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