PATHOLOGY
Respiratory
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Matching: Types of obstructive lung disease (COPD):
| -?-emphysema | enlargement of air spaces & ↓ recoil resulting from destruction of alveolar walls; caused by smoking & α1-antitrypsin deficiency → ↓ elastic activity; findings: dyspnea, ↓ breath sounds, tachycardia, ↓ I/E ratio; "pink puffer" |
| -?-asthma | bronchial hyperresponsiveness causes reversible bronchoconstsriction; can be triggered by viral URIs, allergens, stress; findings: cough, wheezing, dyspnea, tachypnea, hypoxemia, ↓ I/E ratio, pulsus paradoxus |
| -?-chronic bronchitis | productive cough for > 3 consecutive months in 2 or more yrs; hypertrophy of mucus-secreting glands in the bronchioles (Reid index > 50%); leading cause is smoking; findings: wheezing, crackles, cyanosis |
| -?-bronchiectasis | chronic necrotizing infection of bronchi → dilated airways, purulent sputum, recurrent infections, hemoptysis; associated with bronchial obstruction, cystic fibrosis, poor ciliary motility |
| chronic bronchitis emphysema asthma bronchiectasis | |
Restrictive lung disease
| Type | Feature | Diseases |
|---|---|---|
| I. Poor breathing mechanics (extrapulmonary) | a) poor muscular effort | two diseases? |
| b) poor apparatus | one disease?
|
|
| II. Interstitial lung diseases | Polypeptide | eight diseases? |
Lung - physical findings
| Abnormality | Breath Sounds | Resonace | Fremitus | Tracheal Deviation |
|---|---|---|---|---|
| Bronchial obstsruction | Absent over area | ↓ | -?-↓ | Toward side of lesion |
| Pleural effusion | ↓ over effusion | -?-Dulless | ↓ | -- |
| Pneumonia (lobar) | -?-May have bronchial breath sounds over lesion | Dullness | ↑ | -- |
| Pneumothorax | ↓ | Hyperresonant | Absent | -?-Away from side of lesion |
Lung cancer/bronchogenic carcinoma
Tumors that arise centrally:
-?-squamous cell carcinoma
clear link to smoking; ectopic PTH-related peptide production
-?-small cell carcinoma
clear link to smoking; associated with ectopic hormone production (ADH, ACTH); may lead to Lambert-Eaton syndrome
Tumors that arise peripherally:
-?-adenocarcinoma
most common
-?-bronchioalveolar carcinoma
thought not to be related to smoking
-?-large cell carcinoma
undifferentiated
Lung cancer:
Features of carcinoid tumor: -?-can cause carcinoid syndrome (flushing, diarrhea, wheezing, salivation)
Features of metastases: -?-very common; brain (epilepsy), bone (pathologic fracture), and liver (jaundice, hepatomegaly)
Pneumonia
| Type | Organism(s) | Characteristics |
|---|---|---|
| Lobar | Most frequently? -?-pneumococcus | Intra-alveolar exudates → consolidation; may involve -?-entire lung |
| Bronchopneumonia |
S. pyogenes and the other three? -?-S. aureus -?-H. Flu -?-Klebsiella |
Acute inflammatory infiltrates from brochioles into adjacent alveoli; -?-patchy distribution involving ≥ 1 lobes |
| Interstitial (atypical) pneumonia | Two viruses? -?-RSV -?-adenoviruses Also mycoplasma, legionella and -?-chlamydia |
Diffuse patchy inflammation localized to interstitial areas at -?-alveolar walls; distribution involving ≥ 1 lobes |