Respiratory System

Help!

Question

Answer

Congenital anomalies of the respiratory system

agenesis, hypoplasia, cong pulmonary airway malform, tracheal/bronchial atresia/stenosis/fistula, vascular anomalies, foregut cysts, congen lobar overinflation, pulm sequestrations

🗑

Lung Hypoplasia

defective development of both lungs; dec wt/vol/acini; 10% of neonatal autopsies; mc d/t space occupying lesions in uterus, oligo or impaired fetal respiratory movements

🗑

Congenital pulmonary airway malformation (CPAM)

hamartomatous lesion; 1/5000 births; 5 types rated by cyst size; Type 1: mc w/large cysts & good Px; Type 2: medium cysts w/poor Px; (types 3-5 are very rare)

🗑

Pulmonary sequestration

lung tissue w/o connection to airway; blood supplied from aorta (not pulm aa); can be either extralobar or intralobar

🗑

Extralobar lung sequestration

external to lung; may be a/w other congenital anomalies; more common in male babies

🗑

Intralobar lung sequestration

in the lung substance; a/w infection and bronchiectasis

🗑

Atelectasis

**a REVERSIBLE condition**; incomplete expansion or collapse of previously infated lung; 3 Types: (Obstructive/resorption, Compression, Contraction)

🗑

Obstructive/Reabsorption Atelectasis

d/t resorption of air distal to a complete obstruction by foreign body, mucous plug, COPD, post-op; **Trachea shifts TOWARDS AFFECTED LUNG;** No blood flow problems

🗑

Compression Atelectasis

d/t fluid, air, blood or tumor in pleural space (hemo/pneumothoraces); **shift of trachea AWAY from AFFECTED LUNG b/c there is filling of space**

🗑

Contraction Atelectasis

d/t generalized fibrosis and scarring of lung; probably shifts towards affected lung

🗑

Pulmonary Edema

Hemodynamic Edema (vol overload, hypoalbuminemia, nephrotic syndrome, liver dx), Microvascular Injury (infxn, gases, aspiration/near drowning, shock, radiation, drugs/chemicals), Unknown Origin (altitude, CNS trauma); Tx directed at cause (ex CHF d/t LHF)

🗑

Acute Respiratory Distress Syndrome (ARDS)

aka: diffuse alveolar damage, shock lung, acute alveolar/lung injury; diffuse damage of alveolar epithelium/capillaries w/hyaline membranes (edema+debris), progressive respiratory failure, cyanosis, arterial hypoxemia that is unresponsive to O2 therapy

🗑

Conditions a/w ARDS

infection, chemical injury (heroin, meth OD, asprin), physical injury, hematologic conditions (disseminated intravascular coagulation), inhaled irritants, pancreatitis, uremia, cardiopulmonary bypass, hypersensitivity rxns

🗑

Hyaline membrane formation in ARDS

activated PMNs (neutrophils) release cytokines that induce local tissue damage; interstitial and intra-alveolar edema and cellular debris form membrane; interstitial inflammation, loss of type I pneumocytes

🗑

Obstructive Pulmonary Diseases

emphysema, chronic bronchitis, asthma, bronchiectasis

🗑

Obstructive lung disease

1. tumors/foreign bodies; 2. Lung diseases; characterized by inc resistance to air flow d/t partial or complete obstruction at any level; on PFT the TLC is nml to increased w/dec expiratory flow rate;

🗑

Chronic Obstructive Pulmonary Disease (COPD)

persistant and irreversible air flow obstruction including: Chronic Bronchitis and Emphysema

🗑

Emphysema

destruction of alveolar septa resulting in enlarged air spaces and loss of elastic recoil distal to terminal bronchioles; proteases (incl elastase) from PMNs/MQs stimulated by smoke/pollution; antiproteases incl: a-1-antitrypsin; 95% is CENTRILOBAR

🗑

Centrilobar/centriacinar Emphysema

involves blebs/bullae in central (proximal) parts of acini (respiratory bronchioles) in upper/APICAL lobes; black pigment around emphysematous space; d/t smoking & pollution; mc in males; resembles 'Coal Worker's Pneumoconiosis'

🗑

Panacinar (panlobular) emphysema

acini are uniformly enlarged; worse in LOWER lobes; d/t alpha-1-antitrypsin deficiency

🗑

Distal acinar (paraseptal) emphysema

distal acinus involved (proximal is nml); adjacent to pleura in paraseptal CT at lobular margins next to fibrosis/scars/atelectasis; usu limited to UPPER HALF of lung; can form bullae and spontaneous pneumos in young adults

🗑

Bullous Emphysema

any emphysema with blebs or bullae (usu sub-pleural) prone to rupture causing spontaneous pneumothorax; spaces >1cm diameter; typical presentation in kid is 16-18 skinny complaining of problems breathing

🗑

Alpha-1-antitrypsin deficiency (AAT)

nml enzyme present in serum/MQs (inhibits proteases/elastases secreted by PMNs); chrom14 PiZZ = marked dec in 0.12% of pop; inc tendency for emphysema, elastic tissue destruction b/c lack of protective enzyme; double wammy if they smoke! develop dx early

🗑

Clinical Course of Emphysema

insidous progression (dyspnea when 1/3 of parenchyma is lost)! "pink puffer" - barrel chested, cachectic, accessory mm, hyperventilation, dyspnea, blood gases OK; Px = death by **pulmonary failure; Complications = less common (pulm HT, cor pulmonale)

🗑

Chronic Bronchitis

persistent productive cough for >3 consecutive mo in at least 2 consecutive yrs; usu co-exists w/emphysema

🗑

Chronic Bronchitis Pathophysiology

d/t cigarette smoke or pollutants; sulfur or nitrogen dioxides; hypertrophy & hypersecretion of bronchial mucosal glands; goblet cell metaplasia, thick bronchial squamous wall/inflam/fibrosis, infection

🗑

Clinical Course of Chronic Bronchitis

presents w/productive cough, may progress to COPD (5-15% of smokers); "blue bloater" - obese, edematous male in CHF, hypoxic and cyanotic w/inc CO2, poor respiratory drive; Cause of death = **cardiac failure (cor pulmonale), recurrent infxn

🗑

Emphysema vs (Bronchitis)

50-75(40-45); bad early dyspea (mild late); pink puff (blue bloat); late cough (early); no sputum (copious); few infxns (many); terminal resp insuff (repeat); cor pulm rare/term (common); nml air resist (inc); dec elastic (nml); sm heart (lg); flat diaphr

🗑

Asthma

hyperreactive airways resulting in episodic bronchospasm when triggered by certain stimuli; sudden onset severe dyspnea; wheezing (not all); common (5% of adults, 7-10% kids)

🗑

Extrinsit Asthma (type I hypersensitivity reaction)

IgE rxn to extrinsic antigen; 3 Types: Atopic (allergic d/t genetics); Occupational; Allergic bronchopulmonary asperigillosis

🗑

Atopic Asthma

mc; triggered by environ allergens; onset in 1st 2 decades; fam Hx of atopy; a/w allergic rhinitis, urticaria, eczema; IgE elevated; eosinophilia common; type 1 wheal and flare rxn to allergen

🗑

Intrinsic Asthma

non-immune triggering mechanism (aspirin sensitivity, viral pulmonary infxn, cold, stress, exercise, inhaled irritants); *people w/extrinsic asthma are also susceptible to intrinsic triggers

🗑

Acute of Immediate Phase of Asthma

30-60min after exposure; Ag-x-links IgE on mast cell & primary mediators released (*histamine: eosinophil/neutrophil chemotactic factors - leukotriene B4); Ag enter mucosa activate mast/eosinophils (2* mediators released: Leutriene C4, D4, E, PG D2, PAF)

🗑

Late Phase of Asthma

4-8hrs after exposure; mediated by recruited cells (basophils, neutrophils, eosinophils); eosinophils relsease PAF, leukotriene C4, major basic ptn, eosinophil cationic ptn (ECP); *MBP & ECP damage epithelial cells*

🗑

Asthma histological findings

hyperplasia of mucous glands and goblet cells, hypertrophy of bronchial smooth muscle, edema/inflam w/eosinophils, thickened BM, patchy necrosis of epithelium, intraluminal mucus plugs (w/Curshmann's spirals & Carcot-Levden crystals)

🗑

Asthma: clinical course

acute attacks may be fatal; status asthmaticus is when a pt doesn't come out of an attack; there is an inc risk of COPD in adults; when a pt wheezes it indicates that air is moving at least (if you don't hear wheezes, pt may be tiring out)

🗑

Bronchiectasis

permanent dilation of bronchi and bronchiles d/t destruction of muscle & elastic supporting tissue; a/w chronic necrotizing infxns; 2* to many etiologies; occurs at any age, but esp in children

🗑

Causes of Bronchiectasis

obstruction (tumor, foreign body); Congen/hereditary (CF, immotile cilia, Kartagener's syndrome, immunodef: RA, SLE, IBD); necrotizing/suppurative pneumonia or post-infectious (measles, whooping cough, influenza, TB, staph, pseudomonas); post transplant

🗑

Bronchiectasis histological findings

acute/chronic inflam in walls of bronchi & bronchioles; desquamation of lining epithelium w/necrotizing ulcers; squamous metaplasia/dysplasia; necrosis/abscess; fibrosis w/chronicity; acute inflam a/w acute exacerbation

🗑

Restrictive Lung Diseases

fibrosing, granulomatous, pulmonary eosinophilia, smoking-related, pulmonary alveolar proteinosis

🗑

Restrictive lung disease: characteristics

reduced expansion of lung parenchyma & dec total lung capacity; Pulm Fxn Tests: dec TLC w/nml expiratory flow rate;

🗑

Two categories of restructive lung diseases

1. Chest wall disorder w/nml lung (polio, obesity, pleural dx); 2. Interstitial Lung Dxs (ARDS, Pneumoconiosis, Sarcoidosis)

🗑

Interstitial Lung Disease

grp of diseases characterized by diffuse and chronic involvment of the pulmonary connective tissue; the interstitium gets fibrotic

🗑

Interstitial Lung Disease: Pathogenesis

regardless of type, the earliest manifestation is Alveolitis (inflam w/in alveolar walls & spaces w/ accumulation of alveolar MQs)

🗑

Fibrosing Lung Diseases

idiopathic pulm fibrosis d/t repeated cycles of alveolitis (wound healing causes fibroblast proliferation); **early & late lesions are present at same time**; subpleural fibrosis is more pronounced; insidious onset w/gradual dyspnea

🗑

Fibrosing Lung Diseases: Clinical course

insidious onset w/gradual dyspnea; dry cough, 40-70yo; hypoxemia, cyanosis, clubbing occurs late; mean survival is <3yrs; Tx: lung transplant

🗑

Honeycomb lung

the end stage of any interstitial lung disease; cystic spaces w/thick bands of fibrous tissue

🗑

Pulmonary involvement in collagen vascular diseases

lung changes seen in: SLE, RA (30-40

🗑

Pneumoconiosis

non-neoplastic lung rxn to inhalation of mineral dusts, organic and inorganic particulates, chemical fumes and vapor; most commonly a/w coal dust, silica, asbestos and beryllium from workplace exposure

🗑

Coal Workers' Pneumoconiosis

range of asymptomatic anthracosis (pigment change w/o cellular rxn) to simple CWP w/MQ accumulation & lettle destruction; to complicated PWC or progressive massive fibrosis (PMF) w/extensive fibrosis & compromised lung fxn

🗑

Caplan Syndrome

coexistance of RA with a pneumoconiosis; develops a distinct nodular pulmonary lesion w/central necrosis surrounded by palisading fibroblasts, MQs and plasma cells

🗑

Silicosis

a/w quarry mining, sandblasting, drilling, tunneling, stone cutting; actue, chronic/nodular, complicated/conglomerate forms

🗑

Asbestosis

linked to parenchymal interstitial fibrosis, bronchogenic carcinoma, pleural effusions, local fibrous plaques or diffuse pleural fibrosis, malignant pleural & pertoneal mesotheliomask, & laryngeal carcinoma; family members of exposed workers also at risk

🗑

Sarcoidosis

multisystem disorder w/unknown etiology; **formation of non-caseating granulomas**; <40yo; blacks>whites; F>>M; (classicly a young black female)

🗑

Sites affected by sarcoidosis

lungs (diffuse interstitial alveolitis, permanent respiratory dysfxn in 25% pts); Bilateral hilar adenopathy (potato nodes); skin and/or eye symptoms too

🗑

Sarcoidosis lab findings

not diagnostic; elevated ACE (produced by granulomas); Hypercalcemia (d/t inc Ca absorption 2* to activated Vit D by MQ in granulomas); Hyperagammaglobuilinemia

🗑

Sarcoidosis immune findings

cutaneous anergy to common Ag (candida); Dec peripheral T lymph w/absolute lymphopenia; CD4/CD8 ratio is reduced; Lungs (inc activated CD4 cells; CD4:CD8 ratio is 10:1 in lung); Polyclonal hypergammopathy

🗑

Sarcoidosis Histological Findings

non-caseating granulomas (exclude mycobacteria, fungi & berylliosis), tight clusters of epithelioid cells, multinucleated giant cells, rim of CD4 cells, Schaumann (chonchoid bodies - basophilic concretions of Ca/Fe/ptn); Asteroid bodies (in giant cells)

🗑

Manifestations of Extrapulmonary Sarcoidosis

skin lesions (nodules, plaques, red macules); Eyes (blindness, iritis, iridocyclitis, uveitis); Mikulicz's Syndrome (salivary glands + uveitis); Spleen & liver (in 75% of cases); Bone marrow (rare: 3-5%)...differentiate from TB

🗑

Hypersensitivity Pneumonitis (allergic alveolitis)

an immune mediated inflam lung disease that affects alveoli; usu occupational, restrictive lung disease (dec diffusion capacity, dec compliance, dec lung vol); acute symptoms (4-8hrs: fever, cough, dyspnea)

🗑

Farmers lung

moldy hay exposure; actinomyces asperigillosis

🗑

Bagassiosis syndrome

moldy sugar cane exposure; thermophilic actinomycetes

🗑

Maple bark disease

exposure to maple bark; cryptostroma corticale

🗑

Humidifier lung

exposure to cool humidifiers; thermophilic actinomyces

🗑

Pigeon breeders' lung

exposure to pigeon droppings; pigeon ptns or cryptococcosis

🗑

Bat cave/spelunking lung

exposure to histoplasma capsulatum

🗑

Hypersensitivity Histological Findings

chronic interstitial inflammation; interstitial fibrosis; obliterative bronchiolitis, granuloma formation

🗑

Pulmonary embolism

usu HUGE; 95% are embolic from DVTs; 50.000 deaths/yr d/t immobilization, hypercoaguable states, instant death

🗑

Pulmonary infarct

usu d/t smaller emboli; inadequate circulation to lung; may be septic

🗑

Pulmonary HTN

results in cor pulmonale; a/w COPD, interstitial diseases, heart disease, recurrent PE, AI disorders (ex: scleroderma); primary or idiopathic

🗑

Pulmonary Hemorrhage Syndromes

Goodpastures syndrome, Idiopathic pulmonary hemosiderosis; Vasculitis associated hemorrhage (hypersensitivity angiitis, Wegener granulomatosis, Lupus erythematosis)

🗑

Goodpastures Syndrome

rapidly progressive glomerulonephritis and hemorrhagic interstitial pneumonitis d/t autoantibodies to glomerular and pulmonary BM; causes focal necrosis of alveolar walls, intra-alveolar hemorrhage, fibrosis; hemoptysis & bilat fluffy infiltrates on CXR

🗑

Pulmonary Defenses: Upper airways

gag reflex and mucociliary elevator

🗑

Pulmonary defenses: Lower airways

alveolar MQs; PMNs, alternate compliment path (opsonization); IgA secretions; serum IgG & IgM in alveolar fluid (activate comp by classic C3b path); Tcells to control viruses/intracellular organisms

🗑

Lobar pneumonia

entire lobe involved; streptococcus pneumonia (pneumococcus)

🗑

Bronchopneumonia

common bacterial pneumonia; patchy lobular distribution; spread via airways

🗑

Interstitial pneumonia

patchy interstitial inflammation; viral or mycoplasma

🗑

Streptococcus pneumonia

pneumococcus; G+ diplococci; mc community acquired bacterial pneumonia; usu healthy young-mid age adults (elderly and debillitated too)

🗑

Pneumococcal pneumonia: lobular characteristics

abrupt onset fever; shaking chills; pleuritic chest pain; productive cough; rusty colored sputum; four stages (congestion, red hepatization, gray hepatization, resolution)

🗑

Bronchopneumonia

multiple foci of infection; bilateral and basal; poorly delineated firm areas (grey, yellow, red coloration)

🗑

Pneumonia complications

pleuritis (pleural fibrosis, pyothorax, empyema); abscesses; fibrosis, bronchopleural fistula, bronchiectasis, sepsis

🗑

Pneumonia: Staphylococcus aureus

G+ cocci, complication of viral (influenza) pneumonia; a/w IVDA, debilitated, chronic lung disease; bronchopneumonia w/abscesses; complications (bacterial endocarditis, brain/kidney abscess)

🗑

Klebsiella pneumonia: Freidlanders Bacillus

mc Gram-negative bacillary pneumonia; a/w elderly, debilitated, malnourished & alcoholic pts; lobar distribution; hemorrhagic necrosis w/red currant jelly sputum; abscesses, bronchopleural fistula, fibrosis, bronchiectasis

🗑

Legionella pneumonia

G(-) flagella bacillus; a/w standing water; elderly & compromised; 15-25% fatal; Pontiac fever (milder self-limited resp illness w/same organism); bronchopneumonia (mononuclear exudate, necrosis, silver stain/immunoflu); diff culture; retrospective titer

🗑

Aspiration Bronchopneumonia

in pts w/dec consciousness or vomiting; alcoholics; gastric contents causes chemical & bacterial pneumonia; mixed aerobic & microerophillic orgs; often fatal; abscesses in survivors

🗑

Lung abscess

d/t aspiration (infective material or gastric contents); complication of bacterial pneumonia, septic emboli, bronchogenic carcinoma, cryptogenic; mixed anaerobes/aerobes (mc:staph, pseudomonas, klebsiella)

🗑

Sites of lung abscesses

supapical and axillary R upper lobe; apical R lower lobe; ends of vertical airways; usu multiple; air fluid level on CXR; suppurative/fibrotic periphery on histo; drains into bronchi

🗑

Clinical features of lung abscess

productive cough (purulent/bloody sputum; positional, resembles bronchiectasis); fever, malaise, wt loss; complications (finger clubbing, 2* amyloidosis, lung infarct, bronchopleural fistula); *rule out underlying carcinoma*

🗑

Interstitial pneumonia

primary atypical pneumonia (mycoplasma); viral pneumonia

🗑

Primary atypical pneumonia: mycoplasma

usu kids; sporadic/epidemic; atypical features (non-prod cough, no consolid, no leukocytosis), insidious onset, self-limited, mild, resp distress; interstitial mononuclear infiltrate; type 1 pneumocyte necrosis; hyaline membrane/edema; clear alveoli

🗑

Viral pneumonia pneumonitis: pathogens

interstitial lung infxn; influenza A, B & C; parainfluenza, respiratory syncitial virus, measles, chickenpox, cytomegalovirus (AIDS_

🗑

Viral pneumonia pneumonitis: clinical features

fever, HA, malaise, hacking non-prod cough; ill defined patches in lung (no consolidation, marked resp distress); little sputum production; no leukocytosis; Diffuse alveolar damage (type 1 pneumocytes); Necrotizing bronchiolitis w/influenza, measles, CMV

🗑

Cytomegalovirus: types of infection

herpesvirus; all infected sites show cytopathic change (gigantic cells; huge basophilic intranuclear inclusion, surrounding halo); Cytomegalic inclusion disease; Interstitial Pneumonia (AIDS); Transfusion-induced (mononucleosis-like syndrome)

🗑

Viral Pneumonia Histopathology

1. type 1 pneumocyte infxn (cytopathic - Adeno, CMV, herpes, measles); Viral inclusions (CMV, herpes) w/necrosis; 2. Interstitial inflam (mononuc cells, edema); 3. Hyaline membrane (diffuse alveolar damage); 4. Necrotiz bronchiolitis (flu, measles, CMV)

🗑

Anthrax

G+ bacillus; cutaneous infxn (wild/domestic animals); Pasteur's first vaccine; Koch's postulates; pulmonary disease (bioterrorism)

🗑

Anthrax infection

Sm 1* lung infxn (pneumonia w/sm focus; alveolar MQs carry bacteria to hilar nodes); Bacteria germinate in hilar nodes (hemorrhagic mediastinitis); Hemorrhagic meningitis (cardinal cap); Progress (10days to symptoms; 3 days to death)

🗑

Anthrax toxins

edema factor (capillary leak w/little cell response); Lethal factor; Protective Antigen (accounts for poor response to antibacterial treatment

🗑

Deep mycoses: Pathogenic Fungi

dimorphic; cause disease in nml hosts; Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitis

🗑

Deep mycosis: Opportunistic Fungi

ubiquitous; cause disease in compromised hosts; Mucorales (non-septate); Asperigillus (mold-like); Candida sp, Cryptococcus neoformans (yeast-like)

🗑

Histoplasmosis (histoplasma capsulatum)

mimics TB; Ohio & Central Mississippi River Valley; appalachia; soil, Starling/bat droppings; test w/Histoplasmin skin test

🗑

Histoplasmosis: Pathology

1* lesion (many periph pulm lesions w/hilar adeonopathy; mimics Ghon complex; progressive fibrosis & calcification); 2* Dx (progressive; upper lobe cavitation); Disseminated Dx (immunocomp/infants; liver, spleen, nodes, meninges, adrenal, upper oral GI)

🗑

Histoplasmosis Histological Findings

round/oval yeast forms in MQs; visible w/silver not H&E stain; In Lungs (MQ+org in alveoli; *Caseating Granulomas* w/langhan's giant cells, fibrosis, calcification); Disseminated (reticulo-epith cells/MQs+org; no Tcell response = no granulomas)

🗑

Histoplasmosis: Clinical Findings

similar symptoms to TB; disseminated (fever, hepatosplenomegaly, anemia, leukopenia, thrombocytopenia)

🗑

Histoplasmosis: Diagnosis

culture; ID org w/special stain; Ag in fluids; Histoplasmin skin test (like TB test, indicates exposure only*); serology 4-6wks

🗑

Coccidiodomycosis (coccidi

endemic SW USA; San Joaquin Valley Fever; spread by dust; 3 forms: 1. Asymptomatic pulm infxn (60% of exposed); 2. Progressive Pulm Dx; 3. Miliary Dx (systemic spread in darker skin; also w/AIDS)

🗑

Coccidiodomycosis: Pathology

initial infxn (sm focus w/consolidation in mid/lower lung w/hilar adenopathy); *thick walled non-bud spherules filled w/endospores); *Caseating granulomas; heal w/fibrosis & calcification; progressive/miliary (suppurative inflam d/t loss of cell immunity)

🗑

Coccidiodomycosis: Clinical findings

Dx by identifying org in sputum/Bx; rising IgM titers; Coccidiodin skin test (indicates exposure only); Prognosis is favorable (worse w/ systemic, bone or CNS involvement)

🗑

Blastomycosis (blastomyces dermatitis)

3 Forms: 1. Asymptomatic 1* Pulm Infxn; 2. Progressive Pulmn Dx; 3. Disseminated Miliary Dx (rare); endemic areas in central/western US (chicago)

🗑

Blastomycosis: Pathology

**broad based budding**; suppurative inflam; skin involvement (pseudoepitheliomatous hyperplasia mimics squamous cell carcinoma)

🗑

Blastomycosis: Clinical Course

non-specific symptoms (like TB); skin papules/fungating ulcers; self-limited requiring no therapy while progressive responds poorly to therapy

🗑

Blastomycosis: Diagnosis

**NO RELIABLE SKIN or SEROLOGIC TESTS**; diagnosis by direct ID of organism or culture

🗑

Candidiasis (moniliasis; Candida albicans)

mc fungal disease; normal flora of mouth, GI tract, vagina; causes disease when host defenses are low; Yeast-like cells with **budding hyphae & pseudohyphae (elongated chains w/constriction at attachment); Dx w/culture or Bx

🗑

Candida clinical disease patterns; Minor infxn of mucosa or skin

vagina, oral cavity (thrush), diaper rash; occurs in diabetics, AIDS pts & nml pts after broad spec Abx

🗑

Candida clinical disease patterns; Erosive Mucocutaneous candidiasis

usu esophageal involvement; terminally ill; AIDS pts and other immunocomp

🗑

Candida clinical disease patterns; Systemic Infxn (hematogenous)

immunocomp pts, neonates, nidus of infxn (ex: IV catheter); removal of nidus may be curative

🗑

Candida pathology: Thrush

grey-white membranes over hyperemic mucosa; superficial mass of matted orgs & inflam debris; intact mucosa w/superficial inflam

🗑

Candida pathology: Erosive esophageal disease

ulceration, necrosis, acute inflam; underlaying granulation tissue; org in superficial detritus

🗑

Candida pathology: Systemic candidiasis

abscesses in kidneys, liver, lung; lesions are often hemorrhagic d/t vascular invasion

🗑

Actinomycosis and Nocardiosis

filamentous, G+ slow growing bacteria (former fungi);

🗑

Actinomyces

anaerobic normal oral flora; pathogenic w/devitalization of tissue and dec O2 tension; infects jaw, neck, thorax (bronchopneumonia w/abscesses), and abdominal/pelvic areas; **sulfur granules of yellow colonies visible to naked eye on histo**

🗑

Nocardia

acid fast aerobes; NOT normal flora; cause acute bronchopneumonia w/abscess formation; **branching filaments w/o colonies**

🗑

Actinomyces & Nocardia Pathology

similar organisms; intense suppuration w/abscess formation; **sinus tracts and fistulae**;

🗑

Actinomyces & Nocardia Histological Findings

colonies are tangled masses of threads surrounded by radiating/terminal clubbed organisms;

🗑

Actinomyces & Nocardia Clinical Findings

protracted clinical course; chronic infxn common; fibroblastic rxn (scarring) w/fistulous sinus tracts; Dx by morphology or culture; rarely diagnosed by gross appearance of sulfur granules in sinus drainage (actino)

🗑

Asperigillosis

2nd mc fungal infxn; spores = asthma/allergic alveolitis typeIII/IV rxns; Colonize (fungus balls in existant lung cavities; no invasion); Invasive Opportunistic Infxn (immunocomp, necro pneumonia, "target lesions"/vascula=sepsis; Flavotoxin (liver cancer)

🗑

Asperigillosis pathology

**acute angle-branching septate hyphae (40* angle)**; filaments w/uniform widths; fruiting body (holy water sprinkler; rare)

🗑

Asperigillosis Clinical Findings

invasive disease limited to immunocomp hosts; Dx by organism on Bx or culture usu in tissue, rarely in sputum or blood

🗑

Cryptococcus neoformans

opportunistic infxn in AIDS, leukemia/lymphoma, Hodkins disease; found in soil and bird droppings; pigeons excrete it w/o having disease; 2 sites of infxn: Pulmonary (mild/asypmtomatic) and CNS (lethal meningitis w/HA and fever)

🗑

Cryptococcus neoformans: Pathology

**budded yeast w/thick mucus capsule**; capsule is mucicarmine+; **India Ink reveals Halo around capsule**; little/no host response b/c naked organisms

🗑

Cryptococcus neoformans: Diagnosis

ID organism in sputum, Bx or CSF; Latex Cryptococcal Agglutination Test (LCAT) detects capsular antigen in body fluids (95% sensitive; confirm w/culture); India ink prep (fast/cheap, but insensitive)

🗑

Pneumocystis Pneumonia (P. jiroveci)

opportunistic; formerly P. carinii; disease limited to AIDS, sick elderly, malnourished infants; genetics like fungi but life cycle like protozoa; latent infxn d/t benign exposure during infancy; host response is interstitial (but bugs are in alveoli)

🗑

Pneumocystis Pathology

lungs resemble ARDS (heavy, red, firm, diffuse, patchy pneumonia; alveoli filled w/pink foamy proteinaceous exudate; septae thick edematous w/mononuclear infiltrate); detected w/silver stain

🗑

Pneumocystis Clinical Findings

Dx made by visualizing organism in sputum, BAL or Bx; effective Abx available, but prognosis depends on underlying condition

🗑

Carcinoma of the lung

mc cause of death worldwide; 85% occur in smokers most linked to *squamous and small cell*; **non-smokers a/w adenocarcinoma**

🗑

Ras mutations a/w lung carcinoma

Ras mutations (25% adenocarcinoma dec Px; 20% large cell; 5% squamous); very rare in small cell

🗑

Myc oncogene overexpression and lung cancer

a/w 10-40% of small cell cancers

🗑

p53 mutations and lung cancer

found in >80% of small cell and 50% of non-small cell

🗑

Rb mutation and lung cancer

found in 80% of small cell and 25% of non-small cell

🗑

Genetic mutation found in all lung cancer types

deletion in short arm of chromosome 3 (3p)

🗑

Types of lung cancer

small cell (20-25%; responds to chemo) and non-small cell (squamous, large cell, adenocarcinoma; doesn't respond to chem)

🗑

Lung Cancer Prognosis

Grading (according to worst component); Staging is the most important predictor of prognosis (5yr survival: Bronchioalveolar (operable) >> adenocarcinoma > squamous > large cell > small cell (non-operable))

🗑

Signs and Symptoms of all types of lung cancer

cough, SOB, hemoptysis, CP, pleural effusion, pneumonia

🗑

Paraneoplastic Syndromes a/w Lung Cancer

Acanthosis nigricans (a/w diabetics); Dermato/polymyositis; Clubbing of fingers; Myasthenic Syndromes (Eaton-Lambert A.I. in *small cell; Progressive multi-focal encephalopathy); Endocrine (Cushings, extra ADH (*small cell), Hypercalcemia (*squamous))

🗑

Pancoast Tumor

mc a/w squamous cell lung cancer; growth in apex may involve C8, T1, T2 nerves; severe shoulder pain radiating down arm; may paralyze cervical sympathetics; can cause Horner's syndrome

🗑

Horners Syndrome from Pancoast Tumor

enophthalmos (sunken eyeball); Ptosis of upper eyelid (drooping); Miosis (constriction of pupil); Anhidrosis (lack of sweat)

🗑

Pathogenesis of lung cancer

**unlike other cancers, the major environmental insult that inflicts damage is smoking**; injury, regeneration of basal layer, metaplasia, dysplasia, CIS, invasive tumor

🗑

Lung cancer and smoking

87% in smokers or recent quitters; depends on daily amount, tendency to inhale, duration of habit; 10-60x greater risk than non-smokers (also a/w cancers of mouth, pharynx, larynx, esophagus, pancreas, cervix, kidney, bladder); squamous and sm cell mc

🗑

Other risk factors for lung cancer

industrial hazards (radiation, uranium, asbestos), air pollution (radon), molecular genetics, precursor lesions (squamous dysplasia & Carcinoma In Situ; atypical adenomatous hyperplasia; neuroendocrine cell hyperplasia)

🗑

Squamous cell carcinoma

closely a/w smoking; mc in men; **central; 90% bronchi**; firm gray lesions extend into parenchyma; well differentiated **pearls & bridges**; highest freq of p53 mutations

🗑

Adenocarcinoma

mc in women & non-smokers; epithelial neoplasm w/*glandular differentiation w/mucin production*; **peripherally located w/pleural fibrosis**; 4 subtypes (acinar, papillary, solid w/mucin, bronchioalveolar); Size: 2.5cm-->replacing entire lobe

🗑

Bronchioalveolar

1-5% of all; grows along walls of alveoli **birds on a wire**; 1/3 a/w copious mucin (2/3 no mucin); Stage 1 is good Px; **not linked to smoking**

🗑

Small cell carcinoma; aka: Oat Cell

*highly malignant*; neuroendocrine features; strongly a/w smoking; **perihilar mass**; grows & mets FAST (70% present at advanced stage); Paraneoplastic syndromes (diabetes insipidus, ectopic ACTH, Eaton-Lambert Syndrome block Ca chan dec ACh weak muscle)

🗑

Small cell carcinoma histological findings

**chemo responsive**sheets of small cells (round/oval); scant cytoplasm; absent nucleoli; inc mitotic rate

🗑

Large Cell Carcinoma

10% of all; this is diagnosed by exclusion; poorly differentiated tumors w/no features of squamous, glands, or small cells; large cells w/lots of cytoplasm, prominent nucleoli and vesicular chromatin

🗑

Carcinoid Tumors

neuroendocrine (serotonin) neoplasms derived from basal layer of resp epithelium; no clear a/w smoking; 50% asymptomatic when found on CXR for something else; hemoptysis, SOB, 55yo

🗑

Other pulmonary tumors

inflammatory pseudo tumors, pulmonary epithelioid hemangioendotheliomas, carcinomas pulmonary blastoma

🗑

Pulmonary metastases

1/3 of all fatal cancers; found at autopsy; multiple & circumscribed "cannon ball lesions"; histology resembles a primary tumor

🗑

Pneumothorax

air in pleural cavity; traumatic (penetrating injury, scuba diving), spontaneous (bleb in young adult), Iatrogenic (lung Bx, positive pressure ventilation)

🗑

Tension pneumothorax

when pneumothroax is intense enough to shift the mediastinum to the opposite side; must be reduced immediately

🗑

Hydrothorax

pleural effusion; resembles water (elsewhere in body regarded as edema); heart failure d/t hydrostatic pressure; dec oncotic pressure (nephrotic syndrome, cirrhosis, **severe starvation**)

🗑

Pyothorax

turbid fluid containing PMNs; d/t infxn (stab wounds, extension of bacterial pneumonia)

🗑

Empyema

thick pustular pleural effusion; flocculation and fibrosis (tries to wall itself off)

🗑

Hemothorax

blood in pleural space (ruptured vessel; dissecting aneurysm, stab wound, gun shot wound); fluid may be blood stained, serosanguinous (TB, cancer, pneumonias)

🗑

Chylothorax

pleural effusion of milky fluid; lipid rich (chyle - separates on standing w/fat layer on top); due to lymphatic obstruction

🗑

Pleuritis

inflammtion of pleura d/t extension of any pulmonary infxn (visceral pleura, bacterial, viral, collagen vascular disease, pulmonary infarct); sharp stabbing chest pain on inspiration

🗑

Tumors of the Pleura - solitary fibrous tumor

uncommon localized neoplasm a/w pleura; usu benign (1/3 malignant); 80% arise on visceral pleura; can arise on any mesothelial suface; on a stalk...**not linked to asbestos**

🗑

Malignant Mesothelioma

neoplasm of mesothelial cells of pleura; **80% a/w asbestos exposure**; no inc risk w/smoking, but definate inc risk of other lung cancers in asbestos exposed smokers; latency period of 12-60yrs; encases lung into fissures/septa; limited to periphery

🗑

Mesothelioma histological findings

biphasic pattern of epithelial and sarcomatous elements; often difficult to distinguish from adenocarcinoma (use IHC to differentiate: Meso is CEA/Leu-M1 negative and Calretinin/WT-1 positive)

🗑

Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.

To hide a column, click on the column name.

To hide the entire table, click on the "Hide All" button.

You may also shuffle the rows of the table by clicking on the "Shuffle" button.

Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

Normal Size Small Size show me how

Created by: bscaryp