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56 Cards in this Set
- Front
- Back
What microscopic structure is involved in restrictive lung diseases?
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this has damage to BM of endothelial and epithelial cells
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What are the common clinical features of restrictive lung disease?
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FVC is decreased
FEV: FVC ratios are normal (the lung is smaller, but everything works as it should) Abnormal ventilation to perfusion ratio---HYPOXIA* Dyspenia, tachypnea, END inspiratory crackles |
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What are the two CXR pattern to recognize for Diffuse intersitial diseases?
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Ground Glass pattern (think frosted glass areas)
Reticulonodular pattern- small nodes with irregular lines Honeycomb lung- advanced |
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What happens to the alveolar septae in intersisital fibrosis?
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they become seriously thickened** and FIBROUS
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What should the blood gasses be like for a person with intersitial lung disease?
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Low pO2
Low O2 sat% |
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What is the morphology of Idiopathic Pulmonary Fibrosis?***
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this is a the clinical symptoms, with the morphology of usual interstitial pneumonia (peppo!)
On biopsy: Fibroblasts, Hyperplastic type II pneumoctes On CXR: honeycombing Cobble stone pleural surface*** |
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What chemical mediators of Idiopathic pulmonary fibrosis cause disease?
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Inflamamtion's Th2, IL-4, IL-13
TGF-Beta-1 |
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What is TGF-B1's role in Idiopathic pulmonary fibrosis?
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TGF-B1 is released from injured type 1 pneumocytes, this transforms fibroblasts into myofibroblasts
inhibits telomerase, causes apoptosis of pneumocytes |
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What is the clinical course of IPF? Signs?
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40-70 years old
Gradual progression Dry or Velcro crackles on inspiration Hypoxia |
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What does Caveolin do?
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this usually inhibits fibrosis, but it is taken out by TGF-B1 in IPF
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What is the clinical behavior of COP? (cryptogenic organizing pneumonia)
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cough, dyspenia,
subpleural or peribronchial patchy airspace consolidation* |
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What four vascular diseases are associated with pulmonary fibrosis?
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SLE
Rhemuatoid Scleroderma Dermatomyositis |
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What causes coal workers pneumoconiosis?
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being derek zoolander for a day "i think ive got the black lung pop!"
or carbon (not coal) dust |
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Do people with black lung have increased risks of cancer or TB?
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Nope they do not
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What three diseases can you get from Black lung, and how bad are they?
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Anthracosis- no problems
Simple coal workers pneumoconiosis- little/no dysfunction, less than 10% progress Complicated coal workers pneumoconiosis- respiratory compromise |
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What is Anthracosis?
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accumulation of black carbon pigment in the lungs.
causes my macrophages taking up junk, and migrating to perilymphatic lung, pleura, and hilar lymph nodes |
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What is Caplans syndrome?
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Lung disease of Rheumatoid arthritis AND pneumoconiosis at the same time!
progresses rapidly |
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What is the most common chronic occupational disease...in the world?
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silicosis
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What form of silica is the worst?
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crystalline form-quartz
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How does silicosis damage your lungs?
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SiOH are rich in free radicals,
these bind with epithelial cell membrane phospholipids. causing damage. Macrophages that have ingested silica are activated and release TNF/IL-1 to cause fibrosis |
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What are the clinical features of chronic silicosis?
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NODULES in upper lobes (because its inhaled, yah?)
These may cavitate Progressive Massive Fibrosis (scars up to 10cm in diameter)- which causes dyspnea Calcification polarized birefrigent material in nodules. (has two different kinds of refraction) |
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If you have silicosis, what are you at increased risk for?**
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TB!!
Caplan's syndrome (but not cancer) |
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What are the five types of asbestos related disease?
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Asbestosis (fibrosis)
Pleural plaques Pleural effusions Bronchogenic carcinoma Mesothelioma |
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What types of asbestos are most associated with mesothelioma?
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Amphiboles
straight, brittle, insoluble fibers |
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How does asbestos causes disease?
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Fibers generate free radicals, absorb and hold toxic chemicals
Macrophages try and eat these fibers, and become Activated**, which then release fibrogenic factors** |
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What are the rod forms of asbestos in the lungs called? what do they look like?
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Ferruginous bodies
-golden-brown, fuiform, or breaded rods coated by iron containing protein |
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What is the most common manifestation of Asbestos?
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Pleural Plaques
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What does the patter of diffuse pulmonary fibrosis due to asbestos look like?
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Honeycomb
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What two cancers have a high association with asbestos?
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bronchogenic carcinoma
mesothelioma |
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What three drugs/therapies are associated with Pulmonary fibrosis
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Bleomycin, Busulfan *** (have been in two lectures)
Radiation- (looks like ARDS, up to 6 months post rads Tx) |
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What is sarcidosis?
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this is multisystem disease, of UKO.
causes noncaseating (hard) granulomas in many tissues |
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What are the main signs of Sarcoidosis on Xray?
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Bilateral hilar lymphadenopathy***
, or lung involvement. Pulmonary infiltrates 1-2cm granulomas producing restrictive lung disease |
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DO NOTE the difference between silicosis, and sarcoidosis in the lungs- they both have round spots in the lung...
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BUT silicosis is collagenous, and doesnt have cells (nuceli) in the center of it
ANd Sarcoidosis is a typical granuloma, giant cells, neutrophils and all that goodness in the granuloma |
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What is the typical pt with sarcoidosis?
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black woman, 20-40, in southeastern USA
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What is the immunologic basis of sarcoidosis?
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Type IV cell mediated immune response to unknown antigen
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What systemic immunologic abnormalities are found in sarcoidosis?
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Anergy to skin test antigens
polyclonal hypergammaglobulinemia |
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What are asteroid bodies?
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these are stellate structures within giant cells, found in sarcoidosis
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what are schaumann bodies?
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these are concretions that are found in sarcoidosis
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What are the skin lesions associated with sarcoidosis?
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Skin plaques and nodules
Lupus perino- violaceous, scaling plaques Erythema nodosum- a hypersensitivity vasculitis |
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Because Sarcoidosis is usually a Dx of exclusion, what should you rule out?
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other causes of granulomas, like TB and fungus
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What are the LAB tests for sarcoidosis?
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lymphocytoepnia;s
anemia hypercalcemia polyclonal gammapathy HIGH ACE (angiotensin converting enzyme) for active sarcoidosis |
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What causes hypersensitivity pneumonitis?
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immunologically mediated intersitial lung disorders.
causes by Type III hypersensitivity |
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although hypersensitivity pneumonitis is type III, what can it turn into in 2/3rds of cases?
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this turns into Type IV interstitial NONcaseating granulomas
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What are the typical signs of hypersensitivity pneumonitis?
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intersitial pneumonitis
fibrosis noncaseating granulomas Sx's occur 4-6 hours after exposure |
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What are the clinical features of hypersensitivity penumonitiis?
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symptoms 4-6 hours post exposure.
leukocytosis, cough, dyspnea Diffuse nodular infiltrates on X-ray Restrictive FEV:FVC resolves in 24 hours usually |
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What is the morphology and clinical of berylliosis?
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noncaseating granulomas in pleura, septa, and bronchovasuclar tissue.
cancer risk |
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What are the signs of pulmonary eosinophilia?
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eosinophilia on CBC
fever, night sweats, abnormal CXR |
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What things can cause pulmonary eosinophilia?
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parasites
fungi drug allergies aserpgillosis PAD asthma hypersensitivity pneumonitis |
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What causes desquamative intersitial pneumonia?
What characterizes it ? |
smoking related
Smokers macrophages in the alveoli |
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How is DIP treated?
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this responds well to corticosteroids
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What causes acquired pulmonary alveolar proteinosis?
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antibodies to GM-CSF, an autoimmune reaction.
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What are the clinical signs of Pulmonary alveolar proteinosis?
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insidious cough onset.
Production of abundant GELATINOUS MATERIAL, sometimes in chunks (on microscope, looks like hyaline material everywhere....tons of pink crap in every alveoli- PAS positive) |
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What is the Tx for pulmonary alveolar proteinosis?
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whole lung lavage, flush that crap out
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how does smoking related to on the job injuries?
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they are increased in smokers!
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What is Cotinine?
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this is the oxidative metabolite of nicotine.
Specific and sensitive for nicotine exposure |
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What are the LAB tests** seen in smokers?
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INCREASED everything..
glucose catecholamines/cortisol FFA's WBC's Carcinoembryonic antigen carboxyhemoglobin polycythemia |