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101 Cards in this Set

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COPD characteristics
obstruction of air flow resulting in air trapping in lungs. hallmark of FEV1/FVC < 80%
Characteristics of chronic bronchitis COPD
hypertrophy of mucus-secreting glands in bronchioles (Reid index > 50%). Productive cough for >3 consecutive months in >/= 2 years. disease of small airways
Emphysema characteristics
enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls. increase in elastase activity and increased compliance
causes of emphysema
smoking, alpha-1-antitrypsin deficiency
findings in chronic bronchitis
wheezing, crackles, cyanosis
findings in emphysema
dyspnea, decreased breath sounds, tachycardia, decreased I/E ratio
where is the damage in emphysema caused by smoking?
centriacinar
where is the damage in emphysema caused by a-1-antitrypsin deficiency
panacinar
what are the associations with paraseptal emphysema
bullae --> can rupture --> spontaneous pneumothorax; often in young, healthy males
characteristics of asthma
bronchial hyperresponsiveness causes reversible bronchoconstriction. smooth muscle hypertrophy, curschmann's spirals
findings in asthma
cough, wheezing, dyspnea, tachypnea, hypoxemia, decreased I/E ratio, pulsus paradoxus, mucus plugging
Bronchiectasis characteristics/findings
chronic necrotizing infection of bronchi --> permanently dilated airways, purulent sputum, recurrent infections, hemoptysis
bronchiectasis is associated with what conditions?
bronchial obstruction, CF, poor ciliary motility, Kartagener's syndrome
what infection does bronchiectasis predispose to?
aspergillosis
What is Kartagener's syndrome
Triad: situs inversus, chronic sinusitis, bronchiectasis; AR; defective dynein in ciliated epithelium (respiratory tract,eustachian tube, middle ear, fallopian tube, sperm)
restrictive lung disease general characteristics
decreased FVC and TLC. PFTs are normal (FEV1/FVC > 80%)
What are the two main categories of restrictive lung diseases?
Poor breathing mechanics (extrapulmonary, peripheral hypoventilation) and interstitial lung diseases
Causes of RLDs due to poor breathing mechanics
poor muscular effort (polio, myasthenia gravis, Duchenne MD), poor structural apparatus (scoliosis, morbid obesity)
causes of interstitial lung diseases (x9)
ARDS, Neonatal RDS, Pneumoconioses, Sarcoidosis, Idiopathic pulmonary fibrosis, Goodpasture's syndrome, Wegener's granulomatosis, Eosinophilic granuloma (histiocytosis X), Drug toxicity
causes of pneumoconioses?
Anthracosis from inhalation of carbon dust, Coal worker's pneumoconiosis, Progressive massive fibrosis, Silicosis, Asbestosis
black teenager has noncaseating granulomas, involving multiple organ systems. patient has bilateral hilar lymphadenopathy, interstitial lung disease with diffuse reticular densities. what is the diagnosis?
sarcoidosis
what are the lab abnormalities in sarcoidosis?
hypercalcemia and hypercalciuria, hypergammaglobulinemia, increased activity of serum ACE
immunologic phenomena in sarcoidosis?
reduced sensitivity to skin test antigens (characteristic negative PPD), and polyclonal hyperglobulinemia
hemorrhagic pneumonitis and glomerulonephritis caused by antibodies against glomerular basement membranes
goodpasture's syndrome
characteristics of asbestosis
diffuse interstitial fibrosis, mainly of lower lobes. ferruginous bodies (prussian blue stain), dense hyalinized fibrocacific plaques of the parietal pleura.
To what cancers does asbestosis predispose? Which has an additive effect with smoking?
bronchogenic carcinoma (smoking is additive) and malignant mesothelioma
silicosis often seen in what professions?
miners, glass manufacturers, and stone cutters
pathogenesis of silicosis?
alveolar macrophages ingest silica dust. damage to macrophages initiates inflammatory response mediated by lysosomal enzymes.
a1-antitrypsin deficiency genetics?
variants in proteinase inhibitor (pi) on chromosome 14
in homozygous state (piZZ), associated with a1-antitrypsin deficiency, panacinar emphysema and hepatic cirrhosis
ARDS findings
produced by diffuse alveolar damage with increased capillary permeability and leakage of protein-rich fluid into alveoli. Marked by formation of intra-alveolar hyaline membrane
predisposing factors to neonatal RDS
prematurity, maternal diabetes, birth by caesarean section
localized proliferation of alveolar histiocytes. tennis-racket-like inclusion bodies on EM
eosinophilic granuloma (associated with Letterer-Siwe, Hand-Schuller-Christian and histiocytosis X)
common causes of secondary pulmonary hypertension
COPD (most common), increased pulmonary blood flow, increased resistance within the pulmonary circulation (emboli, hypoxic vasoconstriction) increased blood viscosity (polycythemia)
pulmonary hypertension can lead to what
RV hypertrophy, cor pulmonale
symptoms of bacterial pneumonia
chills, fever, productive cough, blood-tinged sputum, pleuritic pain, hypoxia with dyspnea, sometimes cyanosis. Also neutrophilic leukocytosis with an increase in band neutrophils (left shift)
Lobar pneumonia
Strep pneumoniae, characterized by intra-alveolar exudate, may involve entire lobe
patchy distribution of one or more lobes, with inflammatory infiltrate extending from bronchioles into adjacent alveoli
bronchopneumonia
causes of interstitial pneumonia
mycoplasma pneumoniae or viruses, Rickettsial pneumonias (Q fever), Ornithosis
Mycoplasma pneumonia
inflammatory condition confined to interstitium, no exudate, intraalveolar hyaline membranes. associated with nonspecific cold agglutinins reacitve to red cells
methods of diagnosing mycoplasma pneumonia
sputum cultures and complement fixation
giant cell pneumonia cause
measles virus
most common viral pneumonia
influenza viruses
atypical pneumonia in a person who works with cattle or sheep or drinks unpasteurized milk
rickettsial pneumonia (Coxiella burnetii)
atypical pneumonia from inhalation of dried bird shit
Chlamydia psittacosis
most common pneumonia in AIDS patients
pneumocystis jiroveci (PCP)
pneumonia caused by gram negative infections....which are most common bugs and what is the major virulence factor?
Klebsiella, Pseudomonas aeruginosa, E. coli; endotoxins are most important virulence factor
a localized area of suppuration within the parenchyma, usually resulting from bronchial obstruction or from aspiration of gastric contents
lung abscess
what organisms can cause lung abscesses?
Staph, strep pyogenes, Pseudomonas, Klebsiella or Proteus (often in combination with anaerobes)
how do lung abscesses present?
fever, foul-smelling purulent sputum, and x-ray evidence of a fluid-filled cavity
four stages of lobar pneumonia
congestion, red hepatization, gray hepatization, resolution
organisms causing bronchopneumonia
staphylococcus aureus, H. influenzae, Klebsiella pneumoniae, Strep. pyogenes
Strep. pneumoniae patients
most common in elderly or debilitated patients, malnourished or with cardiopulmonary disease
post-viral bacterial pneumonia in IV drug user
staph aureus
complication of measles or influenza
strep. pyogenes
bacterial pneumonia in infants and children. may also have epiglottitis and meningitis
H. influenzae
PE shows localized absence of breath sounds, decreased resonance and fremitus and tracheal deviation to the Right
bronchial obstruction (Right sided)
PE shows localized decrease in breath sounds, dullness to percussion, decreased fremitus
pleural effusion
PE shows bronchial breath sounds, dullness to percussion, increased fremitus
lobar pneumonia
PE shows decreased breath sounds, hyperresonance, absent fremitus and tracheal deviation to right
pneumothorax (left sided)
primary tuberculosis findings
Ghon complex in central and lower lobes with hilar lymph node involvement. granulomatous inflammation with central caseous necrosis and langerhans giant cells
pathologic changes in secondary tuberculosis
localized lesions in apical segments of upper lobes and hilar lymph node involvement. Also, cavitary lesions from expulsion of caseous necrotic tissue
symptoms of secondary Tb
hemoptysis, pleural effusion, generalized wasting (also fever and progressive disability)
spread of Tb is called what? Where does it go?
miliary tuberculosis may cause meningitis, Pott diseas of the spine, paravertebral abscess or psoas abscess
cause of acute epiglottitis
H. influenzae (inflammation of epiglottis)
harsh cough followed by inspiratory stridor
Croup, inflammation fo the larynx, trachea and epiglottis due to viral infection
immigrant from SE asia or East Africa, get EBV, predisposes to what tumor of Upper respiratory tract
nasopharyngeal carcinoma
most frequently occurring malignant nasal tumor
squamous cell carcinoma
what is a singer's nodule?
benign laryngeal polyp due to excessive use of voice and associated with heavy cigarette smoking.
where do singer's nodules occur?
localized to true vocal cords
what causes laryngeal papillomas?
HPV, may progress to malignancy in adults
most common malignant tumor of larynx?
Squamous cell carcinoma
man over 40 who is chronic alcoholic and has been smoking since his twenties presents with persistent hoarseness
squamous cell carcinoma of larynx
nocardia characteristics
gram-positive, aerobic, filamentous, weakly acid-fast bacteria that may disseminate to brain and meninges. closely associated with actinomyces
Histoplasmosis characteristics
clinically similar to Tb, results in multiple pulmonary lesions with late calcification, may disseminate. see infiltrates of macrophages filled with fungal yeast forms
coccidiomycosis characteristics
fungal spherules containing endospores found within granulomas
What are the centrally appearing cancers of the lung?
Squamous cell and Small Cell (oat cell) carcinoma
What are the peripherally appearing cancers of the lung?
Adenocarcinoma (bronchial and bronchioloalveolar), and Large cell carcinoma
What lung cancers are directly related to smoking?
squamous cell carcinoma
What are the complications of bronchogenic carcinoma?
SPHERE: SVC syndrome, Pancoast's tumor, Horner's syndrome, Endocrine (paraneoplastic), Recurrent laryngeal symptoms, Effusions
most common lung cancer in nonsmokers and females?
adenocarcinoma
hilar mass arising from bronchus. ectopic PTHrP production. what do you see histologically'?
squamous cell carcinoma --> keratin pearls
lung cancer that develops on site of prior inflammation or injury. histologically see type II pneumocytes and multiple densities on chest x-ray
bronchial adenocarcinoma
columnar-to-cuboidal tumor cells line alveolar walls; multiple densities on x-ray, mimicking pneumonia
bronchioloalveolar adenocarcinoma
very aggressive undifferentiated cells that appear dark blue. have ectopic production of ACTH or ADH what is the cancer? what type of cell is malignant?
small-cell. cells are called Kulchitsky cells. they are neuroendocrine in origin
What is Lambert-Eaton syndrome and what cancer is it associated with?
autoantibodies against calcium channels; associated with small cell carcinoma
carcinoid tumor characteristics?
located in major bronchi, spreads by direct extension, secretes serotonin
exposure to what can lead to bronchogenic carcinoma?
smoking, air pollution, radiation, asbestos, nickel and chromates
common paraneoplastic syndromes associated with lung cancers
ACTH (small cell, most common), SIADH (small cell), PTHrP (SCC)
what is a pancoast tumor?
involvement of apex of the lung manifests as horner syndrome (ptosis, miosis, anhidrosis)
SVC syndrome is what?
compression or invasion of SVC resulting in facial swelling and cyanosis with dilation of the veins of head, neck and upper extremities.
H1 histamine antagonists (first generation)
diphenhydramine, dimenhydrinate, chlorpheniramine
Clinical uses: allergy, motion sickness, sleep aid
Toxicity: sedation, antimuscarinic, anti-a-adrenergic
2nd gen. H1 histamine antagonists
Loratadine, fexofenadine, desloratadine, cetirizine
clinical uses: allergy
toxicity: little CNS tox
Isoproterenol
non-specific Beta agonist; relaxes bronchial smooth muscle (B2); tachycardia from B1
Albuterol and Salmeterol
B2 specific agonists; albuterol for acute asthma exacerbation and salmeterol for prophylaxis; may cause tremor and arrhythmias
Theophylline (use, mechanism, toxicity)
Methylxanthine that causes bronchodilation by inhibiting phosphodiesterase --> increases cAMP t(1/2). narrow therapeutic index
ipratropium
muscarinic antagonist, prevents bronchoconstriction. used for COPD and asthma
Beclomethasone, prednisone mechanism
stops production of TNF-a by inactivating NF-kappaB
Zileuton mechanism
antileukotriene that blocks conversion of arachidonic acid to leukotrienes
Zafirlukast, montelukast mechanism and use
block leukotriene receptors. good for aspirin-induced asthma
Guaifenesin mechanism
removes excess sputum but large doses necessary
N-acetylcysteine class and uses
mucolytic --> can loosen mucous plugs in CF patients. also used as an antidote for acetaminophen overdose