Term
| What are the usual source of pulmonary emboli? |
|
Definition
| thrombi in deep veins of leg |
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Term
| Examples of primary hyper-coagulbale states |
|
Definition
factor V Leiden
Prothrombin mutations
Antiphospholipid syndrome |
|
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Term
| Examples of secondary hyper-coagulable states |
|
Definition
obesity
recent surgery
cancer
oral contraceptive use
pregnancy |
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Term
| 2 main pathophysiologic consequences of emboli: |
|
Definition
RESPIRATORY COMPROMISE - from non-perfused by ventilated segments
HEMODYNAMIC COMPROMISE - increased resistance to pulmonary blood flow |
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Term
|
Definition
| Acute failure of the right side of the heart |
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Term
|
Definition
-only caused by about 10% of emboli
-occur when circulation is already inadequate (heart/lung disease)
-usually in lower lobes |
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Term
| How to distinguish a post-mortem clot causing pulmonary embolism |
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Definition
| Lines of Zahn - antemortum clots (alternating bands) |
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Term
| unresolved small emboli can lead to |
|
Definition
pulmonary hypertension
pulmonary vascular sclerosis
chronic cor pulmonale |
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Term
| patients with a pulmonary embolism have a ___% chance of developing a second embolism |
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Definition
|
|
Term
| pulmonary circulation is ____ resistance compared to systemic circulation |
|
Definition
|
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Term
| When does pulmonary hypertension occur? |
|
Definition
| when pulmonary pressure reaches 1/4 of systemic levels |
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Term
| Structural cardiopulmonary conditions that assoc with Pulmonary Hypertension |
|
Definition
-increase in pulmonary blood flow and/or pressure
-pulmonary vascular resistance
-left heart resistance to blood flow |
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Term
| Pulmonary Hypertension in Chronic Obstructive or Interstitial Lung disease |
|
Definition
hypoxia & destruction of lung parenchyma --> fewer alveolar capilaries
**increased pulmonary arterial resistance
**elevated pressure |
|
|
Term
| Pulmonary Hypertension inCongenital or Acquired Heart Disease |
|
Definition
-Incease in left atrial pressure --> increase in pulmonary venous pressure
**increase in pulmonary artery pressure |
|
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Term
| Pulmonary Hypertension in Recurrent Thromboemboli |
|
Definition
obstruction of pulmonary vascular bed
**increase in pulmonary vascular resistance |
|
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Term
| Pulmonary Hypertension in Connective Tissue disease |
|
Definition
| -inflammation, intimal firbsosi, medial hypertrophy and PH |
|
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Term
| Pulmonary Hypertension in Obstructive Sleep Apnea |
|
Definition
| impt in development of PH & Cor Pulmonale |
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Term
| Familial PH is caused by mutations in |
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Definition
| Bone Morphogenetic Protein Receptor Type 2 (BMPR2) signaling pathway |
|
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Term
| Role of BMPR2 in familial hypertension |
|
Definition
-NORMALLY: Vascular Smooth Muscle Cells BMPR2 signaling = inhibition of proliferation & favors apoptosis
-INACTIVE: increase smooth muscle survival & proliferaiton |
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Term
| What occurs in secondary Pulmonary Hypertension |
|
Definition
-Decreased prostacylcin & decreased NO
*Unchecked platelet adhesion & activation
-Increased release endothelin
*All above ++ Pulmonary Vasoconstriction |
|
|
Term
| Common pathologic features of PH |
|
Definition
-medial hypertrophy of muscular & elastic arteries
-atheromas of pulmonary artery & its major branches
-right ventricular hypertrophy |
|
|
Term
|
Definition
Occurs in: idiopathic/familial PH; unrpaired congenital disease (left-to-right shunts; PH assoc with drugs, HIV
-tuft of capillary formations produce a network that spans in the lumens of dilated thin-walled, small arteries |
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Term
| Idiopathic PH is most common in: |
|
Definition
| women age 20-40 & occasionally in young children |
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Term
| Examples of pulmonary hemorrhage syndrome |
|
Definition
-Good-pasture syndrome
-Idiopathic pulmonary hemosiderosis
-Vasculitis-associated hemorrhage |
|
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Term
| Good-Pasture is produces autoantibodies against: |
|
Definition
alpha3 chain of Collagen IV
attacks basement membrane in kidneys & lungs |
|
|
Term
Morphological changes from Good-Pastures in:
Lung
Kidney |
|
Definition
LUNG - focal necrosis of alveolar walls; hemosiderin-laden macrophages in alveoli; hypertrophy of Type II Pneumocytes; deposition of antibodies in basement membrane
KIDNEY:focal proliferative glomerulonephritis |
|
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Term
|
Definition
| remove circulating anti-basement membrane Ab's & chemical mediators of immunological injury |
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Term
| Features of Idiopathic Pulmonary Hemosiderosis |
|
Definition
-intermittend, diffuse alveolar hemorrhage
-most cases in young children
-unknown etiology: but responds to long-term immune suppression (may have a autoimmune factor) |
|
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Term
| Features of Wegener Granulomatosis |
|
Definition
-autoimmune disease of upper resp tract and/or lungs
-Hemoptysis common presenting symptom
-Need transbronchial lung biopsy = capillaritis & scattered, poorly formed granulomas = diagnostic features |
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Term
| Interference of pulmonary defense mechanisms include: |
|
Definition
-loss / suppression of cough reflex
-injury to mucociliary apparatus
-accumulation of secretions
-interference with phagocytic/bacterial action
-pulmonary congestion / edema |
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Term
| Defects in innate & humoral immunity leads to increased incidence of what type of infections? |
|
Definition
| pyogenic (pus-forming) bacteria |
|
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Term
| Defects in cell-mediated immunity result in an increase in what type of infections? |
|
Definition
| Intracellular microbes (e.g. mycobacteria, herpes) & microbes with low virulence |
|
|
Term
|
Definition
-Most common cause of community acquired pneumonia
-gram positive
-lancet shaped diplococci |
|
|
Term
|
Definition
-Pleomorphic, gram negative
-Major cause of life-threatening acute lower respiratory tract infections & meningitis in children
-Colonizes pharynx: encapsulated (5%) & unencapsulated (95%) encapsulated
-Encapsulated secretes haemocin that kills unencapsulated
-pilli for adherence
-secretes anti-ciliary factor & protease against IgA (major respiratory Ig)
-capsule prevents opsonization
-Cause of pink eye
-most common bacterial cause of acute exacerbation of COPD |
|
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Term
|
Definition
-2nd most common bacterial cause of acute exacerbation of COPD
-1 of 3 common cause of otitis media in children |
|
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Term
|
Definition
-important cause of secondary bacterial pneumonia following viral respiratory illnesses
-assoc with hi incidence of complications
-IV drug users - high risk of developing staph pneumonoia in assoc w/ endocarditis |
|
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Term
|
Definition
-most frequent cause of Gram Negative bacteria
-affects malnourish & debilitated (chronic alcoholics)
-Thick & gelatinous sputum |
|
|
Term
|
Definition
-most common cause of hospital-acquired infections
-opportunistic in cystic fibrosis
-common in neutropenics |
|
|
Term
|
Definition
-agent of Legionnaire's Disease
-causes Pontiac Fever (self-limiting URI)
-transmission: inhilation of aerosolized or aspiration of contaminated water
-organ transplants are susceptible |
|
|
Term
| 2 patterns of anatomic distribution in bacterial pneumonia: |
|
Definition
-LOBULAR BRONCHOPNEUMONIA - patchy consolidation of lung
-LOBAR PNEUMONIA - fibrinosuppurative consolidation of large portion of a lobe/entire lobe |
|
|
Term
| Complications of pneumonia: |
|
Definition
1 - tissue destruction/necrosis ==> abscess
2. spread of infxn to pleural cavity --> empyema (intrapleural fibrinosuppurative rxn)
-bacteremic dissemination to heart valves, pericardium, brain, spleen, joints |
|
|
Term
| 4 stages of lobar pneumonia: |
|
Definition
CONGESTION - lung is heavy, boggy & red; vascular engorgement, intra-alveolar fluid w/ few neutrophils
RED HEPATIZATION - massive confluent exudation w/ neutrophils, red cells, fibrin filling alveolar spaces
GRAY HEPATIZATION - progressive disintegration of red cells & persistance of fibrinosupprative exudate; gray-brown, dry surface
RESOLUTION - enzymatic digestion of consolidated exudate - debris is resorbed, expectorated or rearranged |
|
|
Term
| Primary atypical pneumonia characteristics |
|
Definition
-acute febrile respiratory disease
-patchy inflammatory changes in lungs confined to alveolar septa & pulmonary interstitium
-moderate amount of sputum & no physical findings of consolidation |
|
|
Term
| Most common cause of primary atypical pneumonia |
|
Definition
Mycoplasma pneumoniae
-common among children & young adults |
|
|
Term
| Commmon morphology of community-acquired atypical pneumonias |
|
Definition
interstitial inflammatory reaction, localized within walls of alveoli
-alveolar septar are widened & edematous w. monoculear inflammatory infiltrate |
|
|
Term
| Influenza Virus characteristics |
|
Definition
-ssRNA - 8 helices
-Hemagluttinin & Neuraminidase
-2 clearance mechanisms: cytotoxic T cels & Intracellular anti-influenza protein Mx1 induced in macrophages by IFN alpha & gamma |
|
|
Term
| Influenza epidemic vs influenza pandemic |
|
Definition
EPIDEMIC - predominates througout the world @ given time **antigenic drift** mutations of H & N
-PANDEMIC - longer, more widespread **antigenic shift** H & N are replaced with Animal segments thru recombination |
|
|
Term
|
Definition
-severity of the dzs b/c it spreads thruout body - not limited to lung
-H protein can be cleaved by ubiqutous proteases |
|
|
Term
|
Definition
-mucosal hyperemia
-swelling w/ predominantly lymphomonocytic & plasmacytic infiltration of submucosa |
|
|
Term
| Human Metapneumovirus (MPV) |
|
Definition
-paramyxovirus
-upper & lower respiratory functions
-indistinguishable from RCV |
|
|
Term
| Severe Acute Respiratory Syndrome (SARS) |
|
Definition
-Incubation period 2 days
-dry cough, malalise, myalgia, fever, chill
-coronavirus
-transmission by wild masked palm civets |
|
|
Term
| More common cause of hospital acquired infections: |
|
Definition
-Gram Negative Rods: Enterobacter, pseudomonas
-Staph aureus |
|
|
Term
|
Definition
-aspiration of gastric contents
-pneumonia is party chemical and partly bacterial |
|
|
Term
| What is a pulmonary abcess? |
|
Definition
| Local suppurative process within lung, characterized by necrosis of lung tissue |
|
|
Term
| Introduction of abscess forming pathogens via: |
|
Definition
-aspiration of infective material
-antecedent primary lung infection
-septic embolism
-neoplasia
-miscellaneous - trauma, spread of neighboring infection |
|
|
Term
| Primary cryptogenic lung anscesses |
|
Definition
| abscess without any explanation |
|
|
Term
| Where are pulmonary abscesses due to aspiration more common? |
|
Definition
| right side - more vertical right main bronchus |
|
|
Term
| Cardinal histologic change in abscesses |
|
Definition
| suppurative destruction of lung parenchyma within central area of cavitation |
|
|
Term
| Histoplasmosis, Blastomycosis, Coccidiodiomycosis have in common: |
|
Definition
-Caused by Fungi
-granulomatous diseases resembling TB
-has regional distribution |
|
|
Term
|
Definition
-inhalation contaminated with bird/bat dropping
-intracellular parasite of macrophages
-granulomas undergo fibrosis - concentric calcification with tree-bark appearance
-Missippi River, Ohio River, Carribbean |
|
|
Term
| Fulminant disseminated histoplasmosis |
|
Definition
immunosuppressed individuals
-no granuloma formation - instead focal accumulations of mononuclear phagocytes filled with fungal yeasts |
|
|
Term
|
Definition
-soil inhabiting, dimprophic fungus
-macrophages have limited available to destroy it
-Central & Southeast USA |
|
|
Term
| How does IS fight histoplasmosis? |
|
Definition
-Controlled by helper T cells & secrete IFN-Gamma to activate macrophages to kill
-histoplasma induces macrophages to secrete TNF - recruits and stimulates macrophage to kill |
|
|
Term
|
Definition
-delayed-type hypersensitivity to fungus
-blocks fusion of phagosome & lysosome (resistant to intracellular killing)
-Far West & South West |
|
|
Term
| Bacterial & Tubercular infections are more likely at ... |
|
Definition
|
|
Term
| Pneumocytistis pneumonia is at what CD4+ count |
|
Definition
|
|
Term
| Cytomegalovirus & Mycobacterium avium occur at what CD4+ level? |
|
Definition
|
|
Term
| What can cause pleural effusion? |
|
Definition
-increase hydrostratic pressure
-increased vascular permeability
-decreased osmotic pressure
-increased intrapleural negative pressure
-decreased lymphatic drainage |
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