Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
235 Cards in this Set
- Front
- Back
|
What is Marantic endocarditis? |
Non-bacterial thrombotic endocarditis
-vegetations of fibrin, platelets -non-destructive unless secondarily infected -secondary infections common |
|
|
What is the general rule for infections of the three cardiac layers? |
Endocardium-bacterial and fungal infections Myocardium-viral and parasitic Pericardium-viral and bacterial |
|
|
What organisms often cause bacterial endocarditis and by what mechanism briefly? |
Staphylococcus aureus and Streptococcus pyogenes
-infect eroded valves -CT destruction by lytic enzymes -defect collects thrombi -vegetations grow -inflammation -healing by fibrosis, valve deformity |
|
|
Which vegetations are more abundant: rheumatic or bacterial endocarditis? |
Bacterial endocarditis |
|
|
What areas are most often affected by septic emboli from valvular vegetations? |
Brain Kidneys Extremities |
|
|
What do septic emboli from valvular vegetations cause in the affected tissues? |
ischemic infarcts foci infections |
|
|
What is the most characteristic clinical finding of bacterial endocarditis? |
numerous heart murmurs -irregular flow over deformed murmurs |
|
|
Which side of the heart is most commonly affected by Bacterial endocarditis? |
left |
|
|
Cardiac tumors are fairly common
True or False |
False, consistent contraction of heart deters tumor growth
Angiosarcomas and hemangiomas more common |
|
|
Where can vasculitis occur and what are 4 clinical manifestations? |
Any vessel type in any organ
1. arthralgia 2. myalgia 3. malaise 4. fever |
|
|
What are the 2 most common mechanisms of Vasculitis? |
1. immune mediated inflammation 2. direct infection of vascular wall |
|
|
Name the 5 pathologies that result in vasculitis from direct infection |
1. Systemic bacterial (Neisseria) 2. Rickettsial (Rocky mountain spotted fever) 3. Spirochetal (Syphilis) 4. Fungal (aspergillosis) 5. Viral (herpes, zoster, varicella) |
|
|
The mechanism of which three pathologies of Vasculitis is unknown? |
1. Giant cell arteritis (Temporal arteritis) 2. Takayasu arteritis 3. Polyarteritis nodosa |
|
|
What are the six immunologic arteritic diseases? |
1. Wegener granulomatosis 2. Henoch-Schonlein purpura 3. Systemic lupus erythematosus 4. Goodpasture syndrome 5. Kawasaki disease 6. Churg-strauss syndrome |
|
|
What are the three arteritic disease that affect large vessels? |
1. temporal arteritis 2. Takayasu arteritis 3. Syphilitic aortitis |
|
|
What are the two arteritic diseases that affect medium vessels primarily? |
1. PAN 2. Kawasaki |
|
|
What are the two arteritic diseases that affect small sized vessels primarily? |
1. Henoch-Schonlein purpura 2. Wegener Granulomatosis |
|
|
What locations are typically involved in PAN?
Which location is typically spared? |
Involved: renal , visceral vessels
Spared: pulmonary circulation |
|
|
What age group is typically affected with PAN? |
young adults |
|
|
Which clinical feature of PAN often causes death? |
Renal involvement |
|
|
30% of PAN patients display what antigen in their serum? |
hepatitis B |
|
|
PAN causes a slow, but steadily increase in blood pressure.
True or false |
False
Hypertension develops rapidly |
|
|
Name 4 common symptoms of PAN |
-fever -malaise -weight loss -diffuse muscular aches and pain |
|
|
PAN has no association with ANCA (Anti-neutrophil cytoplasmic antibody)
True or false |
True
Anti-neutrophil cytoplasmic antibody are IgG type antibodies against neutrophils seen in some autoimmune diseases |
|
|
Name the etiology and triad of symptoms of Wegener Granulomatosis |
Etiology: unknown
Triad: 1. Acute necrotizing granulomas of respiratory tract 2. Necrotizing vasculitis of small or medium vessels (lungs most prominent) 3. Focal necrotizing glomerulonephritis |
|
|
Wegeners Granulomatosis
Age group: Gender: Clinical features:
|
40 yrs male
epistaxis (nosebleed) strawberry gingivitis |
|
|
Churg Strauss syndrome affects what vessels of what size in often in what location? |
small and medium commonly affects the lungs
(same as Wegener Granulomatosis) |
|
|
What pathologies are Churg Strauss syndrome strongly associated with and what can it lead to? |
Strong association with allergic rhinitis, asthma, and peripheral eosinophilia
Leads to coronary arteritis and myocarditis |
|
|
Which disease is very similar to Wegener Granulomatosis and displays elevated serum p-ANCAs? |
Churg Strauss syndrome |
|
|
Temporal arteritis
Cause? Age group? Location? |
Unknown etiology Elderly people Temporal artery and branches of carotid |
|
|
What are the 4 clinical features of Temporal arteritis? |
-Unilateral Temporal headaches -palpable nodules along artery -Visual impairment -Jaw pain and TMD-like symptoms -focal chronic granulomatous inflammation |
|
|
What are the 2 two serious complications that Temporal arteritis can lead to? |
1. blindness 2. tissue necrosis |
|
|
What is another name for Takayasu arteritis and what is the basis for that name? |
"Pulseless Disease" because the lumen of the aortic arch will be almost occluded |
|
|
What vessels are most often affected by Takayasu arteritis? |
Medium and large arteries Aortic arch and branches frequently involved |
|
|
Takayasu arteritis
Etiology? Age? Gender? |
Suspected to be autoimmune Women 30 yrs |
|
|
Takayasu arteritis
7 Clinical features |
-absent pulse in carotid, radial, and ulnar -painful skin nodules -arthritis -myalgia -fever -night sweats -ocular problems |
|
|
Kawasaki disease is also known as? |
"mucocutaneous lymph node syndrome" |
|
|
Kawasaki disease
Age group? Acute or Chronic? Vessels affected? |
-Infants and children -Acute, self-limiting -necrotizing vasculitis of small-medium vessels -especially coronary arteries |
|
|
Kawasaki disease
3 Clinical features |
-fever -hemorrhagic edema of conjunctiva, lips, oral mucosa -cervical lymphadenopathy -patchy rash and peeling skin |
|
|
Kawasaki disease
Leads to what serious complications? |
Coronary artery aneurysm |
|
|
Henoch-Schonlein purpura
Affects what size of vessels? Age group affected? Etiology? |
-small; capillaries/venules -children -associated with upper respiratory infections, post-streptococcal infections, or certain drugs |
|
|
Henoch-Schonlein purpura (Hypersensitivity vasculitis)
Clinical features? |
-Acute inflammatory response -Hemorrhagic urticaria -extensor surfaces of arms, legs, buttocks |
|
|
What is the common name for Thromboangiitis obliterans? |
Buerger disease |
|
|
What are the features of Buerger disease? |
-Also Thromboangiitis obliterans -Acute inflammation of small to medium sized arteries, veins, and nerves -Painful ischemia -leads to gangrene
|
|
|
What exacerbates the symptoms of Buerger disease? |
Cigarette smoking |
|
|
Which disease is most frequent in Jewish young men and in Japan and India? |
Buerger disease |
|
|
Name the functional vascular disorder discussed in the slides |
Raynauds disease or Primary Raynaud's phenomenon |
|
|
What are the features of Raynaud's disease? |
-Recurrent vasospams of small arteries -pallor and cyanosis -occurs in fingers and toes |
|
|
What is the difference between Raynaud's disease and Raynaud's phenomenon? |
The phenomenon is secondary to another disease -SLE -scleroderma |
|
|
Briefly describe the two venous disorders discussed in the slides? |
1. Varicose veins -dilated and torturous veins due to weak valves -obese people -people who stand all day -includes Hemorrhoids and esophageal varices 2. Venous thrombosis (thrombophlebitis) -deep veins of lower extremities -predisposed by venous circulatory stasis -gives rise to thromboembolism and pulmonary infarction |
|
|
How many lobes are in each lung? |
Right: 3 lobes Left: 2 lobes |
|
|
What distinguishes bronchioles from bronchi? |
bronchioles -no cartilage -no mucus glands |
|
|
What structures are included in an Acinus? |
Terminal bronchiole Respiratory bronchiole Alveolar duct Alveoli |
|
|
Briefly describe the components of the Alveolar wall |
Alveolar wall -Type I pneumocyte: epithelium -Type II pneumocyte: rounded, produces surfactant -perforated by numerous pores of Kohn -macrophages (Dust cells)
|
|
|
Briefly describe the components of the Interstitium |
Interstitium -elastic fibers -collagen bundles -fibroblasts -smooth muscle -mast cells -rare mononuclear cells |
|
|
Name the 4 congenital lung diseases mentioned in the slides.
Which is most common? Which is most significant? |
1. Tracheo-esophageal fistula (most significant) 2. Bronchiogenic cyst 3. Pulmonary hypoplasia or agenesis (most common) 4. Vascular anomalies |
|
|
What are the defining characteristics of a bronchiogenic cyst? |
-lined by epithelium (all cysts) -pseudostratified ciliated columnar -not connected trachea -well differentiated |
|
|
Pulmonary hypoplasia usually affects both lungs symmetrically
True or false |
False |
|
|
What is the one inherited lung disease listed on the slides |
Cystic fibrosis |
|
|
What is the mechanism behind Cystic Fibrosis? |
Mutation of CFTR gene on long arm of chromosome 7 -cl- and Na+ ions not transported -H20 doesn't follow into respiratory lumen to dilute mucous |
|
|
Where does sticky mucous build up in Cystic Fibrosis |
respiratory tract and digestive tract pancreas liver |
|
|
How is Cystic Fibrosis passed genetically? |
-autosomal recessive -varying mutations of chromosome 7 cause varying degree of disease |
|
|
By what age are most children diagnosed with Cystic fibrosis and what indicator commonly leads to diagnosis? |
-2 yrs -babies have salty sweat |
|
|
How common is Cystic fibrosis and among what peoples? |
1:2,500 Common among caucasians of Northern European descent |
|
|
What is the median survival of Cystic Fibrosis patients? |
30 years |
|
|
What heart problem is a complication of Cystic fibrosis? |
cor pulmonale -right side heart failure due to primary pulmonary problem |
|
|
Males can be rendered infertile due to Cystic fibrosis
True or False |
True |
|
|
What is the proper term for a collapsed lung? |
Atelectasis |
|
|
What are the common features and 3 categories of Atelectasis? |
-loss of lung expansion -shunt of inadequately oxygenated blood into pulmonary veins - leads to hypoxia if not treated promptly 1. Resorption atelectasis 2. Compression atelectasis 3. Contraction atelectasis |
|
|
Describe resorption atelectasis |
-distal airway obstruction -mucous -tumor -foreign body -postoperatively -inhaled air goes to tissues, then lung collapses |
|
|
What is compression atelectasis? |
-this category is irreversible -fluid, blood, or air in pleural cavity -smashes alveoli |
|
|
What is a common cause of compression atelectasis? |
Edema from congestive heart failure |
|
|
Describe contraction atelectasis |
-also known as cicatrization atelectasis -fibrosis limits lung expansion -chronic infections |
|
|
What are the defining features of ALI (Acute Lung Injury) |
-Pulmonary damage -Bilateral -Not due to left-sided heart failure! -due to many other cuases |
|
|
What are the 3 clinical features of ALI (Acute Lung Injury) |
1. Acute onset dyspnea 2. Low arterial oxygen 3. Bilateral pulmonary infiltration chest x-rays |
|
|
What are the 2 direct causes of Acute Lung Injury? |
1. Pneumonia 2. Aspiration of gastric contents |
|
|
What are the 2 indirect causes of Acute Lung Injury? |
1. Sepsis 2. Severe trauma from shock |
|
|
What is the syndrome associated with ALI (Acute Lung Injury) |
ARDS (Acute Respiratory Distress Syndrome) |
|
|
Describe ARDS
Definition? Cause? Percent of patients that develop ARDS after ALI? Duration? |
-Clinical syndrome of progressive respiratory insufficiency -caused by diffuse alveolar damage (ALI) -85% of patients get it within 72 hours of ALI -6-12 month duration for those who survive and don't get chronic form
|
|
|
What inflammatory cell and its products are involved in the pathology of ARDS? |
Neutrophil |
|
|
What is the difference between obstructive and restrictive pulmonary diseases? |
Obstructive -airway disease -limitation of airflow at any level
Restrictive -reduced expansion and lung capacity -not to be confused with resorption atelectasis (collapsed lung) |
|
|
Name the four obstructive lung diseases
(COPD is an umbrella terms that includes these) |
1. Emphysema 2. Chronic bronchitis 3. Bronchiectasis 4. Asthma |
|
|
What are the 2 general conditions leading to restrictive lung disease? |
1. chest wall disorder -obesity -neuromuscular disorders (Guillain-Barre syndrome)
2. Interstitial lung diseases -ARDS -Fibrosis -Sarcoidosis |
|
|
Chronic bronchitis
Site: Pathologic changes: Etiology: Clinical features: |
-Bronchus -mucous gland growth, oversecretion -from smoking and pollution -causes productive cough of clear mucous |
|
|
Emphysema
Site: Pathologic changes: Etiology: Clinical features: |
-Acinus (terminal bronchiole and distal) -alveolar wall destruction and air space enlargement -smoking -causes dyspnea (shortness of breath) |
|
|
Bronchiectasis
"dilation or lengthening of bronchi"
2 Sites: 2 Pathologic changes: Etiology: 2 Clinical features: |
-Bronchi and bronchioles -permanent airway dilation, smooth muscle scarring -secondary disease to severe infections -purulent, fetid cough and club fingers |
|
|
Asthma
Site: Pathologic changes: Etiology: Clinical features: |
Site - bronchus
Pathologic changes - smooth muscle proliferation
Etiology - immunologic
Clinical features- episodic wheezing, dyspnea |
|
|
Which is the only obstructive disease that doesn't affect the bronchi? |
Emphysema |
|
|
Which two obstructive diseases are caused by smoking? |
Emphysema Chronic bronchitis |
|
|
How long must a person have persistent productive cough for it to be considered Chronic Bronchitis? |
3 consecutive months 2 consecutive years |
|
|
What disorder sometimes accompanies Chronic Bronchitis? |
COPD |
|
|
What descriptive name is often given to those with severe Chronic Bronchitis? |
"blue bloaters" -due to hypoxemia, cyanosis |
|
|
Which obstructive lung disease is characterized by reversible bronchoconstriction? |
Asthma |
|
|
What is the difference between Atopic and Non-atopic asthma? |
Atopic - IgE and TH2 cells - antigens immediate reactions
Non-atopic - viruses -pollution
Eosinophils involved in both |
|
|
The chief problem of Asthma is getting air out of the lungs
True or false? |
True |
|
|
How long do most asthma attacks last? How can they be treated? |
-1 to several hours -bronchodilators or corticosteriods |
|
|
Emphysema patients are sometimes descriptively called what? |
"pink puffers" |
|
|
Name the 4 subtypes of emphysema
Which is most common? Which has the largest effect clinically? |
1. centriacinar - most common, smoking related 2. panacinar - largest effect (pan=all) 3. distal acinar 4. irregular |
|
|
Emphysema is often confused with what non-related pathology?
Why? |
-Malignant tumor -severe weight loss is common |
|
|
What is the classic presentation of an Emphysema patient? |
-barrel-chested -major expiratory effort -hunched-over |
|
|
In emphysema blood gas values are normal until late in the disease because of prominent dyspnea and adequate oxygenation of the blood until late in the disease, True or False |
True |
|
|
Chronic bronchitis vs. emphysema
Which disease is slowly progressive and which is early onset?
|
emphysema-slowly progressing bronchitis-early onset |
|
|
Chronic bronchitis vs. emphysema
Which disease is involves scant mucus and with has copious, purulent mucus? |
emphysema-scant chronic bronchitis- copious |
|
|
Chronic bronchitis vs. emphysema?
Rhonchi (or noisy chest) |
Chronic bronchitis |
|
|
Chronic bronchitis vs. emphysema
Small heart? |
Emphysema |
|
|
Chronic bronchitis vs. emphysema
55-80 year olds?
45-60? |
55-60 is emphysema
45-60 is chronic bronchitis |
|
|
What are the 4 subtypes of Restrictive (chronic interstitial) Lung Disease? |
1. Fibrosing 2. Granulomatous 3. Eosinophilic 4. Smoking-related |
|
|
Describe the 2 types of Fibrosing Chronic Interstitial Lung Disease |
1. Idiopathic pulmonary fibrosis -patchy, progressive, bilateral fibrosis -60 year old males -hypoxemia, cyanosis
2. Pneumoconiosis -macrophages promote inflammation, create ROSs, and fibrogenic cytokines - Coal dust - Silica - Asbestos |
|
|
What is the progression of diseases caused by coal dust and what impacts that progression? |
1. asymptomatic anthracosis 2. simple coal worker's pneumoconiosis 3. progressive massive fibrosis
progression impacted by exposure level and total dust burden |
|
|
Coal inhalation does not increase risk for lung carcinoma
True or False |
True
smoking causes increased risk in coal miners, not coal |
|
|
Anthracosis produces little decrement in lung function
True or false |
True |
|
|
Progressive massive fibrosis from coal dust does not progress after exposure to coal has ended.
True or false |
False |
|
|
What is the most prevalent chronic occupational disease in the world? |
Silicosis |
|
|
How is silicosis typically detected in asymptomatic workers? |
Routine chest radiographs |
|
|
When do most silicosis patients develop symptoms? |
10 years disease after PFM (progressive massive fibrosis) |
|
|
Describe the nature of silicotic lesions |
cellular nodules of dust-laden macrophages |
|
|
Occupational exposure to asbestos is linked to what six diseases? |
1. asbestosis 2. localized fibrous plaques 3. pleural effusions 4. lung carcinomas 5. mesotheliomas 4. laryngeal carcinomas |
|
|
The increased incidence of what has alerted the public to the hazards of asbestos? |
Asbestos-related cancers in family members of asbestos workers |
|
|
Asbestos workers are at high risk for what cancers? |
lung carcinoma 5x risk mesothelioma 1,000x risk |
|
|
Asbestosis can progress to what serious heart diseases? |
-congestive heart failure -cor pulmonale -death |
|
|
Adding smoking to Asbestosis increases the risk of what cancer specifically?
|
lung carcinoma
not ties to increased mesothelioma |
|
|
What is the name given to asbestos bodies seen in lung biopsies? |
Ferruginous bodies |
|
|
What are the two types of granulomatous Chronic Interstitial Lung diseases? |
1. Sarcoidosis 2. Hypersensitivity pheumonia |
|
|
Sarcoidosis
Etiology? Diagnostic histopathologic feature? Systems affected?
|
-idiopathic -noncaseating granulomas (no necrosis) -Affects: lungs, skin, viscera, eyes
|
|
|
In Sarcoidosis cases, what percentage involve the lungs? |
90% |
|
|
What distinguishes Hypersensitivity Pneumonitis from asthma? |
Granulomas aren't formed in asthma |
|
|
What is similar between Hypersensitivity Pneumonitis and asthma? |
Both immunologically mediated inflammatory lung diseases. |
|
|
What is another name for Hypersensitivity Pneumonitis and why is it called that? |
Allergic Alveolitis because it affects the alveoli |
|
|
What causes Hypersensitivity Pneumonitis? |
Heightened sensitivity to an occupational antigen such as moldy hay |
|
|
What are the 3 lung diseases of vascular origin? |
1. Pulmonary embolism 2. Pulmonary hypertension 3. Diffuse alveolar hemorrhage syndrome |
|
|
Most pulmonary emboli are of what type and originate where? |
Thrombotic Originate in deep veins just above the knee |
|
|
What are some risk factors for pulmonary embolism? |
1. prolonged bed rest 2. leg surgery 3. severe trauma 4. Congestive heart failure 5. oral contraceptives 6. disseminated cancer 7. genetic disposition to hypercoagulability |
|
|
What percentage of pulmonary embolisms are clinically silent? |
60-80% |
|
|
What to the minority of pulmonary embolisms cause and size are they? |
Large saddle emboli cause acute cor pulmonale, shock, death |
|
|
Where do saddle emboli lodge and what side of the heart usually fails as a result? |
-at the bifurcation of main pulmonary artery -right side |
|
|
What percentage of pulmonary embolisms are caused by infection? |
5% |
|
|
What is the histopathologic spectrum of Pneumonia? |
Bacterial pneumonia: fibrinopurulent alveolar exudate
Viral pneumonia: mononuclear interstitial infiltrate
Chronic pneumonia: granulomas |
|
|
In what 2 ways does acute bacterial pneumonia manifest itself? |
1. Bronchopneumonia -patchy inflammation -multilobar
2. Lobar Pneumonia -Contiguous air spaces filled with exudate -all or part of a lobe -evident radiographically |
|
|
Streptococcus pneumoniae is responsible for 90% of what subtype of acute bacterial pneumonias? |
Lobar Pneumonia |
|
|
What organism is the most common cause of community-acquired acute pneumonia? |
strep pneumoniae |
|
|
What are the four morphological stages of acute Lobar Pneumonia |
1. congestion 2. red hepatization (lobe looks like liver tissue) 3. gray hepatization 4. resolution |
|
|
What defines an Atypical Pneumonia? |
1. Respiratory distress out of proportion to the clinical and radiographic finds
2. inflammation confined to interstitium with clear alveoli |
|
|
What are the 5 most common causes of Atypical Pneumonias? |
1. Mycoplasma pneumoniae 2. Flu virus A and B 3. Human etapneumovirus 4. Chlamydophila pneumoniae 5. Coxiella burnetii |
|
|
What group of bacteria cause chronic Pneumonias? |
Mycobacterium -tubercular -nontubercular |
|
|
Tuberculosis is communicable, chronic, and non-granulomatous.
True or false |
False
communicable, chronic, granulomatous |
|
|
Tuberculosis often involves lungs, but can affect any organ in the body.
True or false |
True (supposedly) |
|
|
What type of necrosis is common in Tubercular granulomas? |
caseous |
|
|
What occurs in most persons infected with Mycobacterium tuberculosis? |
asymptomatic focus of pulmonary infection that is self-limited |
|
|
What is generally the only evidence of asymptomatic infection and how long can viable organisms remain dormant in the host? |
-Fibrocalcific nodules at the site of infection -decades |
|
|
Anyone with a tuberculosis infection can communicate the disease through lipid droplets of sputum
True or false |
Dorman infections are not communicable to others |
|
|
What often occurs to activate a dormant tuberculosis infection to the disease state? |
lowered immune system |
|
|
What is the official name for the tuberculin test? |
Mantoux test |
|
|
What is injected into the skin during the Mantoux test? |
PPD (purified protein derivative) |
|
|
What are the requirements for a positive Mantoux test? |
-visible and palpable induration -5mm diameter peaks 48-72 hours later |
|
|
The Mantoux tuberculin test can be used to distinguish between infection and disease.
True or false |
false |
|
|
What 7 things can cause a false positive Mantoux Test? |
1. virus 2. atypical mycobacterium infection 3. Sarcoidosis 4. overwhelming active tuberculosis (ironic) 5. Hodgkin lymphoma 6. immunosuppression 7. malnutrition |
|
|
What percent of newly infected people acquire Primary Tuberculosis? |
5% |
|
|
It it possible to develop primary tuberculosis? |
By definition it shouldn't be, but it is. Elderly persons and immunosuppressed patients by lose sensitivity to the disease and get it again. |
|
|
What is it called when immunocompromised (HIV) patients move beyond Primary TB? |
progressive primary tuberculosis |
|
|
Where are Secondary TB infections typically localized? |
Apex of one or both upper lobes (maybe to get more oxygen) |
|
|
What are the systemic symptoms of Secondary TB? |
1. Malaise 2. Anorexia 3. Weight loss 4. Low grade fever 5. night sweats 6. increasing sputum |
|
|
Hemoptysis (coughing blood) is present in about what percentage of TB cases? |
50% |
|
|
When _________ is present in TB, the patient's sputum contain tubercle bacilli. |
cavitation (caseous necrosis) of the lungs |
|
|
Name 3 serious manifestations of Tuberculosis in organs other than the lungs? |
-TB salpingitis (infertility) -TB meningitis -Pott disease (paraplegia) |
|
|
What is miliary disease? |
TB drains through lymphatics to heart, liver, spleen
Forms foci of yellow consolidations
Looks like millet seeds
|
|
|
What nontuberculous mycobacterial agent most commonly causes disease in HIV patients? |
M. avium |
|
|
What 3 organisms are responsible for fungal lung infections? |
1. Histoplasma capsulatum 2. Coccidioides immitis 3. Blastomyces dermatitidis |
|
|
Which cell is most important for containing fungal lung infections? |
T cell |
|
|
Which lung infecting fungus comes from bat and bird droppings? |
Histoplama capsulatum |
|
|
Where does the fungus C immitis reside in the USA? |
SouthWest, especially San Joaquin Valley, California
|
|
|
Similar to Mycobacterial infections, what three forms can fungal lung infections take? |
1. acute (primary) 2. chronic (granulomatous) 3. disseminated (miliary) |
|
|
How can fungal lung infections be distinguished from tubercular infections? |
Histological identification of the yeast forms |
|
|
Where is Histoplasmosis found in the U.S.? |
Near Ohio Southeast |
|
|
What percent of lung tumors are carcinomas? |
95%
|
|
|
What is the most common type of benign lung tumor? |
3-4 cm "coin shaped" hamartoma |
|
|
Primary and Secondary (metastases from other organs) tumors of the lung are common.
True or False |
True |
|
|
Lung carcinoma is the most common cancer in industrialized countries
True or false |
True |
|
|
At what age is the peak incidence of Lung Carcinoma and in what gender? |
50- yrs old Men and Women |
|
|
What is the 5 -year survival rate for lung cancer and why? |
16%
often caught too late asymptomatic for too long |
|
|
What are the 4 types of Lung Carcinomas? |
1. Squamous cell 2. Adenocarcinoma 3. Small cell carcinoma 4. Large cell carcinoma |
|
|
Which lung carcinomas show strongest association to smoking? |
Squamous and Small cell
remember the "s"s |
|
|
Which type of lung carcinoma is currently most common in the US? |
adenocarcinoma |
|
|
What symptoms eventually lead to the late diagnosis of lung cancers? |
hoarseness chest pain superior vena cava syndrome pleural effusion atelectasis pneumonitis |
|
|
How many lung cancer cases develop clinically overt paraneoplastic syndromes? |
3-10% |
|
|
What 3 hormones secretions are caused by lung carcinoma paraneoplastic syndromes? |
1. Parathyroid hormone-like peptide 2. Adrenocorticotropic 3. Antidiuretic |
|
|
Which type of lung carcinoma is best treated by chemotherapy? |
Small cell because most are metastatic at presentation |
|
|
What is the most important risk factor for lung cancer? |
smoking |
|
|
What are the 2 important primary causes of Pleural lesions (not pulmonary)? |
1. bacterial infections 2. neoplasms (mesothelioma) |
|
|
What is the difference between hemothorax and bloody effusion into the pleural cavity? |
Hemothorax is an infiltration of whole blood -aortic aneurysm -blood clots |
|
|
What is Chylothorax and why does it matter? |
lymphatic fluid containing fat in the pleura
indicates cancerous obstruction of lymph ducts |
|
|
The risk of mesothelioma after exposure to asbestos diminishes over time.
True or False |
False |
|
|
Mechanism of mesothelioma development? |
asbestos fibers generate reactive oxygen species that damage DNA |
|
|
Which is usually cancerous?
Unilateral lymphoid lesion vs. bilateral Moveable lymphoid lesion vs. attached |
unilateral and attached |
|
|
List the 2 reactive lymphoid lesions discussed |
1. Lymphoid hyperplasia 2. Angiolymphoid hyperplasia with eosinophilia |
|
|
What are the 4 oral sites where reactive lymphoid hyperplasia normally occurs? |
1. lingual tonsil 2. floor of mouth 3. anterior tonsillar pillars 4. posterior soft palate |
|
|
How does reactive oral lymphoid hyperplasia normally present? |
-discreet submucosal enlargements -nontender -1 cm or smaller -pink to yellow |
|
|
What differences in lymphoid hyperplasia due to chronic infections vs. acute? |
Chronic -rubbery firm -non tender
Acute -soft -tender
Both moveable and enlarged |
|
|
It is important to quickly remove lymphoid hyperplasia from chronic infections surgically.
True or False |
False |
|
|
Lymphoid hyperplasia is most common in what gender and at what age? |
males 20s-30s |
|
|
Angiolymphoid Hyperplasia with Eosinophilia should be removed
True or False |
True |
|
|
What are the common sites for Angiolymphoid Hyperplasia with Eosinophilia? |
Head and neck 85% -especially periauricular and forehead |
|
|
ALHE vs. Kimura disease
Lymphadenopathy present? |
Kimura |
|
|
ALHE vs. Kimura disease
Peripheral eosinophilia? |
Kimura over 50%
ALHE less than 25% |
|
|
ALHE vs. Kimura disease
Plump endothelial cells and vascular proliferation? |
ALHE |
|
|
Infectious Mononucleosis
Etiology? Site? Mechanism? |
-caused by Epstein-Barr virus (85% of cases) -systemic in lymphoid tissue -Infected B cells proliferate and elicit humoral and cellular response |
|
|
How is Infectious Mononucleosis spread? |
intimate contact -kissing -sharing -straws -toys |
|
|
Infective Mononucleosis is progressive and malignant.
True or False |
False
benign and self-limiting |
|
|
Who is infected by Infectious Mononucleosis and what are the general symptoms? |
-Young adults adolescents
-2 weeks malaise -then sore throat -high fever 3-4 days (104 degrees) -swollen lymph nodes
|
|
|
What are the oral symptoms of Infectious Mononucleosis? |
Petechiae of soft palate -25% of cases Yellow exudate on swollen tonsils NUG |
|
|
How is Infectious Mononucleosis diagnosed? |
Absolute Lymphocytosis -50% more lymphocytes in blood than normal
Downey cells -atypical lymphocytes
Serum antibodies -Mono spot test -Paul Bunnell heterphile |
|
|
Which test for IM involves serum antibodies clumping with Horse red cells? |
Mono Spot test |
|
|
Which test for IM involves serum antibodies clumping with Sheep RBCs? |
Paul-Bunnell heterophile antibody test |
|
|
At what stage should antivirals and corticosteriods be given in Mono? |
No antivirals given!
Corticosteroids only given in extreme cases
Let it resolve in 4-6 weeks. |
|
|
Why are recovering Mono patients cautioned against contact sports? |
Enlarged spleen could rupture |
|
|
What developmental lymphoid lesion is mentioned in the slides? |
Lymphoepithelial Cyst |
|
|
What characteristic defines a Lymphoepithelial Cyst and how does it occur? |
Epithelium lined cavity -all cysts are lined by epithelium by definition
Epithelium trapped in lymph nodes during development |
|
|
What do Lymphoepithelial Cysts look like and where are they found? |
-well defined -yellow -bb sized nodule
-found on floor of mouth |
|
|
Lymphoepithelial Cysts occur mostly in 60 year old males.
True or False |
False
Wide range 20s-70s
Male and Female |
|
|
List the 6. Lymphomas presented in lecture. |
1. Hodgkin 2. Non-hodgkin 3. Burkitt 4. HIV associated 5. Mycosis Fungoides 6. Sezary Syndrome |
|
|
Lymphoma is a broad term for malignant neoplastic proliferations of lymphoid cells.
True of False |
True |
|
|
Hodgkin vs. Non-Hodgkin Lymphoma
Common in the oral cavity? |
Non-Hodgkin |
|
|
How do intraoral NHLs present in the oral cavity? |
-non-tender boggy mass -can have intraosseous lesion (ill-defined on x-ray) -telangiectasia (small dilated vessels near the surface) |
|
|
NHL cells are enlarged, have scant cytoplasm, and irregular nuclei.
T or F |
False
abundant cytoplasm |
|
|
What is the most important prognostic factor for HL and NHL? |
Clinical staging (extent of metastasis) |
|
|
Hodgkin's Lymphoma vs. Non-Hodgkin's Lymphoma
Which is most curable? |
HL |
|
|
What are the most common sites of Hodgkin Lymphoma? |
Cervical and supraclavicular nodes
-rare in mouth -unilateral tonsillar enlargement might be seen |
|
|
Hodgkin Lymphoma
Age range? Symptoms? Histopathology? |
-bimodal age peaks 15-35, 55+
-painless lymphadenopathy -itching -weight loss -fever
-Reed Sternberg cells |
|
|
What must be present to confirm diagnosis of Hodgkin Lymphoma? |
Reed Sternberg cells |
|
|
What type of Hodgkin Lymphoma has the worst prognosis? |
Lymphocyte depleted |
|
|
Which type of Hodgkin Lymphoma is most common? |
Nodular sclerosing |
|
|
What are the 3 types of Reed Sternberg cells? |
1. classic 2. lacunar 3. popcorn |
|
|
Which type of Hodgkin Lymphoma is indicated by the presence of popcorn RS cells? |
Nodular Lymphocyte predominant (best prognosis) |
|
|
What cells are found only in Nodular Sclerosing classical Hodgkin Lymphoma? |
Lacunal cells |
|
|
What cell is uniquely seen in Mixed Cellularity classical Hodgkin Lymphoma? |
eosinophils |
|
|
When treating Hodgkin Lymphoma, spread beyond what landmark calls for Radiation and Chemotherapy? |
Diaphragm |
