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252 Cards in this Set
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- Back
- 3rd side (hint)
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How does the epithelium of the embryo's developing bronchi evolve over time (histologically)?
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From columnar to cuboidal to squamous.
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It becomes thinner over time.
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How does the epithelium of the embryo's developing bronchi evolve over time (histologically)?
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From columnar to cuboidal to squamous.
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It becomes thinner over time.
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What do Alveolar type II cells do?
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Produce surfactant
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in lungs
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What is atresia and what is its cause?
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Failure of normal recanalization of the gut and trachea because of defective apoptosis, during embryogenesis.
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Embryogenesis
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Terms for abnormalities of amniotic fluid?
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Polyhydramnios = abnormal accumulation; oligohydramnios = too little amniotic fluid
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There are 2 terms
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The rest and digest system?
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Parasympathetic nervous system
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Part of autonomic nervous system
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Main type of receptor in sympathetic system? Exception?
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Adrenergic receptor. Exception = most sweat glands
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Main type of receptor in parasympathetic system?
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Cholinergic receptor.
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Main type of neurotransmitter in parasympatetic NS?
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Acetylcholine.
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Main type of neurotransmitter in sympathetic NS? Exception?
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Norepinephrine, except for acetylcholine for sweat glands.
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Which are faster : nicotinic or muscarinic cholinergic receptors? How fast?
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Nicotinic : in milliseconds (vs. in seconds to minutes for muscarinic cholinergic receptors)
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Think of which ones sometimes have G-proteins and which ones have ligand-gated ion channels
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Subtypes of adrenergic receptors?
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alpha and beta
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What do subtypes of alpha adrenergic receptors affect?
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alpha1 = vascular smooth muscle; alpha2 = autoreceptors
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What do subtypes of beta adrenergic receptors affect?
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beta1 = heart; beta2 = bronchi
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How is blood flow affected by the autonomic nervous system? What part of the ANS has no effect on blood flow
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Only the sympathetic NS has an effect; inhibits blood flow to skin and viscera; stimulates blood flow to skeletal muscle (think flight or fight)
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How are bronchi affected by the autonomic nervous system?
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Sympathetic = relaxes; parasympathetic = constricts.
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How is heart rate affected by the autonomic nervous system?
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Sympathetic = increases; parasympathetic decreases.
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What is the pathway by which the vagus nerve affects heart rate?
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Vagus nerve releases acetylcholine which activates M2 receptors in sino-atrial node of the heart
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In parasympathetic system.
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What receptors does clonidine affect? What is this drug's clinical effect?
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alpha2 adrenergic receptors; antihypertensive
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What is the effect of a partial agonist on the action of a full agonist?
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Inhibit the action of full agonist
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What receptors does prazosin affect and how?
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alpha1 adrenergic receptors : it is an inverse agonist.
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Possible negative side effects of beta antagonists?
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bronchoconstriction, reduced cardiac output, fatigue
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What type of receptors affect heart rate in the parasympathetic system and how?
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M2 receptors; inhibit heart rate
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Is there paraympathetic pathway that affects blood flow in skin, viscera or blood flow?
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No - only sympathetic NS affects these functions
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What receptors relax and constrict bronchi
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Relax = b2 in sympathetic nervous system; constrict = muscarinic acetylcholine receptors in parasympathetic NS
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Clinical use of beta2 adrenergic agonists? Example of such a drug?
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Treatment of asthma and COPD. ex = albuterol. Note : mAChR antagonists can also be used for the same purpose
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Name a non-selective beta blocker is used to treat hypertension, angina, arrhythmias and migraines?
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Propanolol. Note : blocks beta1 and beta2.
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What is hematocrit?
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Volume percentage of red blood cells
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What is a reticulocyte?
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Immature RBC which still contains ribosomal RNA
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What hormone controls RBC production and what structure produces it in reaction to what information?
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Erythropoietin, which is produced by renal tubule cells which sense O2 levels in blood.
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RBC production is called erythropoiesis
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Name the 6 physiological mechanisms leading to anemia
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1- not enough building blocks for RBCs 2- Congenital abnormality of content (ex. sickle cell) 3- abnormality in RBC production site (bone marrow) 4- Loss of RBCs (ex bleeding) 5- Decreased lifespan (ex. hemolysis) 6- Chronic Illness leading to suppressed erythropoiesis
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Mnemonic = BCSLLC = Black cows should love liquid chocolate = Building blocks, congenital abnormality, site of production, loss, lifespan decrease, chronic illness
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Characteristic cytological feature of thalassemia?
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Target pattern on RBCs
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Questions to ask about when taking anemia history?
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Ethnic origin, diet, blood loss, bone marrow failure (look for fatigue, weight loss and bruising), renal failure, rheumatoid arthritis.
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Signs of anemia?
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Pallor, nails change, tachycardia, bleeding (nose and GI), bone marrow failure, jaundice, splenomegaly
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What lab tests are ordered for suspected anemia?
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CBC= complete blood count, reticulocyte count, Mean cell volume.
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In the setting of anemia, what does an elevated reticulocyte count suggest vs. normal or low count?
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Elevated = bleeding or hemolysis; normal to low = problem with RBC production or bone marrow (aplastic anemia or leukemia) or suppression of bone marrow secondary to renal failure or chronic disease
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What is included in the complete blood count?
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white blood cells, platelets count, Red blood cell count, hemoglobin and RBC indices
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What might cause microcytosis of RBCs?
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Iron deficiency, Thalassemia, Chronic disease
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What might cause macrocytosis or RBCs?
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Vitamin B12 deficiency, Chemotherapy drugs, liver disease, myelodysplasia, reticulocytosis
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Causes of hemolysis?
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1- Extra-corpuscular (autoimmune response; heart valve defect) 2-RBC membrane (hereditary elliptocytosis or hered. spherocytosis) 3-Hemoglobin (sickle cell; thalassemia) 4- enzyme defects (G6PD or pyruvase deficiencies)
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Mnemonic = EMHE
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Main difference between benign and malignant neoplasms
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Potential for metastasis in malignant neoplasms only.
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Difference between carcinoma and sarcoma
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Carcinoma is from epithelium, sarcoma is from mesenchyme
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Is carcinoma in situ malignant
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Yes, it just hasn't yet crossed the basement membrane and invaded or metastasized
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What is de-differentiation (context = neoplasia)? What is the relation to anaplasia?
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Normally, cells in a tissue are well differentiated. De-differentiation is when this differentiation is lost to some degree. Anaplasia = no longer any resemblance to parent tissue.
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What is a sure histological sign of high grade squamous cell carcinoma?
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Lack of keratin
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What is the main route by which carcinomas metastasize?
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Lymphatic drainage
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What is a sentinel node?
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The first lymph node draining a tumor
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What is the difference between staging and grading?
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Grading = measure of cell differentiation using microscopy. Staging = measure of size of malignant neoplasm and of its metastatic spread using clinical methods as well as histology or cytology.
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3 aspects of tumor staging?
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Tumor size, lymp node involvement, distant metastases
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TNM
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What is the sequence of development of a carcinoma?
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Carcinoma in situ -- invasion -- metastasis
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Difference between predictive and prognostic factors in neoplasia?
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Predictive = predicts response to treatment ex. a drug; prognostic = factors that determine outcome ex. chances of survival.
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What are the cancers with highest incidence in women in Canada? Which is most deadly?
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breast>lung>colorectal. Lung is cancer with highest mortality rate for both men and women in Canada.
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What are the cancers with highest incidence in men in Canada? Which is most deadly?
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prostate>lung>colorectal. Lung is cancer with highest mortality rate for men and women in Canada.
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Difference between initiators and promoters in carcinogenesis?
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Initiators are mutagenic - change DNA. Promoters increase cell proliferation.
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5 categories of proteins coded for by oncogenes which when mutated promote neoplasia
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Growth factors, growth factor receptors, signal transducing proteins, nuclear transcription factors, cyclins and CDKs.
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Differences in endothelial cells of tumor vessels vs. normal vessels?
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Tumor vessel endothelial cells are: NOT mutated but have more fenestrations (are more permeable - leads to exudate formation ex. pleural effusion), have all sorts of shunts between arterioles and venules, a much faster cell division rate, and they secrete growth factors and cytokines. Tissue has a "higgledy-piggledy" appearance.
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3 types of DNA repair defects? Can it occur in heterozygous mutation?
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DNA mismatch repair gene defects; nucleotide excision repair defects; recombination repair defects. Usually these mutations are homozygous.
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What is lung vital capacity minus total lung capacity?
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Residual volume.
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What is lung functional residual capacity?
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All the air one can breathe out with effort, plus all the air left afterwards. in other words, Expiratory reserve volume plus residual volume.
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What are the components of lung vital capacity?
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Expiratory reserve volume, and inspiratory capacity
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In the presence of obstructive lung syndrome, how is FEV1/FVC affected relative to normal function?
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FEV1/FVC is decreased relative to normal.
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In the presence of a restrictive lung syndrome, what is a typical FEV1/FVC reading?
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This ratio will be equal to 1 whereas it is closer to 0.70 in normal.
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What is the measure of lung stiffness called? How is it calculated? If lungs are stiff, do they have high or low compliance?
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Lung compliance. Compliance = deltaV/deltaP (slope of pressure-volume curve). Stiff lungs have low compliance
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How many days elapse between fertilization of ovum and implantation into the endometrium
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6 days
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What is the sequence of events between fertilization and gastrulation?
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Zygote, then Totipotent cell phase (Blastomere), then Morula, then Blastocyst, then Bilaminar embryo, then Gastrulation
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What is gastrulation
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Reorganization from single-layered blastocyst into a three-layered embryo - the gastrula
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What structures stem from the embryonic ectoderm?
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Skin epithelium, central nervous system, neural crest cells
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What structures stem from the embryonic mesoderm?
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Connective tissue, cartilage, bone, cardiovascular system, uro-genital system
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What structures stem from the embryonic endoderm?
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epithelium lining the GI tract, respiratory system.
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What happened during the French revolution that changed the practice of medicine?
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Creation of municipal hospital systems, large numbers of patients observed before and after death, new medical schools, new ideal of objectivity, fusion of surgery and medicine as disciplines
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Around what decade did the laboratory supersede the clinic and the practice of pathological anatomy in terms of scientific objectification?
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1850s
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In the developing embryo, what does the foregut become later on?
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The pharynx, esophagus and respiratory system, stomach, duodenum, liver, pancreas.
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What characterizes Potter's syndrome?
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In neonates, absence of kidneys and severe lung hypoplasia. Also club feet and facial distortion.
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What is oligohydramnios?
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oligohydramnios = too little amniotic fluid
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What is the enzyme present in red blood cells that facilitates the main way of transport of CO2 in the blood?
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Carbonic anhydrase
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How is the oxygen dissociation curve different from the CO2 dissociation curve?
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The CO2 dissociation curve is more linear.
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What is called the effect of O2 content on hemoglobin's affinity for CO2?
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The Haldane effect
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What are the functions of the bronchial circulation?
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provide O2 and nutriments to the bronchial tree, maintain temperature and humidity of wall airway, provides bloods elements for inflammation and repair
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Why does PVR is lower at higher flows?
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vascular distension(increased diameter of open vessels) and vascular recruitment (opening of previously closed vessels)
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What are the 3 determinants of regional flow?
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Alveolar pressure, arterial pressure, venous pressure
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What is the function of surfactant in the alveoli?
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To reduce surfact tension and facilitate expansion of alveoli
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What are the 2 main abnormalities of tracheal budding during embryo development?
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1) Esophageal atresia (causes obstruction) and 2) tracheo-esophageal fistula (connection between trachea and esophagus)
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What are the 4 periods of lung maturation?
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(1) Pseudoglandular, 6-16 wks (2) Canalicular, 16-26 wks (3) Terminal Saccular, 26-32 wks (4) Alveolar, 32 wks to 8 yrs
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What is the cause of Cystic Adenomatoid Malformation (CCAM) in the lungs?
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Segment of lung arrests development in the pseudoglandular phase; overgrowth of terminal bronchioles with deficiency of alveoli
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What are the main differences between fetal and neonatal circulation?
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Fetal: in parallel, high pulmonary vascular pressure and resistance, low blood flow to lungs, lungs do not participate in oxygenation (this is done by the placenta), blood shunted through foramen ovale in the heart; Neonate: in series, lower PVR, foramen ovale closed, blood now flows through the lungs and is oxygenated by lungs.
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What does fluoroscopy measure that a regular chest x-ray cannot?
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Fluoroscopes can detect movement of a fluid that contains contrast, e.g. blood. Allows for better determination of function as opposed to just structure.
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For units of radiation, how are Sieverts different from Grays?
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Sieverts take into account the type of radiation and the sensitivity of the tissue. millisieverts are most commonly used in clinical practice.
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In an ultrasound, what colour is fluid that is moving away from the probe?
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Blue. (BART = blue away, red towards)
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Why are intensifying screens used in x-rays?
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They allow for lower radiation doses because they amplifiy reflected x-rays by converting them into visible light (through fluorescence).
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What is the exome?
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The coding part of the genome / the part that is expressed. (1.5-2% of the genome)
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For what type of genetic disease is exome sequencing most effective?
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rare mendelian diseases
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What is the difference between exome sequencing and more conventional methods?
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During exome sequencing, the entire genes that encode proteins in humans are sequenced using new methods that allow for fast replication of genetic material. Conventional methods targeted single genes and cost more money on average.
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What is an inverse agonist, in pharmacology
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an inverse agonist is an agent that binds to the same receptor as an agonist but induces a pharmacological response opposite to that agonist. (wikipedia)
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The two types of cholinomimetic drugs?
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Acetylcholine esterase inhibitors + acetylcholine receptor agonists.
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What are the three determinants of Maximum Expiratory Flow?
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Airway resistance, elastic recoil of lungs, expiratory muscles
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Effects of pulmonary fibrosis on flow-volume curve: how do RV, TLC, PEF, FEV1 and FVC change with this disease? What is the reason behind the effect on PEF?
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RV and TLC diminished, PEF remains the same, FEV1 and FVC diminished. PEF remains the same because of the increase in the recoil pressure of the lungs caused by fibrosis.
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How does lung volume affect airway resistance (mechanism)?
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INTERDEPENDENCE phenomena: the lung parenchyma and the alveoli are joined at points of attachement. At high lung volume, the distenced parenchyma pulls on the alveoli at these points, thus decreasing the airway resistance.
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Location of central controller?
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Caudal pons and rostral medulla oblongata.
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What do receptor cells inthe carotid and aortic bodies sense?
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O2
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What do receptor cells in the cerebrospinal fluid near the respiratory center sense?
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H+ (as a result of CO2)
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What structure is believed to be the inspiratory pacemaker in the human?
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Prebotzinger complex.
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What is the structure responsible for relaying lung parenchymal and airway afferent information to the central controller (NST)?
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Vagus
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What cell type comprises the largest part of the Carotid body and what is the role of the Carotid body?
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Type 1 glomus cells. Role:sense changes in arterial pH, pO2, pCO2
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Name the three processes that would occur within the glomus cell if low PO2 were sensed.
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Outward K+ current, inward Ca2+ current, release of dopamine which will activate the afferent fibers directed to the CNS.
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Define hypercapnia.
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"Hypercapnia, also known as CO2 retention, hypercapnea, and hypercarbia, is a condition of abnormally elevated carbon dioxide levels in the blood"
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Q: How would the ventilatory response differ for a situation of hypoxia versus a situation of combined hypoxia and hypercapnea?
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Augmented ventilatory response
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Q:What is the main locus of CO2 sensitivity?
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A:Retrotrapeoid nucleus(RTN)
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Q: How do the ventilatory pattern responses differ in hypoxia an hypercapnia?
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A: Hypoxia=rapid shallow, hypercapnia=deep, slow
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Result of cutting the vagus
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Massive tidal volume
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Q: Which are the important nerves for feedback from airways and what do they innervate?
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A: 9th and 10th cranial nerves. The 9th ”glossopharyngeal” innervates the oropharynx and hypopharynx. The 10th vagal nerve innervates the larynx.
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Q: What does the respiratory system regulate to regulate acid-base status in the body?
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PaCO2
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What is Kussmaul's breathing?
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Deep and slow (slow relative to hyperventilation. Ex. Repsiratory rate of 26-28/min, goal is to minimize vd/vt
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Q: What are the three factors that contribute to chronic hypoventilation in the respiratory system?
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A: chest wall deformities, neuromuscular disease, parenchymal lung disease
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What are the two main features of COPD?
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1) Increased airway resistance to airflow 2) Decreased elastic recoil of the lung/chest wall
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What is the difference between a pulmonary acinus and pulmonary lobule?
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Pulmonary acinus is lung parenchyma distal to a terminal bronchiole and pulmonary lobule is lung tissue surrounded by interlobular septae
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Which lobe of the lung is affected most in centrilobular emphysema and why?
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The upper lobe because of 1) underperfusion relative to ventilation so less antiproteases delivered to the upper lobe 2) slower transit time of leukocytes which secrete elastases that break down elastic fibers in the lung 3) reduced clearance of inhaled material
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What is bronchiectasis?
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Irreversible dilation of a portion of the bronchial tree; can be cylindrical, varicose or saccular
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What is an ecological study and why is it used?
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a descriptive comparison of disease and exposure. It's used for hypothesis generation
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What is the 'main' flaw in a cross sectional study when looking to determine causality
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Data is collected at one time point so can't speak to the time course of exposure and outcome
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When is a case-control study most appropriate?
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For rare diseases: need to seek out cases and then find matched controls when the cases don't present very often
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You are a student researcher conducting a study whereby you use an existing registry of individuals followed from birth until age 18. What type of study are you doing?
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Retrospective cohort
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two segments of Respiratory system?
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Conducting and respiratory
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Two types of columnar cells in respiratory epithelium?
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Ciliated and brush cells.
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What are the stem cells for respiratory epithelium?
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Basal cells
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3 types of cells in olfactory epithelium?
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olfactory, sustentacular and basal
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Definition of pulmonary acinus?
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Lung parenchyma distal to terminal bronchiole
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Two physiological causes of COPD?
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Increased airway resistance to airflow + Decreased lung or chest wall elastic recoil
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Condition characterized by permanent and abnormal enlargement of airspaces + destruction of alveolar walls
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Emphysema
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What protease is significant in understanding the pathophysiology of emphysema?
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Elastase (no longer inhibited by anti-proteases because of cigarette smoking or alpha-1 antitrypsin deficiency)
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What characterizes Bronchiolitis?
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Chronic inflammation and fibrosis in airway wall and goblet cell metaplasia
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What characterizes asthma?
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Chronic inflammatory disease marked by bronchiole spasms and smooth muscle hypertrophy.
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Formal definition of chronic bronchitis?
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Mucus expectorated on most days for at least 3 consecutive months for 2 years
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5 types of COPD?
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Emphysema, Bronchiolitis, Asthma, Chronic Bronchitis, Bronchiectasis
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Condition characterized by irreversible and abnormal dilation of portion of bronchial tree
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Bronchiectasis
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3 types of emphysema?
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Centrilobular, panlobular, paraseptal OR proximal acinar, panacinar, distal acinar
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Which type of emphysema most associated with tobacco smoking
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Centrilobular
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Disease causing panlobular emphysema?
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alpha-1 antitrypsin deficiency
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In what type of emphysema do large blebs or bullae form near pleura
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Paraseptal
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Clinical presentation of COPD
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SOB, chronic cough, sputum
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What happens to FEV1/FVC ratio in COPD?
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less than 0.7 = low
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Appearance of flow-volume loop in COPD patient?
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Scooped out after peak expiratory flow rate reached
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Examples of treatments for COPD?
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Short and long-acting bronchodilators, inhaled corticosteroids, oxygen therapy, surgery
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What are p and q arms of chromosomes?
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p = short, q = long arm
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What is FISH used for?
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FISH = fluroescence in situ hybridization. Used to assess specific region of genetic material - hypothesis driven test
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What are genetic microarrays used for? (aka array comparative genomic hybridization)
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Assess whole genome for copy numbers
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Three autosomes significant for developmental disorders
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Chromosomes 13, 18 and 21
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Only know risk factor for non-disjunction during meiosis I leading to trisomy or monosomy?
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Maternal age
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Name for the region of the lung involved in gas exchange?
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Lung parenchyma
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Basic anatomic unit of the lung?
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Secondary lobule
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What runs in the interlobular septae of the lung?
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Pulmonary veins and lymphatics
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Interstitial lung disease characterized by non-necrotizing granulomatous inflammation, sometimes with fibrosis
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Sarcoidosis
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These are types of ____: usual, acute, desquamative, nonspecific
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Interstitial pneumonias
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A honeycomb change pattern and biphasic patchy distribution of lesions of lungs with predominance at periphery (near pleura) is seen on CT Chest. What disease?
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Idiopathic pulmonary fibrosis (clinical term) OR usual interstitial pneumonia (pathological findings)
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Uniformly distributed, mature, non-biphasic fibrotic tissue in lung. No honeycomb change. Probably Dx?
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Non-specific interstitial pneumonia
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Pathological findings show lung with diffuse changes, whose alveolar airspaces are almost filled by edema fluid and hyaline membranes lining alveoli. Probable Dx?
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Acute interstitial pneumonia (Clinical) OR Diffuse alveolar damage (pathological finding)
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Pathological features of organizing pneumonia?
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patchy distribution, fibroblastic tissue in bronchiole + alveoli lumens and airspaces. Fibrotic material spreads in a branching pattern i.e. along airways
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Disease associated with organizing pneumonia?
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Cryptogenic Organizing Pneumonia (aka BOOP)
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Interstitial lung diseases usually present a(n) (obstructive/restrictive) profile
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Restrictive
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Clinical presentation of interstitial lung disease?
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Rapid and shallow respiratory pattern, non-productive cough, dyspnea, clubbed fingers, crepitations on auscultation, reduced lung volumes
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Chest X-Ray shows bilateral hilar lymphadenopathy - Probably Dx?
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Sarcoidosis
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Diseases that show a mixed restrictive+obstructive pattern?
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Bronchiolitis, sarcoidosis
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At what stage, and after how many weeks, do TB bacteria typically spread to regional lymph nodes in a primary infection?
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Weeks 2-4 during 2nd phase
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What can compromise cell-mediated immunity primary TB infection?
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Extremes of age, HIV+, immunocompromised for other reasons, diabetes, renal failure
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Strongest known risk factor for TB reactivation?
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HIV/AIDS
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Clinical presentation of TB
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Cough, sputum (chronic), fever and sweating at night, low grade fever, sometimes hemoptysis
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What do the following tests have in common: sputum smear, bacterial culture, nucleic acid amplification
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All test for TB
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two immune tests for TB?
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PPD skin test and the in-vitro IGRA
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2 most important drugs to treat TB
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Isoniazid and Rifampin
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Signs n symptoms of Mycobacterium avium?
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Often seen in HIV+ patients with uncontrolled AIDS. Systemic symptoms, diarrhea, some pulmonary + lymph node involvement.
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Rate ratio - formula?
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Incidence rate in exposed / incidence rate in unexposed. Note: move along lines of 2x2 table (not columns)
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Risk ratio - formula?
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cumulative incidence in exposed / cumulative incidence in unexposed
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Odds ratio - formula
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Odds of exposure in cases / odds of exposure in control. Note: move along 2x2 table columns. Can also express this as a/c divided by b/d aka the cross-product
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Under what assumption may odds ratio = relative risk?
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If the disease is rare.
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The difference in incidence rates or risks (ex. cumulative incidences)
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Attributable risk
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Incidence in exposed minus incidence in unexposed, all divided by incidence in exposed
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Attributable fraction.
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Relation between attributable risk and odds ratio in a case control study? (Formula)
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OR-1/OR
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Relation between attributable risk and RR in a cohort study? (Formula)
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RR-1/RR. This is a measure of the probability of causation
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When keeping rate of dropout in a study low, what are we trying to minimize?
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Selection bias
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What do these 3 criteria describe? 1) Associated with outcome, 2) associated with exposure, 3) not in causal pathway
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Confounder (in epidemiology). Examples: age, gender/sex, SES. Note: all three criteria necessary to call the variable a confounder
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Criteria for causality (name 4)
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Strong association (RR>=3), consistent association, correct temporal sequence, dose-response relation, biological plausibility, coherence with other studies
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Describe 2 main characteristics of asthma
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1) Episodic reversible bronchoconstriction 2) airway inflammation
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Describe the general principles for asthma therapy
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1) Intermittent: SABA 2) Mild persistent: Low-dose ICS 3) Moderate persistent: Low-dose ICS/LABA 4) Severe persistent: Medium-High dose ICS/LABA
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Describe the function of SABAs
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Short Acting Beta Agonists used for quick relief (within 5 minutes) and lasts for 4-6 hours; does not reduce inflammation or modify disease
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Which is the most effective long-term treatment for control of asthma?
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Inhaled corticosteroids (ICS)
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What phase of sleep takes up most of the duration of a night's sleep?
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N2
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Name three normal changes that happen to breathing during sleep
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Reduced muscle activity (especially during REM sleep, and especially non-diaphragm respiratory muscles), increased upper airway resistance, reduced responses to ventilatory stimuli (hypoxia, hypercapnia, etc). Note: in pathological setting, these changes lead to increased susceptibility to blood gas disturbances during sleep
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Difference between obstructive and central sleep apnea?
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Obstructive SA = because upper airways blocked; central = problem with brain's signals to respiratory muscles at night, or due to Congestive heart failure. OSA is more common.
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What index is used to measure the severity of sleep apnea?
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The apnea-hypopnea index. Measures number of events lasting >=10s that are also associated with hypoxemia, per hour.
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Main symptom of sleep apnea?
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Excessive daytime sleepiness
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Aside from people directly involved in asbestos mining, who is at risk of asbestosis?
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Shipyard workers, plumbers, construction workers, refinery workers
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Benign marker of asbestos exposure?
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Pleural plaques
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Name some pneumoconioses?
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Silicosis, asbestosis, coal miner's pneumoconiosis
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Aside from lung cancer, what are 2 lung diseases probably caused by, or exacerbated by, occupational exposures?
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COPD. Occupational exposures plus smoking multiply risk of COPD. Also asthma.
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Definition of thrombosis?
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Pathologic counterpart of normal hemostasis - blood clot forms in an intact vessel.
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Virchow's triangle describes three factors that contribute to thrombosis - name them
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1- Endothelial injury 2- abnormal blood flow 3- hypercoagulability
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Does pulmonary embolism increase or decrease dead space?
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increase
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Usual effect of Pulmonary embolism on blood CO2 levels?
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Usually hypocapnia, because induces hyperventilation (despite increase in dead space which might make you think of hypercapnia). Exception = patients on a ventilator or with severe restrictions on capacity to increase minute ventilation
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Clinical presentation of pulmonary embolism?
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Dyspnea, pleuritic chest pain, hemoptysis, swollen or tender leg, heart palpitations
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Typical findings on physical exam for pulmonary embolism?
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low blood pressure, low O2 sats, pleural friction rub on auscultation, tachycardia
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Used to determin clinical probability of a PE?
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Wells score
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Most common test used when PE is suspected?
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Computerized Tomographic Pulmonary Angiogram.
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Standard pharmacological drugs used for PE?
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Low molecular weight heparin, subcutaneous / Warfarin, oral / Rivaroxaban, oral. General idea = these are all anticoagulants
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Type of lung cancer most associated with tobacco smoking?
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Small cell lung cancer
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How is pack-year calculated (for smoking)?
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# of cigarettes smoked per day times number of years smoked
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Old tuberculosis scars and pulmonary fibrosis are risk factors for ______
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Lung cancer
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Four main types of lung cancer?
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Small cell, adenocarcinoma, squamous cell, large cell
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Lung cancer - central tumours, hilar lymph node involvement, early metastasis, bad prognosis?
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Small cell lung cancer
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Lung cancer - peripheral, similar to pneumonia, patient has higher chance of being non-smoker?
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Adenocarcinoma
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Lung cancer - central location, possible hypercalcemia, tendency to cavitate, decent prognosis?
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Squamous cell
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Lung cancer complication - brachial plexus involvement, Horner's syndrome (droopy eyes, pupil constriction and reduced sweating)
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Pancoast syndrome
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Lung cancer complication - facial swelling and swelling of collateral veins
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superior vena cava obstruction (SVCO)
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Paraneoplastic effect of SCLC?
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Cushing syndrome (excessive cortisol), SIADH (excessive antidiuretic hormone production)
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Non-small cell lung cancer - paraneoplastic effects?
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Hypercalcemia, clubbing, muscle weakness
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This imaging technique uses uptake of radio-marked glucose to measure glucose metabolism
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PET scan
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How is small cell lung cancer staged?
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since it doesn't form discrete masses - limited involvement = only one hemithorax and only regional lymph node involvement
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Four steps of hemostasis (or thrombosis)?
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1- Vasoconstriction 2- Primary hemostasis (initial platelet plug) 3- secondary hemostasis (stabilization of platelet plug) 4- fibrinolysis
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In the setting of hemostasis, what is the role of endothelin?
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Released by injured endothelial cells - induces vasoconstriction by smooth muscle cells
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What happens to von Willibrand factors during hemostasis?
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binds to extracellular matrix (collagen fibers) which facilitates platelet adhesion during primary hemostasis. Deficiency leads to von Willibrand's disease.
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Three steps of primary hemostasis (involving platelets)?
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Adhesion, activation, aggregation
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At what stage of hemostasis is thrombin activated, thus cleaving fibrinogen and forming insoluble fibrin polymer?
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During secondary hemostasis
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Mechanism of action of warfarin (brand name Coumadin)?
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Warfarin inhibits the vitamin K-dependent synthesis of biologically active forms of the calcium-dependent clotting factors II, VII, IX and X (wikipedia)
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What blood tests are used to monitor warfarin dosing, and coagulation cascade disorders?
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Prothrombin time and partial thromboplastin time
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Main enzyme responsible for fibrinolysis
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Plasmin
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What is a D-dimer test?
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Test that measures level of fibrin split products - indicates abnormal thrombotic tests such as DVT, PE, intravascular coagulation
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Typically, when a venous blood clot is a result of ___ , which allows ____ and ___ to come into contact with endothelium and slows washout of _____
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stasis, leukocytes, platelets, activated clotting factors
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Common primary cause of hypercoagulability, especially if of European origin?
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Factor V mutation
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Differences in arterial vs. venous thrombi?
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Arterial thrombi form where there is turbulence vs. venous thrombi form where there is stasis.
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Most likely site of reactivation TB?
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Apices (pl. or apex) of lungs
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Granulomatous infection of lung - likely Dx?
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Tuberculosis
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Typical pathological finding for Staph. Aureus?
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Bronchopneumonia = patchy to confluent pattern of necrosis.
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Four patterns of lung pathology
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Interstitial, diffuse parenchymal, patchy parenchymal, nodular
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Three categories of respiratory tract defense mechanisms that can be compromised and lead to pneumonia?
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1- nasopharynx and vocal cords 2- mucociliary escalator and epithelial barrier 3- lung's immune cells.
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Most common cause of pneumonia?
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Streptococcus pneumoniae. Most common cause of CAP *and* nosocomial pneumonia - should come up on top of DDx in both cases
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Are S. Pneumoniae gram negative?
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No - they are gram positive and stain accordingly
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Typical CXR for S. Pneumoniae?
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Lobar pneumonia + air bronchograms
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Acute onset, high fever, shaking chills, pleuritic chest pain, rust coloured sputum - Probable Dx?
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Clinical symptoms of S. Pneumoniae
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Most common cause of atypical pneumonia and typical presentation
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Mycoplasma pneumoniae; typically mild presentation - headache, sore throat, myalgia and often in young adults
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Typical CXR for Mycoplasma pneumoniae
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interstitial pattern
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Typical CXR for Staphylococcus aureus?
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Bronchopneumonia, no air bronchograms. atelectasis and frequent pleural effusions
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Examples of gram negative bacteria that cause pneumonia (and which might not react to drugs used for bacteria with cell walls)?
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Pseudomonas aeruginosa, Mycoplasma pneumoniae
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CXR with diffuse interstitial pattern in lungs, and no bacteria present. Probable Dx?
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Influenze pneumonia
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How will aspiration pneumonia present on CXR?
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predominantly right side; gravity-dependent regions
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For what populations are atypical pneumonias and viral pneumonias more common?
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Young adults and children
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Egophony, crackles, wheezing, decreased breath sounds or bronchial breath sounds, pleural friction rub on auscultation - what type of DZ?
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Typical findings on auscultation for pneumonia
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Complication that can arise from untreated pleural effusion?
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Fibrotic tissue encasing lung
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What lab values are needed to tell exudative vs. transudative pleural fluid apart from each other?
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LDH fluid, protein fluid, glucose, pH
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One cause of transudative pleural effusion?
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Congestive heart failure
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One cause of exudative pleural effusion?
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Pneumonia
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Typical readings for exudative pleural effusion consisting of empyema?
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High LDH fluid to serum ratio, high protein fluid to serum ratio, low glucose fluid to serum ratio, low pH, presence of bacteria
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Drug class usually used to treat S Pneumonia and some atypicals?
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Macrolides - drugs that end in -mycin
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Drug of choice for gram negative bacteria causing pneumonia?
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Fluoroquinolones - end in "floxacin"
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What can present similar symptoms to pneumonia (i.e. what would be in your DDx?)
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TB, non-infectious respiratory DZ, other respiratory infections, malignancy
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