spontaneous vs tension pneumothorax
sp- due to rupture of emphysematous bleb in young adults --> collapses portion of lung and trachea shifts to SIDE OF COLLAPSE (SAME SIDE) ten- penetrating chest injury --> TRACHEA TO OPPOSITE SIDE OF INJURY
hypertrophy of bronchial mucinous glands (reid index >50%) chronic productive cough (due to excess mucous production) for atleast 3 months for min of two years, cyanosis (mucus traps co2) associatedw smoking
rare cause of emphysema lack of antiprotease leaves air sacs vulnerable to protease mediated damage --> lower lobe pancinar emphysema may cause liver cirhhosis due to mutant A1AT buildup in ER of hepatocytes
what triad characterized aspirin intolerant asthma?
asthma aspirin induced bronchospasms nasal polyps
what does surfactant do? what happens without?
it decreases surface tension in lungs, preventing collapse of alveolar air sacs after expiration lack of surfactant leads to air sac collapse and formation of hyaline membranes
unique site of distant metastasis of lung cancer
obstructive; permanent dilation of bronchioles and bronchi due to necrotizing inflammation with damage to airway walls; loss of airway tone --> air trapping presents with cough, dyspnea and foul smelling sputum
large cell carcinoma
poorly differentiated large cells NO keratin pearls, mucin, glands, or intercellular bridges POOR PROGNOSIS, central or peripheral
primary vs secondary pulmonary hypertension
pri- young adult females, inactivated BMPR2 mutation that causes vascular SM proliferation sec- due to hypoxemia (COPD or interstitial lung disease) or increased volume in the pulmonary circuit (congenital heart disease); may arise from pulmonary embolism
central; poorly differentiated small cells from neuroendocrine cells male smokers
small cell carcinoma
penumonia like consolidation on imaging with excellent prognosis
risk factors for laryngeal carcinoma?
alcohol tobacco laryngeal papilloma
pathogenesis of asthma
type 1 hypersensitivity 1) allergens induce TH2 CD4 t cells 2) TH2 cells secrete IL4 (class switch to IgE), IL5(attract eosinophils), and IL10 (TH2 stimulation and TH1 inhibition) 3) reexposure to allergen leads to IgE mediated mast cell activation 4) histamine release 5) production of leukotrienes C4 D4 and E4 causes bronchoconstriction, inflammation and edema (early rxn) 6) late rxn = inflammation, eosinophil protein, damages cells and perpetuates bronchoconstriction
treatment for acute respiratory distress syndrome
treat underlying cause ventilation with + end expiratory pressure (PEEP) damage and loss of type 2 pneumocytes leaves scarring and fibrosis
croup upper airway inflammation presents with hoarse, barking cough and inspiratory stridor
phases of lobar pneumonia
1) congestion of vessels and edema 2)red hepatization - exudate neutrophils and hemorrhage fill alveolar spaces making lung more solid 3) gray hepatization - degeneration of red cells 4) resolution
lung cancer treatment small cell carcinoma vs nonsmall cell carcinoma
SCC - treat with chemo NSCC - treat with surgical resection, not chemo
benign papillary tumor of the vocal cord presents w hoarseness single in adults, multiple in children
acute respiratory distress syndrome
alveolar damage; leakage of protein rich fluids leads to edema edema + necrotic epithelial cells = hyaline membranes in alveoli
malignant neoplasm of mesothelial cells associated with occupational asbestos presents with pleural effusions, dyspnea, and chest pain tumor encases the lung
who is at risk for aspiration pneumonia? where does it occur usually?
comatose alcoholics right lower lobe due to easier entrance in right mainstem
what is asthma associated with?
childhood presentation allergic rhinitis, eczema, family history of atopy
squamous cell carcinoma
keratin pearls or intercellular bridges most common tumor in male smokers may produce PTHrP
croup is another name for?
infection of lung parenchyma when normal defense are impaired; involves alveolar sacs
systemic disease with noncaseating granulomas in multuple organs
what can chronic exposure with hypersensitivity pneumonitis lead to?
three ways to diagnose pneumonia
CXR sputum gram stain and culture blood culture
restrictive; interstitial fibrosis due to chronic exposure to small fibrogenic particles (carbon/coal, silica, berrylium, asbestos) --> alveolar macrophages engulf foreign particles and induce fibrosis