sounds over lesion
Resonance: dullness Fremitus: increased |
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PE: Pneumothorax
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Breath sounds: decreased
Resonance: HYPERresonance Fremitus: absent Tracheal Deviation: away from side of lesion(tension pneumothorax) |
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Adenocarcinoma
Bronchial |
Peripheral
Develops in site of prior pulmonary inflammation or injury(most common lung cancer in nonsmokers and females) Clara cells, type 2 pneumocytes CXR: multiple densities |
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Adenocarcinoma
Bronchoalveolar |
Peripheral
Not assoc with smoking Clara cells, type 2 pneumocytes CXR: multiple densities |
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Small cell(oat cell) carcinoma
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Central
Undifferentiated: VERY aggressive often assoc with ectopic production of ACTH or ADH Assoc with Lambert Eaton syndrome(autoantibodies against calcium channels) Responsive to chemotx Neoplasm of neuroendocrine Kulchitsky cells: small dark blue cells gross: grey, white masses strong assoc with smoking oncogene L-myc |
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Large cell carcinoma
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Peripheral
Highly anaplastic undifferentiated tumor, poor prognosis and less responsive to chemotx Removed surgically Pleomorphic giant cells with leukocyte fragments in cytoplasm |
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Carcinoid Syndrome
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Secretes Serotonin, can cause carcinoid syndrome(flushing, diarrhea, wheezing, salivation)
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Lung Cancer: Metastases
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Very common
Brain(epilepsy), bone(pathologic fracture), and liver(jaundice, hepatomegaly) |
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Pancoast Tumor
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Carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus, causing Horner's Syndrome
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Horner's Syndrome
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HS: ptosis, miosis, anhidrosis
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Pneumonia: LOBAR
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Organism: pneumococcus
Intra-alveolar exudate: consolidation, may involve the entire lung |
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Pneumonia: Bronchopneumonia
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Organism: S. aureus, H. flu, Klebsiella, S. pyogenes
Acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving more then one lobe |
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Pneumonia: Interstitial (atypical) pneumonia
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Organism: Viruses(RSV, adenovirus), Mycoplasma, Legionella, Chlamydia
Diffuse Patchy inflammation localized to interstitial areas at alveolar walls Distribution involving greater than one lobe |
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Lung Abscess
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localized collection of pus within the parenchyma, usually resulting from bronchial obstruction(e.g. cancer) or aspiration of gastric contents(esp in patients predisposed to loss of consciousness, e.g. alcoholics or epileptics)
Often due to S. aureus or anaerobes. |
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Pleural Effusion: Transudate
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Decreased protein content
Due to CHF, nephrotic syndrome, or hepatic cirrhosis |
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Pleural Effusion: Exudate
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Increased protein content, cloudy. Due to malignancy, pneumonia, collagen vascular disease, trauma.
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