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Pulmonary 1.1

UWORLD + FA Pulmonary Respiratory Review

Question	Answer
Unique fungus with a Polysaccharide capsule?	Cryptococcus neoformans
The polysaccharide capsule in C. neoformans, stains?	Red on Muscarine stain CLEAR on INDIA INK
What are the possible infections of Cryptococcus neoformans?	CNS --- meningoencephalitis (AIDS patients MC) Cryptococcal Lung disease --LUNGS
What is the treatment of C. neoformans?	Initially Amphotericin B and Flucytosine. Then maintenance is done by fluconazole (AIDS patients)
Cryptococcus is an _________________- (+) organism, which causes _______ in pH by increasing release of _______________ and ______.	Urease; Increase in pH; Ammonia and CO2
Narrow budding, heavily encapsulated, and Urease positive? Where is it commonly found?	C. neoformans is commonly found in soil and bird droppings
C. neoforman infection in HIV (+) patient is commonly due when the CD4+ count falls below?	100 cell/mm3
What is the MCC of meningitis in HIV patients?	Cryptococcus neoformans infection
Pulmonary V/Q is defined by _____________ and _____________.	Perfusion and Ventilation
Perfusion and ventilation are both larger in the _________________ of the lung.	BASE
V/Q ______________________ from the _____________ to the base.	Decreases; Apex to Base
The greatest V/Q value is at the _____________ of the lung, while the lowest V/Q value is at the ____________ of the lung.	APEX-- max value BASE -- min value
Which, perfusion or ventilation, has a greater or more significant increase as it we travel from apex to the base of the lungs?	Perfusion has a greater/more significant increase as we travel down the lung.
On what factors is gas exchange dependable?	Perfusion and Diffusion
Gas exchange occurs among which two structures?	ALVEOLI and pulmonary capillary
Healthy individual is _______________________ - limited, meaning?	Perfusion-limited; Alveolar and Capillary pressures are EQUAL
A patients with Emphysema or pulmonary fibrosis, is ______________-limited.	Diffusion limited
What are some common condition that promote gas exchange to be Diffusion-limited?	Emphysema and Pulmonary fibrosis
In Diffusion-limited gas exchange, the is a ________ gradient between the _____ and _______________ ________.	Large; alveolar; capillary ; PO2
Why is PO2 affected in much more significant effect than PCO2, in cases of deficiency gas exchange?	CO2 has a greater diffusing capacity and it crosses the between the capillary and the alveoli, 20x faster
What are the approximate partial pressures INSIDE the alveolus?	PAO2 --> 105 PA CO2 --> 40
Approximate values of Partial pressures in the Pulmonary vein, and systemic (body) arteries?	PaO2 is 100 and PaCO2 is 40
What are the changes to partial pressure in the systemic venous system and pulmonary artery, compared to those in the systemic arterial systems and pulmonary vein?	The Partial arterial pressure of Oxygen drops dramatically form 100 to 40, while in the case of PaCO2 the venous system has an slight elevation of 6 units, making it 46.
What factor/action may induce an increase in skeletal CO2 production?	Aerobic exercise
Elevation of blood CO2 causes:	1. Decrease In O2 content 2, Increase in CO2 content which lead to a decrease in venous blood pH.
Homeostatic mechanisms to maintain normal ABGs, are more effective controlling the ________________ pH, than the venous pH.	Arterial
Exercise does not affect _______________ and _____________, but increase ____________ and decrease _______________.	PaO2 and PaCO2 are not changed; Increase in venous CO2 content and decreased venous O2 content
Partial pressures are not affected in exercise because it is a measure of __________________ and not a ____________.	Dissolving; Quantity measure.
What is the most aggressive type of lung cancer?	Small cell lung cancer
Small cell lung cancer is of _______________ origin. Its tumor cells contain __________________ granules in the cytoplasm, which incice __________, _____________, _______________, and _______________.	Neuroendocrine; Neurosecretory; NCAM, Enolase, Chromogranin, and synaptophysin
KRAS genes are associated with:	NON-small cell lung cancer
What type of cancer is staind with vimentin?	Sarcomas
Sarcomas stain positive for ____________________.	Vimentin
What are the functions of Ciliated epithelial cells?	1. Mucociliary clearance 2. Clear most inhaled particle in the bronchial tree, especially at the Proximal bronchial.
What is the major stimulator of respiration?	PaCO2
An increase in PaCO2 leads to:	Increased pulmonary ventilation
A patient with COPD, has a defective to _________ response, leaving _____________________ as the most important contributor of respiratory drive.	PaCO2; HYPOXEMIA
Which chemoreceptors are the most important affecting respiration in cases of changes to PaCO2 response?	Peripheral chemoreceptors, especially those in the CAROTIDS
Description of Central chemoreceptors:	Located in MEDULLA -Primarily stimulated by pH of CSF - CO2 can readily cross BBB, causing an increase in [H+] - Increase in PaCO2 is a major stimulator of central chemoreceptors
Where are the Peripheral chemoreceptors located?	Carotid and Aortic areas
Description of Peripheral chemoreceptors:	Located in CAROTIDS & AORTIC - Primary for sensing PaCO2 and stimulated by HYPOXEMIA - Also stimulated by: - Increased PaCO2 - Increase in blood [H+]
What are Pulmonary Stretch receptors?	Myelinated and unmyelinated G-fibers in lungs and airways
Regulation and duration of respiration of depending on the degree of lung distension.	Hering-Breuer reflex
What are the 2 main function of Type II Pneumocytes?	1. Regeneration of the alveolar lining following an injury 2. Surfactant production
Type II pneumocytes account of _______% of all cells in the lungs.	5%
What cells are the progenitors of Type I (1) pneumocytes?	Type II pneumocytes
Type I pneumocytes:	Cover 95% of alveolar surface and cannot regenerate their own
Respiratory epithelium of bronchi and larger bronchioles. Terminally-differentiated, mucin-producing cells	Goblet cells
What pulmonary cells are responsible for production of mucus?	Goblet cells
What are characteristics and functions of Club cells?	- Non-ciliated - Terminal portions of bronchioles - Act as regenerative ciliated cells in the bronchioles
Squamous; thin for optimal gas diffusion	Type I pneumocytes
What is pulmonary surfactant?	Complex mix of lecithins, the most important which is dipalmitoylphosphatidylcholine (DPPC)
At which week of gestation is surfactant begins to be produced?	20 week
At week ______ of gestation, _________ should be fully produced.	35 week; Surfactant
Cyclic breathing pattern in which apnea is followed by gradually increasing and then decreasing TV until the next apneic period.	Cheyne-Stoke breathing
What conditions are associated with Cheyne-Stoke breathing?	Advance congestive heart failure - Neurologic conditions such as: * Stroke, brain tumors, and traumatic brain injury
Hypocapnia, especially at night and chronic hyperventilation, seen with a abnormal breathing pattern?	Cheyne-Stoke breathing
Respiration pattern described as DEEP and LABORED pattern, associated with metabolic acidosis, especially in DKA.	Kussmaul breathing
Patient with DKA may develop metabolic acidosis and ___________ breathing.	Kussmaul breathing
What is a common corticosteroid drug used to treat the inflammatory effects of asthma?	Fluticasone
What type of medications used for asthma, have the strongest anti-inflammatory effects?	Corticosteroids
Muscarinic antagonist	Ipratropium
Montelukast is an _____________ ______________, used in long-term treatment of __________, but has low efficacy and no ____________ effects.	Leukotriene inhibitor; ASTHMA; anti-inflammatory
Phosphodiesterase inhibitor used in asthma is ________________.	Theophylline
What is the results of the MoA seen in Theophylline?	Increase in intracellular cAMP -----> Bronchodilation
Narrow therapeutic index, causes bronchodilation by increasing cAMP, and may cause cardiotoxicity and nephrotoxicity?	Theophylline
What are the most important uses of Montelukast?	Aspirin-induced and exercise-induced asthma
Omalizumab is an ______________________________.	Anti-IgE monoclonal therapy
Which asthma drugs are directed to relieve symptoms and act as an early response?	B-agonist, Theophylline, Muscarinic antagonists
What asthma drugs are directed to relieve symptoms and act on late response, and prevent bronchial hyperreactivity?	Steroids and Antileukotrienes
What enzyme is responsible for the green-color of pus?	Myeloperoxidase
Myeloperoxidase is released by _____________________, which then gives its _____________-color to pus.	Neutrophils; GREEN
Community-acquired Pneumonia (CAP), is most commonly by _____________, CAP is seen in with _____________________ within one lobe of the lung.	Strep pneumoniae; cough with consolidation
What is the normal range of PaCO2?	38 - 42 mmHg
High V/Q?	Blood saturated with O2 and lowest saturation of CO2.
High ventilated areas _________ compensate for less ventilated	Cannot
Blood cannot become fully saturated with __________, and highly ventilated areas _______ compensate with less ventilated.	CO2; can
Arterial PCO2 (PaCO2) is a direct indicator of __________________ status.	Alveolar ventilation
Hypocapnia produces _________________________.	Hyperventilation
Why does hypocapnia produces hypoventilation?	Upper airway obstruction, reduced ventilation rate, respiratory failure and deces chest wall compliance, all together produces a low ventilation rate.
What is the major serum inhibitor of neutrophil elastase?	Alpha-1-antitrypsin (AAT)
What kind of emphysema is often caused by AAT deficiency?	Panacinar emphysema
Panacinar emphysema affects the ___________________lobes of the lung.	Lower
The _________ lobes of the lungs are most affected ____________________ emphysema.	Upper lobes; Centriacinar
Panacinar emphysema is associated to:	1. Family Hx of Lung and/or Liver disease (AAT deficiency) 2. Young age and minimal personal tobacco use
Centriacinar emphysema, that affects the ________ lung lobes. It is strongly associated with:	Upper; Smoking --> leads to macrophages and neutrophils become activated, release proteasomes and acinar wall destruction
CXR: Increased AP diameter, flattened diaphragm, Increased lung field lucency	Emphysema
Enlargement of air spaces, increased recoil, increased compliance, and decreased diffusing capacity of CO. Dx?	Emphysema
Barrel-chest	Emphysema
Patient presents with barrel-shaped chest, exhalation through pursed lips. MC Dx?	Emphysema
Why does a patient with chronic emphysema exhales through pursed lips?	Increases airway pressure and prevents airway collapse
Physical findings in asthmatic patient:	Cough, WHEEZING, tachypnea, dyspnea, hypoxemia, decreased inspiratory/expiratory ratio, pulsus paradoxus, and mucus plugging
What COPD condition shows an increased Diffusing capacity of CO?	Asthma
Eosinophilic, hexagonal, double-pointed crystals, made from breakdown of eosinophils in sputum.	Charcot-Leyden crystals
Charcot-Leyden crystals are associated with:	Asthma
In COPD, what lung volumes are increased?	FRC, RV and TLC
The FEV1: FVC ratio is _______________________ in COPD.	Decreased
Decreased FEV1:FVC ratio is seen in __________________.	Obstructive lung diseases
Increased FVE1;FVC ratio is seen in _____________________.	Restrictive lung diseases
Decreased lung volumes, especially TLC and FVC, describes which kind of lung diseases?	Restrictive lung diseases
Air goes in but gets trapped in alveoli, describes in simple terms, the pathogenesis of?	Obstructive lung diseases
If air cannot get into the lungs, and shows short and shallow breaths.	Restrictive lung diseases
MCC of "walking" pneumonia	Mycoplasma pneumoniae
What are cold agglutinins?	IgM antibodies atha bind to RBCs and lead to agglutination/ clumping at low body temperatures
Cold agglutinins are associated with ________________________ (microbe), which the most common cause of ________________ pneumonia.	Mycoplasma pneumoniae (M. pneumoniae); Walking
Structural damage to lungs defines ______________ lung disease profile.	Restrictive
What conditions or diseases are associated with cold agglutinin?	Mycoplasma pneumoniae infection, Mononucleosis, and hematologic malignancies such as CLL.
Warm agglutinin are associated with?	IgG antibodies associated with SLE, CLL, and drugs such as a-methyldopa.
Gram positive rod (branching/beaded), partially acid-fast, and aerobic.	Nocardia spp
What are the CNS and lung manifestations of Nocardia infection?	Pneumonia symptoms similar to TB, and Brain abscesses.
What is the treatment for Nocardiosis?	TMP-SMX
Nocardia is:	1. Partially (weakly) acid-fast stain 2. Aerobe 3. Urase (+) 4. Catalase (+) 5. Found in soil 6. Treated with sulfonamides (TMP-SMX)
SNAP	Mnemonic to differentiate treatment between Nocardia and Actinomyces sppcs. Sulfonamides ----- Nocardia Actinomyces ------- Penicillin
Clinical signs of Collapsed lung:	Due to Bronchial obstruction. Decreased breath sounds, hemithorax opacification , tracheal deviation towards affected side
What is a common bronchial obstruction causing collapse of a lung?	Central lung tumor (Small cell or Squamous)
Tracheal deviation to _____________________ side is to "_____" , as seen in cases of _____________________ and ____________________.	IPSILATERAL (affected); pull; Collapse and Fibrosis
___________________ tracheal deviation is to "_________" the trachea to the _____________ affected side, as seen in cases of _____________ and _________________.	Contralateral; Push; Non-affected; Apical mass and Pleural effusion
"DULL" lung auscultation is used to describe which conditions?	1. Pleural effusion 2. Atelectasis 3. Consolidation (lobar pneumonia, pulmonary edema)
Hyperresonant percussion of the thorax is seen in:	Tension pneumothorax and simple pneumothorax
Which lung condition is the only to demonstrate Increased fremitus?	Consolidation (Lobar pneumonia and Pulmonary edema)
Paroxysmal breathlessness and wheezing in young patient.	Extrinsic Allergic Asthma
3-base pair deletion in the CFTR	Cystic Fibrosis
In Cystic fibrosis, the mutated _________ gene in amino acid position __________, leads to impaired ______________________ processing of CFTR, leading to its destruction by Proteasome and its absence in the cell membrane.	CFTR gene; position 508; POST-TRANSLATIONAL;
Elevated levels or Cl- and Na+ in the sweat make the diagnosis for:	Cystic Fibrosis
Clinical presentation of Cystic fibrosis:	1. Recurrent sinopulmonary infections, especially by PSEUDOMONAS AERUGINOSA 2. Pancreatic insufficiency --> pancreatitis 3. Malabsorption --> deficiency in Vitamins ADEK 4. Infertility
Common organism in CF patient hat provokes URIs?	Pseudomonas aeruginosa
CF patient is prone to fracture, dry skin, poor night vision, and possible bleeding, due to?	Malabsorption of lipid soluble vitamins
Patient seeks help for infertility. Hx of recurrent sinopulmonary infections, with complete antibiotic treatment. Patient complains of recurrent central abdominal pain with greasy foods. Dx?	Cystic Fibrosis
MC organism causing pneumonia in CF patient	Pseudomonas aeruginosa
Reason of infertility seen in CF in males?	Absence of vas deferens
Pulmonary actinomycosis affects more readily the _________ lobes, and MC occurs in cases of _________________.	Lower; Aspiration
Filamentous, branching, gram (+) bacterial with sulfur granules.	Actinomyces
Actinomyces:	Anaerobe, found in normal oral, reproductive and GI flora, sulfur granule producer, and treatment with Penicillin
What are clinical manifestations of actinomyces infection?	1. Oral/facial abscesses (drain in sinuses) 2. PID with IUDs
Labs seen in sarcoidosis demonstrate:	Hypercalcemia and hyperuricemia, and elevated ACE levels.
Non-caseating granulomas -->	Sarcoidosis
What cytokines are secreted by Th1 cells?	INF-gamma, IL-2, and lymphotoxin B
Th2 release which cytokines?	IL-4, IL-5, IL-10, and IL-13
INF-gamma inhibits __________ cells.	Th2
Which cytokines released by Th2 cells inhibit Th1 actions?	IL-4 and IL-10
Humoral immunity is mediated by:	Th2 cells
Th1 cells mediated with immunity?	Cell mediated immunity
A lack of IL-12 causes a decrease in:	Th1 cell activity, thus a impaired cell-mediated immune response.
What are the effects of Th1 cytokine release, previously stimulated by IL-12?	1. Activation of macrophages and CD8+ cells 2. Measure of delay type hypersensitivity
Where does an primary (initial) TB infection replicate?	Alveolar space and Alveolar macrophages
What substance/cytokine is released by macrophages previously infected with TB?	Interferon-gamma, which activates macrophages and controls the infection.
Macrophage release of INF-g, causes phagolysosomes to destroy bacteria and also to:	Differentiate epithelioid cells and Multinucleated Langerhan cells, to surround mycobacteria within granulomas
What kind of granulomas are seen in TB infection?	Caseating
What cytokines are responsible to maintain the caseating granulomas seen in TB?	IL-12, INF-g, and TNF-a
Histoplasma capsulatum:	dimorphic fungus that exists as a small, ovoid yeast at tissue temperatures.
H. capsulatum may cause disseminated disease to the _________ , bone marrow, and ______________, causing _______________, _____________, and __________________, respectively.	liver, bone marrow, spleen; Hepatomegaly, Pancytopenia, splenomegaly
What is used to culture H. capsulatum?	Sabour agar (cooler temperatures)
Unique signs and symptoms of Histoplasmosis?	1. Palatal/tongue ulcers 2. Splenomegaly
Histoplasma is ________ than a RBC.	Smaller
What kind or type of necrosis is seen with Histoplasma?	Caseous necrosis
What is the treatment for all local infection by systemic mycoses?	Itraconazole or Fluconazole
Disseminated histoplasmosis is treated with:	Amphotericin B
Endemic in MIssissippi and Ohio River valleys	Histoplasma capsulatum
Endemic region of Blastomyces?	Eastern and Central USA
Southwestern USA and California are endemic region for which mycoses?	Coccidioides
Latin America is the endemic region for which mycosis	Paracoccidioides
Which mycoses is in similar size to a RBC?	Blastomyces
_______________________ is much larger than an RBC.	Paracoccidioides
Spherule filled with endospores in San Francisco, CA	Coccidioides
Primary mediators of COPD?	Neutrophils, Macrophages, and CD8+ T-cells
Primary mediators of COPD _______________, secrete _____________ which cause _____________________ seen in Emphysema, and __________________ found in cases of Chronic bronchitis.	Neutrophils, Macrophages, and CD8+ T-cells; Proteases; Alveolar destruction; Mucus hypersecretion
At which level is a Chest tube best placed?	4th and 5th intercostal spaces along the anterior maxillary or midaxillary lines.
The 4th and 5th intercostal spaces at midaxillary line represent the base anatomical location to place a __________________.	Chest tube
What is bronchitis obliterans?	Lung transplant chronic rejection, that progressively scares the small airways.
Common cause of Respiratory alkalosis?	High altitude
High altitude causes _____________________, which is compensated by the kidneys after several __________.	Hypoxemia; days
Respiratory Alkalosis:	1. High pH (>7.45) 2. Low PaCO2 (<35) 3. Delayed renal compensation
ABG: Low HCO3, low pH, describes	Metabolic Acidosis
ABG: Low pH and High PaCO2, describes?	Respiratory Acidosis
The number of ___________ cells, decrease _______________ just before reaching the ___________________ ________________.	Goblet cells; Distally; Terminal bronchioles
CLub cells form part of the cells in the _________________ bronchiole.	Terminal
Which parts of the respiratory system have Ciliated epithelium?	Bronchi, Proxima bronchioles, and terminal bronchioles
Ciliated Columnar cells in bronchial mucosa are found in?	Bronchi and Proximal Bronchioles
The Respiratory bronchioles and Terminal bronchioles, have Ciliated ____________ epithelium.	Cuboidal
The ______________ is the only part of bronchial mucosa that has ________________ and ____________.	Submucosal glands and Cartilage
What lung forces are changed in AGING?	- Decrease in chest wall compliance - Increase in LUNG compliance, due to loss of Elastic recoil, thus, increasing RV, and derasein FVC.
What is the purpose of lung's collateral circulation?	Protect against lung infarction
The Pulmonary dual circulation is done by which to blood supply bodies?	1. Pulmonary arteries 2. Bronchial arteries
What is the major source of deoxygenated blood to the lung?	Pulmonary arteries
Distal pulmonary vasculature occlusions tend to produce________ or __________ infarctions.	Red or Hemorrhagic
A adequately perfused by poorly ventilated area is defined as _______________________.	Intrapulmonary shunting
Simplistic pathogenesis of Intrapulmonary shunting.	The alveoli is not able to fully oxygenate the incoming blood----> hypoxemia.
Centriacinar emphysema is associated with heavy _______________, affects the ___________________ of the lung, adn involves the release of proteinases such as _____________________, from neutrophils and alveolar macrophages.	Smoking; Upper lobes; Elastase
A _______________ (club) cell is a secretory constituent found in the _______________ broinchile. Secretes protein and ________________ components, that help the detoxification of inhaled substance, such as cigarette smoke.	Clara; Terminal; Surfactant components
Non-ciliated, low columnar/cuboidal epithelial cell with secretory granules, found in terminal bronchiole.	Club cell
Proliferate during lung damage	Type II Pneumocytes
What climate conditions worsen the hypochloremia and hyponatremia seen in CF?	Hot temperatures, as they increase the sweat production
Absence CFTR in cell membrane	Cystic Fibrosis
Why is important for a CF patient to be careful to practice exercise?	Increase in sweat increases the hypochloremia and hyponatremia
Endothelin:	1. Potent vasoconstriction 2. Smooth muscle prolerion stimulant
Bosentan and Ambisetron are:	Endothelin receptor antagonists
Drug commonly used to lower pulmonary arterial pressure, and improve dyspnea in patients with Pulmonary HTN	Bosentan
What is the main difference in final effects between Endothelin, NO, and Prostacyclin?	Endothelin is a vasoCONSTRICTOR and Increase Smooth muscle proliferation, NO and PROSTACYCLIN are vasoDILATORS, and both decreased smooth muscle proliferation
The nitrate oxide (NO) increases the levels of ________________, leading to _________________ and _____________________________.	cGMP; Vasodilation and decreased smooth muscle proliferation
NO pathway and the Prostacyclin both achieve vasodilation and decrease SM proliferation by increased the serum level of __________.	cGMP
What amino acid is precursor of NO?	L-arginine
L-arginine becomes ____________________, which leads to an elevated level of _______________, resulting in: __________________ and decreased SM proliferation.	Nitric Oxide (NO); cGMP; Vasodilation
Hypoxia caused by Chronic bronchitis:	Decreased diameter of the conducting airways, preventing adequate airflow
Dilating alveolar air spaces leading to insufficient contact between the arie space the deoxygenated blood in the alveolar capillaries.	Hypoxia seen in Emphysema
How is hypoxia caused by smoking?	Increased concentrations of carboxyhemoglobin in the blood
Hypoxia relation to kidneys	Hypoxia is sensed by the RENAL cells in the RENAL CORTEX, which lead to an increase release in ERYTHROPOIETIN --> more RBC production.
Stimulation of which cranial nerve in a patient with OSA, would aid to prevent apneic events during sleep?	Cranial Nerve 9 (Hypoglossal)
What is the most common cause of CAP in HIV+ patients? in non-HIV infected?	Strep pneumoniae, in both populations
Clinical presentation of Strep Pneumoniae CAP:	Acute-onset fever, productive cough, leukocytosis, and signs of lobar consolidation (dull percussion and increased fremitus), crackles.
Any pathologic process that fills alveoli with fluid, pus, blood, cells, or other substances that result in lobar, diffuse, or multifocal ill defined opacities	Consolidation
Interstitial lung pattern in X-ray	Involvement of supporting tissue of the lung parenchyma resulting in fine or coarse reticular opacities or small nodules
PCP is seen in AIDS patients with a CD4+ count less than	< 200
Common source of Legionella pneumophila infection	Contaminated WATER SOURCE, such as A/C. Suspect in cases of recent cruise travel, hotel stay.
Fever >39 (102F), bradycardia relative to the high fever, headache, confusion, and watery diarrhea. Labs: Hyponatremia, and gram stain with neutrophilia but no organisms.	Legionella pneumophila infection
What are the most characteristic findings in L. pneumophila infection?	Contaminated water source, pyrexia (>102F), and HYPONATREMIA
What medium is used to grow Legionella?	Culture on BCYE, supplemented with L-cysteine and Iron
What common test is used to Dx Legionella?	Urine analysis to detect Legionella antigen in urine
What kind of bacteria are most common to cause lung abscesses?	ANAEROBES
Which anaerobes are most commonly seen in lung abscesses?	Peptostreptococcus, Prevotella, BACTEROIDES,and Fusobacterium.
There risk of ____________________ leads to an increase risk of lung abscess formation.	Aspiration
What conditions increase risk of Aspiration, thus developing lung abscesses by anaerobes?	Alcoholism, drug abuse, SEIZURE disorder, stroke and dementia.
What is the clinical profile of a aspiration patient with formed lung abscess?	Indolent fever, night sweats, weigh loss, and productive cough with FOUL-smelling odor
Foul-smelling odor in sputum is often indicative of _______________ infection.	ANAEROBE
Form of primary ciliary dyskinesia is:	Kartagener syndrome
Kartagener syndrome is characterized by?	1. Situs inversus 2. Chronic sinusitis 3. Bronchiectasis 4. Infertility in men and women
Why is the infertility present in Kartagener syndrome?	Impaired ciliary movement leads: Men --> impaired sperm motility Women --> Immobility of Fallopian Tube cilia
What vessel in fetal circulation carries highly oxygenated blood?	Umbilical vein
Deoxygenated blood in fetal circulation is carried by the umbilical _________________, (____).	Arteries (2)
The umbilical vein drains directly into the ___________, via the ________________, and bypases the _______________, to reach the placenta.	IVC; Ductus venosus; Liver
Dynein arm defect affecting the cilia	Kartagener syndrome
Dextrocardia is a common finding of:	Kartagener syndrome
Asbestosis represents a risk for development of pleural disease and which malignancies?	BRONCHOGENIC CARCINOMA >>>>>> mesothelioma
What lung malignancy is most common person with asbestos exposure?	Bronchogenic carcinoma
Bronchogenic carcinoma is a ________________ lesion that is most commonly developed after prolonged _______________ exposure.	Central; Asbestos
Mesothelioma is seen in the _________ of the lung, is the second most common malignancy seen in asbestos exposure over the years.	Periphery
Bronchogenic carcinoma:	malignant neoplastic growth of bronchial epithelial cells. Classified dependending on the cell affected, thus categorized as Squamous cell ca or Small Cell Ca of the lung.
What are the types of bronchogenic carcinoma?	1. Small cell carcinoma 2. Non-small cell carcinoma
Which are the most common Non-small cell carcinomas of the lung?	1. Squamous cell carcinoma 2. Adenocarcinoma 3. Large cell anaplastic carcinoma
1. Squamous cell carcinoma 2. Adenocarcinoma 3. Large cell anaplastic carcinoma	NSCC
What is the most common type of Lung cancer in women and NONSMOKERS?	Adenocarcinoma (NSCC)
Adenocarcinoma of the Lung:	Peripherally located; Presents with CLUBBING; MC in women and nonsmokers; Associated with Hypertrophic Osteoarthropathy.
Squamous cell cancer of the lung presents with __________________, nad it is _______________ located.	HYPERCALCEMIA; Centrally
What lung cancer is associated with development of Cushing syndrome, SIADH, and Lambert-Eaton MG?	Small cell carcinoma
Peripherally located; Lung cancer presents with Gynecomastia and Galactorrhea.	Large cell carcinoma
What part of the lung is above the level of the clavicle and 1st rib, through the Superior Thoracic aperture?	Lung APICE
Knife wound between the Sternal border and the midclavicular section of the clavicle may injure the:	Lung pleura, causing: - Pneumothorax, tension pneumothorax, or Hemothorax
CXR shows a cavitation with air-fluid level. Patient presents fever, cough, and copious sputum. Dx?	Lung Abscess
Common used for Varenicline?	Smoking cessation
Varenicline is a partial ________________ of the _____________ _______ receptors, which is used to aid in _________________________.	Agonist of the Nicotinic ACh receptors; Smoking cessation.
What drug can be used for smoking cessation?	Varenicline
First phase of lobar pneumonia is:	Congestion
Congestion in lobar pneumonia:	Day 0-2; Bacteria secretes cytokines that cause an increase in permeability of capillary endothelium, leading to an abundance of RBCs and proteins.
What gives the second phase of lobar pneumonia its appropriate naming?	Red Hepatization; Lung acquires a Liver-like appearance. It is red due to the excess amount of RBCs and other substances.
What is the 3rd phase of lobar pneumonia?	Grey hepatization; RBC disintegrate and give a grayish color to the tissue. Also the neutrophils start been replaced by macrophages.
What stage in lobar pneumonia do the neutrophils are replaced by macrophages?	Gray Hepatization
Resolution	Last phase of Lobar pneumonia pathogenesis
Underlying cause of the development of Pulmonary HTN?	Systemic Sclerosis
What is a common syndrome, that causes Pulmonary HTN, due to is pathogenesis?	CREST syndrome
What is the common presentation of CREST syndrome? (main symptoms)	Calcinosis Raynaud phenomenon --> fingertip ulcers Esophageal dysmotility Sclerodactyly, Sclerosis, Skin tightening Telangiectasias
Common findings in physical examination of pulmonary HTN:	Second heart sound Right-sided Heart failure signs such as EDEMA without Pulmonary edema and Hepatomegaly
Heart failure in pulmonary HTN is due to	Cor pulmonale
Bordetella pertussis infection in an adult is usually due to:	Missed vaccination booster
Paroxysmal cough for more than 2 weeks, associated with posttussive emesis, and an inspiratory whoop after severe coughing episode. Dx.	Pertussis
Bordetella pertussis is a_______________________.	Gram negative coccobacillus
The Pertussis toxin (virulence factor) causes:	Excessive adenyl cyclase activity, which prevents phagocytosis and allows for bacterial survival
COPD has a decreased ______________ ratio.	FEV1/FVC
Main cause of Hypercalcemia in Sarcoidosis?	Increased intestinal absorption of Ca2+ by activated macrophages.

Created by: rakomi

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