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104 Cards in this Set
- Front
- Back
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lecithin to sphingomyelin ration of ? indicates fetal lung maturity
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2
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how far down does pseudostratified ciliated cells go
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respiratory bronchioles
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how far down do goblet cells go
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terminal bronchioles
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what kind of cells are type I pneumocytes and what do they do
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squamous
line alveoli |
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what's dipalmitoyl phosphatidylcholine
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surfactant
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what kind of cells are type II pneumocytes and what do they do?
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cuboidal
precursors to I and secrete surfactant |
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what kind of cells proliferate in lung damage
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II
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are clara cells cilieated?
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no
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what kind of cells are clara cells
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columnar with secretory granules for a portion of surfactant
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what pneumocytes degrade toxins
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Clara
Clara cleans even though she doesn't have cilia to sweep with |
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which vessels run with the airways
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Arteries run with the airways
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why does right lung get inhaled objects
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right mainstem bronchus is wider and more vertical
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where does the IVC perforate the diaphragm
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at T8
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where do esophagus and vagus perforate the diaphragm
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T10
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where does aorta, thoracic duct and azygous vein pierce the diaphragm
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T12
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accessories for inspiration
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Neck and externals
External intercostals Scalenes Sternomastoids |
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accessories for expiration
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Stomach, internal and externals
rectus and transverse abdomisabdominis internal/external obliques internal intercostals |
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which intercostals do inspiration
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externals do inspiration
internals do expiration E does I, I does E |
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what does kallikrein activate
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bradykinin
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what inactivates bradykinin
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angiotensin II
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what is vital capacity
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everything but the reserve volume/dead space
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what is tidal volume relative to vital capaciety
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it's teh VC less the inspiratory and expiratory reserve volumes
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what is VC + RV
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TLC
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what is physiologic dead space
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its the anatomical dead space of the conducting airways plus the functional dead space in the alveoli
it's also the volume of inspired air that does not take part in gas exchange |
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what's the formula for dead space?
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VD= VT x (PaCO2 - PeCO2) / PaCO2
PaCO2 is arterial PCO2 PeCO2 is expired air PCO2 VT = tidal volume VD = dead space |
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an increases in all factors (except one) causes what kind of a shift of the hemoglobin dissociation curve
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all but pH and CO shift it to the right
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Right Shift factors
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CADET face right
CO2 Acid/Altitude DPG Exercise Temperature |
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in normal health is oxygen exchange perfusion or diffusion limited?
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perfusion
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in emphysema or fibrosis is oxygen exchange perfusion or diffiusion imited?
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diffusion
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which gasses are perfusion or diffusion limited?
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CO2 - perfusion limited
N2O - perfusion limited CO - diffusion limited |
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how does CO affect the oxygen-hemoglobin dissociation curve
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left
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mmHg that marks pulmonary hypertension
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25
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Pulmonary vascular resistance formula
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PVR = (Ppa - Pleft atrium) / (CO)
this is basically just R= P/Q |
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how does pulmonary resistance get affected by the viscosity of inspired air? airway radius
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proportional to viscosity
inversely proportional to r to the fourth power |
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what is oxygen content of the blood
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O2 binding capacity x % saturation + dissolved O2
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normal O2 binding capacity
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1.34 ml O2 per gram hemoglobin
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what is normal hemoglobin?
at what level is cyanosis |
15
cyanosis at <5 |
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what is normal O2 binding capacity
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20.1 mL O2 /dL
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what is affected by decrease in hemoglobin?
O2 content O2 saturation arterial PO2 |
O2 content only
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what happens to PO2 in chronic lung disease? why?
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decreases, because physiologic shunt decreases O2 extraction
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alveolar gas equation
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PAO2 = 150 - PaCO2 / 0.8
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A-a gradient
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PAO2 - PaO2
Normally 10-15 mmHG |
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what is wasted in the apex of teh lung, ventilation or perfusion
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ventilation is wasted
(in the base perfusion is wasted) |
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where is ventilation greater, at the base or apex of the lung? where is perfusion greater?
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both greater at the base!!!!
but there's nevertheless wasted ventilation in the apex Wasted Air At Apex |
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in shunt what does V/Q value become
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closer to 0.
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what's the Haldane effect
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that's where oxygenation of Hb in the lungs promotes the dissociation of H+ from ttHb and pushes equilibrium toward CO2 formation so that CO2 is released from RBCs
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what is the Bohr effect
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this refers to the push of high H+ concentration in the peripheral tissues towards a rigth shift in the dissociation curve
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what's carbaminohemoglobin
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this is carbon dioxide bound to hemoglobin (5% of total CO2 in body)
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what happens to ventilation in high altitude
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acute increase
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what happens to 2,3 DPG in high altitude
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binds to hemoglobin to release more O2
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what happens to mitochondria in high altitude
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they increase in number
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what happens to bicarb excretion in high altitude
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it increaese
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how can you increase renal excretion of bicarb in high altitutde
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acetazolamide
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what happens to the heart in high altitude
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eventually, chronic hypoxic pulmonary vasoconstriction results in RVH
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FEV1/FVC ration in COPD
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decreased
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name the 4 COPDs
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chronic bronchitis
emphysema Asthma Bronchiectasis |
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hypertrophy of mucus secreting glands in bronchiles
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Blue Boater
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Reid index in COPD
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greater than 50%, which means that gland depth is more than 50% of total thickness of the bronchial wall
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diagnostic criterion for chronic bronchitis
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cough for ?3 consecutive months in the past 2y years or more
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cause of centriacinar vs panacinar emphysema
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panacinar is from alpha 1
centriacinar is from smoking |
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what is paraseptal emphysema associated with
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bullae that can rupture and cause spontaneous pneumothroax
happens in young, healthy males |
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Curschmann's spirals
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asthma
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chronic necrotizing infection of bronchi
permanently dilated airways purulent sputum recurrent infections hemoptysis |
bronchiectasis
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cause of bronchiectasis
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bronchial obstruction, CF, poor ciliary motility, Kartajener's
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diseases that cause poor breathing mechanics
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polio
myasthenia gravis scoliosis morbid obesity |
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drugs that cause interstitial lung diseases
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bleomycin
busulfan amiodarone |
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cause of neonatal respiratory distress syndrome
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surfactant deficiency
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fev1/fvc in restrictive lung disease
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> normal (80%)
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difference between central and obstructive sleep apnea
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in cntral there's no respiratory effort
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ferruginous bodies in lung
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asbestos fibers coated with hemosierin
asbestosis |
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ivory white pleural plaques
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asbestosis
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what part of lungs does asbestosis affect
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lower lobes
all other pneumoconioses affect upper lobes |
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typical pneumoconiosis affects what part of lungs
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upper lobes
(except asbstosis is in the lower) |
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in which of these is smoking an additive risk factor to asbestos:
bronchogenic cancer mesothelioma |
bronchogenic cancer
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breath sounds in pleural effusion
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decreased over effusion
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resonance in bronchial obstruction
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decreased
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breath sounds in pleural effusion
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dullness
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breath sounds in pneumonia
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dullness
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breath sounds in pneumothorax
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hyperresonant
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fremitus in bronchial obstruction
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decreased
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fremitus in pleural effusion
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decreased
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fremitus in pneumonia
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increased
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fremitus in pneumothorax
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absent
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tracheal deviation in bronchial obstruction? pneumothorax?
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in bronchial obstruction it's toward side of lesion; in pneumothorax its away from side of lesion
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location of squamous cell carcinoma
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Central
squamous sentral smoking |
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location of bronchial adenocarcinoma
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peripheral
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locaiton of small cell carcinoma
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central
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location of large cell carcinoma
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peripheral
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hilar mass arising from the bronchus with cavitation and increased PTHrP
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Squamous cell carcinoma
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lung cancer that increases PTHrP
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squamous cell carcinoma
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tumor in which Clara cells become type II pneumocyts
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Adenocarcinoma
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Kulchitsky cells
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small cell carcionoma
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sequela of small cell carcinoma
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Lambert Eaton
first he made a small sell and then Mr Eaton made it big |
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where do mets to lungs come from
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Brain (epilepsy)
bone (pathologic fracture) liver (jaundice, hepatomegaly) |
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bug for lobar pneumonia
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pneumococcus
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bug for bronchopneumonia
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staph aureus
H flu Klebsiella S pyogenes |
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bugs for interstitial pneumonia
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RAM Lung Cells
RSV adenovirus mycoplasma legionella chlamydia |
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typical cause of a pus filled abscess
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bronchial obstruction (e.g., cancer)
aspiration of gastric contents staph aureus or anaerobes |
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causes of pleural effusions with transudate
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a TRANS guy wearing a Hot, Colorful Negligee
CHF nephrotic syndrome hepatic cirrhosis |
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causes of pleural effusions with exudate
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Too Much Protein Collects
Trauma Malignancy Pneumonia Collagen vascular disease EXudate has EXtra protein |
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drawback of theophylline
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narrow therapeutic index (cardiotoxicity, neurotoxicity)
metabolized by p450 |
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moa of Ipratropium
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muscarinic antagonist
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use of ipratropium
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asthma
COPD |
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use of Guaifenesin
and of N acetylcysteine |
expectorant of sputum
does not suppress cough reflex loosens mucous plugs in CF patients also used as an antidote for acetaminophen overdose |
