Path pulmonary

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Path pulmonary
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  1. ATELECTASIS
    collapse. loss of lung volume due to inadequate expansion of airspace
  2. Resorption atelectasis
    occurs when obstruction prevents air from reaching distal airways. Air already present gradually becomes absorbed, and alveolar collapse follows
  3. most common cause of resorption atelectasis
    obstruction of a bronchus by a mucous or mucopurulent plug
  4. resorption atelectasis most commonly occurs...
    postoperatively but may also complicate bronchial asthma, bronchiectasis, chronic bronchitis, tumors, vascular aneurysms, enlarged lymph nodes or the aspiration of foreign bodies, particularly in children
  5. compression atelectasis
    passive or relaxation atelectasis. accumulations of fluid, blood, or air within the pleural cavity, which mechanically collapse adjacent lung
  6. common causes of compression atelectasis
    • Frequent occurrence w/ pleural effusions, caused most commonly by CHF.
    • Leakage of air into the pleural cavity (pneumothorax)
    • Basal atelectasis resulting from elevated position of diaphragm commonly in bedridden pts, in pts with ascites, and in pts during and after surgery
  7. Micro-atelectasis (nonobstructive atelectasis)
    generalized loss of lung expansion
  8. common causes of Micro-atelectasis (nonobstructive atelectasis)
    loss of surfactant, acute respiratory distress syndrome (ARDS), interstitial inflammation, post-surgical
  9. Contraction atelectasis
    occurs when either local or generalized fibrotic changes in the lung or pleura hamper expansion and increase elastic recoil during expiration
  10. only type of atelectasis that is NOT reversible
    contraction atelectasis
  11. Hyaline membranes lining distended alveolar ducts and neutrophils (if lung injury) are seen in...
    acute respiratory distress syndrome
  12. ratio of FEV1 to FVC is characteristically decreased
    obstructive dz: emphysema, chronic bronchitis, asthma, and bronchiectasis
  13. chest wall disorders in presence of normal lungs (severe obesity, dz of pleura, & neuro-muscular dz, such as Guillain-Barré syndrome, that affect respiratory muscles)
    restrictive dz
  14. FEV1 to FVC is near normal
    Restrictive lung dz
  15. Interstitial infiltrates are found in...
    acute and chronic interstitial lung dz (restrictive dz)
  16. classic acute restrictive dz
    acute respiratory distress syndrome
  17. chronic restrictive dz
    pneumoconioses, interstitial fibrosis, sarcoidosis
  18. 2 groups of emphysema pts
    Non bronchitic pts are pink puffers because they have oxygenated Hb w/ dyspnea.

    Bronchitic pts are blue bloaters because they have no prominent dyspnea/respiratory effort à retain CO2 à hypoxic & cyanotic. Pts tend to be obese
  19. centriacinar emphysema
    involves central/proximal parts of acini, mainly upper lobes affected, common in smokers
  20. panacinar emphysema
    more common in those w/ alpha 1 antitrypsin deficiency. involves lower lung zones, acini are uniformly enlarged from the level of the respiratory bronchiole to terminal blind alveoli
  21. Distal Acinar (Paraseptal) Emphysema
    proximal portion of the acinus is normal but the distal part is primarily involved
  22. distal acinar emphysema characteristics





    i.
    emphysema is more striking adjacent to the
    pleura, along the lobular connective tissue septa, and at the margins of the
    lobules


    ii.
    adjacent to areas of fibrosis, scarring, or
    atelectasis and is usually more severe in the upper half of the lungs


    iii.
    cystlike structures referred to as bullae.

    probably underlies many cases of spontaneous
    pneumothorax in young adults

    emphysema is more striking adjacent to the pleura, along the lobular connective tissue septa, and at the margins of lobules. adjacent to areas of fibrosis, scarring, or atelectasis and is usually more severe in the upper half of the lungs bullae.
  23. almost invariably assoc w/ scarring. May be the most common form of emphysema
    irregular emphysema
  24. compensatory emphysema
    compensatory dilation of alveoli in response to loss of lung substance elsewhere
  25. produces large subpleural blebs or bullae. They represent localized accentuations of one of the emphysemas, are most often subpleural, and may rupture leading to pneumothorax
    bullae emphysema
  26. emphysema that may occur spontaneously w/ sudden incr in intra-alveolar pressure (vomiting or violent coughing) that causes a tear. Sometimes
    in children w/ whooping cough. Pts on respirators who have partial bronchiolar obstruction or in persons who suffer a perforating injury
    mediastinal (interstitial) emphysema
  27. chronic bronchitis criteria
    persistent productive cough for at least 3 consecutive months in at least 2 consecutive years
  28. Common at night and/or early in morning. attacks last from 1 to several hours. Thickening of basement membrane of bronchial epithelium. Hypertrophy of bronchial muscle walls
    asthma
  29. histological diagnostic features of asthma
    Curschmann spirals and Charcot-Leyden crystals
  30. Bronchospasm is much more severe and sustained. A positive family history is uncommon, serum IgE levels are normal, and there are no associated allergies
    Non-atopic asthma
  31. drug induced asthma
    usually aspirin. recurrent rhinitis and nasal polyps, urticaria, and bronchospasm
  32. permanent dilation of bronchi & bronchioles (may be to pleural surfaces) caused by destruction of muscle & elastic supporting tissue
    bronchiectasis
  33. affecting lower lobes bilaterally, resulting from or associated w/ chronic necrotizing infections (may lead to abscess)
    bronchiectasis
  34. features of bronchiectasis
    • desquamation of lining epithelium --> extensive areas of ulceration
    • peribronchialar fibrosis
    • severe, persistent cough with expectoration of mucopurulent, sometimes fetid, sputum. The sputum may contain flecks of blood; frank hemoptysis can occur
  35. bronchial obstruction subtype of bronchiectasis caused by...
    Congenital or hereditary conditions(Kartagener’s and cystic fibrosis)
  36. conditions that predispose people to bronchiectasis
    Necrotizing, or suppurative, pneumonia: Staph aureus or Klebsiella spp.. childhood pneumonias that complicated measles, whooping cough, and influenza. TB.
  37. In full-blown active case, an intense acute and chronic inflammatory exudate within the walls of bronchi and bronchioles and the desquamation of lining epithelium cause extensive areas of ulceration
    bronchiectasis
  38. mixed flora of bronchiectasis
    staphylococci, streptococci, pneumococci, enteric organisms, anaerobic and microaerophilic bacteria, and (particularly in children) Haemophilus influenzae and Pseudomonas aeruginosa.
  39. reduced compliance, hypoxia, Chest radiographs show diffuse infiltration by small nodules, irregular lines, or "ground-glass shadows."
    diffuse interstitial (restrictive) dz
  40. most chronic restrictive lung diseases, irrespective of etiology, shows up as
    diffuse interstitial pulmonary fibrosis with or without honeycombing
  41. earliest common manifestation is alveolitis --> proliferation of fibroblasts
    diffuse interstitial (restrictive) lung dz. progressive interstitial fibrosis
  42. diffuse interstitial fibrosis. Males are affected more often than are females, pts older than 60
    Idiopathic pulmonary fibrosis, also known as cryptogenic fibrosing alveolitis. also called usual interstitial pneumonia.
  43. Idiopathic pulmonary fibrosis or usual interstitial pneumonia
  44. usual interstitial pneumonia
  45. Sarcoidosis. more common in African Americans and Scandinavians. Hilar lymphadenopathy
  46. Asteroid bodies are found in...
    sarcoidosis. more common in African Americans and Scandinavians. Hilar lymphadenopathy
  47. extrinsic allergic alveolitis. Goes away when leaves site of exposure

    Bird fancier’s lung
    Air conditioner/hot tub lung
    Farm’s (silo fillers) lung
    Byssiniosis
    Suberosis
    hypersensitivity pneumonia
  48. acute eosinophilic pneumonia
    Rapid onset fever, dyspnea, hypoxia, pulmonary infiltrates. Bronchoalveolar lavage: 25% eosinophils
  49. Loffler’s syndrome (simple pulmonary eosinophilia)
    eosinophilia in blood, transient pulmonary lesions. benign
  50. tropical eosinophilia
    Infection with microfilirial parasites
  51. idiopathic chronic eosinophilia
    High fever, night sweats, dyspnea. Lymphocytes & eosinophils within alveolar spaces, septal wall
  52. Idiopathic pulmonary fibrosing conditions
    usual interstitial pneumonia, pneumonia, collagen vascular dz, Pneumoconiosis
  53. granulomatous fibrosing dz
    hypersensitivity pneumonia, sarcoidosis
  54. eosinophilic fibrosing dz
    tropical eosinophilia, acute eosinophilic pneumonia, idiopathic chronic eosinophilia, Loffler’s syndrome (simple pulmonary eosinophilia)
  55. smoking related fibrosing dz
    desquamative pneumonia and Respiratory bronchiolitis
  56. desquamative pneumonia. Ground glass infiltrates predominantly in lower lobes
  57. lymphoid interstitial pneumonia. Rare lymphoplasmacytic infiltrate. Associated w/ collagen vascular disease, dysproteinemia, immunodeficiency, infection
  58. drug associated w/ pneumotitis and fibrosis
    amiodarone
  59. anticancer agent, causes pneumonitis and interstitial fibrosis, as a result of direct toxicity of drug and by stimulating influx of inflammatory cells into alveoli
    bleomycin
  60. pulmonary hypertension in main elastic artery
    atheromas similar to those in systemic atherosclerosis
  61. pulmonary hypertension in medium-sized muscular arteries
    proliferationof myointimal cells and smooth muscle cells, causing thickening of intima and media with narrowing of the lumina
  62. pulmonary hypertension in smaller arteries and arterioles
    thickening, medial hypertrophy, and reduplication of the internal and external elastic membranes.
  63. plexogenic pulmonary arteriopathy
    Individuals w/ severe, long-standing primary pulmonary htn may develop capillary formations, producing a network, or web, that spans the lumens of dilated thin-walled, small arteries
  64. Goodpasture syndrome
    proliferative, usually rapidly progressive, glomerulonephritis & hemorrhagic interstitial pneumonitis. Both renal & pulmonary lesions are caused by Abs against collagen IV
  65. Features of Goodpasture syndrome
    diffuse alveolar hemorrhage, fibrous thickening of the septa, hypertrophy of septal lining cells. hemosiderin, linear pattern of immunoglobulin deposition (usually IgG, sometimes IgA or IgM)
  66. bronchopneumonia
    patchy distribution of inflammation that generally involves more than one lobe
  67. lobar pneumonia
    airspaces of part or all of a lobe are homogeneously filled w/ exudate that can be visualized on X ray lobar or segmental consolidation. Streptococcus pneumoniae (>90%)
  68. Community-acquired acute pneumonia
    S pneumoniae most common. abscess formation, infective endocarditis, meningitis, arthritis, empyema
  69. bronchopneumonic pattern of community-acquired pneumonia
    foci of inflammatory consolidation are distributed in patches thru out 1 or several lobes, most frequently bilateral and basal. Lesions up to 3 or 4 cm in diameter are slightly elevated and are gray-red to yellow
  70. other common causes of community-acquired pneumonia
    H influenza, Moraxella, Staph aureus, Klebsellia pneumonae, pseudomonas, legionella
  71. stages of community-acquired pneumonia
    first stage--congestion, proteinaceous fluid, scattered neutrophils, and many bacteria in alveoli.

    W/in a few days, stage of red hepatization: lung lobe has a liver-like consistency; alveolar spaces are packed w/ neutrophils, red cells, and fibrin.

    In gray hepatization, lung is dry, gray, & firm, cuz red cells are lysed, while fibrinosuppurative exudate persists w/in alveoli.

    Resolution: follows in uncomplicated cases. granular, semifluid debris ingested by macs, coughed up, or organized by fibroblasts growing into it. pleural rxn (fibrinous or fibrinopurulent pleuritis) may resolve or undergo organization, leaving fibrous thickening or permanent adhesions
  72. community-acquired atypical pneumonia
    moderate amts of sputum, absence of consolidation, moderate elevation of WBCs, lack of alveolar exudates. Mycoplasma pneumoniae most common (particularly common among children and young adults). Viruses, including influenza types A and B, respiratory syncytial viruses, adenovirus, rhinoviruses, rubeola, and varicella viruses; Chlamydia pneumoniae and Coxiella burnetti (Q fever)
  73. Acute infections of upper resp (common cold) etiology
    most common pathogens are rhinoviruses, but coronaviruses, respiratory syncytial viruses, parainfluenza and influenza viruses, adenoviruses, enteroviruses, and sometimes even group A β-hemolytic streptococci
  74. More severe forms w/ tonsillitis, marked hyperemia and exudates, occur w/ β-hemolytic strep and adeno-virus infections
    acute pharyngitis
  75. strep tonsilitis can develop into...
    peritonsillar abscesses ("quinsy") or result in post-streptococcal glomerulonephritis and acute rheumatic fever
  76. Acute bacterial epiglottitis is a syndrome predominantly of young children who have an infection of the epiglottis by
    Haemophillus influenza
  77. can result from inhalation of irritants or may be caused by allergic reactions. It may also be caused by agents that produce the common cold and usually involve pharynx and nasal passages as well as the larynx
    acute laryngitis
  78. type of acute laryngitis that shows sloughing and aspiration of the pseudomembrane (causing obstruction of major airways) and absorption of bacterial exotoxins (producing myocarditis, peripheral neuropathy, or other tissue injury)
    diptheritic. inhaled Corynebacterium diphtheriae
  79. types of acute laryngitis
    diptheritic and tuberculosis
  80. laryngotracheobronchitis, more commonly known as croup
    more common in children, most common cause is parainfluenza virus. inspiratory stridor and harsh, persistent cough. secondary bacterial infection, by staphylococci, streptococci, and H. influenzae
  81. benign laryngeal tumors
    vocal cord nodules and laryngeal papilloma (squamous papilloma of larynx)
  82. vocal cord nodules
    smooth, hemispherical protrusions located on true vocal cords. Nodules are composed of fibrous tissue & covered by stratified squamous mucosa. lesions occur chiefly in heavy smokers or singers (singer's nodes), suggesting that they are the result of chronic irritation or abuse
  83. laryngeal papilloma or squamous papilloma of larynx
    benign neoplasm, usually on true vocal cords, that forms a soft, raspberry-like excrescence. Multiple, slender, finger-like projections supported by central fibrovascular cores & covered by an orderly, typical, stratified squamous epithelium. trauma may lead to ulceration that can be accompanied by hemoptysis
  84. laryngeal papilloma or squamous papilloma of larynx
    Papillomas are usually single in adults but are often multiple in children, in whom they are referred to as recurrent respiratory papillomatosis (RRP). Caused HPV types 6 and 11, do not become malignant (rare), and often spontaneously regress at puberty.
  85. 2% of all cancers. It most commonly occurs after age 40 years and is more common in men (7 : 1) than in women
    carcinoma of larynx
  86. persistent hoarseness. Glottic region has a sparse lymphatic supply, and spread beyond larynx is uncommon. supraglottic larynx is rich in lymphatic spaces --> metastasize to regional (cervical) lymph nodes
    carcinoma of larynx
  87. Subglottic tumors tend to remain clinically quiescent, usually presenting as advanced disease. 1/3 die of dz
    carcinoma of larynx
  88. occurs in smokers, alcoholics, and asbestos exposure. typical squamous cell lesions. Tumor develops directly on cords (glottic tumors) in 60% to 75% of cases, but it may arise above the cords (supraglottic; 25% to 40%) or below the cords (subglottic; less then 5%)
    carcinoma of larynx
  89. a certain change in the way the tongue looks. whitish, well-defined mucosal patch caused by epidermal thickening or hyperkeratosis
    leukoplakia
  90. more frequent among older men
    Risk Factors: tobacco, chronic friction, alcohol abuse
    3% - 6% transformation risk to squamous cell carcinoma. Much higher risk of transformation if it is red
    leukoplakia
  91. leukoplakia
  92. Mostly are squamous cell carcinomas. difficulty chewing, asymptomatic, or pain. can be caused by chewing Paan
    oral and tongue cancers
  93. risk factors for oral/tongue cancers
    • Leukoplakia (particularly if it is a reddish leukoplakia)
    • HPV 16 &18 oral sex
    • Tobacco and Alcohol (prognosis is better in HPV patients, compared to tobacco-induced carcinomas)
  94. Waldeyer's ring
    ring of lymphoid tissue in the back of the throat, the nasopharynx. It contains the tonsils, the adenoids
  95. eustachian tube is close to the..
    adenoids. --> otitis media infections
  96. otitis media needs to be treated immediate to avoid..
    meningitis
  97. distinguishing features (for etiology) of pharyngitis
    water blisters = viral cause. Whitish pharynx w/ red specks = bacterial cause
  98. "barking" cough, inspiratory stridor, and hoarseness. It is often worse at night. most commonly between 6 months and 6 years of age. It is almost never seen in teenagers or adults
    Croup (laryngotracheobronchitis)
  99. Croup. Steeple sign is due to epithelial edema --> blocking airway
  100. medical emergency that may result in death if not treated quickly. ... complete blockage of the airway may occur
    epiglottitis
  101. etiology of epiglottitis
    haemophilus influenza B. can be pertussis --> whooping cough
  102. Positive stranded RNA viruses
    • a. small: picorno viruses (Polio, Echo, Coxsackie)
    • b. large: Arboviruses (Equine encephalitis, West Nile encephalitis)
  103. negative stranded RNA virus
    influenza, Parainfluenza (aka Myxovirus, Paramyxovirus; measles)
  104. Double stranded circular RNA viruses
    Rheo virus, Rotavirus (infantile diarrhea)
  105. laryngeal carcinoma
    accts for 25% of head and neck cancer but 1-2% of all cancers. Most prevalent in the 6th and 7th decades of life. 4:1 male predilection. Patients considered cured after being disease free for five years. Most laryngeal cancers reoccur in the first two years
  106. features of progressive respiratory failure in ARDS
    • honeycomb appearance of lung, acute onset of dyspnea, decreased arterial oxygen pressure (hypoxemia) , bilateral pulmonary infiltrates on
    • radiographs, absence of primary left-sided heart failure, caused by damage to the alveolar capillary membrane, most common cause of non cardiogenic pulmonary edema
  107. phases of ARDS
    Exudative phase (0 to 7 days): capillary congestion, necrosis of alveolar cells, alveolar edema and hemorrhage. Alveoli collapse. Fibrin thrombi in capillaries and large vessels. most characteristic finding is hyaline membranes.

    proliferative phase (1 to 3 weeks): proliferation of type II pneumocytes (produces surfactant DPPC). phagocytosis of remnant hyaline membrane

    Fibrotic phases: diffuse interstitial fibrosis (honeycomb lung)
  108. diffuse alveolar dz is the same as
    hyaline membrane dz of the newborn aka- infant respiratory distress syndrome (IRDS)
  109. pts develop ARDS w/in ___ hrs of insult
    72
  110. distal acinar (paraseptal) emphysema
    • bullae formation, upper half of lungs, can lead to spontaneous pneumothorax in young adults, emphysema is more striking adjacent to the pleura,
    • along lobular connective tissue septa, and at the margins of the lobules
  111. carrier is resistant to something in the environment. URIs? TB? Pneumonia? Influenza? Infections generally
    panacinar emphysema. common in those w/ alpha 1 antitrypsin deficiency. lower lobe of lung
  112. chronic bronchitis
  113. early phase of asthma lasts...
    30-60min
  114. late phase asthma lasts...
    4-8hrs
  115. extrinsic asthma more often affects adult or children?
    children
  116. intrinsic asthma more often affects adults or children?
    adults
  117. pulmonary fibrosis
    Alveolitis produces fibroblast proliferation --> destroys distal part of acinus. collagen deposition over time (Trichrome stain). Proximal part becomes dilated
  118. acute hypersensitivity pneumotitis is type ___
    III
  119. chronic hypersensitivty pneumotitis is type
    IV --> granulomatous formation
  120. chronic hypersensitivity pneumotitis
  121. hypersensitivity pneumotitis causes...
    progressive pulmonary fibrosis. Bilateral diffuse soft nodular densities. Reflects inflammation and scarring
  122. pneumoconiosis
    Chronic fibrosis pulmonary disorders caused by dust inhalation. > 40 inhaled minerals cause lung lesions and radiographic abnormalities. Some lead to crippling pulmonary diseases. Restrictive lung dz
  123. silicosis
    • most prevalent chronic occupational disease in world. A dz of sandblaster, mining, ceramic manufacturing, stone cutting. Particles 0.2-2.0 mm are most dangerous. Crystalline silica (silicon dioxide) is more toxic
    • Simple nodular silicosis (most common): Whirled nodule with concentrically arranged collagen Nodules are less than 1 cm
  124. silicosis
  125. acute silicosis
    (uncommon). Diffuse lung fibrosis; no nodules. Due to heavy exposure
  126. coal worker's pneumoconiosis
    Inhalation of coal dust causes anthracosis. Black lung dz. Asymptomatic anthracosis
  127. coal worker pneumoconiosis
  128. simple coal worker's lung
    (nodules): Small lesions (1-4 mm), multiple
  129. complicated coal worker's lung
    (aka. Progressive massive fibrosis): 2 cm or larger
  130. asbestos
    • Chrysotile type is used mostly for commercial use. Amphibole crocidolite has high disease association than crysotile
    • Asbestos (Ferruginous) bodies = coated with iron & protein
  131. asbestos bodies
  132. asbestos bodies
  133. risks associated w/ asbestos fibers
    • Usually present in office & house building materials, pipe (insulation)
    • Cigarette smoking increases the risk of lung cancer (not mesothelioma)
    • Exposed family members: increased cancer risk
  134. asbestos fiber
  135. asbestos-related dz
    • asbestos
    • mesothelioma (pleural & peritoneal)
    • carcinoma of lung
    • pleural plaque
    • diffuse pleural fibrosis
    • benign pleural effusion
    • laryngeal carcinoma
  136. asbestos and pleural plaques
  137. mesothelioma. much later complication of asbestos
  138. Lymphangioleimyomatosis
    • Abnormal smooth muscle proliferation in lungs, lymph nodes, & lymphatics. Growth along blood vessels, lymphatics, and bronchioles
    • Rare interstitial lymphoid dz. Etiology unknown; Possible hormonal control. Women, child-bearing age
    • SOB, cough, spontaneous pneumothorax, cough, hemoptysis, chylous effusion
    • Special histologic stain: HMB-45 (melanoma antigen). May also be estrogen,progesterone receptor positive
  139. asthma morphology
    • peribronchiolar cuffing, whorls of shed epithelium (Curschmann spirals). Charcot-Leyden crystals (collections of crystalloids made up of eosinophil
    • proteins)

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