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69 Cards in this Set
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- 3rd side (hint)
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Danger of appetite suppressants
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Fenfluramine or Phentermine
↑ 5-HT release ↑ risk pulmonary htn after 3 mo → sudden cardiac death |
#pathology #nutrition #pulmonology
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Phentermine
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appetite suppressent
↑ 5-HT release like fenfluramine ↑ risk pulmonary htn after 3 mo → sudden cardiac death |
#pathology #nutrition #pulmonology #drugs
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Fenfluramine
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appetite suppressant
↑ 5-HT release like phentermine ↑ risk pulmonary htn after 3 mo → sudden cardiac death |
#pathology #nutrition #pulmonology #drugs
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Periacinar v Centriacinar Emphysema
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Periacinar: air trapped in terminal bronchioles before acini
α1 anti-trypsin deficiency lower lung fields worse: ↑ perfusion = ↑ PMN's Centriacinar: air trapped in acini after TB's smoking upper fields worse: ↓ perfusion = ↓ α1 anti-trypsin |
#pathology #pulmonology
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What part of airways are attacked in lung transplant rejexn
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small airways
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#pathology #pulmonology
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Reid Index
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Submucosal Gland thickness/ thickenss of wall from epithlium to cartilage (not including cartilage)
normally 0.4 higher index ≈ severity/duration of chronic bornchitis |
#pathology #pulmonology #diognostics
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↑ Lipase & Amylase → Dyspnea
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Acute Pancreatitis → ARDS
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#pathology #pulmonology
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Bosentan
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endothelin-receptor antagonist
prevents vasoconstriction and endothelial proliferation DOC: pumonary artery hypertension |
#pharmacology #pulmonology
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DOC: pulmonary artery hypertension
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Bosentan
endothelin-receptor antagonist prevents vasoconstriction and endothelial proliferation |
#pharmacology #pulmonology
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Most common cause of superior vena cava sro?
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1. bronchogenic carcinoma
esp 20 years after asbestos exposure |
#pathology #pulmonology
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Cromolyn
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Inhibit mast cell degranulation
useful in tx of asthma sibling: nedocromil |
#pharmacology #pulmonology
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Nedocromil
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Inhibit mast cell degranulation
useful in tx of asthma sibling: cromolyn |
#pharmacology #pulmonology
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inhibitors of mast cell degranualtion
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cromolyn and nedocromil
useful vs asthma |
#pharmacology #pulmonology
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The progression of lobar pneumonia
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First 24h: Congestion
macro: red, heavy boggy micro: vascular dilation, bacteria rich exudate d2-3: Red hepatization macro: red, firm micro: RBC, PMN & fibrin infiltrate d4-6: Grey hepatization macro: grew brown & firm micro: PMN's & Fibrin resolution macro: normal architecture enzymatic degradation of exudate |
#pathology #pulmonology
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D-glutamate capsule
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The primary virulence factor of Bacillus anthracis, required for pathogenicity, uniquely does not contain polysaccharide
"wool-workers dz" grows "medusa head" colonies on media spores grow once ingested by alvoelar M∅ → mediastinal lymkph nodes → hemorrhagic mediastinitis → septic shock and death anthrax toxin |
#microbiology #pulmonology
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Wool Worker with Widened Mediastinum
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Bacillus anthracis --"wool workers dz"
spores grow once ingested by alvoelar M∅ → mediastinal lymkph nodes → hemorrhagic mediastinitis → septic shock and death D-glutamate capsule is the The primary virulence factor of Bacillus anthracis, required for pathogenicity, uniquely does not contain polysaccharide grows "medusa head" colonies on media anthrax toxin |
#microbiology #pulmonology
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"medusa head" colonies on agar
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Bacillus anthracis --"wool workers dz"
spores grow once ingested by alvoelar M∅ → mediastinal lymkph nodes → hemorrhagic mediastinitis → septic shock and death D-glutamate capsule is the The primary virulence factor of Bacillus anthracis, required for pathogenicity, uniquely does not contain polysaccharide anthrax toxin |
#microbiology #pulmonology
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Small Cell Lung Cancer
Risk Factors, Histology, Location, Behavior/Px, Genetics, Staining, PNP Sros, Tx |
Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium
Arises Centrally Px: Very Aggressuve, Mets Early & Widely Genetics: c-myc Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase Risks: Smoking Tx: Chemo Many PNP Sros: Cushing, Lambert Eaton, SIADH |
#pathology #neoplasia #pulmonology
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Bronchial Adenocarcinoma
Risk Factors, Histology, Location, Behavior/Px, Genetics, Staining, PNP Sros, Tx |
Risk Factors: most common non-small cell cancer
non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #neoplasia #pulmonology
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Bronchioalveolar Carcinoma
Risk Factors, Histology, Location, Behavior/Px |
Risk Factors: not assoc. with smoking
Histology: lepidic growth w/o invasion Location: Periphery, Terminal broncheolavoli Behavior/Px: Aerogenous Seeding, Death from Suffox → consolidatn |
#pathology #neoplasia #pulmonology
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Squamous Cell Carcinoma of the Lung
Risk Factors, Histology, Location, Behavior/Px, PNP Sros |
Risk Factors: Males, Smoking
Histology: Cavitating; Keratin Pearls & Intracellular Bridges Location: Central (Bronchus/Hilar Mass) Behavior/Px: Large & Slow, Late Mets PNP Sros: PTHrP induced Hypercalcemia |
#pathology #neoplasia #pulmonology
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Large Cell Lung Cancer
Histology, Location, Behavior/Px, Genetics, Staining, PNP Sros, Tx |
Histology: Highly anaplastic: large cells with large nuclei
Location: Peripheral Behavior/Px: Extensive Local Growth PNP Sros: Gynecomastia, Galactorrhea Tx: non responsive to chemotheray |
#pathology #neoplasia #pulmonology
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Lung Cancer:
Dark Blue Cells |
Small Cell Lung Cancer
Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium Arises Centrally Px: Very Aggressuve, Mets Early & Widely Genetics: c-myc Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase Risks: Smoking Many PNP Sros: Cushing, Lambert Eaton, SIADH Tx: Chemo |
#pathology #neoplasia #pulmonology
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Lung Cancer:
C-Myc |
Small Cell Lung Cancer
Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium Arises Centrally Px: Very Aggressuve, Mets Early & Widely Genetics: c-myc Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase Risks: Smoking Many PNP Sros: Cushing, Lambert Eaton, SIADH Tx: Chemo |
#pathology #neoplasia #pulmonology
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Lung Cancer:
TTF-1 positive Stain |
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #neoplasia #pulmonology
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Lung Cancer
CEA positive Stain |
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #neoplasia #pulmonology
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Lung Cancer
Hypertrophic Osteoarthropathy |
Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg Bronchioalveolar Carcinoma Risk Factors: not assoc. with smoking Histology: lepidic growth w/o invasion Location: Periphery, Terminal broncheolavoli PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Behavior/Px: Aerogenous Seeding, Death from Suffox → consolidatn |
#pathology #neoplasia #pulmonology
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Lung Cancer: EGFR
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Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #neoplasia #pulmonology
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Lung Cancer: Kras
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Bronchial Adenocarcinoma
Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #neoplasia #pulmonology
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Lung Cancer:
Gyneocomastia |
Large Cell Lung Cancer
Histology: Highly anaplastic: large cells with large nuclei Location: Peripheral Behavior/Px: Extensive Local Growth PNP Sros: Gynecomastia, Galactorrhea Tx: non responsive to chemotheray |
#pathology #neoplasia #pulmonology
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Lung Cancer:
Galactorrhea |
Large Cell Lung Cancer
Histology: Highly anaplastic: large cells with large nuclei Location: Peripheral Behavior/Px: Extensive Local Growth PNP Sros: Gynecomastia, Galactorrhea Tx: non responsive to chemotheray |
#pathology #neoplasia #pulmonology
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Peripheral Lung Cancers
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Bronchial & Bronchioalveolar Adenocarcinoma
Large Cell Lung Cancer |
#pathology #pulmonology #neoplasia
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Central Lung Cancers
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Small Cell & Squamous Cell Carcinomas
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#pathology #pulmonology #neoplasia
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Lung Cancer:
Non-smoking Women |
Bronchial Adenocarcinoma
_____________________ Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #pulmonology #neoplasia
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Lung Cancer
Definitively Not Caused by Smoking |
Bronchioalveolar Carcinoma
____________________________ Risk Factors: not assoc. with smoking Histology: lepidic growth w/o invasion Location: Periphery, Terminal broncheolavoli PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Behavior/Px: Aerogenous Seeding, Death from Suffox → consolidatn |
#pathology #pulmonology #neoplasia
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Lung Cancer
Slow Growth Early Mets |
Bronchial Adenocarcinoma
__________________________________ Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #pulmonology #neoplasia
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Lung Cancer
Fast Growth Early Mets |
Small Cell
Large Cell _____________________ Small Cell Lung Cancer Histology: Kulchitsky cells: Small Dark & Blue beneith intact epithelium Arises Centrally Px: Very Aggressuve, Mets Early & Widely Genetics: c-myc Stains: chromogranin, synaptophysin, CD56, neuron specific enoslase Risks: Smoking Many PNP Sros: Cushing, Lambert Eaton, SIADH Tx: Chemo Large Cell Lung Cancer Histology: Highly anaplastic: large cells with large nuclei Location: Peripheral Behavior/Px: Extensive Local Growth, Early Mets PNP Sros: Gynecomastia, Galactorrhea Tx: non responsive to chemotheray |
#pathology #pulmonology #neoplasia
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Lung Cancer
Slow Growth Late Mets |
Squamous Cell
________________________ Risk Factors: Males, Smoking Histology: Cavitating; Keratin Pearls & Intracellular Bridges Location: Central (Bronchus/Hilar Mass) Behavior/Px: Large & Slow, Late Mets PNP Sros: PTHrP induced Hypercalcemia |
#pathology #pulmonology #neoplasia
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Lung Cancer
Hypercalcemia |
Squamous Cell Carcinoma
___________________________ Risk Factors: Males, Smoking Histology: Cavitating; Keratin Pearls & Intracellular Bridges Location: Central (Bronchus/Hilar Mass) Behavior/Px: Large & Slow, Late Mets PNP Sros: PTHrP induced Hypercalcemia |
#pathology #pulmonology #neoplasia
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Lung Cancer
Mucin Producing Glands |
Bronchial Adenocarcinoma
_____________________ Risk Factors: most common non-small cell cancer non-smoking females at sites of scarring Histology: Glandular differentiation with mucin prodxn Location: Peripheral Behavior/Px: Slow & Small but with Early & Wide Mets Genetics: EGFR overexpression, Kras mutation Staining: TTF-1, CEA PNP Sros: Clubbing, Hypertrophic Osteoarthropathy Tx: Surg |
#pathology #pulmonology #neoplasia
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Lung Cancer
Cavitating |
Squamous Cell Carcinoma
_____________________ Risk Factors: Males, Smoking Histology: Cavitating; Keratin Pearls & Intracellular Bridges Location: Central (Bronchus/Hilar Mass) Behavior/Px: Large & Slow, Late Mets PNP Sros: PTHrP induced Hypercalcemia |
#pathology #pulmonology #neoplasia
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Lung Cancer
Intercellular Bridges |
Squamous Cell Carcinoma
_____________________ Risk Factors: Males, Smoking Histology: Cavitating; Keratin Pearls & Intracellular Bridges Location: Central (Bronchus/Hilar Mass) Behavior/Px: Large & Slow, Late Mets PNP Sros: PTHrP induced Hypercalcemia |
#pathology #pulmonology #neoplasia
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Most common cause of asthma
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inhaled allergens like animal dander >> other stuff like cold air & exercise
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#pathology #pulmonology
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Acid-Base State of Pulmonary Ebolus Pt
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Respiratory Alkalosis
PE → V/Q mismatch → hypoxia → hyperventilation → ↓ pCO2 |
#pathology #pulmonology
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Flunisolide
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inhaled glucocorticoid
prophylaxis vs bronchial asthma DOC vs bronchial asthma for anti-inflam effects |
#pharmacology #pulmonology
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Theophylline
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Methylxanthines: theophylline & aminophylline
phosphodiesterase inhibitor, increases [cAMP] → bronchodilation also block adensoine receptors |
#pharmacology #pulmonology
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aminophylline
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Methylxanthines: theophylline & aminophylline
phosphodiesterase inhibitor, increases [cAMP] → bronchodilation also block adensoine receptors |
#pharmacology #pulmonology
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Phosphodiesterase Inhibitors vs Asthma
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Methylxanthines: theophylline & aminophylline
phosphodiesterase inhibitor, increases [cAMP] → bronchodilation also block adensoine receptors |
#pharmacology #pulmonology
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Size cutoff:
mucociliary elevator vs M∅ |
>2.5 mucociliary elevator
≤2mm Alveolar M∅ [Pneumoconiosis = interstital lung fibrosis 2° to M∅ stimulation & growth factor prodxn] |
#physiology #pulmonology
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Pulmonary perfusion
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Left and Right Bronchial Arteries arise from Descending Aorta.
These perfuse the areas which would not be perfused by simple flow of pulmonary arteries. Majority drains into the Right atrium → RA blood is less oxygenated than blood from pulmonary veins. |
#physiology #anatomy #pulmonology
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Pulmonary infarction:
what kind of necrosis? |
almost always hemorrhagic thanks to dual blood supply (pulmonary and bronchial arteries)
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#pathology #pulmonology
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Drug using population:
what organisms cause endocarditis |
1. Staph aureus
2. Pseudomonas aeruginosa NB: Tricuspid endocarditis, septic emboli to lungs → hemorrhagic necrosis |
#microbiology #pulmonology
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Where do the respiratory drive signals originate
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Hypercapnea (normal individuals):
-Medulla detects pH Hypoxia (<60 mmHg or chronic hypercapnics) -Chemoreceptors in aotic arch and carotid bodies via CN9 |
#cardiovascular
#pulmonary #neurology #physiology |
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Pleural Pressure Through Inspiration and Expriation
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always negative (collapses pleural space)
-8 at fully inspired -5 at fully expired |
#physiology #pulmonology
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Where do aspirations go?
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superior regions of lower lobes
posterior regions of upper lobes |
#pathology #pulmonology
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ARDS
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diffuse injury to endothelium or epithelium
→ ↑ permeability → interstitial & alveolar edema, inflam, hyalin membranization ↓ compliance, ↑ workload ↓ diffusion severe involvment or atalectasis will cause V/Q mismatch requires an absence of cardiogenic ie hemodynamic causes ie wedge pressures, atrial pressures should not be hchanged |
#pathology #pulmonlogy
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Laplace's law
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Pressure necessary to distend a hollow organ is directly proprtional to the tension and inversely proprortional to the radius
P = 2T/r assuming constant surface tension, sphere with smaller radius will have higher distending pressure requirement thus will want to collapse when in communication with a larger sphere of the same surface tension (ergo we need surfactant) |
#physiology #pulmonology
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In pulmonary edema what accounts for dyspnea?
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↓ lung compliance from interstitial fluid
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#pathology #pulmonology
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Ideopathic Pulmonary Artery Hypertension
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Ideopathic Pulmonary Hypertension
abnormal Bone Morphogenic Protein Receptor Type 2 BMPR2 30 yo women ↓ NO & Prostaglandins ↑ endothelin ↑ VSMC proliferation |
#pathology #pulmonology
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BMPR2
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Ideopathic Pulmonary Hypertension
abnormal Bone Morphogenic Protein Receptor Type 2 BMPR2 30 yo women ↓ NO & Prostaglandins ↑ endothelin ↑ VSMC proliferation |
#pathology #pulmonology
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1° mtb infx
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Gohn focus: fibrotic focus in lower lobe of lung
Ispilateral hilar adenopathy (w/ calcification) Gohn complex = both of those aspiration of <2mm droplets → M∅ phagocytosis → intracellular proliferation → lymphatic cirulation → dissemination |
#microbiology #pulmonology
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Gohn Focus vs Gohn Complex
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Gohn focus: fibrotic focus in lower lobe of lung
Ispilateral hilar adenopathy (w/ calcification) Gohn complex = both of those aspiration of <2mm droplets → M∅ phagocytosis → intracellular proliferation → lymphatic cirulation → dissemination |
#microbiology #pulmonology
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Physiologic Pulmonary Dead Space Formula
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Vd =
Vtotal x (PaCO2 - PexpiredCO2) / PaCO2 |
#physiology
#pulmonology |
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Radial Traction in lungs means what
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pulling inwards
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#pathology #pulmonology
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When is pulmonary vascular resistance lowest
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at the low volume end of normal tidal volume
above this the stretch in the wall squeezes the vasculature below this muscular is placing pressure on the system |
#physiology #pulmonology
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CXR: pulmonary infiltrates far worse than expected from clincial presentation
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M pneumoniae "walking pneumonia"
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#microbiology #pulmonology
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The pathology of heart failure cells
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↑ Pulmonary BP → RBC extravasation → M∅ Hemoglobin ingestion → Hemosiderin Laden M∅
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#pathology #pulmonology
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Calculate A-a gradient
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Normal Aa gradient <15
(Not 0 because ventilation better in apex and perfusion better in lower lobes = ventilation perfusion mismatch) >15 means that the problem is definitely in the lungs: air is not exchanging appropriately A-a = PAO2 - PaO2 and PAO2 ≈ 150 - (PaCO2/0.8) Deriving the formula is complicated but the formula is not so just memorize this: |
#physiology #pathology #pulmonology
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URI's s Croup
Causes by Freq |
1. Rhinovirus
2. Influenza 3. Coronavirus 4. Adeno etc |
#microbiology #pulmonology
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