Terms in this set (91)
What is the most common cause of rhinitis?
What type of hypersensitivity reaction is allergic rhinitis?
Type I Hypersensitivity
What should you suspect in a child with a nasal polyp?
Aspirin-intolerant asthma triad
asthma, aspirin-induced broncospasms, nasal polyps
Who gets angiofibromas?
What virus is nasopharyngeal carcinoma associated with?
Classic presentation of nasopharyngeal carcinoma
-African kids or Chinese adults
-biopsy revealing pleomorphic keratin-positive epithelial cells
________________ is the most common cause of acute epiglottitis
H.influenzae type b
-upper airway inflammation
-parainfluenza virus most common cause
-bilateral vocal cord nodule
-due to excessive use
-improves with rest of vocal cords
What virus causes laryngeal papillomas?
HPV 6 and 11
benign papillary tumors that are usually single in adults and multiple in children
What are the main risk factors for laryngeal carcinoma?
alcohol and tobacco
What organisms most commonly cause lobar -pneumonia?
Classic gross phases of lobar pneumonia
2. red hepatization
3. gray hepatization
What type of pneumocytes act as stem cells?
Type II pneumocytes act as stem cells and help regenerate lung tissue.
Who is at risk for lobar pneumonia caused by Klebsiella pneumoniae?
-Klebsiella is a part of our enteric flora
-at risk groups are those who are at risk for aspiration, malnourished or debilitated
-nursing home patients, alcoholics, diabetics
How would you describe the sputum of a pneumonia caused by Klebsiella pneumoniae?
Klebsiella causes a thick mucoid capsule so you would expect to see a gelatinous sputum
Why is interstitial pneumonia considered atypical?
Because it presents with mild upper respiratory Sx, minimal sputum and a low fever
Which of these infections can be due to an viral agent - lobar pneumonia, bronchopneumonia or interstitial pneumonia?
interstitial pneumonia can be due to a viral or bacterial agent.
What is the most common cause of atypical pneumonia in adults? Infants?
-Mycoplasma pneumoniae in adults
-RSV in infants
Complications of mycoplasma pneumoniae
-autoimmune hemolytic anemia
What commonly causes atypical pneumonia in patients with posttransplant immunosuppressive therapy?
Primary tuberculosis histology
-caseating necrosis of lower lobe and hilar lymph nodes
-Ghon complex (subpleural)
-fibrosis and calcification
Primary TB presentation
What disease is often accompanies reactivation of TB (secondary TB)?
Where is secondary TB most likely to spread to?
-kidneys (sterile pyuria)
-meninges/base of the brain (meningitis)
-cervical lymph nodes
-bones/lumbar vertebrae (Pott's disease)
- hallmark: decreased FEV1/FVC ration
Describe the submucosa of chronic bronchitis
-hypertrophy of bronchial mucinous glands
-Reid index of 50% or more
chronic bronchitis is often associated with an irritant such as smoking; increased mucus production helps patients remove pollutants
Chronic bronchitis is a clinical diagnosis. What do you expect to see?
-productive cough with excessive mucus
-cyanosis (blue bloaters)
-increased risk of infection and cor pulmonale
destruction of alveolar sacs
How does emphysema cause airway obstruction?
-destruction of alveolar sacs leads to loss of elastic recoil (alveolar walls usually help hold open the airways)
-airways collapse during exhalation
-obstruction and air trapping
An imbalance of what is seen in emphysema?
proteases and antiproteases
What is the most common cause of emphysema?
Function of alpha1-antitrypsin (A1AT)
Smoking causes __________________ emphysema
affects the upper lobes
A1AT deficiency causes _______________ emphysema
affects lower lobes
A1AT deficiency liver biopsy
pink, PAS positive globules in hepatocytes
normal A1AT allele
most common A1AT allele mutation
How does the breathing of emphysema patients present clinically?
Prolonged expirations with pursed lips
Describe the x-ray finding of emphysema
increased anterior-posterior diameter
What type of hypersensitivity reaction is asthma?
Type I hypersensitivity
What interleukins are secreted by T-helper (Th) 2 cells?
IL 4, IL 5, IL10
mediates class switch to IgE
stimulates Th2 cells and inhibits Th1 cells
Findings associated with the mucus of asthmatic patients
-Curschmann spirals (spiral-shaped mucus plugs)
-Charcot-Leyden crystals (eosinophil derived)
Non-atopic causes of asthma
exercise, viral infection, aspirin, occupational exposures
-permanent dilatation of bronchioles and bronchi
-loss of airway tone
causes of bronchiectasis
-necrotizing inflammation damage to airways
-includes: cystic fibrosis, Kartagener syndrome, tumor, foreign body, infection, allergic bronchiopulmonary aspergillosis
clinical finding of bronchiectasis
-hypoxemia with cor pulmonale
-secondary (AA) amyloidosis
restrictive disease spirometry
-decreased TLC, FEV1, FVC
-increased FEV1/FVC ratio
CT finding of diffuse, end-stage interstitial pulmonary fibrosis
interstitial fibrosis due to occupational exposure
Coal Workers' pneumoconiosis - pathological findings
-Caplan syndrome (rheumatoid arthritis)
mild exposure to carbon (e.g. living in a big city); not clinically significant
only pneumoconiosis associated with increased risk for TB
pneumoconiosis associated with berryllium miners and aerospace industry
Which is a more common complication of asbestos exposure - mesothelioma or lung carcinoma?
lesions containing long, golden-brown fibers with associated iron
noncaseating granulomas in multiple organs, but most commonly hilar lymph nodes and the lung
Which pneumoconiosis has similar pathologic findings as sarcoidosis?
granulomas in sarcoidosis include ___________ bodies
tissues commonly involved in sarcoidosis
uvea, skin, salivary and lacrimal glands
sarcoidosis clinical presentation
usually spontaneously resolves
may use steroids
mean arterial pressure of more than 25mmHg in the pulmonary circuit
Pulmonary hypertension - histology
-smooth muscle hypertrophy of pulmonary arteries
mutation seen in familial forms of pulmonary hypertension; leads to proliferation of vascular smooth muscle
Causes of secondary pulmonary hypertension
-recurrent pulmonary embolisms
-increased volume in pulmonary circuit
"white out" on CXR
acute respiratory distress syndrome
surfactant is made by _________________________
type II pneumocytes
What is surfactants role in respiratory health?
surfactant decreases surface tension in the lung, preventing collapse of alveolar air sacs after expiration
acute respiratory distress syndrome
diffuse damage to alveolar-capillary interface
neonatal respiratory distress syndrome
respiratory distress due to inadequate surfactant levels
major component of surfactant
conditions associated with neonatal RDS
-prematurity (L:S ratio <2)
-caesarian section delivery
Complications of neonatal RDS
-risk of free radical injury
What is the most common cancer mortality in the U.S.?
especially mutagenic components of cigarrettes
polycyclic aromatic hydrocarbons and arsenic
what is revealed in the imaging of a lung cancer patient?
coin lesion (solitary nodule)
benign lung coin lesions in younger patients
two categories of lung carcinoma
small cell carcinoma (15%) and non-small cell carcinoma (85%)
What are the Tx differences between small cell and non-small cell carcinoma?
-small cell: not amenable by resection, needs chemo
-nonsmall cell: needs surgical resection; chemo resistant
accumulation of air in the pleural space
rupture of an emphysematous bleb
direction of trachea movement in spontaneous pneumothorax
trachea moves to the side of the collapsed lung
arises with penetrating chest wall injury -->air can enter pleural space, but cannot exit
direction of trachea movement in tension pneumothorax
trachea is pushed opposite to the side of injury