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173 Cards in this Set

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Where are aspirations more likely to occur in the bronchus?
Right main bronchus because it's straighter
What does the trachea have that allows it to provide structure and support?
C-rings of catilage
Is catilage present in the bronchioles?
No cartilage but does have an incomplete ring of smooth muscle
What structure contains cartilage and submucosal glands?
The bronchus
What structure contains columnuar and cuboidal epithelium and smooth muscle?
Bronchioles
What structure contains pneumocytes?
Alevolus
What type of pneumocytes does the alveolus contain
Type 1 and Type 2
Where does gas exchange take place in the lung?
Alveolus
What are the cellular components of the alveolus?
Surface alveolar lining cells (Type 1 and Type 2 pneumo)
Capillary endothelial cells
Occassional intersitial cells and alveolar macrophages
What is the most common type of tracheoesphageal fistula?
Blind esophagus with a distal tracheoesophageal fistula
What is a Congenital Foregut cyst?
Detached section of maldeveloped foregut
Where is the congenital foregut cyst located?
At the mediastinal and hilar location
Is a congenital foregut cyst connected to the airways?
No
What is a congenital foregut cyst usually lined with?
Respiratory epithelium
How does a congenital foregut cyst typically present?
As a mass or incidental finding--possibly in adulthood
What is a congenital cystic adenomatoid malformation (CPAM)?
Hamartomatous lesion--abnormal bronchiolar structure
Is a Bronchopulmonary sequestration connected to the airway?
No
Where does the blood supply come from in a bronchopulmonary sequestration?
Systemic arteries
What are the two types of bronchopulmonary sequestrations?
Extralobar and Intralobar
What is extralobar?
Found in thorax or mediastinum external to the lung--usually diagnosed as mass lesions
What is intralobar?
Within the lung and associated with recurrent local infection and or bronchiectasis--Most likely an acquired lesion
What side is bronchopulmonay sequestration usually seen on?
The left side
Which type of bronchopulmonary sequestration do we see later in childhood or adulthood?
Intralobar
What is atelectasis?
A collapsed lung
What are the types of atelectasis?
Acquired collapse (adult) or incomplete expansion (neonatal)
What are the 3 type of acquired collapse in the adult?
Resorption
Compression
Contraction
What is a resportion collapse usually caused by?
Airway obstruction--mucus, foreign body, or tumor
Which way is the mediastinal shift in a resporption collapse?
Mediastinal shift towards
What is a compressions collapse usually caused by?
Secondary to external pressure--usually in the pleural cavity or elevated diaphragm
Which was is the mediastinal shift in a compression collapse ?
Mediastinal shift away
What is a contraction collapse usually caused by?
Fibrosis--irreversible and bilateral
What type of collapse is a tension pneumothorax?
Compression atelectasis--usually due to trauma
What are the two types of pulmonary edema?
Hemodynamic (most common) and microvascular (alveolar) injury
What is hemodynamic pulmonary edema usually caused by?
Increased hydrostatic pressure due to left sided heart failure
What are heart failure cells?
Marcophages with iron in them
What is microvascular injury pulmonary edema usually caused from?
Fluid leaking into alveolar space--infection, toxin, etc.
Which type of pulmonary edeam is more likely to lead to ARDS?
Microvascular injury
What is the hydrostatic and oncotic pressures in pulmonary edema?
Increased and decreased respectively
What is the vasuclar permeability in pulmonary edema?
Increased
What is coal worker's pneumoconiosis also referred to?
"Black lung"
What is Silicosis?
Slowly progressive--Silica ingested by macrophages and kills; inflammatory response with release of TNF
What is the most prevalent chronic occupational disease in the world?
Silicosis
Who is affected by silicosis?
Sandblasters and miners
If a fibrotic nodule is found in the lung, what should you do?
Look under light microscopy--silica particles light up
What is asbestos related disease?
Fibrotic lung disease that begins in the lower lobe
What is the typical finding in asbestos related disease?
Pleural plaque
What does a biopsy of an asbestos exposed lung typically reveal?
Amphibole fibers--accumulation of iron
What do you need to see to be able to diagnose asbestos related disease?
Asbestos (iron) bodies--looks like a baton
What is Sarcoidosis?
Systemic disease--mostly pulmonary--of unknown origin characterized by the formation of numerous non-caseating granulomas
How should sarcoidosis be diagnosed?
By exclusion--rule out everything that can cause granulomas
What is a common finding in sarcoidosis?
Bilateral pulmonary lymphadnopathy
Who is mostly affected by sarcoidosis?
Women
What is the CD4 and IL-2 count in sarcoidosis?
Increased CD4 and Increased IL-2
What organs are affected in sarcoidosis?
Lung, lymph nodes, spleen, liver, bone marrow, skin, eyes, salivary glands, muscle
What is a better prognosis for sarcoidosis?
Hilar lymph node involvement only--much better than lung and lymph node involvement
What bodies are characteristic of sarcoidosis?
"Asteroid and Schaumann body"
What is hypersensitivity pneumonitis?
Hypersensitivity reaction to offending agent--OCCURS AT THE ALVEOLAR LEVEL
Why is it critical to take a good history on a patient with hypersensitivity pneumonitis?
Because removal of an envirnomental agent can spare serious fibroitc lung disease
What type of granulomas are seen in hypersensitivity pneumonitis?
Noncaseating granulomas in distal lung
What is desquamative interstitial pneumonia (DIP)?
Large collections of macrophages in alveoli--minimal fibrosis
Who is more affected by DIP?
Males greater than 50
What is DIP usually caused by?
Smoking
Is DIP treatable?
Yes--steroids and cessation of smoking
What is Histiocytosis?
Proliferation of dendritic cells in response to smoking
What type of cell is histocytosis full of?
Eosinophils
What is pathognomonic for histiocytosis?
Birbeck granule
What is RBILD?
Pigmented macrophages in bronchioles--common in smokers
What is Pulmonary Alveolar Proteinosis?
Accumulation of acellular surfactant in the intra-alveolar and bronchiolar spaces
Who is usually affected by PAP?
Middle aged (20-50)
What is the treatment for PAP?
Pulmonary lavage
What is the most common type of PAP?
Acquired--idiopathic--variable course
What is a pulmonary embolism?
A thrombus that most often originates in the lower leg that becomes mobile
What is a pulmonary embolus most often a cause of?
Sudden death
What increases the risk of a pulmonary embolus?
Sitting for a long time
Hypercoaguable states
BCP
What are other types of emboli?
Fat
Air
Nitrogen
Tumor
Amniotic Fluid
What is a fat embolus most often a result of?
Trauma
What is pulmonary hypertension?
Increased pressure in a low pressure system--can be primary or secondary
What causes primary pulmonary hypertension?
Idiopathic--94% of the time
(6% familial)
What is the mutation in primary pulmonary hypertension?
BMPR2--normally codes for inhibition of smooth muscle
Is there a mutation involved with secondary pulmonary hypertension?
No--caused by a normal reaction of pulmonary arteries to increased pressure
What is Good Pasture Syndrome?
Autoimmune--antiboides to basement membrane
What type of symptoms do patients with Goodpasture's have?
Pulmonary and renal symptoms--Hemoptosis and Hematuria
What is the most common cause of death in Goodpasture's patients?
Renal failure
What 3 things need to be present for a diagnosis of Wegener granulomatosis?
Granulomas of lung arteries
Inflammation of URT
Glomerulonephritis
Who is typically affected by Goodpasture's syndrome?
Young patients--Males more than females
Who is typically affected by Wegener's?
Males in the 5th decade
What are the two types of bacterial pneumonia?
Bronchopneumonia and lobar pneumonia
What is the predominate type of bacterial pneumonia?
Bronchopneumonia
What part of the lung does Bronchopneumonia involve? Lobar pneumonia?
Broncho--involves whole lung bilaterally

Lobar--only involves one lobe
What is the typical cause of lobar pneumonia?
Strep pneumo
What is the most important thing to determine first in bacterial pneumonia?
What is the organism
What are the stages of pneumococcal lobar pneumonia?
Congestion--hyperemia
Red hepatization
Gray hepatization
Fibrosis
What is a pulmonary abcess?
A collection of neutrophils
What is the most common cause of a pulmonary abcess?
Staph aureus and many gram negatives
What is the #1 sequelae of pulmonary abcess?
Aspiration
What is seen in TB primary infection?
Gohn complex--located at the hilum of the lung
What is a Gohn complex called once it is healed?
A Ranke complex
Where does TB go in a reactivation or secondary TB?
Apical because of the high O2 content
What is almost always present in secondary TB?
Granulomas
What is miliary TB?
Occurs when tubercle erodes into a vessel
Where is miliary TB classically seen?
In the kidney and the lung
In what population may TB seen without granuloma formation?
HIV--M. avium common causative organism
What chronic pneumonia presents with a coin like lesion and is seen in the Ohio River Valley?
Histoplasma
Where is coccidiodes immitus often seen?
Southwest US
Where is blastomycosis typically seen?
Central southeast
How does blastomycosis look histologically?
Broad budding yeasts
Who is at risk for contracting PCP, CMV, Aspergillus and Candida?
HIV and immunocompromised patients
How does aspergillus typically appear histologically?
Fungal balls
What type of tumors occur very commonly in the lung?
Mestatic tumors
What is the most common cause of death?
Primary lung tumors
What is the leading cause of cancer deaths in men and women?
Lung cancer
What is the second most common cancer in both genders in the US?
Lung cancer
What are the risk factors for lung cancer?
SMOKING--accounts for up to 90% of all lung cancer deaths
Environmental
Genetics
What are the signs and symptoms of lung cancer?
Pain
Hemoptysis
Weight loss
Underlying chronic lung disease symptoms
Where do most lung cancers develop?
Centrally
What is the most common lung cancer with a high correlation to smoking?
Squamous Cell Carcinoma
Where is SCC of the lung located?
Central, endobronchial growth
What are the precursor lesion to SCC of the lung?
Metaplasia
Dysplasia
CIS
What is frequently seen in SCC of the lung?
Keratinization--Kertain pearls
What paraneoplastic effect does SCC of the lung have?
Hypercalcemia
What type of lung cancer has blue cells all clumped together on a histological slide?
Small cell carcinoma of the lung
What type of carcinoma has keratin pearls?
Squamous cell carcinoma of the lung
What type of lung cancer involves glandular tissue?
Adenocarcinoma
What type of lung cancer involves "a complete mess?"
Large cell carcinoma
What is the most common lung cancer in women and non-smokers?
Adenocarcinoma
Where is adenocarcinoma of the lung located?
Peripherally
What is a common product of Adenocarcinoma?
Mucin
What can predispose you to a risk of developing Adenocarcinoma of the lung?
Scar formation--"Scar Carcinoma"
What is a subtype of adenocarcinoma that can be confused with other pulmonary diseases?
Bronchioalveolar Carcinoma
Where is brochioalveolar carcinoma usually found in the lung?
Peripheal--may be multifocal/lobar and diffuse
Where do bronchioalveolar carcinomas like to grow?
Along the alveolar septa
Where are most smoking related tumors located?
Centrally
How does large cell carcinoma appear histologically?
Undifferentiated--a big mess
What percentage of large cell carcinomas are neuroendocrine?
A small percentage
What is small cell carcinoma most likely a cause of?
SMOKING!!!! (99% are smokers)
What is the first step of management of small cell carcinoma of the lung?
Chemotherapy--very aggressive--poor prognosis--assume metastisis
What origin is small cell carcinoma of the lung?
Neuroendocrine origin
Do small cell carcinomas have paraneoplastic effects?
Yes
What mutations are common in small cell carcinoma?
p53, RB, bcl-2
Where do small cell carcinomas frequently arise?
Just under the epithelium--need a full thickness biopsy
What is a T1 stage?
<3 cms
No pleura/main stem
What is a T2?
>3 cms or main stem
What is a T3?
Local extension
What is a T4?
Regional extension, malignant pleural effusion
What is N1?
Ipsilateral hilar/peribronchial node involvment
What is N2?
Ipsilateral mediastinal/subcarinal
What is N3?
Contralateral
What is M1?
Distant metastisis
What is stage 1?
T1 or T2
No nodal involvement
No metastisis
What is stage 2?
T1, 2, or 3
N0, 1
No metastisis
What is stage 3?
T1, 2, or 3
N2
No metastisis

OR

Any T
N3
No metastisis

OR

T4
Any nodes
No metastisis
What is stage 4?
Any T
Any nodes
Distant metastisis
What type of lung cancer has the worst prognosis?
Small cell carcinoma--very small amount make it 2 years
What is type of cancer has the best 5 year survival rate?
Non small cell carcinoma, Stage 1 (47%)
What are the types of non small cell carcinoma?
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Where are common site of metastisis of lung cancer?
Regional nodes
Adrenal glands
Liver
Brain
Bone
Where does the lung receive metastisis from?
Breast
GI
Sarcomas
Melanoma
What are the most common type of pleural neoplasms?
Metastatic--especially lung and breast
What is an example of a pleural neoplasm?
Malignant Mesothelioma
What is N2?
Ipsilateral mediastinal/subcarinal
What is N3?
Contralateral
What is M1?
Distant metastisis
What is stage 1?
T1 or T2
No nodal involvement
No metastisis
What is stage 2?
T1, 2, or 3
N0, 1
No metastisis
What is stage 3?
T1, 2, or 3
N2
No metastisis

OR

Any T
N3
No metastisis

OR

T4
Any nodes
No metastisis
What is stage 4?
Any T
Any nodes
Distant metastisis
What type of lung cancer has the worst prognosis?
Small cell carcinoma--very small amount make it 2 years
What is type of cancer has the best 5 year survival rate?
Non small cell carcinoma, Stage 1 (47%)
What are the types of non small cell carcinoma?
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Where are common site of metastisis of lung cancer?
Regional nodes
Adrenal glands
Liver
Brain
Bone
Where does the lung receive metastisis from?
Breast
GI
Sarcomas
Melanoma
What are the most common type of pleural neoplasms?
Metastatic--especially lung and breast
What is an example of a pleural neoplasm?
Malignant Mesothelioma