Respiratory System

Front 1

What are three types of acute rhinitis?

Back 1

1) Common cold
2) Allergic rhinitis
3) Bacterial infection

Front 2

What is the common cold?

Back 2

1) Most common of all illnesses and is caused by viruses, especially hte adenoviruses
2) manifest by coryza (runny nose), sneezing, nasal congestion and mild sore throat

Front 3

What allergic rhinitis?

Back 3

1) Mediated by IgE type I immune reaction involving mucosal and submucosal mast cells
2) Characterized by increased eosinophils in peripheral blood and nasal discharge

Front 4

What is Bacterial infection in acute rhinitis?

Back 4

1) May be superimposed on acute viral or allergic rhinitis by injury to mucosal cilia, which may also occur from other environmental factors.
2) Caused most commonly by streptococci, staphylococci, or Haemophilus influenzae
3) Can lead to fibrous scarring, decreased vascularity, and atrophy of the epithelium and mucos glands.

Front 5

What is sinusitis?

Back 5

1) Inflammation of the paranasal sinuses often caused by extension of nasal cavity or dental infection.
2) Results in obstructed drainage outlets from teh sinuses, leading to an accumulation of mucoid secretions or exudate

Front 6

What is laryngitis?

Back 6

1) Acute inflammation of the larynx produced by viruses or bacteria, irritants, or overuse of hte voice.
2) Characterized by inflammation and edema of the vocal cords, with resultant hoarseness.

Front 7

What is acute epiglottitis?

Back 7

1) Inflammation of the epiglottis and may be life-threatening in young children
2) Usually caused by H. influenzae.

Front 8

What is acute laryngotracheobronchitis (croup)?

Back 8

1) Acute inflammation of the larynx, trachea, and epiglottis that is potentially life-threatening in infants.
2) Most often caused by viral infection.
3) Characterized by a harsh cough and inspiratory stridor.

Front 9

Describe four malignant tumors of the nose and nasal sinuses.

Back 9

1) Nasopharyngeal carcinoma; most common in SE Asia and East Africa; caused by EBV
2) Squamous cell carcinoma; most frequently occurring malignant nasal tumor
3) Adenocarcinoma; accounts for 5% of malignant tumors of the nose and throat
4) Plasmacytoma; is a plasma cell neoplasm that, in its extraosseous form, produces tumors in the upper respiratory tract.

Front 10

What is a singer's nodule?

Back 10

1) Benign laryngeal polyp, usually induced by chronic irritation, such as excessive use of the voice, and is associated most commonly wiht heavy cigarette smoking
2) Usually localized to the true vocal cords.

Front 11

What are laryngeal papilloma?

Back 11

1) Benign neoplasm usually located on the true vocal cords.
2) In adults, usually occurs singly and sometimes undergoes malignant change.
3) In children, multiple lesions, caused by HPV, appear. These lesions are benign but often recur after resection.

Front 12

What is squamous cell carcinoma of the larynx?

Back 12

1) Most common malignant tumor of the larynx and is usually seen in men older than 40 years of age; it is often associated with the combination of cigarette smoking and alcoholism.
2) Most often presents initially with persistent hoarseness.

Front 13

What is glottic carcinoma?

Back 13

1) Arises from the true vocal cords
2) Most common laryngeal carcinoma and has the best prognosis

Front 14

What are supraglottic and subglottic carcinomas?

Back 14

Less common and typically have a poorer prognosis

Front 15

What is COPD?

Back 15

1) A group of disorders characterized by airflow obstruction
2) Characterized by a marked decrease in the 1-second forced expiratory volume (FEV1) and an increased or normal forced vital capacity (FVC), resulting in a decreased FEV1:FVC ratio
3) Often contrasted with restrictive pulmonary disease, a group of disorders characterized by reduced lung capacity due either to chest wall or skeltal abnormalities such as kyphoscoliosis or to interstitial or infiltrative parenchymal disease. In restrictive lung disease, the FEV1 and FVC are both decreased proportionately, resulting in a normal FEV1:FVC ratio

Front 16

What is extrinsic bronchial asthma?

Back 16

1) Mediated by a type I hypersensitivity response involving IgE bound to mast cells
2) Begins in childhood, usually in patients with a family history of allergy

Front 17

What is intrinsic bronchial asthma?

Back 17

1) Includes asthma associated with chronic bronchitis as well as other asthma variants such as exercise- or cold-induced asthma
2) Usually begins in adult life and is not associated with a history of allergy.

Front 18

What are the characteristics of bronchial asthma?

Back 18

1) Marked by episodic dyspnea and wheezing expiration caused by narrowing of the airways.
2) Related to increased sensitivity of air passages to stimuli.
3) Manifest morphologically by bronchial smooth muscle hypertrophy, hyperplasia of goblet cells, thickening and hyalinization of basement membranes, proliferation of eosinophils, and intrabronchial mucous plugs containing whorl-like accumulations of epithelial cells (Curschmann spirals) and crystalloids of eosinophil-derived proteins (Charcot-Leyden crystals)

Front 19

What are the complications of bronchial asthma?

Back 19

1) Include superimposed infection, chronic bronchitis, and pulmonary emphysema.
2) May lead to status asthmaticus, a prolonged bout of bronchial asthma that can last for days and responds poorly to therapy; can result in death.

Front 20

What is chronic bronchitis?

Back 20

1) Clinically defined as a productive cough occurring during at least 3 consecutive months over at least 2 consecutive years.
2) Clearly linked to cigarete smoking and is also associated with air pollution, infarction, and genetic factors.
3) Typically characterized by hypersecretion of mucus-secreting submucosal glands.
4) May lead to cor pulmonale

Front 21

What is emphysema?

Back 21

1) Dilation of air spaces with destruction of alveolar walls and lack of elastic recoil.
2) Strongly associated wiht cigarette smoking.
3) Clinically characterized by increased anteroposterior diameter of the chest; increased total vital capacity; and hypoxia, cynosis, and respiratory acidosis.

Front 22

What is emphysema?

Back 22

1) Dilationof air spaces with destruction of alveolar walls and lack of elastic recoil.
2) Strongly associated with cigarette smoking.
3) Typically characterized by hypersecretion of mucus due to marked hyperplasia of mucus-secreting submucosal glands.
4) May lead to cor pulmonale.

Front 23

What is centrilobular emphysema?

Back 23

1) Dilation of the respiratory bronchioles
2) Most often localized to the upper part of the pulmonary lobes.

Front 24

What is panacinar emphysema?

Back 24

1) Dilation of the entire acinus, including the alveoli, aveolar ducts, respiratory bronchioles, and terminal bronchioles.
2) Most often distributed uniformly throughout the lung.
3) Associated with loss of elasticity and sometimes of genetically determined deficiency of alpha1-antitrypsin (alpha1-protease inhibitor)

Front 25

What is paraseptal emphysema?

Back 25

1) Dilation involving mainly the distal part of the acinus, including the alveoli and, to a lesser extent, the alveolar ducts.
2) Tends to localize subjacent to the pleura and interlobar septa.
3) Associated occasionally with large subpleural bullae, or blebs

Front 26

What is irregular emphysema?

Back 26

1) Irregular involvement of the acinus with scarring wiht the walls of enlarged air spaces.
2) Usually a complication of various inflammatory processes.

Front 27

What are the complications of emphysema?

Back 27

1) Often complicated by, or coexistent with, chronic bronchitis.
2) May be complicated by interstitial emphysema, in which air escapes into the interstitial tissues of the chest from a tear in the airways.
3) may also be complicated by rupture of a surface bleb with resultant pneumothorax.

Front 28

What are the postulated causes of emphysema?

Back 28

1) May result from action of proteolytic enzymes such as elastase on teh alveolar wall. Elastase can induce destruction of elastin unless neutralized by the antiproteinase-antielastase activities of alpha1-antitrypsin.
2) Cigarette smoking; attracts neutroophils and macrophages, source of elastaes; inactivates alpha1-antitrypsin
3) Hereditary alpha1-antitrypsin deficiency; accounts for a small subgroup of cases of panacinar emphysema; caused by variants in the pi gene, localized to chromosome 14.

Front 29

What is the pi gene?

Back 29

1) The piZ allele codes for a structural alteratino in the protein that interfers with its hepatic secretin. Hepatic cytoplasmic droplets accumulate, with resultant liver damage.
2) Homozygous state (piZZ) is associated with greatly decreased activity in alpha1-antitrypsin, panacinar emphysema, and often hepatic cirrhosis.

Front 30

What is bronchiectasis?

Back 30

1) Permanent abnormal bronchial dilation caused by chronic infection, with inflammation and necrosis of the bronchial wall.
2) Predisposed by bronchial obstruction, most often by tumor
3) Also predisposed by chronic sinusitis accompanied by postnasal drip; rarely may be manifestation of Kartagener syndrome, caused by a defect in the motility of respiratory, auditory, and sperm celia
4) Most often involves the lower lobes of both lungs.
5) Characterized by production of copious purulent sputum, hemoptysis, and recurrent pulmonary infection that may lead to lung abscess.

Front 31

What is Kartagener syndrome?

Back 31

Sinusitis, bronchiectasis, and situs inversus, sometimes with hearing loss and male sterility.

Front 32

What is restrictive pulmonary disease?

Back 32

1) Group of disorders characterized by reduced epansion of the lung and reduction in total lung capacity.
2) Exemplified by abnormalities of the chest wall from bony abnormalities or neuromuscular disease that restrict lung expansion.
3) Includes interstitial lung disease.

Front 33

What is interstitial lung disease?

Back 33

1) A heterogeneous group of disorders characterized by interstitial accumulations of cells or noncellular material within the alveolar walls that restrict expansion and often interfere with gaseous exchange.
2) Prominent examples are acute conditions such as the adult and neonatal respiratory distress syndromes; pneumoconioses such as coal worker's pneumoconiosis, silicosis, and asbestosis; diseases of unknown etiology such as sarcoidosis and idiopathic pulmonary fibrosis; various other conditions such as eosinophilic granuloma, hypersentitivity pneumonitis, and drug-associated disorders such as berylliosis or the pulmonary fibrosis associated with bleomycin toxicity; and immune disorders such as systemic lupus erythematosus, stemic sclerosis (scleroderma), Wegener granulomatosis, and Goodpasture syndrome

Front 34

What is adult respiratory distress syndrome (ARDS).

Back 34

1) Produced by diffuse alveolar damage with resultant increase in alveolar capillary permeability, causing leakage of protein-rich fluid into alveoli
2) Marked by the formation of an intra-alveolar hyaline membrane composed of fibrin and cellular debris.
3) Results in severe impairment of respiratory gas exchange with consequent severe hypoxia.
4) Caused by a wide variety ofmechanisms and toxic agents, including shock, sepsis, trauma, uremia, aspiration of gastric contents, acute pancreatitis, inhallation of chemical irritants such as chlorine, oxygen toxicity, or overdose with street drugs such as heroin or therapeutic drugs such as bleomycin.
5) Initiated by damage to alveolar capillary endotheliumand alveolar epithelium and is influenced by pathogenetic factors

Front 35

What pathogenetic factors influence ARDS?

Back 35

1) Neutrophils release substances toxic to the alveolar wall
2) Activation of the coagulation cascade is suggested by the presence of microemboli
3) Oxygen toxicity is mediated by the formationof oxygen-derived free radicals

Front 36

What is neonatal respiratory distress syndrome (hyaline membrane disease)?

Back 36

1) Most common cause of respiratory failure in teh newborn and is the most common cause od death in premature infants.
2) marked by dyspnea, cyanosis, and tachypnea shortly after birth.
3) Results from a deficiency of surfactant, most often as a result of immaturity.

Front 37

What is the role od surfactant?

Back 37

1) Reduces surface tension within the lung, facilitating expansoin during inspiratin and preventing atelectasis during expiration.
2) Consists primarily of dipalmitoyl lecithin and is secreted by type II pneumocytes.
3) Fetal pulmonary maturity can be assessed by measuring the ratio of surfactant lecithin to sphingomyelin in the amniotic fluid; the lecithin concentration increases form about the 33rd week of pregnancy, while the sphingomyelin concentration remains stable. A lecithin-sphingomyelin ratio of 2:1 or greater indicates pulmonary maturity.

Front 38

What are teh predisposing factors of Neonatal respiratory distress syndrome?

Back 38

1) Prematurity
2) Maternal diabetes mellitus
3) Birth by caesarean section

Front 39

What are the pathologic findings of NRDS?

Back 39

1) Lungs are heavier than usual, with areas of atelectasis alternating wiht occasional dilated alveoli or alveolar ducts.
2) Small pulmonary vessels are engorged, with leakage of blood products into the alveoli and formation of intra-alveolar hyaline membranes consisting of fibrin and cellular debris.

Front 40

What complications and associated conditions relate to NRDS?

Back 40

1) Bronchopulmonary dysplasia, which appears to be prcipitated by treatment wiht high-concentration oxygen adn mechanical ventilation
2) PDA, caused by failure of closure of the ductus caused by immaturity and hypoxia
3) Intraventricular brain hemorrhage
4) Necrotizing enterocolitis, a fulminant inflammation of the small and large intestines

Front 41

What is Pneumoconioses?

Back 41

1) Environmental diseases caused by inhalation of inorganic dust particles.
2) Anthracosis; coal workers' pneumoconiosis; silicosis; asbestosis

Front 42

What is Anthracosis?

Back 42

1) Caused by inhalation of carbon dust; it is endemic in urban areas and causes no harm.
2) Marked by carbon-carrying macrophages, resulting in irregular black patches visible on gross inspection.

Front 43

What is coal workers' pneumoconiosis?

Back 43

1) Caused by inhallation of coal dust, which contains both carbon and silica.
2) Simple coal workers' pneumoconiosis; marked by coal macules around the bronchiles, formed by ingestion of coal dust particles by macrophages; most cases is inconsequential and produces no disability
3) Progressive massive fibrosis; marked by fibrotic nodules filled wiht necrotic black fluid; can result in bronchiectasis, pulmonary hypertension, or death from respiratory failure on right-sided heart failure.

Front 44

What is silicosis?

Back 44

1) Chronic occupational lung disease cuased by exposure to free silica dust: it is seen in miners, glass manufacturers, and stone cutters.
2) Initiated by ingestion of silica dust by alveolar macrophages; damage to macrophages initiates an inflammatory response mediated by lysosomal enzymes adn various chemical mediators
3) Marked by silicotic nodules that enlarge and eventually obstruct the airways and blood vessels
4) Associated with increased susceptibity to tuberculosis; the frequent concurrence is referred to as silicotuberculosis.

Front 45

What is asbestosis?

Back 45

1) Caused by inhalation of asbestos fibers
2) Initiated by uptake of asbestos fibers by alveolar macrophages. A fibroblastic response occurs, probably from release of fibroblast stimulating growth factors by macrophages, adn leads to diffuse interstitial fibrosis, mainly in teh lower lobes.
3) Characterized by ferruginous bodies, yellow-brown, rod-shaped bodies with clubbed ends that stain postively with Prussian Blue these; these arise from iron and protein coating on fibers. Dense hyalinized fibrocalcific plaques of the partial pleura are also present.
4) Results in marked predisposition to bronchogenic carcinoma and to malignant mesothelioma of the pleura or peritoneum. Cigarette smoking further increase the risk of bronchogenic carcinoma.

Front 46

What are two types of restrictive lung disease of unkonwn etiology?

Back 46

Sarcoidosis
Idiopathic pulmonary fibrosis

Front 47

What is sarcoidosis?

Back 47

1) Of unknown etiology
2) Characterized by noncaseating granulomas, often involving multiple organ systems; can involve almost any organ system
3) Occurs most frequently in persons of African lineage
4) Usually becomes clinically apparent during the teenage or young adult years

Front 48

What are the commmon pathologic changes that occur in sarcoidosis?

Back 48

1) Interstitial lung disease
2) Enlarged hilar lymph nodes
3) Arterior uveitis
4) Erythema nodosum of the skin
5) Polyarthritis

Front 49

What are the immunologic phenomena of sarcoidosis?

Back 49

1) Reduced sensitivity and often anergy to skin test antigens (characteristically negative on a tuberculin test)
2) Polyclonal hyperglobulinemia

Front 50

What are the clinical abnormalities of sarcoidosis?

Back 50

1) Bilateral hilar lymphadenopathy
2) Interstitial lung disease manifest as diffuse reticular densities
3) Hypercalcemia and hypercalciuria
4) Hypergammaglobulinemia
5) Increased activity of serum angiotensin-converting enzyme

Front 51

How is sarcoidosis definitively diagnosed?

Back 51

Biopsy demonstrating noncaseating granulomas

Front 52

What is idiopathic pulmonary fibrosis?

Back 52

1) Characterized by chronic inflammation and fibrosis of the alveolar wall.
2) Begins with alveolitis, progressive to fibrosis, and ends in a distorted fibrotic lung filled wiht cystic spaces (honecomb lung)
3) Often results in death within 5 years.

Front 53

What is eosinophilic granuloma?

Back 53

1) Localized proliferation of histiocytic cells closely related to Langerhans cells of the skin. These cells have characteristic cytoplasmic inclusions (Birbeck granules) resembling tennis rackets.
2) Also characterized by prominent monocytes-macrophages, lymphocytes, and eosinophils
3) Found in the lung or in bony sites such as the ribs
4) Often grouped wiht Hand-Schuller-Christian disease and Letterer-Siew syndrome as a variant of histiocytosis X syndrome

Front 54

What is hypersensitivity pneumonitis (extrinsic allergic alveolitis).

Back 54

Interstitial pneumonia caused by inhallation of various antigenic substances; exemlified by inhalation of spores of thermophilic actinomycetes form moldy hay causing "farmer's lung".

Front 55

What is goodpasture syndrome?

Back 55

Hemorrhagic pneumonitis and glomerulonephritis caused by antibodies directed against glomerular basement membranes.

Front 56

What is Idiopathic pulmonary hemosiderosis?

Back 56

Resembles pulmonary component of Goodpasture syndrome without the renal component.

Front 57

What is Pulmonary Embolism?

Back 57

1) Found in more than half of all autopsies
2) Most often originates from venous thrombosis in the lower extremities or pelvis
3) Can rarely be due to nonthrombotic particulate material such as fat, amniotic fluid, clumps of tumor cells or bone marrow, or foreign matter such as bullet fragments
4) Occurs in clinical settings marked by venous stasis, including primary venous disease, congestive heart failure, prolonged bed rest or immobilization, and prolonged sitting while traveling
5) Also predisposed by cancer, multiple fractures, and the use of oral contraceptives
6) Results in hemorrhgic, or red, infarcts, usually in patients with compromised circulation, but can occur without infarction because of the dual blood supply to the lungs
7) Can have variable clinical consequences, ranging from asymptomatic disease to sudden death.

Front 58

What is primary pulmonary hypertension?

Back 58

Disorder of unknown etiology and poor prognosis that arises in the absence of heart or lung disease.

Front 59

What is secondary pulmonary hypertension?

Back 59

1) More common than the primary form.
2) Most often caused by COPD; can also be caused by increased pulmonary blood flow, as in congenital left-to-right shunt; increased resistance with the pulmonary circulation, form embolism or vasoconstriction secondary to hypoxia; or increased blood viscosity from polycythemia
3) Often leads to right ventricular hypertrophy.

Front 60

What is pulmonary edema?

Back 60

Intra-alveolar accumulation of fluid caused by:
1) Increased hydrostatic pressure, as a result of left ventricular failure or mitral stenosis.
2) Increased alveolar capillary permeability, as in inflammatory alveolar reactions, resulting from inhalation of irritant gases, pneumonia, shock, sepsis, pancreatitis, uremia, or drug overdose.
3) Miscellaneous mechanisms such as rapid ascent to high altitude.

Front 61

What are the general characteristics of pneumonia?

Back 61

1) Inflammatory process of infectious origin affecting the pulmonary parenchyma
2) Characterized by chills and fever productive cough, blood-tinged or rusty sputum, pleuritic pain, hypoxia with shortness of breath, and sometimes cyanosis
3) If bacterial, is most characteristically associated iwth neutrophilic leukocytosis wiht an increase in band neutrophils (left shift)

Front 62

What are the morphologic types of pneumonia?

Back 62

Occur in three morphologic an dclinical patterns:
1) Lobar pneumonia
2) Bronchopneumonia
3) Interstitial pneumonia

Front 63

What is Lobar pneumonia?

Back 63

1) Most frequently caused by streptoccus pneumoniae
2) Predominantly intra-alveolar exudate resulting in consolidation
3) May involve the entire lobe
4) If untreated, may mophologically evolve through four stages

Front 64

What are the four stages of untreated lobar pneumonia?

Back 64

1) Congenstion
2) Red hepatization
3) Gray hepatization
4) Resolution

Front 65

What is bronchopneumonia?

Back 65

1) Many organisms may cause it
2) Acute inflammatory infiltrates extending from the bronchiles into the adjacent alveoli
3) Patchy distribution involving one or more lobes.

Front 66

What organisms cause bronchopneumonia?

Back 66

1) Staphyloccus aureus
2) Haemophilus influenzae
3) Klebsiella pneumonia
4) Streptococcus pyogenes

Front 67

What is interstitial pneumonia?

Back 67

1) Most frequently caused by viruses or mycoplasma pneumoniae
2) Diffuse, patchy inflammation localized ot interstitial areas of the alveolar walls

Front 68

Whta are the characteristics and complications of strep pneumonia?

Back 68

1) Most common in elderly or debilitated patients, especially those with cardiopulmonary disease, and malnourished persons
2) May lead to empyema (pus in the pleural cavity)

Front 69

What are the characteristics and complications of staph aureus?

Back 69

1) Often a complication of influenza or viral pneumonias or a result of blood-borne infection in IVDU
2) Seen principally in debilitated hospitalized patients, the elderly, and those with chronic lung disease

Front 70

What are the characteristics and complications of Strep pyogenes?

Back 70

1) Often a complicatoin of influenza or measles
2) Lung abscess

Front 71

What are the characteristics adn complications of Klebsiella pneumoniae?

Back 71

1) Most frequentl in debilitated hospitalized patients adn diabetic or alcoholic patients
2) High mortality rate in elderly patients
2) Considerable alveolar wall damage, leading to necrosis, sometimes with abscess formation

Front 72

What are the characteristics and complications of Haemophilus influenzae?

Back 72

1) Usually seen in infants and hildren but may occur in debilitated adults, most often those with chronic obstructive pulmonary disease
2) Meningitis and epiglottitis in infants and children

Front 73

What are the characteristics of legionella pneumophila?

Back 73

Infection from inhallation of aerosol from contaminated stored water, most often in air-conditioning systems.

Front 74

What is mycoplasma pneumonia?

Back 74

1) Most common form of interstitial pneumonia
2) Usually occurs in children and young adults
3) May occur in epidemics
4) Characterized by an inflammatory reaction confined to the interstitium, with no exudate in alveolar spaces, and by intraalveolar hyaline membranes
5) Has a more insidious onset than bacterial pneumonias and usually follows a mild, self-limited course
6) Diagnosed by sputum cultures, requiring several weeks of incubation, and by complement-fixing antibodies
7) May be associated with nonspecific cold agglutinins reactive to red cells. (basis for facile lab test)

Front 75

What is viral pneumonia?

Back 75

1) Most common types of pneumonia in childhood
2) Caused most commonly by influenza viruses, adenoviruses, rhinovirus, and RSV
3) May also arise after chidhood exanthems such as rubeola or varicella
4) Measles virus produces giant cell pneumonia, marked by numerous giant cells and often complicated by tracheobronchitis

Front 76

What is rickettsial pneumonia: Q fever?

Back 76

1) Most common rickettsial pneumonia
2) Caused by Coxiella burnetii
3) May infect persons working with infected cattle or sheep, who inhale dust particles containing the organism, or those who drink unpasturized milk from infected animals

Front 77

What is ornithosis (psittacosis)?

Back 77

1) Caused by an organism of the genus chlamydia
2) Tansmitted by inhalation of dried excretia of infected birds.

Front 78

What is pneumocystis carinii pneumonia?

Back 78

1) Most common opportunistic infection in AIDS patients (also occurs in other types of immunodeficiency)
2) Caused by P. carinii, usually classified as a protozoan
3) diagnosed by morphologic demonstration of the organism in biopsy or bronchial washing specimens.

Front 79

Wht is hospital-acquired G- pneumonia?

Back 79

1) Often fatal and occur in hospitalized patients, usually those iwth serious, debilitating diseases
2) Caused by many G- organisms
3) Endotoxins produced by these organisms play an important role in the infection.

Front 80

What organisms cause hospital-acquired G- pneumonia?

Back 80

1) Klebsiella
2) Pseudomonas aeruginosa
3) Escherichia coli

Front 81

What is a lung abscess?

Back 81

1) Localized area of suppuration within the parenchyma
2) Usually resulting form bronchial obstruction (often cancer)
3) From aspiration of gastric contents
4) May be a complication of bacterial infection.

Front 82

In what patients is lung abscess seen?

Back 82

Especially in patients predisposed to aspiration by loss of consciousness from alcohol or drug overdose neurologic disorders, or general anesthesia.

Front 83

What organisms cause lung abscess?

Back 83

1) Staphyoccus
2) Psuedomonas
3) Klebsiella
4) Proteus

Front 84

How is a lung abscess clinically manifest?

Back 84

1) Fever
2) Foul-smelling purulent sputum
3) X-ray evidence of a fluid-filled cavity

Front 85

What are the general characteristics of tuberculosis?

Back 85

1) Occurs worldwide, with greatest frequency in disadvantaged groups
2) Pulmonary form, is spread by inhalation of droplets containing the organism Mycobacterium tuberculosis
3) In the nonpulmonary form, it is most often caused by the ingestion of infected milk

Front 86

What is primary tuberculosis?

Back 86

1) Initial infection characterized by the primary, or Ghon comples
2) Although granulomatous inflammation is characteristic of both primary and secondary tuberculosis, the Ghon complex is characteristic only of primary tuberculosis
3) The granuloma of tuberculosis is referred to as a tubercle and is characterized by cenral caseous necrosis and often by Langhans giant cells.
4) Calcified lesions are often seen by x-ray
5) Most often asymptomatic
6) Usually does not progress to clinically evident disease

Front 87

What is the Ghon complex?

Back 87

Combination of peripheral subpleural parenchymal lesion and involved hilar lymph nodes.

Front 88

What is secondary tuberculosis?

Back 88

1) Usually results form activation of a prior Ghon complex, with spread to a new pulmonary or extrapulmonary site
2) Characterized clinically by progressive disability, fever, hemoptysis, pleural effusion (often bloody), and generalized wasting

Front 89

What are the pathologic changes of secondary tuberculosis?

Back 89

1) Localized lesions, usually in the apical or posterior segments of the upper lobes. Involvement of hilar lymph nodes is also common
2) Tubercle formation: lesions frequently coalesce and rupture into the bronchi.
3) Caseous contents may liquefy and be expelled, resulting incavitary lesoins.
4) Cavitation is characteristic of secondary, but not primary tuberculosis
5) Caseation is seen in both (a manifestation of partial immunity)
6) Scarring and calcification

Front 90

How does tuberculosis spread?

Back 90

1) Secondary tuberculosis may be complicated by lymphatic and hematogenous spread, resulting in miliary tuberulosis, which is seedig of distal organs with innumerable small millet seed-like lesions.
2) Hematogenous spread may also result in larger lesions, which may involve almost any organ

Front 91

What are examples of extrapulmonary tuberculosis?

Back 91

1) Tuberculous meningitis
2) Potts disease of the spine
3) Paravertebral abscess, or psoas abscess

Front 92

What are immune mechanisms in pathogenesis of tuberculosis?

Back 92

1) Organisms are ingested by macrophages, which process teh bacterial antigens for presentation to CD4 Th1 T cells in teh context of class II MHC molecules
2) CD4+ T cells proliferate and secrete cytokines, attracting lymphocytes adn macrophages
3) Macrophages ingest and kill some of the tubercle bacilli or are morphologically altered to form epithelioid cells and Langhans multinucleated giant cells
4) Causes of caseous necrosis remain obscure by tmost likely include the action of cytokines elaborated by immunologically stimulated cells
5) Delayed hypersensitivity is marked by a positive tuberculin skin tst result. The test is positive in both primary and secondary infection represents hypersensitivity and relative immunity, and usually remains positive throughtout life

Front 93

What is Mycobacterium avium-intracellulare infection?

Back 93

1) Infectionwith nontuberculous mycobacteria
2) Seen most often in patients with AIDS adn other immunodeficiency diseases
3) Often manifest by nonpulmonary involvement

Front 94

How are infections by fungi and fungus-like bacteria caused?

Back 94

1) Usually result form inhalation of the organism or from inoculation through the skin
2) In most instances, are manifest as inflammatory reactions similar to tuberculosis

Front 95

What is acquired atelectasis?

Back 95

Alveolar collapse caused by bronchial obstruction or external compressoin of lung parenchyma by tumors or by pleural accumulation of fluid

Front 96

What is atelectasis neonatorum?

Back 96

1) Failure of alveolar spaces to expand adequately at birth
2) There are two forms

Front 97

What is primary atelectasis neonatorum?

Back 97

1) Failure of initial aeration of the lungs at birth
2) Aleoli remain collapsed and respiration is never fully established
3) Associated with prematurity and intrauterine fetal anoxia

Front 98

What is secondary atelectasis neonatorum?

Back 98

Collapse of previously aerated bronchi

Front 99

What is pulmonary alveolar proteinosis?

Back 99

1) Uncommon and is chaacterized by accumulation of amorphous, PAS-positive material in the alveolar air spaces.
2) This material sometimes appears to be surfactant

Front 100

What is Actinomycosis?

Back 100

1) Actinomyces, G+ anaerobic filamentous bacteria no longer classified as a fungus
2) Abscess and sinus tract formation
3) Exudate containing characteristic sulfur granules, yellow clumps of the organism

Front 101

What is Nocardiosis?

Back 101

1) Nocardia, G+ aerobic filamentous, weakly acid-fast bacteria closely related to actinomyces
2) Typiclaly opportunistic infection
3) May disseminate to the brain and meninges

Front 102

What is Candidiasis?

Back 102

1) Candida albicnas
2) In immunocompromised patients, invasive form produces blood-borne dissemination
3) Pulmonary, renal and hepatic abscesses and vegetative endocarditis.

Front 103

What is Aspergillosis?

Back 103

1) Aspergillus
2) Invasive form has predilection for growth into vessels, with consequent widespread hematogenous dissemination

Front 104

What is Histoplasmosis?

Back 104

1) Histoplasma capsulatum
2) Plmonary manifestations similar to tuberculosis
3) Occurs in primary and secondary forms
4) Results in multiple pulmonary lesions with late calcifications
5) Disseminated form, marked by multisystem involvement with infiltrates of macrophages filled with fungal yeast forms

Front 105

What is coccidioidomycosis?

Back 105

1) coccidioides immitis
2) Ocurs in primary and disseminated forms
3) Fungal spherules containing endospores found within granulomas

Front 106

What are the general characteristics of lung cancer?

Back 106

Most lung tumors are malignant; those that arise from metastases from primary tumors elsewhere occur more frequently than those that originate in the lung.

Front 107

What is Bronchogenic carcinoma?

Back 107

1) The leading cause od death from cancer in both men and women.
2) Increasing in incidence, especially in women, in parallel with cigarette smoking.
3) Directly proportional in incidence to the number of cigarettes smoked daily and to the number of years of smoking
4) Preceded in cigarette smokers by various histologic changes, including squamous metaplasia of the respiratory epithelium, often with atyical changes ranging from dysplasia to carcinoma in situ.

Front 108

What are other etiopathogenic factors leading to bronchogenic carcinoma?

Back 108

1) Air pollution
2) Radiation; incidence increased in radium and uranium workers
3) Asbestos; increased incidence with asbestos and greater increase with combination of asbestos and cigarette smoking
4) Industrial exposure to nickel and chromates

Front 109

What are the clinical features of bronchogenic carcinoma?

Back 109

1) 5-year survival rate of less than 10%
2) Manifest clinically by cough, hemoptysis, and bronchial obstruction, often with atelectasis and pneumonitis
3) Often spreads by local extension into the pleura, pericardium, or ribs

Front 110

What is superior vena cava syndrome?

Back 110

1) Compression or invasion of the superior vena cava, resulting in facial swelling and cyanosis along with dilation of the veins of the head, neck, and upper extremities.
2) A syndrome of bronchogenic carcinoma.

Front 111

What is Pancoast tumor?

Back 111

1) Superior sulcus tumor
2) Involvement of the apex of the lung, often with Horner syndrome
3) Due to involvement of the cervical sympathetic plexus
4) Can be associated with bronchogenic carcinoma

Front 112

Wht is horner syndrome?

Back 112

1) Ptosis
2) Anhidrosis
3) Miosis
(PAM is horney)

Front 113

How is hoarseness associated with bronchogenic carcinoma?

Back 113

Recurrent laryngeal nerve paralysis

Front 114

What is pleural effusion involved with bronchogenic carcinoma?

Back 114

1) Often bloody
2) Bloody pleural effusion suggests malignancy, tuberculosis, or trauma

Front 115

What is paraneoplastic endocrine syndrome?

Back 115

1) Most frequently of which is ACTH
2) ACTH-like activity with small cell carcinoma
3) Also of note are the syndrome of inappropriate antidiuretic hormone secretion with small cell carcinoma of the lung and parathyroid-like activity with squamous cell carcinoma

Front 116

How is bronchogenic carcinoma classified?

Back 116

1) Squamous cell carcinoma
2) Adenocarcinoma (including bronchioloalveolar carcinoma)
3) Small cell carcinoma
4) Large cell carcinoma
5) All share a common endodermal origin despite their morphologic differences.

Front 117

How do the classifications of bronchogenic carcinoma relate to therapy?

Back 117

1) Small cell carcinoma is NOT amenable to surgery
2) Non-small cell carcinoma IS considered

Front 118

What is squamous cell carcinoma?

Back 118

1) Centrally located
2) Appears as a hilar mass adn frequently results in cavitation
3) Clearly linked to smoking
4) May be marked by inappropriate parathyroid hormone (PTH)-like activity wiht resultant hypercalcemia

Front 119

What is Adenocarcinoma (bronchial-derived)?

Back 119

1) Peripherally located
2) Develops on site of prior pulmonary inflammation or injury (scar carcinoma)
3) Less clearly linked to smoking

Front 120

What is adenocarcinoma (bronchioloalveolar)?

Back 120

1) Peripherally derived
2) Less clearly related to smoking
3) Columnar-to-cuboidal tumor cells line alveolar wals
4) Multiple densities on x-ray mimicking pneumonia

Front 121

What is small cell carcinoma?

Back 121

1) Centrally located
2) Undifferentiated tumor
3) Most aggressive bronchogenic carcinoma
4) Least likely form to be cured by surgery
5) Usually already metastatic at diagnosis
6) Often associated with extopic production of corticotrophin (ACTH) or antidiuretic hormone (ADH)
7) Incidence greatly increases in smokers

Front 122

What is large cell carcinoma?

Back 122

1) Peripheraly located
2) Undifferentiated tumor
3) May show features of squamous cell or adenocarcinoma on electron microscopy

Front 123

What is carcinoid?

Back 123

1) Carcinoma of the major bronchi
2) Low malignancy
3) Spreading by direct extension into adjacent tissues
4) May result in carcinoid syndrome

Front 124

carcinoma metastatic to the lung compare to bronchogenic carcinoma in frequency?

Back 124

Mets to the lung have higher incidence than primary lung cancer