respiratory pathology, pharmacology, pathophysiology
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| asthma immune response | Th2, il4, il13-->bcell-->IgE-->mast cells-->histamine, LKTs, IL5, GMCSF, eosinophils, smooth muscle, neutrophils
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| diff asthma vs bronchitis | asthma reversible by bronchodilators
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| bronchitis immune response | CD8 tcells, macrophages (^bc of smoking)
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| inflam from smoking | macrophages, neutrophils-->oxidants, proteases (>>antiproteases), IL8, TNFa, IL1, IL6-->remodeling, mucous, destruction
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| clinical hallmarks of emphysema | dyspnea, cachectic, pursed lip breathing, decreased breath sounds, hyperresonant to percussion, distant heart sounds
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| clinical hallmarks of chronic bronchitis | chronic cough, dyspnea, wheezing, ^AP diameter, decreased breath sounds, wheezing, cyanosis, edema, poss loud P2
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| clinical hallmarks of asthma | dyspnea, chest tightness, wheezing, cough (Sx=episodic, may be persistent), use of accessory muscles, prolonged expiratory phase, wheezing
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| apthous canker | common, recurrent, painful, shallow hyperemic ulcer covered by thing exudate
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| HSV infection of mouth | cold sore, grouped clear fluid filled vesicles in area innervated by nerve fiber, person to person transmission
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| oral candidiasis | immunosuppressed, superficial curdy white membrane easily scraped off
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| glossitis | beefy red tougue
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| irritation fibroma | nodular mass of fibrous tissue on buccal mucosa
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| pyogenic granuloma | highly vascular pedunculated gingival lesion, pregnancy tumor, erythematous
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| hairy leukoplakia | immunosuppressed, white confluent patches, lateral tongue, hyperkeratosis, acanthosis, baloon cells
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| leukoplakia | white plaque that can't be removed by scraping, varying dysplasia, from acanthosis/hyperkeratosis to carcinoma in situ
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| white plaques-can be scraped vs. can't | candidiasis can be scraped, leukoplakia cannot be scraped off easily
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| erythroplakia | red velvety plaque, less commonrelated to tobacco, etoh, hpv
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| squamous cell carcinoma of oral cavity | 95% of oral cavity cancersassoc w/ tobacco, etohlocation: ventral tongue, mouth floor, lower lip, soft palate, gingivalooks like plaque/mass, starts as dysplasia, may invade then metast
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| kaposi sarcoma | caused by KSHV (HHV8), intraoral purple nodular lesions
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| nasopharyngial carcinoma | assoc w/EBV, can be keratinizing squamous, non, undiff
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| what is most common tumor of oral cavity? | squamous cell carcinoma
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| paraganglioma | carotid body tumor, cluster of neuroendocrine cells, rare, usually sporadic, may metast
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| branchial cleft cyst | benign, anterolateral neck, remnant of branchial arch, squamous/columnar lining
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| thyroglossal duct cyst | resp/squamous epith, has lymphoid, thyroid tissue
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| sialadenitis | saliv gland inflametio: viral, bac, autoimmune (SLE, sjorgen's)may be secondary to obstruction, impaction, injury
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| mucocele | common lesion of saliv glandsblock/rupture fo duct-->mucous spills into stroma=bluish swelling
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| benign lymphoepithilial lesion | nonneoplastic enlarged saliv gland, dense lymphoid prolif in gland, ducts invaded by lympocytes
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| diff b/w sialadenitis and benign lymphoepithelial lesion | lymphocytes invade ducts in BLL, not sialadenitis
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| benign lymphoepithelial cyst | asso w/HIV, EBVduct destruction due to lymphoid hyperplasia, epith lined cyst w/lympoid infiltration
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| most common benign saliv gland neoplasms | 1.pleomorphic adenoma 2. warthin's
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| most common malignant saliv gland | 1. mucoepidermoid2. adenocarcinoma
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| pleomorphic adenoma | ^in parotid, slow growing, epith/mesench diff, plus myoepitheliod cells
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| warthin's tumor | papillary cystadenoma lymphatosumusually in parotid, cleft like cystic mass lined by oncocytic cells surrounding lymphocytes
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| mucoepidermoid | most common salivary malig tumoradmixture of squamous, goblet, intermediate cellsnon encapsulated, infiltrative
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| most common tumor of minor saliv glands | adenoid cystic carcinoma
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| most common benign saliv gland neoplasms | 1.pleomorphic adenoma 2. warthin's
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| most common malignant saliv gland | 1. mucoepidermoid2. adenocarcinoma
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| pleomorphic adenoma | ^in parotid, slow growing, epith/mesench diff, plus myoepitheliod cells
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| warthin's tumor | papillary cystadenoma lymphatosumusually in parotid, cleft like cystic mass lined by oncocytic cells surrounding lymphocytes
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| mucoepidermoid | most common salivary malig tumoradmixture of squamous, goblet, intermediate cellsnon encapsulated, infiltrative
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| most common tumor of minor saliv glands | adenoid cystic carcinoma
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| corticosteroids mechanism of action | cytoplasmic receptor to GRE=affect transcription/translation, TFs, broad spectrum of action
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| effects of corticosteroids (desired) | decrease: recruitment of inflam cells, activation of inlfam, cytokine synth, airway edema, vascular permincreases: response to bronchodilators
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| side effects of steroids | metabolic/mineralcortoid effects: fat deposition, osteoperosis, hyperglycemia, HTN, muscle wasting, bruisability, cataracts, immune suppression, adrenal axis supression
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| inhibitors of leukotriene synth | zileuton-5LO blockerhepatotoxic
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| LTK receptor blockers | monteleukast, zafrileukastused as controller/preventor
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| anti IgE | omalizumabbinds Fc portion so IgE can't bind/activate mast cells
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| short acting beta agonists | albuterol, pirbuterolrapid onset, use for acute asthma in all asthma patientsADR: tachycardia, tremors, tolerance
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| long acting beta agonists | salmeterol, formoterolcontroller/preventors
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| cholinergic bronchodilators | ipotropium, tiotropiumblock muscarinic (ip3-Ca-smooth muscle contrac)tio=better, selective for m1, m3 receptors=1st line therapy for COPD
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| theophylline | xanthine, controller/preventor, ^side effects, narrow theraputic index
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| nonpulm restrictive | neuromuscular, chest wall, pleural spaceno diffusion defect, RV is normal because no process to hold airways open
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| Idiopathic pulm fibrosis | restrictive process, decreased lung compliance, diffusion impairedCXR-peripheral reticular markingsfibroblastic foci (collagen deposition), heterogeneousetio: poss lung injury and abnl repair, related to TGFbeta
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| sarcoid | granulomatous, non caseating, poss immune originhilar adenopathy-->parenchymal infiltrates-->advanced fibrosis/destruction
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| desquamative IP | smoking assoc, macrophages in airspaces
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| respiratory bronchiolitis | smoking, macrophages
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| actue IP | ARDS but without discernable cause
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| Cryptogenic organizing pneum | protrusions of granulation tissue into distal airspaces
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| nonspecific interstitial pneum | doesn't look like others
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| lymphocytic IP | lymphoproliferative, ^in HIV
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| hypersensitivity pneumonitis | gradual or acute, due to environmental exposureactive inflamation, giant cells, granulomatous inflam
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| asbestos | causes: asbestosis, methothelioma, pleural plaques
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| most lobar pneumonia caused by | Strep Pneum
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| bronchopneum vs lobar | bronch=patchy, diffuse, lobar=only 1 lobe, whole lobe affected
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| CA PNA | usually strep pneumonia Hflu, staph Aur, Pseud, Klebs, Legio^in CHF, COPD, diabetes
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| course Strep Pneum | congestion: 1-2 days, heavy, red boggy, vascular congestion, bacteria, prot fluidred hepat: 2-4 days, neutrophils, RBCs, fibrinGrey hepat: RBCs lysed, neutrophils/fibrin exudateresolution: organizing PNA, connective tissue
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| CA PNA complications | abscess, empyema, scarring, bacteremia
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| staph aureuous PNA | 2nd to viral resp infec, ^complic, assoc w/right sided IE in IVDU
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| Klebsiella Pneum | ^common G- bac PNA, chronic etoh, currant jelly sputum
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| Pseudamonas pna | vasculitis/bacteremia, infarcts
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| legionella pna | aquatic env=humidifier
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| atypical pna | acute, afebrile, distress out of proportion with signsmycoplasma pneum=^ commoninflam confined to septa=thickened-inflam infiltrateNO alveolar exudate=no productive cough
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| nosocomial | severe disease, immunosuppG- (enterobac, psued), staphy aureus
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| aspiration pna | necrotizing, abnl gag reflex, subsequent abscess
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| lung abscess | local area of supperative necrosis-->cavitationanaerobic bac from oral cavity, ^ on rightcan rupture, cause bronch obstructhick fibrous wall, necrotic debris inside
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| pna in immunocompromised host | pseud, mycobac, legio, listeria monocyt, CMV, HSV, PCP, candida, aspergilla, cryptococcus
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| CMV PNA | cells=giant, mononuc, ^ in immunosupp, hyaline membranes, edema/inflam, CMV owl's eye halo inclusions
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| PCP | fungal, PNA in immunosuppdry cough, dysp, feverbilat perihilar shadowingcup shaped cysts, foamy pink staining exudate, thickened septaecan be with CMV
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| Diffuse alveolar damage | ARDS-rapid onset resp insuff, hypoxinjury to alv capillary endoth/epith-->pulm edema, hyaline membrane formation, eventually organization/fibrosis
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| pulm TB | chronic infec of lung
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