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27 Cards in this Set

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List of substances that can infiltrate alveoli

(Chest x-rays)
1) Water*
2) Blood*
3) Cells
4) Pus
5) Protien
6) Calcium

* These can dissipate quickly with serial radiographs
Diseases associated with diffuse bilateral upper lobe disease (lower lobe sparing)

(Chest X-rays)
- Eosinophilic granulomae
- Hypersensitivity pneumonitis
- Pneumoconiosis
- Cystic fibrosis
- Sarcoidosis
Diseases associated with interstisital disease AND hyperinflation

(Chest X-rays)
- CF
- Diffuse panbroncholitis (Japan only)
- Eosinophilic granulomae
- Familial dysautonomia
- Lymphangioleiomatosis
- Sarcoidosis
Diseases associated with diffuse bilateral lower lobe disease (BADASSU)

(Chest X-rays)
- Brochiectasis
- Aspriation
- Dermato-polymyositis
- Asbestos
- Scleroderma (or other CV disease)
- Sarcoidosis
- Intersitital pulmonary fibrosis
Unilateral upper lobe diseases

(Chest X-rays)
- TB
- Histoplasmosis
- Coccidiomycosis
- Lung cancer
- Klebsiella pneumonia

(These apply ONLY in United States)
Causes of unilateral pleural effusions on right side

(Chest-X-rays)
- CHF
- Hepatic hydrothorax
- MEIGS syndrome
Causes of unilateral pleural effusions on left side

(Chest X-rays)
- Aortic dissection
- Esophageal rupture
- Splenic infarct
- Pancreatitis
Definition of COPD and the diseases that comprise it

(COPD Lecture)
COPD is a chronic disease of reduced expiratory airflow with progressive decline in pulm function punctuated by acute exacerbations eventually leading to disability and premature death

Diseases: Primarily EMPHYSEMA and CHRONIC BRONCHITIS

Also: Asthma, Brochiectasis, Cystic Fibrosis
Definition of emphysema

(COPD Lecture)
Anatomic diagnosis - progressive destruction of alveolar septa and capillaries, leads to large colaeced airspaces referred to as BULLAE.

NO FIBROSIS! This is what differentiates it from ILD

Results in reduced elastic recoil which causes reduction in expiratory air flow (increased RV - air trapping).
Definition of chronic bronchitis

(COPD Lecture)
History-based diagnosis - consecutive 2-year history of 3 month periods of chronic sputum production

Results in chronic airway resistance causing reduction in expiratory flow. (Think blocked pipes)
Risk factors for COPD

(COPD Lecture)
1) Age
2) CIGARETTE SMOKING
3) Male gender
4) Airway hyperreactivity
5) Low SES
6) Alpha-1 anti-trypsin deficiency
Pan-acinar vs. Centrilobar emphysema

(COPD Lecture)
Pan-acinar emphysema:
- Rarer of the two
- Caused by alpha-1 anti-trypsin deficiency
- Affects the entire acinus (many-lobed sacs containing groupings of alveoli)
- Affects lung base

Centriacinar emphysema:
- Most common
- Caused by cigarette smoking
- Affects acinus from center outward
- Primarily seen at the apex of the lung
Protease theory of ephysema:
What is it?
What are the proteases involved?
What happens to the cells of the lung?

(COPD Lecture)
The protease theory is that COPD is caused by an imbalance of proteases - both an over production of proteases by inflammatory cells as well as an inhibition of anti-protease factors.

Proteases: ELASTASE, cathepsins, MMPs

Proteases are potent secretogouges - they induce both mucosal hyperplasia AND metaplasia of the epithelial cells which transform into goblet cells and overproduce mucous.
3 pathophysiologic abnormalities that occur with COPD

(COPD Lecture)
1) Airflow obstruction (Early in disease)
2) Hypoxemia (occurs as people's O2 tension decreases)
3) Pulmonary HTN (late disease - affects CV system as well)
3 causes of airflow obstruction that lead to COPD and the associated diseases that contribute to COPD

(COPD Lecture)
1) Decreased elastic recoil (emphysema)
2) Increased airway resistance (chronic bronchitis)
3) Increased constriction of bronchiole smooth muscle tone (asthmatic bronchitis)
3 causes of Hypoxemia that lead to COPD (hypoxemia - decreased partial pressure of O2 in the lungs, O2 sat <90%, not to be confused with hypoxia - where the body as a whole (or region of the body) is deprived of O2 and can be pathologic or physiologic)

(COPD Lecture)
1) Ventilation-Perfusion mismatch (because of the non-linearity of the oxy-hemoglobin dissociation curve)
2) Hypoventilation (more common in chronic bronchitis - occurs late in the course of disease)
3) Diffusion impairment (more common in emphysema because of loss of alveolar surface area - more common at high altitudes or with exercise)
Pulmonary hypertension in COPD:
1) What is the primary cause of PH in COPD?
2) What is the natural progression of PH in COPD?
3) What are the effects of COPD/PH on the cardiovascular system?

(COPD Lecture)
Primary cause of Pulm HTN in COPD is CHRONIC ALVEOLAR HYPOXIA

Natural progression: V/Q mismatch -> alveolar hypoxia -> PH -> Cor Pulmonale

Effects on the CV system include RV dilation, elevated venous pressure (responsible for edema and inability to excercise) and a >50% mortality rate in 5 years post-Dx
Therapy for COPD

(COPD Lecture)`
Chronic O2
Smoking cessation
Bronchodialtors (to decrease spasam)
Corticosteroids to treat exacerbations
Pulm rehabilitation

Advanced:
Lung transplant
A-1 anti-trypsin replacement
Lung volume reduction therapy
Long term mechanical ventilation
Causes of DIFFUSE INTERSTITIAL INFILTRATE on CXR of immunocomprimised patient?
-Pneumocysitis
-CMV
-Kaposi sarcoma
-respiratory viruses
Causes of DIFFUSE NODULAR INFILATRATE (MILIARY) on CXR of immunocomprimised patient?
-Mycobacteria
-Histoplasmosis
-Pneumocystis
-Fungi
Causes of LOCALIZED INFILATRATE on CXR of immunocomprimised patient?
-Typical bacteria
-Nocardia
-Fungi
-Mycobacteria
Causes of LARGE NODULAR/CAVITARY INFLATRATE on CXR of immunocomprimised patient?
-Staph aureus
-Mycobacteria
-Nocardia
-Gram - bacilli
-Aspergillus
-Anaerobes
Causes of HILAR ADENOPATHY on CXR of immunocomprimised patient?
-Mycobacteria
-Fungi
-Kaposi sarcoma
-lymphoma
Bugs that cause COMMUNITY acquired pneumonia

(Pneumonia lecture)
-S. pneumoniae (typical)
-H. influenza (typical)
-Mycoplasma (atypical)
-Chlamydia (atypical)
-Viruses like adeno (atypical)
Bugs that cause NOSOCOMIAL (hospital acquired) pneumonia

(Pneumonia lecture)
-S. aureus
-Psuedomonas
-Enterobacteriaceae
Bugs that cause ACUTE pneumonia

(Pneumonia lecture)
-S. pneumoniae
-H. influenza
-Legionella (atypical)
Bugs that cause CHRONIC pneumonia

(Pneumonia lecture)
-TB
-Endemic fungi
-Anaerobic lung abcesses
-Pneumocystis