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Pulmonary 2
UWORLD + FA Pulmonary Respiratory Review
| Question | Answer |
|---|---|
| What is the percentage of been a child affected with two carrier parents of a AR disease? | 25% |
| Common opportunistic infection in transplant patients | CMV |
| CMV infection is seen with: | Intranuclear and Cytoplasmic inclusion bodies |
| Enveloped, dsDNA virus infection commonly in lung transplant patients | CMV |
| CMV pneumonitis is commonly seen in _____________ transplant patients. | Lung |
| Gram (+) diplococci; alpha-hemolysis; bile-acid soluble; Optochin-sensitive. | Strep pneumoniae |
| What is the major virulence factor of S. pneumoniae? | Polysaccharide capsule |
| What is the main function of POLYSACCHARIDE CAPSULE seen in S. pneumoniae? | Prevents Phagocytosis and complement binding |
| What is the most important virulence factor of S. pneumoniae, and some other less important? | Polysaccharide capsule is the most important virulence factor. Others: IgA protease, Adhesins, and pneumolysin. |
| "Quellung Reaction" | Capsule swells and appear s as a halo around the blue-stained bacterial cells when specific anticapsular antibodies and methylene blue dye are added |
| What infectious agent is associated with the "Quellung Reaction"? | Strep pneumoniae |
| A pulmonary embolism (PE) causes an increase in _________________. | Dead Space Ventilation |
| What is a common cause of PE causing Hypoxemia? | DVT |
| What is Dead Space? | Inspired air that dies not participate in gas exchange |
| FRC (Forced Respiratory capacity) is increased in _____________ | COPD |
| A _______ due to ____________, causes an ____________ A-a gradient, leading to the development of __________________. | PE (Pulmonary Embolism); DVT (Deep Venous Thrombosis); Increased A-a gradient; HYPOXEMIA |
| Increase in Total Airway Resistance due to increased bronchoconstriction, describes? | Asthma pathogenesis |
| H. influenzae is normal part of ___________________, and a common microbial agent causing ________________________________. | Upper Respiratory tract flora; Otitis Media, Sinusitis, and Bronchitis |
| Non-typeable H. influenzae does not have__________________. | Polysaccharide Capsule |
| gram negative coccobacillus, describes ___________________. | H. influenzae |
| The Hib Vaccine: | 1. Protein conjugated 2. Given to persons older than 2 years old 3. Induce --> anticapsular antibodies (humoral immune response) 4. Stimulates T-helper cell response to help activate B-cell antibody formation |
| Low arterial PO2 ---> | Hypoxemia |
| What are the major 5 causes of HYPOXEMIA? | 1. Alveolar hypoventilation 2. Low partial pressure of inspired oxygen 3. V/Q mismatch 4. Diffusion impairment 5. Right-to-Left shunting |
| What is the normal range of A-a gradient? | 4 - 15 mmHg |
| What are the causes of Normal A-a gradient hypoxemia? | 1. Hypoventilation 2. Low inspired oxygen |
| Low inspired oxygen conditions: | 1. High altitude 2. Low FiO2 |
| = (Patm - PH2O) x FiO2 | PiO2 |
| Neuromuscular and CNS disorders represent causes of _______________, leading to __________ A-a gradient causes _____________. | Hypoventilation; Normal A-a gradient; Hypoxemia |
| Increased A-a gradient causes of Hypoxemia include: | 1. Right to Left shunt 2. V/Q mismatch 3. Diffusion impairment |
| What conditions lead to a V/Q mismatch? | PE, Atelectasis, PNA, Obstructive lung disease (COPD), Pneumothorax |
| Emphysema and Pulmonary fibrosis are categorized as _______________, leading to an ______________________, ultimately causing ________________. | Diffusion impairment; Increased A-a gradient; Hypoxemia |
| Oxygen therapy responds good to ______________ and _______________. | V/Q mismatch and Diffusion impairment |
| Right-to-Left shunt responds ____________ to oxygen therapy. | Poorly |
| Anticholinergic agent and derivative of Atropine | Ipratropium |
| Lung irritants then to affect the __________________, due to release of _________. | Muscarinic receptors; ACh |
| What is the clinical use of Ipratropium? | Obstructing Lung disease by blocking ACh of Muscarinic receptors, thus preventing Bronchoconstriction and decrease mucus secretion form tracheo bronchial submucosal glands |
| What are the two types of Pneumococcal Vaccine? | 1. Pneumococcal Polysaccharide vaccine 2. Pneumococcal Conjugate Vaccine |
| Which of the two kind of Pneumococcal vaccine has the strongest response? | Pneumococcal CONJUGATE vaccine |
| The Pneumococcal Polysaccharide vaccine: | - Capsular for 23 serotypes - Immune response LARGELY driven by B-cell activation - Not effective in child < 2 years old - Moderate antibody response |
| What are the features of the Pneumococcal Conjugate vaccine? | - Capsular for 13 serotypes - Covalently attached to recombinant, inactivated diphtheria toxin - T-cell-mediated B-lymphocyte activation - Strong, effective immune response |
| Provides polysaccharide to be displayed by MHC and induces a stronger immunogenic response that involves T-cell-mediated B-lymphocyte activation. | Mode of action of CONJUGATE vaccine |
| What is the summary of advantages of Pneumococcal Polysaccharide vaccine? | 1. Decreases incidence of replacement strains due to lack o mucosal immunity |
| What are the 3 advantages of Pneumococcal Conjugate vaccine? | 1. Increase efficacy in the elderly and children < 2 years old 2. Increase mucosal immunity seduces colonization (herd protection) 3. Increase immunogenic memory |
| What is the most common presentation of Cryptococcus neoformans in immunocompromised? | Meningoencephalitis |
| How is C. neoformans meningoencephalitis diagnosed? | India Ink stain of CSF |
| What is another less common form of C. neoformans infection? | Cryptococcal Pneumonitis |
| How is Cryptococcal Pneumonitis diagnosed? | Mucicarmine stain of Lung tissue and bronchoalveolar washings. |
| What is the description of Cryptococcus Neoformans? | Round, budding yeast that have peripheral clearings and "halos" due to their tick Polysaccharide capsule |
| What cells are overly stimulated in Asthma Sensitization phase? | TH2 cells |
| What cytokines are released by Asthma's stimulation of TH-2 cells? | IL-4, IL-13, and IL-5 |
| What cytokines are involved in class switingin in asthma? | IL-4 together with IL-13 promote B-cell class switching for IgE synthesis, leading to mast cell priming |
| Which interleukin is responsible for activation of eosinophils? | IL-5, secreted by TH-2 cells. |
| Excess of TH-2 cell activity relative to TH-1 activity | Underlying principle of Asthma pathogenesis |
| What are the two main types of Occupational Asthma? | 1. Immunologic: -- expose to a workplace aeroallergen causes TH-2 - mediated IgE formation. -- Cereals, latex, chemicals (formaldehyde, amine, dyes) 2. Non-immunologic -- due to workplace irritants that lead to denunciation of bronchial mucosa -- Commonly caused by large spills of chlorine and/or ammonia |
| Tissue Hypoxia produces or induce to: | Specialized interstitial cells in the Renal CORTEX and MEDULLA to release EPO to stimulate the Bone marrow and increase RBC production. |
| What is intended goal of increased levels of EPO and RBC in tissue hypoxia? | Improve the Oxygen-carrying capacity of blood. |
| Secondary Polycythemia is seen in: | Tissue hypoxia response to Increased EPO production, to increase RBC production and improve oxygen carrying capacity of blood |
| Specialized interstitial cells in the Renal CORTEX and MEDULLA to release EPO to stimulate the Bone marrow and increase RBC production. | Secondary Polycythemia |
| Oxygen Saturation of < 92% | Hypoxemia |
| SaO2 must be below _____________ to be known as ____________. | 92% ; Hypoxemia |
| What are the two main mechanisms of elevated A-a gradient Hypoxemia? | 1. Impairment diffusion of O2, by emphysematous destruction of the alveolar-capillary membrane 2. V/Q mismatch due to airway obstruction and air-trapping |
| "Scooped-out" expression is often related to: | Expiration pattern seen in OBSTRUCTIVE LUNG DISEASES as it is graphed in the Flow-Volume Loop |
| Dynamic Hyperventilation | Major cause of dyspnea and exercise limitation in COPD patients |
| What two type of populations are at higher risk of Aspiration Pneumonia? | 1. Elderly with dementia 2. Patients with Hemiparesis may have dysphagia |
| Aspiration pneumonia is seen on CXR with what kinds of Lung Consolidation? | Dependent lung Consolidation |
| What are the most DEPENDENT lung areas in the supine position? | 1. Superior regions of the LOWER lobes 2. Posterior regions of the UPPER lobes |
| A person with a a DVT will have: | - Normal ventilation (good inhaled dye uptake in lung imaging) - Abnormal/absent perfusion (poor/absent IV dye uptake in lung imaging) |
| What is the structure of MHC I? | Heavy chain + B-2 - microglobulin |
| What type of antigens are usually involved in MHC I? | Viruses, tumor proteins |
| What is the end result of MHC I involvement? | Apoptosis of the presenting cell |
| MHC I is processes in the ________________. | Cytoplasm; involves all nucleated cells |
| Alpha and Beta polypeptide chains are seen in __________. | MHC II |
| What cells use the MHC II? | APCs ( B-cells, macrophages, dendritic cells, and Langerhan cells) |
| Where is the processing of MHC II? | Antigens are phagocytosed and digested by lysosomes within which antigen gids to MHC II |
| What is a common cause of restrictive lung profile? | Central obesity |
| Obesity produces a ___________ _______, which is the maximal expired air after a normal tidal expiration. | Reduced ERV |
| A low/reduced ERV in obese patients lead to a _______________. | Reduced Functional Respiratory Capacity (FRC) |
| Increased TLC and RV, + Reduced FEV1:FVC ratio is seen in: | Emphysema |
| Trained athletes have increased ____________________________. | FEV1, FVC, and TLC |
| Mechanical ventilation tends to produce: | 1. Low Tidal Volumes 2. Compensatory incrase in Respiratory Rate |
| Increase in dead space is done by ________ in Respiratory rate and ______ in Tidal Volumes. | Increase in Respiratory rate; Decrease in Tidal Volume |
| What is wasted ventilation? | Breathing pattern that has a higher proportion of Dead Space on each breath |
| Minute Ventilation (VT) = | (Tidal volume) x (Breathing rate) |
| Dead Space Equation: | VD = VT x ( (PaCO2) - (PECO2)/ (PaCO2)) |
| What are the bronchial mucosa features in chronic bronchitis? | Thickened bronchial walls, lymphocytic infiltration, mucous glands enlargement, and patchy squamous metaplasia |
| Tobacco smoking is considered a __________________ risk factor | Behavioral |
| What is the leading cause of chronic bronchitis? | Tobacco smoking |
| Where are the 3 MC location for a Thoracentesis needle placement? | 1. Below 6th rib in the MIDCLAVICULAR LINE 2. Below 8th rib along the MIDAXILLARY LINE 3. Below 10th rib along the PARAVERTEBRAL line |
| What is the risk of placing a needle below the 9th rib? | Increases risk of penetrating abdominal structures (Liver) |
| In any kind of procedure, such as thoracocentesis, the needle should always be inserted? | Along the UPPER BORDER of the rib in order to prevent intercostal vessel damage. |
| What are the main lung volume changes seen in Obstructive lung disease? | Increase in RV, TLC, and RV:TLC ratio Decrease in FVC, FEV1, ant eh FEV1: FVC ratio |
| Volume in liters, left after maximal expiration | Residual Volume (RV) |
| Restrictive Lung Disease volume patterns: | 1. Reduced: TLC, RV, FVC, and FEV1 Increased or normal FEV1: FVC ratio |
| Mycolic acid is present in ______________ and _______________. | Mycobacterium and Nocardia species |
| Mycolic acid is the source that causes _____________________ stain. | Acid-fast |
| What is a common acid-fast stain? | Carbolfuchsin |
| What saccharides are found in both, gram + and gram - organisms? | 1. N-acetylmuramic acid and, 2. N-acetylglucosamine |
| Teichoic acid is found only in ___________________-bacteria. | Gram Positive |
| LPS is on | Gram Negative bacteria |
| Sterol component of FUNGAL membranes | Ergosterol |
| Dimorphic fungus seen in tissue as round and oval yeast with thick walls and BROAD-based budding | Blastomyces dermatitidis |
| What fungal organism is endemic of Southeastern USA (states east of the Mississippi RIver) | Blastomyces dermatitidis |
| Blastomycosis primary organ of infection are teh _____________, and its disseminated to the ___________and ___________. | Lungs; Skin and Bone |
| Aspergillus fumigatus histological description is: | Septate hyphae that branch at 45-degree angles |
| Aspergillus fumigatus is found in ___________ form only. | Mold |
| Small oval yeast with NARROW-based budding | Candida albicans |
| Cryptococcus neoformans is described as: | Round yeast with variables sizes and Narrow-based budding. |
| Coccidioides immitis is found in ___________________, which are ____________________________________. | Spherules; round, encapsulated structures with many endospores. |
| Which organisms are seen with NARROW-BASED BUDDING? | Cryptococcus neoformans , Candida albicans, and Paracoccidioides. |
| Histoplasma capsulatum? | - dimorphic fungus; smaller than an RBC -Common in Central and Eastern USA along the Ohio and MIssissippi River Valleys |
| Rhizopus species are the MCC of_________________________. | Mucormycosis |
| Broad-ribbon like hyphae with rare septions | Rhizopus spps |
| What is the most important virulence factor of M. tuberculosis? | Cord Factor |
| Long, serpentine cords due to cord factor present in cell wall. | M. tuberculosis |
| What is the main function of Cord Factor in M. Tuberculosis? | 1- Prevents macrophages from being BACTERICIDAL due to inhibition of phagolysosome acidification. 2- Leads to formation of CASEATING granulomas |
| Mycolic acid is _______________________________________________. | Source of mycobacteria acid-fastness |
| Acid-fastness provides? | Ability to retain stain in the presence of acid |
| Pleural effusions are classified as: | Exudate or Transudate |
| What are the common causes of EXUDATE pleural effusion? | 1. Infection (Pneumonia) 2. Malignancy 2. Rheumatologic disease |
| Exudates light criteria (3): | 1. Pleural fluid PROTEIN / Serum PROTEIN ratio > 0.5 or, 2. Pleural fluid LDH / Serum LDH ratio >0.6 or, 3. Pleural fluid LDH > 2/3 upper limit of normal serum LDH |
| What conditions are associated with TRANSUDATE pleural effusion? | 1. Heart failure 2. Cirrhosis (Hepatic hydrothorax) 3. Nephrotic syndrome |
| Alterations in Hydrostatic or Oncotic Pressure are associated with ___________________ pleural effusion. | Transudate |
| Transudate pleural effusion are due to an ___________________ Hydrostatic pressure or a ________________ oncotic pressure. | Increased---- Hydrostatic pressure Decreased ----- Oncotic pressure |
| Inflammation and increased capillary permeability, lead to the formation of _______________ pleural effusions. | Exudative |
| Mesotheoloma: | Neoplasm arising from mesothelial cells and strongly associated with Asbestos exposure. |
| Mesotheoloma is positively stained for: | Cytokeratins and Calretinin |
| Cuboidal or flattened cells (epithelium-like) or spindle-cells (stromal-like), that stain (+) for cytokeratin, are found in ____________________. | Mesotheoloma |
| Malignant Mesothelioma is seen with _____________________. | Psammoma bodies |
| Asbestosis is the only pneumoconiosis that affects the _____________ lobes. | Lower |
| Silicosis, Berylliosis, Coal Workers' pneumoconiosis affect the _______________ lung lobes. | Upper |
| Person working at NASA headquarters is most likely to develop which kind of pneumoconiosis? | Berylliosis |
| Another name for Coal Workers' Pneumoconiosis is? | Black lung disease |
| Coal Workers' pneumoconiosis increases the risk of developing ________ syndrome, which is _________________________________. | Caplan Syndrome; Rheumatoid arthritis and pneumoconiosis with intrapulmonary nodules. |
| Berylliosis increases the risk of cancer and _____________. | cor pulmonale |
| Mesothelioma: | Malignancy associated with asbestos exposure. Not associated with smoking. May result in hemorrhagic exudate pleural effusion, pleural thickening. Histologically (+) for Calretinin and Psammoma bodies. |
| Silicosis is view histologically with: | Nodes composed of WHORLED-COLLAGEN fibers and dust-laden macrophages. |
| What is Empyema? | Thick, fibrinous exudate and pus; bacteria in pleural space; associated with Pneumonia |
| What is the best treatment option for VTE in pregnant women? | LMWHs and Heparin |
| Which are the reasons for increased rate of VTE in pregnant women? | 1. Anatomical changes: ---- Uterine compression of the IVC and Iliac veins 2. Physiologic Hypercoagulability: --- Increased production of clotting factors, decreased protein S, and Protein C resistance. |
| Why is Aspirin not recommended in pregnancy? | Possible associated risk of Preeclampsia |
| What is the best type of IV fluids on a Septic Shock patient? | 1. 0.9% (normal) saline or 2. Ringer Solution |
| IV fluids are classified in 3 main categories: | Isotonic, Hypotonic, and Hypertonic |
| What are the Isotonic IV fluids? | 1. 0.9% (normal) saline; 2. Lactated Ringer solution 3. Albumin (5% or 25%) |
| Volume resuscitation and shock are treated with which kind of solutions? | Isotonic 0.9% (normal) saline and Lactated Ringer solution |
| 3% solution is ____________________, and it is used in cases of _________________________________. | Hypertonic; Severe, symptomatic hyponatremia |
| WHat are the 3 main Hypotonic IV fluid solutions? | 1. Dextrose 5% in water 2. 0.45% (half-normal) saline 3. Dextrose 5% + 0.45% saline |
| Major serum inhibitor of Extracellular ELASTASE | AAT-1 (alpha-1 antitrypsin) |
| AAT-1 deficiency is associated to ________________ emphysema. | Panacinar |
| AAT-1 is released by _________________ and _________________. | Neutrophils and Macrophages |
| What risk factor can dramatically accelerate the development of Panacinar emphysema in AAT-1 deficient patients? | Tobacco smoking |
| Silicosis has internalized silica particles that ____________________, by disrupting phagocytosis and promoting __________________. | Impair MACROPHAGE function; Apoptosis |
| Silicosis pathogenesis allow for ________________ infections, especially by. | Mycobacterial; M. tuberculosis |
| Multiple, rounded nodules located in the upper lobes; seen with whorled collagen fiber patterns. | Silicosis |
| ___________________ is seen with ____________________________. | Cystic Fibrosis ; Impaired mucociliary cleareance |
| What kind of emphysema is associated with chronic, heavy smoking? | Centriacinar emphysema |
| What cells realease proteases (elastase) in centriacinar emphysema? | Infiltrating neutrophils and alveolar macrophages |
| What cells are destroyed by elastase but eventually regenerated? | Type 1 Pneumocytes are destroyed by proteases but regenerated by Type 2 Pneumocytes. |
| What areas are affected by the Ghon complex? | 1. Lower lobe of lung 2. Ipsilateral hilar lymph node |
| The Ghon complex is associated with ________________ tuberculosis infection. | Primary |
| What are the 3 fates of the Ghon complex? | 1. Latent infection (dormant) 2. Resolution 3. Progressive Primary TB infection |
| Dormant bacteria containing a walled-off foci after primary TB infection, is knowns as? | Latent TB infection |
| Secondary Tuberculosis is due to: | Reactivated bacteria spread and cause extensive cavitation. |
| Military Tuberculosis? | Failed immune response to Primary TB infection results in progressive lung consolidation and necrosis. |
| Idiopathic Pulmonary Fibrosis is characterized by: | InterMIXED areas of: 1. Dense fibrosis and normal lung 2. Focal fibroblastic proliferation 3. Honeycomb pattern most prominent in the periphery |
| Focal loss of type 1 pneumocytes and hyperplasia of type 2 pneumocytes is seen in: | Idiopathic Pulmonary Fibrosis |
| ARDS: | cause the loss of Type I and Type II pneumocytes, and the focal fibroblastic hyperplasia |
| Why is the reason of hypercalcemia in Sarcoidosis? | PTH-independent formation of 1,25-(OH)2 Vitamin D activated by MACROPHAGES ----> Intestinal absorption of calcium |
| What are some extrapulmonary findings of Sarcoidosis? | 1. Skin lesion 2. Anterior and Posterior uveitis 3. Lofgren Syndrome |
| Sarcoidosis is seen with ___________________________ on imaging. | Bilateral Hilar adenopathy |
| Non-CASEATING granulomas are seen in ________________. | Sarcoidosis |
| What is the Train-of-Four (TOF) stimulation? | Used during anesthesia to assess the degree of paralysis induced by NMJ-blocking agents |
| NMJ blockers are divided between ____________________ and _________________, to which the later is divided in 2 phases during TOF stimulation. | NON-depolarizing; Depolarizing |
| What is the most common depolarizing NMJ blocker used in TOF stimulation? | Succynilcholine |
| Vecuronium, Atracurium, and Gantacurium are all _____________ agents. | Non-depolarizing NMJ blockers |
| The phase ____ of Depolarizing agents resembles the effect seen in nondepolarizing agents during TOF stimulation. | Phase II |
| What are the Depending lung segments while supine? | 1. Posterior segments of Upper lobes 2. Superior segments of Lower lobes |
| The upright position has the __________________ as the most dependent segments. | Basilar segments |
| A person in the prone position has the ______________ and ___________ as the most dependent segments. | Middle lobe and Lingula |
| Influenza virus is associated with? | Hemagluttin antibodies |
| Anti-Hemagglutinin antibodies are the major reason for? | Immunity against annual Influenza virus |
| What is the tetrad of symptoms associated with Septic Shock? | 1. Fever, 2. Leukocytosis, 3. Tachycardia, 4 . Hypotension |
| Septic shock may lead to ____________________________, which would impair the tissue __________________, causing a decrease in ________________________, overall leading to ________________. | End-organ HYPOPERFUSION; oxygenation; oxidative phosphorylation; ;Lactic acidosis. |
| Honeycomb pattern in lung periphery | Idiopathic Pulmonary Fibrosis |
| Candida albicans is part of the normal flora of the______________. | GI tract and skin |
| A c. albican contaminated sputum usually depicts a ___________ rather than a pulmonary infection . | Oral infection |
| Round, oval, narrow-budding yeast that forms true hyphae (Germ tubes) at body temperature (37C). | Candida albicans |
| Dichotomous, branching hyphae; infects previous lung cavitations. | Aspergillus fumigatus |
| Healthy people is _________________-limited, which means? | Perfusion-limited; alveolar and capillary partial pressures are EQUAL |
| Equal alveolar and capillary partial pressures | Perfusion-limited |
| Diffusion-limited is based on ___________ differences in the alveolar and capillary partial pressures. | PO2 |
| Large gradient between alveolar and capillary PO2? | Diffusion-limited |
| What are common causes of Diffusion-limited? | Pathological: Emphysema and Pulmonary fibrosis. Non-pathological: Exercise |
| What is the normal values of PO2 at the following? Traquea, Alveoli, Capillary (Venous, and Arterial): | Traquea ----> 150 mmHg Alveolar ----> 104 mmHg Capillary (venous) -----> 40 mmHg Capillary (arterial) ----> 70 mmHg |
| What are the normal values of PCO2? | Trachea ----> 0 mmHg Alveoli ---> 40 mmHg Capillary (venous) -----> 45 mmHg Capillary (arterial) ----> 40 mmHg |
| Alveoli fill with fluid (Pneumonia, Pulmonary edema) or Collapse (atelectasis) and alveolar ventilation is essentially zero. | Physiological INTRAPULMONARY SHUNTING |
| What are normal pulmonary changes seen with AGING? | 1. INCREASED: ----- Lung compliance due to loss of elastic recoil ----- Greatly increased Residual Volume (RV) 2. DECREASED: --- Chest wall compliance and FVC 3. Unchanged Total Lung Capacity (TLC) |
| What is the best way to prevent neonatal GBS disorders? | INTRAPARTUM antibiotics (ampicillin and penicillin) |
| What are some of the conditions seen with Group B Strep colonization, in case it was not prevented? | Neonatal GBS sepsis, pneumonia, and meningitis |
| How does Left-sided HF affect the lung? | L-sided HF --> accumulation of fluid or edema in pulmonary interstitium --> Lungs become heavy and still, which leads to: 1. Restriction of Inspiratory expansion 2. Decreased LUNG COMPLIANCE. |
| A decrease in lung compliance is often seen in _______________. | Left-sided Heart Failure |
| Systemic sclerosis is a common underlying cause of the development of ________________________. | Pulmonary Arterial Hypertension |
| Proliferation of T-cells release cytokines (TGF-B) and consequently cause progressive thickening and occlusion of the small and medium-sized PULMONARY arteries/arterioles. | Pulmonary Arterial Hypertension |
| Right sided HF symptoms + Progressive dyspnea and Loud pulmonic S2 component (Loud P2). Dx? | Pulmonary Arterial Hypertension |
| Right-sided HF symptoms are: | Hepatomegaly, Peripheral edema, and JVD. |
| What is the triad of symptoms presented in Fat Embolism Syndrome? | Respiratory distress, Neurologic dysfuntion, and Petechial rash |
| Fat Embolism Syndrome (FES) most commonly results from: | The release of FAT GLOBULES from the BONE MARROW following a long-bone or pelvic bone fracture. |
| Patient with dyspnea, few days after suffering a femur fracture. Suspect dx? | Fat Embolism Syndrome |
| What are hamartomas? | Most common type of benign lung tumor |
| What are the most common benign lung tumors? | Hamartomas |
| Asymptomatic peripherally located "coin lesion" in patients between 50-60 years old. | Hamartomas |
| What is the composition of hamartomas? | Disorganized CARTILAGE and adipose tissue |
| Squamous cell carcinoma is associated with ____________--- | Squamous "Keratin" pearls |
| Small cell lung cancer is positive for | Neuroendocrine markers |
| Common variant of adenocarcinoma | Bronchioalveolar carcinoma |
| A Bronchioalveolar carcinoma is located at the lung's ___________, and is view in the CXR as and peripheral mass or _____________________. | Periphery; Pneumonia-like consolidation |
| What is the key characteristic of Bronchoalveolar carcinoma? | The distribution: It spreads along the ALVEOLAR SEPTAE without vascular or stromal invasion. |
| What is Atopic (Extrinsic) asthma? | Asthma symptoms in a young patients, that are UNRELATED to ingestion of Aspirin, pulmonary infections, irritants, and/or exercise. |
| What are some common findings in Atopic (extrinsic) Asthma? | 1. Charcot- Leyden Crystals 2. Eosinophils |
| TH2 secretes IL-5 which caused recruitment of _____________. | Eosinophils |
| Non-caseating granulomas ------ | Sarcoidosis |
| APCs produce ___________, which then stimulates the differentiation of _________________. | IL-12 ---> differentiation of TH1 CD4 T-cells |
| After initial TH1 stimulation, these cells secrete ___________ and __________. What do each do? | IL-12 ---> Increase Th1 differentiation INF-gamma ---> Macrophage activation |
| Why is supplemental O2 therapy not recommended for COPD patients? | It can further increase the V/Q mismatch leading to a RAPID development of confusion and depressed consciousness. |
| Energy expended during respiration and comprises the work required to overcome both elastic and airflow resistance. | Work of Breathing |
| Elastic Resistance is defined as: | Opposition to lung expnasion |
| What type of lung disease profile increase the Elastic resistance? | Restrictive Lung Disease |
| Elastic Resistance is increased with: | Higher tidal volumes |
| Airflow resistance is defined as: | Opposition of airflow created by limited airway diameter and turbulent flow. |
| What condition lead to an elevation of airflow resistance? | Increased in higher respiratory rates and low lung volumes |
| Why doe higher respiratory rates and low lung volumes increase the airflow resistance? | Increased Respiratory Rate ----> Increased Turbulent Flow Low Lung Volumes -------> Reduced diameter |
| Airflow is increased in ______________ lung diseases. | Obstructive |
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rakomi
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