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227 Cards in this Set

  • Front
  • Back
What is a disorder that is associated with decreased surfactant synthesis in newborns?
Respiratory distress syndrome
Other than RDS when can surfactant production be impaired
interruption of pulmonary perfusion as in pulmonary thromboembolism
What disorders are associated with surfactant inactivation?
hydrostatic pulmonary edema and acute respiratory distress syndrome. Surfactant is inactivated due to alveolar flooding
What does emphysema do to the lung and its properties
It destroys alveolar walls resulting in decreased lung elastic recoil, increased lung compliance and increased TLC and FRC
What effect does emphysema have on the size and resistance of airways?
the airways are narrower at any given lung volume due to decreased elastic recoil and thus decreased tethering effect on the airways. This increases resistance
Why does emphysema cause a decrease in maximal expiratory flow?
decreased lung elastic recoil pressure causes constriction of upstream airways
What 3 conditions decrease chest wall compliance?
obesity, chest wall deformities: ankylosing spondylitis and scoliosis
Why does chronic obstructive pulmonary disease cause a decreased maximal expiratory flow?
COPD causes narrowing of peripheral airways < 2-3 mm in diameter that are upstream from the equal pressure point thus causing airway constriction
What type of diseases can cause hyperinflation?
Obstructive (COPD) or asthma
What are the 6 mechanisms that can cause restrictive pulmonary disease?
1. space occupying abnormalities within the thorax (pleural effusion, tumor), 2. parenchymal infiltration, 3. parenchymal destruction or removal, 4. alveolar collapse, 5. respiratory muscle weakness, 6. abnormal recoil or deformity of the chest wall
What disorder refers to the failure, either unilaterally or bilaterally to establish a passageway from the nose to the nasopharynx?
Choanal atresia - if unilateral won't present until later in life; bilateral presents in infancy
What disorder refers to a reduced volume of the thoracic cavity during development that prevents the lungs from reaching full size
pulmonary hypoplasia
What causes pulmonary hypoplasia?
Decreased thoracic expansion due to
1. internal compression (diaphragmatic hernia, polycystic kidney disease) or
2. external compression due to amniotic fluid deficiencies (renal agenesis, bladder obstruction)
What disorder refers to a partial or total absence of the diaphragm that causes abdominal contents to spill into the thoracic cavity?
Diaphragmatic hernia
What is the name of accessory buds from the embryonic foregut?
bronchogenic cysts, they are lined by bronchial epithelium and often have cartilage. Contain mucoid secretions which predisposes them to infection and abscess formation
Where are bronchogenic cysts usually found?
in the mediastinum around the tracheal bifurcation but can appear in the lung substance itself
What can occur if a broncheogenic cyst ruptures?
If ruptured into the tracheobronchial tree - hemorrhage; if ruptured into the pleural cavity - pneumothorax
What disorder represents the presence of lung tissue that has no connection with the tracheobronchial tree?
Bronchopulmonary sequestration - usually receives its own blood supply directly from the aorta
What disease causes abundant nasal catarrhal discharge, sneezing, airway obstruction and sometimes watering eyes?
acute infectious rhinitis (common cold)
What are the principle viruses that cause the common cold?
rhinoviruses, parainfluenza 1 and 2, echo 28, coxsackie a, respiratory syncytial virus
What occurs to the mucosa during the common cold?
the mucosa is hyperemic and edematous with mononuclear infiltration in the submucosal tissue
What type of disease causes mucoid secretions with inflammatory infiltrate mostly consiting of eosinophils?
Allergic rhinitis - Type I HS, IgE mediated
What is inflammation of the sinus mucosa that usually is preceded by rhinitis?
What diseases may complicate sinusitis?
osteomyelitis, meningitis, intra and extracranial abscesses
What disease causes sore throat and hoarseness, edema of the epiglottis and surrounding pharynx
What bacteria usually causes epiglotitis?
H. influenzae
What disease causes cough, dyspnea and marked inspiratory stridor associated with cyanosis?
Acute obstructive laryngotracheobronchitis (CROUP)
What disease causes laryngeal congestion, edema and or exudates which markedly obstructs airflow through the larynx?
What are polypoid protrusions of edematous mucosa that are inflammatory in nature?
Nasal polyps
What can result from trauma to the vocal cords?
Vocal cord polyps
Where are vocal cord polyps most frequently found?
On the true vocal cords
Is there an increased risk of malignant transformation with vocal cord polyps?
Define squamous papilloma
benign exophytic neoplasm usually on the true vocal cords
What usually causes squamous papillomas?
HPV type 6 and 11
What are the differences in childhood vs. adult onset of squamous papillomas?
Childhood (juvenile laryngeal papillomatosis)- usually multiple lesions that spontaneously regress by puberty; adulthood - solitary lesions
What benign but aggressive endophytic proliferation of squmous cells usually occurs in the nose and paranasal sinuses?
Inverted pailloma - malignant transformation rare. Can grow into orbit or cranial cavities
What is the benign tumor of teenage boys that presents as a nasopharyngeal mass and consists of blood vessels admixed with fibrous tissue?
Nasopharyngeal angiofibroma - surgical removal may have extensive bleeding from the tumor
Malignancy that arises from nasal mucosa or maxillary sinus?
Nasal SCC - correlation between environmental and occupational hazards. Local destruction common, distant metastases rare
What are the 3 types of nasopharyngeal SCC?
keratinizing, non-keratinizing and undifferentiated
Which types of nasopharyngeal SCC are associated with Epstein-Barr virus infections?
non-keratinizing and undifferentiated nasopharyngeal SCC
In which type of tumor are the tumor cells characteristically surrounded by a heavy lymphocytic infiltrate?
Nasopharyngeal SCC
What type of neoplasia is associated with smoking and alcohol abuse?
Laryngeal SCC
A man comes in with hoarseness, what type of neoplasia should we be concerned with?
Laryngeal SCC
What type of lung diseases results from narrowing or obstruction of the tracheobronchial tree or from destruction of the pulmonary parenchyma?
What type of lung disease is found in "blue bloaters"
chronic bronchitis - obstructive lung disease
When I say: chronic bronchitis. You say:
large airway obstruction - not distal (like in emphysema)
What disease is characterized by excessive mucous secretion within the bronchial tree that cannot be explained by specific infection or by infiltrative disease?
chronic bronchitis - obstructive lung disease
What disease is defined as chronic cough with sputum production for at least three months per year in at least two consecutive years?
chronic bronchitis - obstructive lung disease
What are the three major causes of chronic bronchitis?
cigarette smoke >>> air pollution and occupational irritants
What is the major pathophysiologic disruption of chronic bronchitis?
large airway obstruction
What is the Reid Index?
the amount of hypertrophy and hyperplasia of the submucosal mucous glands in the large airways. Increased in pt. with chronic bronchitis
What occurs to inspiration and expiration in a pt with chronic bronchitis?
Inspiration is ok, expiration - bronchioles collapse around the mucus plugs, air trapping is in the distal airways
What do we need to be concerned with in pt with chronic bronchitis?
repeated bacterial infection due to excessive, slowly cleared mucus
What is bronchiolitis fibrosa obliterans?
fibrosis of the bronchiolar walls, the ultimate consequence of chronic bronchitis
What will obstructive lung disease do to the RV, TLC and FEV?
Increase RV and TLC, decrease FEV
What type of hypoxic changes occurs in chronic bronchitis?
ventilation/perfusion mismatch
Does chronic bronchitis cause acidosis or alkyldosis?
What does acidosis do in chronic bronchitis in the short run and long run?
Acutely - corrects V/Q mistmatch by causing poorly oxygenated blood vessels to constrict. Chronically - pulmonary hypertension with ensuing right hreat failure
What appears on chest x-rays that is pathonomonic for chronic bronchitis?
with bronchography, bronchial pits representing enlarged bronchial gland ducts are pathonomic
What are the clinical complications of chronic bronchitis?
repeated infections, cor pulmonale, peptic ulcers and respiratory failure
What disease is characterized by 'pink puffers'?
Emphysema - obstructive lung disease
What disease is defined as abnormal, permanent, destructive lesion of the pulmonary parenchyma which leads to an increased size and volume of the air spaces distal to the terminal bronchiole
Emphysema - obstructive lung disease
When I say: emphysema. You say:
distal airway destruction with loss of recoil
What does loss of elastic recoil do to inspiration and expiration?
inspiration is ok, expiration - requires greater effort of the chest wall to force air out
What does loss of tethering effect do to expiration?
distal airways tend to collapse without tethering thus during expiration air trapping occurs
What do the alveolar walls look like microscopically in emphysema?
attenuated and broken with fragments of the wall appearing to float in large distorted air spaces
What are the 4 patterns of emphysema?
1. centrilobular, 2. panlobular, 3. paraseptal, 4. irregular (scar) emphysema
Which pattern of emphysema is characterized by destructive changes mainly to respiratory bronchioles?
centrilobular emphysema
What lobe and cell types are associated with centriolobular emphysema?
upper lobes - cigarette smoke deposited in lung attracts macrophages which attracts and activates neutrophils. Macrophages and neurtrophils release proteases that unless inactivated digest alveolar walls
What inactivates proteases released from macrophages and neutrophils in pt with emphysema?
antiproteases - alpha-1-trypsin. Cigarette smoke inactivates A-1-T = further damage
What is an early change in the lungs associated with cigarette smoke?
What health risk is associated with centrilobular emphysema?
cigarette smoking
What pattern of emphysema is seen in the lower lobes?
What pattern of emphysema is characterized by uniform involvement of the acinus?
What pattern of emphysema is found in patients with inherited or acquired alpha-1-trypsin deficiency?
panlobular - this effect is multiplied if they smoke
What pattern of emphysema is characterized by destruction of the distal portion of the acinus directly underlying the pleura or fibrous septa?
What area of the lung is spared in paraseptal emphysema?
the respiratory bronchiole
What pattern of emphysema may form subpleural bullae or pleural blebs?
What lobe is affected in paraseptal emphysema and what may it cause in young adults?
upper lobes - may be a cause of spontaneous pneumothorax in young adults
What pattern of emphysema is found as focal parenchymal loss of areas with old scars?
Irregular (scar) emphysema. Scars could be from TB, histoplasmosis etc.
What disease presents with a history of progressive dyspnea, weight loss, and increased diameter of the chest?
Emphysema - obstructive lung disease
What is barrel chest?
increased A-P diameter of the chest due to the increased lung volume found in emphysema
Is V/Q mismatch less or more in emphysema than in chronic bronchitis?
Less - due to destruction of the both the airways and the vessels
Are patients cyanotic in emphysema and what do their blood gasses look like?
No, they are not cyanotic. Their blood gases may look normal until late in the disease
What is found on chest x-ray with emphysema?
increased radiolucency of the lung fields with depression and flattening of the diaphragm
What disease is characterized by increased sensitivity of the tracheobronchial tree that manifests by acute, widespread, narrowing of the small airways due to bronchoconstriction?
bronchial asthma - obstructive lung disease
What are the chronic effects of asthma due to?
chronic narrowing is due to inflammation, edema and increased mucus production and is slower to respond to treatment than acute
What type of asthma is IgE mediated Type I HS reaction?
Atopic (allergic) asthma. Onset usually develops at childhood often has family history
What do the chemical mediators of inflammation do in asthma?
potentiate bronchoconstriction which in addition to edema reduces lung compliance
What are the characteristics of a delayed response in atopic asthma?
persistent bronchospasm resulting from the recruitment of inflammatory cells which release additional chemical mediators
What frequently triggers non-atopic asthma?
upper respiratory infections; neural hyperirritability may play a role
What are Cruschmann's spirals?
mucous plugs containing desquamated epithelial cells present in the small bronchi and bronchioles in pt with asthma (may be coughed up in sputum)
What are Charcot-Leyden crystals?
crystalloids of eosinophil membrane proteins; are often found in sputum of asthmatics
What is the main component of submucosal infiltrates of asthmatics?
What may occur to the lung tissue in asthma?
thickened basement membranes and muscular hypertrophy of bronchial walls in repeat spasm. Goblet cell metaplasia and hyperplasia of submucosal glands
What disease presents with cough and wheezing and tachypnea?
What happens to the patient as the asthma attack continues without intervention?
The pt gets tired due to the increased work needed to breath - breathing rate slows and respiratory acidosis with retention of CO2 develops
What is status asthmaticus?
A severe, prolonged asthma attack that can be fatal
What are the complications of asthma?
status asthmaticus, respiratory failure, pneumothorax or pneumomediastinum, pneumonia, atelaectasis and mucoid impaction
What disease is characterized by permanent dilation of bronchi and bronchioles due to inflammatory damage to their walls?
Bronchiectasis - lower lobes (left more than the right but can be bilateral)
What are the 3 causes of bronchiectasis?
1. bronchial obstruction, 2. necrotizing pneumonia, 3. congenital or inherited disorders (CF)
What disease is associated with cough and copious production of purulent sputum?
What disease is characterized by abnormal exocrine glands that produce abnormally viscous secretions?
Cystic fibrosis
What are the clinical manifestations of CF?
if severe enough can have pancreatic insufficiency, chronic respiratory disease, electroyle disturbances, infertility and occassionally cirrhosis of the liver
What are the 5 obstructive lung diseases?
1. chronic bronchitis, 2. emphysema, 3. bronchial asthma, 4. bronchiectasis, 5. cystic fibrosis
What type of lung disease is characterized by decreased total lung capacity?
Restrictive lung disease
What are the 3 causes of restrictive lung disease?
1. loss of lung tissue, 2. filling of alveolar spaces, 3. infiltration and thickening of the pulmonary interstitium
In what condition is there either collapse or incomplete filling of alveoli?
What causes primary atelectasis?
failure of lungs to ventilate at birth due to birth trauma, bronchial obstruction, drugs, immaturity or CNS disorders. Lungs will sink when placed in water
What are the 5 causes of secondary or aquired atelectasis?
1. deficiency of surfactant (RDS),
2. loss of negative intrapleural pressure (chest trauma, pneumothorax)
3. complete obstruction of an airway,
4. direct pressure on lungs (accumulation of material in pleural cavities),
5. contraction (parenchymal fibrosis)
What is the appearance of the pleural surface over the area of atelectatic?
It has a purple blue color and is slightly depressed from the surrounding parenchyma
What results from atelectasis?
right to left shunt since the atelectatic lung is still perfused but ventilation is decreased
What may occur in a collapsed lung if it is not re-expanded soon after collapse?
infection and "carnification" (complete organization of the tissue) can occur; if re-expanded quickly little to no damage is done
What are the 2 types of RDS?
Type 1 - occurs in newborns, hyaline membrane disease; Type 2 - occurs in adults from diffuse alveolar damage
What stimulates surfactant production and when does it first occur?
corticosteroid secretion in late gestation
Which infants are at risk of RDS?
1. premature infants, 2. those delivered by C-section, 3. those whose mothers are diabetic
What amniotic fluid components are indicative of development of RDS?
lecithin:sphingomylin ratio of less than 2:1 or absence of phosphatidyl glycerol
What disease is clinically manifested by nasal flaring and retraction of the ribs and sternum during inspiration in a newborn?
Type 1 RDS
What are the consequences of RDS?
hypoxia, cyansos, metabolic acidosis, these trigger vasoconstriction resulting in endothelial and alveolar epithelial cell injury
What disease causes exudation of fibrin rich fluid into the interstitium and alveolar space and the subsequent formation of hyaline membranes along the respiratory bronchioles, alveolar ducts and alveoli?
Type 1 RDS
What are hyaline membranes?
fibrinous exudate admixed with necrotic epithelial cell debris
What are complications of Type 1 RDS?
pressure-induced tissue injury and O2 toxicity, retrolental fibroplasia (blindness), bronchopulmonary dysplasia may lead to chronic restrictive lung disease
What disorder is characterized by acute onset of severe dyspnea and tachypnea with resulting tachycardia, hypoxemia refractory to therapy and cyanosis?
Type 2 RDS
What is the common denominator of mechanisms causing Type 2 RDS?
widespread diffuse alveolar epithelial cell and/or capillary endothelial cell injury
What occurs in Type 2 RDS?
leakage of fibrin rich exudate into alveoli and resultant hyaline membrane formation interferes with gas exchange, produces a noncompliant 'stiff' lung
What can be seen in patients that survive Type 2 RDS?
enlarged, regenerating Type II pneumocytes may become prominent along the alveolar membrane. Ultimately interstitial fibrosis can cause permanent loss of compliance
What disease results in activation of inflammation and immunologic activity in the pulmonary interstitium?
Diffuse interstitial disease - macrophages, lymphocytes, neutrophils, complement are all present results in tissue damage
What do early lesions of diffuse interstitial disease show?
diffuse inflammatory infiltrates within the alveolar walls (alveolitis) and peribronchiolar interstium that ultimately cause vascular and parenchymal destruction with extensive fibrosis
What is the end result of diffuse interstitial disease?
end-stage honeycomb lung characterized by multiple cystic spaces separated by dense fibrous scars filled with mucus and cellular debris
What disease is caused by coal dust deposited into small airways?
Coal Workers Lung (black lung) - particles are engulfed by macrophages until they are overwhelmed.
What are the clinical manifestations of coal worker's lung?
asymptomatic anthracosis to progressive massive fibrosis with pulmonary hypertension and cor pulmonale
What occurs in silicosis?
inhalation of crystalline silica is ingested by macrophages which are killed by the toxicity of the silca, more macrophages engulf dead ones = cycle. Viable macrophages release mediators that promote fibrosis until silica becomes 'walled off' by small fibrotic nodules of whorled collagen
Which lobe is most frequently affected by silicosis and coal worker's lung?
upper lobe
How does silica reflect polarized light?
It is birefringent
What may occur in silicosis due to spreading?
Hilar lymphadenophathy
What type of asbestos is pathogenic?
long, thin fibers of the amphibole type (serpentine type not as pathogenic)
What disease does asbestos cause?
alveolitis and interstitial fibrosis
What are asbestos or ferruginous bodies and where are they found?
insoluble fibers of asbestos that have become encrusted by protein and iron. They are seen around alveolar ducts and distal acinar structures primarily in the lower lobes
Which lobes are mostly affected in asbestosis?
lower lobes
What occurs in asbestosis due to fibrogenic cytokine release?
diffuse interstitial fibrosis (rather than whorled as seen in silicosis)
Do patients with asbestosis have an increased risk to develop carcinomas?
yes - increased risk to develop primary bronchogenic carcinomas - especially if they smoke. Also there is an increased incidence of malignant mesothelioma of the pleura and peritoneum
Define Idiopathic pulmonary fibrosis
etiology unknown. Characterized by a variety of changes ranging from slight inflammation of alveolar walls with minimal fibrosis to diffuse alveolar damage with extensive fibrosis and alveolar collapse
In what population is idiopathic pulmonary fibrosis usually seen?
Middle aged males and it is generally progressive. Pt with coexistant collagen vascular disease tend to have a less aggressive clinical course
What is Hamman-Rich syndrome?
A fulminant form of idiopathic pulmonary fibrosis
What disease is characterized by accumulation of macrophages and epithelial cells (Type II) within the alveolar spaces?
Desquamative interstitial pneumonitis (DIP) - may represent early idiopathic pumonary fibrosis but pt are more likely to benefit from steroid therapy
What disease is characterized by mononuclear cells infiltrate in the alveolar walls with relatively little fibrosis?
What disease is characterized by lymphocytic infiltrates confined to the alveolar septa?
Lymphoid Interstitial pneumonia
Is there an increased risk of malignancy with lymphoid interstitial pneumonia?
Yes - incidence of pulmonary lymphoma is increased
What are two types of idopathic pulmonary fibrosis?
usual interstitial pneumonia and cryptogenic fibrosing alveolitis
What type of disease is extrinsic allergic alveolitis?
Hypersensitivity pneumonitis
What disease is characterized by immune-mediated alveolar damage caused by inhalation of environmental organic dusts contaminated by various antigens?
Hypersensitivity pneumonitis
What are the types of hypersensitivity pneumonitis?
1. farmer's lung (moldy hay), 2. byssinosis (cotton dust), 3. bagassosis (sugar cane dust), 4. maple bark stripper's dust (maple bark dust)
What are the characteristics of an acute hypersensitivity pneumonitis attack?
dyspnea and cough following exposure to antigen, results from activation of complement (Type III HS)
What type of HS reaction occurs in an acute hypersensitivity pneumonitis attack?
Complement mediated = Type III HS reaction
What type of HS reaction occurs in a chronic hypersensitivity pneumonitis attack?
cell mediated, Type IV HS reaction. This leads to alveolar damage and progressive fibrosis resulting in respiratory failure
What disease is characterized by loose granulation tissue filling the respiratory bronchioles, alveolar ducts and alveolar spaces?
Bronchiolitis Obliterans (Organizing pneumonia)
What is bronchiolitis obliterans associated with?
diffuse alveolar damage and mild interstitial fibrosis
What disease is characterized by the presence of a dense, proteinaceous PAS+ fluid within alveolar spaces and necrotic Type II pneumoncytes and alveolar macrophages?
Pulmonary Alveolar Proteinosis - inflammation surrounding the alveolar wall is minimal
What disease presents with a cough that is productive of a 'chunky' gelatinous material?
Pulmonary Alveolar Proteinosis
What disease presents classically with: bilateral hilar lymphadenopathy, uveoparotitis, osseous lesions in the short bones of the hands and feet, erythema nodosum, hypergammaglobulinema, hypercalcemia and hyper calciuria?
What disease would produce a reticulodnodular "snow storm" appearance by x-ray due to multiple lesions throughout the lung?
Milary sarcodosis
What 4 disorders are associated with sarcodosis?
1. hilar lymphadenoapthy, 2. milary sarcoidosis, 3. diffuse fibrosis and 4. honeycombing
What disease shows granulomas without central caseation = called 'hard granulomas'?
What disease presents with cough, dyspnea, chest pain, loss of weight, malaise or excessive fatigue?
What two histological findings are characteristic but not pathognomonic of sarcodosis?
intracytoplasmic inclusions in giant cells = Schawmann bodies and asteroid bodies
What population is most affected by primary pulmonary hypertension?
young women
What disease is caused by prolonged vasoconstriction of pulmonary vessels induced by hypersensitivity which produces thickening of small arteries and arterioles?
Primary pulmonary hypertension
What are plexiform lesions?
intralumenal webs in small arterioles that are diagnostic hallmarks for primary pulmonary hypertension
What disease has acute inflammatory lesions of bronchi and bronchioles that may be caused by viruses or irritant gases?
acute bronchitis/bronchiolitis
What occurs in acute bronchitis/bronchiolitis?
damage to epithelial cells impairs normal ciliary action leading to airway plugging and possible bacterial superinfection
What disease causes peribronchiolar and interstitial lesions?
mycoplasma/viral pneumonias
In what disease do you find alveolar walls widened by mononuclear infiltrate?
mycoplasma/viral pneumonias - produces a reticular pattern on chest x ray
What disease presents clinically with a history of recent URI, irregular fever with myalgia and malaise?
mycoplasma/viral pneumonias - persistent cough may be present; substernal chest pain, pleuritic pain and effusions are infrequent; dyspnea and cyanosis are rare
What disease has extensive inflammation involving the alveoli of an entire lobe?
lobar pneumonia
What disease shows 'air bronchograms' on x-ray?
lobar pneumonia
What are the 4 morphologic stages of lobar pneumonia?
1. congestion - rapid proliferation of bacteria and early stages of immune response,
2. red hepatization - intense vascular engorgement, alveolar spaces become backed with neurtophils, extravasated blood and precipiatated fibrin,
3. gray hepatization - vacular engorgement not as prominent, disintegration of neutrophils and red cells but accumlulation of fibrin,
4. resolution - intraalveolar debris is reabsorbed or removed
What are Masson bodies?
clumps of intraalveolar debris present in lobar pneumonia in the resolution stage of the disease
What disease is caused by inflammation that occurs in patches throughout one or more lobes typically following damage to the lung?
bronchopneumonia - less extensive but possibly more destructive
What airways are colonized in bronchopneumonia?
Small airways - terminal or respiratory bronchioles
What disease is characterized by sudden onset of shaking chills following by high fever?
acute bacteria pneumonia. First the cough is dry, at red hepatization stage it is productive of thick purulent and hemorrhagic sputum
What is the most common etiologic agent for both lobar and bronchopneumoias?
Streptococcal pneumonia
What bacteria agent usually causes pneumonia as a complication to an infection?
Staphylococcal pneumonia - most likely S. aureus
What population usually gets S. aureus pneumonia?
infants and young children
What etiologic agent causes pneumonia which produces abscess cavities and pneumatoceles that can progress to empyema or pneumothorax?
Staphylococcal pneumonia - most likely S. aureus
What etiologic agent causes pneumonia in the hospital setting?
Gram-negative pneumonias
Which etiologic agent causes pneumonia in association with alcoholism?
Klebsiella pneumoniae
Which etiologic agent causes pneumonia with a thick, gelatinous, 'red brick' blood positive sputum?
Klebsiella pneumoniae
What etiologic agent is assoicated with pediatric age group espically in cases of obstrutive lung disease?
Haemophilus influenzae
What etiologic agent causes pneumonia and is associated with humidfication and ventilation devices?
Pseudomonas aeruginosa
Which etiologic agent causes pneumonia with extensive hemorrhage but little neutrophilic reaction?
Pseudomonas aeruginosa
What etiologic agent causes a potentially fulminating pneumonia?
Legionella pneumophila
What etiologic agent causes pneumonia due to seeding from UTIs?
Enteric gram negative
What type of reaction is most common for fungal infections of the lungs?
chronic granulomatous inflammatory infections
What 3 fungal organisms are the major opportunistic causes of infection?
candida, mucor and aspergillus
What fungal agent causes pneumonia with purulent abscess formation?
What is the most common opportunistic agent producing pneumonia in AIDS patients?
Pneumocystis carinii - a protozoon
Where is the focus of infection in primary tuberculosis?
subpleural lung parenchyma, upper portion of the lower lobe or lower portion of the upper lobe
What is the Ghon focus?
granulomatous lesion in TB with central caseous necrosis
What is primary Ghon complex?
combination of the subpleural lesion and the hilar node involvement
What is tuberculous pneumonia?
A malignant form of TB that can erode the bronchus and spread throughout the body, mostly occurs in school age children
What is secondary TB?
due to the previous exposure and development of hypersensitivity, reexposure or reactivation produces a prompt granulomatous tissue response often with central caseating necrosis
Which part of the lung is often the focus of secondary TB?
apices of one or both upper lobes
What is the anatomical hallmark of secondary TB?
In which types of patients is aspiration pneumonia most common?
unconscious patients, those with repeated vomiting episodes and those with depressed cough reflexes
What reaction occurs to aspiration of liquid gastric contents?
extensive acute inflammation, pulmonary edema, widespread destruction of epithelium with hemorrhage and hyaline membranes
What is the classical clinical picture if enough low pH fluid is aspirated?
2-5 hours after: cyanosis, dyspnea, tachypnea, tachycardia and shock, bloody frothy sputum marked pulmonary congestion and edema. X-ray shows soft pathcy mottling throughout both lungs
What is the main cause of endogenous lipid pneumonia?
It is a complication of an obstructive lesion of the bronchial tree
Describe what happens in exogenous lipid pneumonia
fatty or oily material is aspirated. Few symptoms - may have occasional cough with sputum production and dyspnea. Xray looks like interstitial fibrosis
What is the most common cause of pulmonary abscess?
aspiration with inoculation of lower respiratory tract by anaerobic organisms of the oral cavity; usually solitary and on the right side
localized suppuration and liquefaction necrosis of lung parenchyma represents what?
Pulmonary abscess
What disease presents with fever and prominent cough with copious amounts of foul smelling or bloody sputum?
Pulmonary abscess - if no sputum think bronchial obstruction as cause
Where are most bronchogenic carcinomas felt to arise from?
basal cells of bronchial epithelium
What lung cancer is strongly associated with smoking?
SCC - primarily a central lesion. more common in men. Infiltrate locally before metastasizing
Which lung cancer may be associated with hypercalcemia?
SCC - due to secretion of parathyroid hormone related protein
Which lung cancer is primarily peripheral?
Which lung cancer affects women more than men?
What is bronchioloalveolar carcinoma?
rare variant of adenocarcinoma - arises from bronchiolar epithlium (type II pneumocytes, clara cells) and grows as cuboidal or columnar cells spreading along alveolar septa
Which lung cancer is almost always a central lesion, occurs more in men, is associated with smoking and has early wide dissemination?
Small cell undifferentiated carcinoma
Where do small cell carcinomas of the lung arise from and what do they produce?
they arise from neuroendocrine Kulchitsky cells; notorious for producing hormone-like substances
What lung cancer is comprised of large pleomorphic undifferentiated cells?
large cell undifferentiated carcinoma
What two lung cancers are most common?
SCC and adenocarcinoma
Which lung cancer resemble interstinal carcinoid tumors and secrete serotonin?
Bronchial tumors - occur at a younger age than other lung cancers
Which lung cancer occurs centrally and extends into both the lumen and the bronchial wall in a dumbbell shape?
Bronchial tumors
What represents overgrowth of normal tissue and are 1-4 cm spherical or ovoid lesions in the lungs occuring in the 6th or 7th decades?
What are the two most frequent components of hamartomas?
hyaline cartilage and mature adipose tissue
What is a late complication of asbestos exposure and arises as a thick pleural mass which tends to encase the lung and invade into the thoracic tissues?
Malignant mesothelioma
Are metastatic or primary lung tumors more common?