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respiratory pathology
n/a
31
Medical
Graduate
09/24/2012

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Cards

Term
def atelectasis
Definition
atelactasis = collapse of the lung

-no air exchange
-it becomes a "culture plate" for bugs
-most common cause of fever post op
Term
physical exam findings of atelectasis/solid lung
Definition
in a solid lung:

^conduction of vibration and sound
^tactile fremitus
^whisper pectoriloquy
^egophany E-->A
Term
bugs that cause rusty colored sputum
Definition
strep pneumo

klebsiella (bloody and mucoid), alcoholics

staph - abscess that gets bloody
Term
final location of aspiration contents based on body position
Definition
standing/sitting: RLL posterior basal segment

laying on back: RLL superior segment

laying on R side: RML, RUL
laying on L side: lingula
Term
major causes of atypical pneumonia
Definition
atypical pneumo = interstitial pneumonitis w/o consolidation, "walking pneumonia"

1. mycoplasma-->cold agglutinins! (IgM)
2. chlamydia pneumo
3. any virus (esp RSV in kids, CMV in immcomp)
Term
ddx of lung granuloma --> how to test
Definition
TB --> acid fast stain
fungus --> silver stain
foreign body --> polarized light
Wegners --> C-ANCA
Sarcoid <-- a dx of exclusion one all of the above ruled out
Term
dissemination of TB
-miliary spread (tropism)
Definition
KIDNEYS are most common site outside of the lung

cervical LN (scrofula), larynx (most contagious), liver/spleen, adrenals (Addisions), terminal ileum, lumbar vertebrae (Psoas signs), bone marrow, fallopian tubes, epididymis
Term
some common features of sarcoidosis
Definition
non-caseating granulomas in ANY organ
-hilar and mediastinal adenopathy

red skin bumps = erythema nodosum (strong association with granulomatous disease)

elevated ACE and calcium (the granuloma activates Vit D)

bx: schaumann bodies (calcification), stellate bodies
Term
etiology of the "blue bloater"
Definition
refers to a COPD patient with chronic bronchitis (most common COPD cause)

BLUE: mucus (hyperplasia of goblet cells) plugs up everything so the terminal bronchioles can't engage in air exchange...cyanosis

BLOATER: 2ndary pulm htn leads to R heart failure (cor pumonale)...edema
Term
etiology of the "pink puffer"
Definition
refers to a COPD patient with emphysema

better O2 exchange than chronic bronchitis pts, so not cyanotic = PINK

breath through pursed lips (make their own PEEP) and increased use of accessory muscles of respiration = PUFFER
Term
etiology of emphysema
Definition
destruction of alveolar septa resulting in enlarged air spaces and loss of elastic recoil

imbalance of proteases (ELASTIN) and antiprotease (alpha-1-antitrypsin)

elastase is produced my NF and macrophages in response to irritation/stimulation from smoke and pollution
Term
centriacinar/centrilobular COPD
Definition
most common type

associated with smoking, air pollution

worst in apical segments of UL (smoke rises)
Term
panacinar/panlobular COPD
Definition
usually from alpha-1-antitrypsin deficeient

everything gets broken down because there is no protection

entire lung involvement, worse in the bases of LL bc tere is more injury there due to more blood flow
Term
micro of asthma sputum
Definition
Curschmann spirals - twisted mucous plugs

eosinophils

Charcot-Leyden crystals
Term
def bronchiectasis
Definition
an abnormal permanent airway dilation due to chronic necrotizing inflammation

cough, fever, malodorous purulent sputum, dyspnea

#1 cause = CF
Term
triad of Kartagener syndrome
Definition
1. bronchiectasis/pneumonias/lung infections
2. chronic sinusitis
3. situs inversus (infertility from immobile sperm, on CXR look for stomach bubble to be on opposite side)

WHY? AR condition of immotile cilia bc of DYEIN arm defect
Term
the role of pneumocytes in ARDS
Definition
diffuse alveolar damage from shock, *SEPSIS*, trauma, GI aspiration, radiation, drugs, infection, etc kills the thinner and weaker type 1 pneumocytes

hyaline membrane formation composed of cellular debris of dead pneumocytes

type 2 pneumocytes important in repairing lung injury - hyplerplasia, reline alveoli, flatten out to a type 1
Term
pneumoconiosis
-def
-presentation
-CXR findings
Definition
fibrosing pulmonary diseases caused by inhalation of an aerosol

all present with dyspnea on exertion and dry cough

CXR showing thickening of septa (fibrosis) and restrictive pulmonary function tests
Term
pneumoconiosis of coal worker
Definition
from ANTHRACOSIS, a carbon pigment in coal that accumulates on the macrophages along the pleural lymphatics and interstitium

-simple:black lung disease. black lungs and sputum

-complicated:progressive massive fibrosis that can lead to secondary pulm htn and cor pulmonale
Term
Caplan syndrome
Definition
pneumoconiosis accompanied by rheumatoid arthritis
Term
asbestosis
Definition
pneumoconiosis with a variety of environmental/occupational exposures:

shipyard worker, insulation, construction, brake-lining, flame retardants

diffuse interstitial fibrosis most severe in LL

ferruginous bodies - needle shaped with iron coating
Term
asbestosis cancer correlations
Definition
bronchocarinoma - most common
synergistic effect with smoking

malignant mesothelioma - rare, but strong association
recurrent pleural effusions, tumor grossly encases and compresses the lung
Term
silicosis
Definition
pneumoconiosis from silicon dioxide (silica exposure)
-sandblasters, metal grinders, ceramics)

"sinister silicosis" - this is the worst one, most toxic

dense nodular fibrosis of the UL
Term
bronchiogenic carcinoma
Definition
-leading cause of cancer death in men and women
-primary lung cancer
-SMOKING
-hemoptysis

ADENOCARCINOMA, BRONCHIOLALVEOLAR CARCINOMA, SQUAMOUS CELL CARCINOMA, SMALL CELL CARCINOMA, LARGE CELL CARCINOMA
Term
genetics of bronchiogenic carcinoma
Definition
mutation of L-myc oncogene (small cell - Little Lung ca)

mutation of K-ras oncogene (adenocarcinoma)

tumor suppressor gene mutations: p53, RB
Term
adenocarcinoma
Definition
#1 type of lung cancer, both smokers and non-smokers
less smoking associations than other lung cancers

F>M

peripheral gray-white mass with pleural puckering

-->bronchioloalverolar carcinoma is a subset of this that arises from terminal brochioles or alveolar walls
Term
squamous cell carcinoma
Definition
strongly associated with smoking, M>F

bronchial epithelium: metaplasia-->dysplasia-->carcinoma insitu-->invasive carcinoma

centrally located grey-white bronchial mass, invasive nests of squamous cells with keratin pearls

(swashbuckling squamous cells of the carribean, pink pearl)
Term
features of INVASIVE cancers
Definition
to be invasive, a cancer must make collagenase 4

why?

bc all basement membranes contain type four collagen and thus need that metalloprotease to invade and spread
Term
small cell (oat cell) carcinoma
Definition
STRONGEST association with smoking, M>F

very aggressive, rapid growth and early dissemination

a neuroendocrine tumor, associated with many paraneoplastic syndromes

central, grey-white masses; small round/polygonal cells in clusters
Term
large cell carcinoma
Definition
very rare and aggressive

large anaplastic cells w/o evidence of differentiation

makes a lot of beta-hcg, can get gynecomastia
Term
vena cava syndrome
Definition
intrathoracis spread of lung cancer causing obstruction of the SVC

distended head and neck veins, plethora (red and swollen from the nipples up), facial and upper arm edema

usually from small cell or squamous cell
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