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708 Cards in this Set
- Front
- Back
Liver failure becomes apparent when _______ of liver is destroyed or dysfunctional
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80%
|
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Liver injury results in release of these two major indicators of liver function.
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Ast (aspartate amlno-transterase) andALT (Alanlne amlno-transferase)
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Which is not a sign of liver failure: Jaundice, Hypoalbumenernia, Hepatorenal syndrome, Portal hypertension, Encephalopathy, Endocrine abnormalities, coagulopathy
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all are signs
|
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Encephalopathy I liver failure is due to the failure of the liver to remove _________ from the blood.
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ammonia
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bile aids in elimination of bilirubrin and cholesterol; and emulsifies dietary fat in the gut. T/F
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True; True
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_______ occurs if blood bilirubin levels are greater than _______mg/dl.
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Jaundice, 1.2
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Jaundice becomes clinically apparent If serum bilirubin Is over _________
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2.0-3.0 mg/dl.
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Jaundice is best recognized in the __________.
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sclera
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Which type of bilirubin is tightly bound to albumin?
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Unconjugated bilirubin:
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Which type of bilirubin is water soluble?
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Conjugated bilirubin
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Which type of bilirubin can be excreted in urine?
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conjugated
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Prehepatic Jaundice is associated with the buildup of ________ bilirubin and the ________of red blood cells.
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Unconjugated, hemolysis
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A manifestation of Gilbert's disease is:
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Prehepatic Jaundice
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_______ Jaundice shows signs of viral or drug-induced hepatitis, alcoholic hepatitis, tumors, and cirrhosis
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Hepatic
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T/F Hepatic Jaundice is associated with a buildup of conjugated bilirubin only.
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False: It is mixed conjugated and unconjugated
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Conjugated hyperbilirubinemia is manifest in what condition?
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post-hepatic jaundice
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post-hepatic jaundice is seen in _________ disorders such as gallstones, tumors of bile ducts, pancreas, or duodenum
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obstructive
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_________ is the accumulation of unconjugated bilirubin (usually> 20 mg/dl) in the brain causing severe neurologic damage
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Kernicterus
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Kernicterus can be seen in this condition that affects infants:
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hemolytic disease of the newborn (erythroblastosis fetalis)
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|
Elevated ammonia levels in the blood from liver failure that lead to disturbances in consciousness ranging from behavioral abnormalities to coma is called:
|
hepatic encephalopathy
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Hepatorenal syndrome:
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liver fails--> kidneys fail drop in urine output, increase in urea nitrogen/creatine levels (in end-stage liver disease)
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______ is synonymous with end-stage liver disease
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Cirrhosis
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T/F Cirrhosis is among the top ten causes of death I western society.
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TRUE
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Cirrhosis may take one to ___ years to develop.
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20
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What is the major pathologic process that accompanies cirrhosis?
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progressive fibrosis (regenerative firm nodular surface)
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________ occurs with changes within the liver itself.; ________ occurs with changes within the biliary tree.
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portal cirrhosis; biliary cirrhosis
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The presence of fibrosis and nodularity impedes blood flow in the liver and is one of the major causes of _____ ____________.
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portal hypertension
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T/F Patients with cirrhosis have an increased risk of death from the following:; a. progressive liver failure b. complications of portal hypertension c. hepatocellular carcinoma
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A. True; B. True; C. True
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T/F portal hypertension leads to:; A. ascites; B. Spleenomegaly; C. formation of anastamoses (shunts) between the portal and systemic circulation; D. Hepatic encephalopathy E. Undeniable urge to smoke barkies
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A. True; B. True C. True D. True E. False (except for individuals from low educational and rural backgrounds, Evan)
|
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formation of anastamoses (shunts) between the portal and systemic circulation (a result of portal hypertension)
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esophageal varacositities - tities?
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|
__ ________hepatitis carriers in US; 1 in __ patients is a carrier
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4 million; 70
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What may be one of the first signs of hepatitis?
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Dark urine
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|
The functional unit of the breast
|
lobule
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Under hormonal influence, terminal buds of breast ductules develop into ______. Milk is produced in response to __________.
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acini, prolactin
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The breast has many lymphatics that drain into the ______(75%) and the _______ nodes.
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axillary, parasternal
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Breasts enlarge during _______ & ________, and atrophy in ________ period
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pregnancy & lactation, post-menopausal
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Fibroadenomas (benign) generally affect ______ _______
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young women
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Fibrocystic breast disease generally affects ______ _____
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middle age
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Breast cancer generally affects age ___ and older
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45
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__ in __ women in US will get breast cancer
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1, 9
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congenital absence of the breast
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amastia
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more that 2 breasts develop
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polymastia
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where do supernumerary breasts develop?
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along the milk line
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invasion by bacteria in the breast is usually caused by ____ or especially ____ in lactating women
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strep, staph
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______ mastitis: Usually affects _______ females ____ ____ milk provides a good medium edema --> _______ if not treated
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Acute, lactating, stagnant milk, abscess
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_______ mastitis: Unknown cause may produce small _____
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chronic, lumps
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Breast changes during puberty are caused by _______
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estrogen
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excessive response to estrogen can cause _______ _______, usually an abnormal enlargement of one breast (treated with a ____________)
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juvenile hyperplasia, mammoplasty
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Post menopausally the breast _________
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atrophy
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female-like enlargement of male breast due to excess estrogen
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Gynocomastia
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The spectrum of macroscopic and microscopic changes in the breast resulting from an exaggerated uncoordinated response of the mammary ducts and stroma to cyclic hormonal stimulation that occurs during the normal menstrual cycle
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Fibrocystic change in the breast
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Most common disorder of the breast
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Fibrocystic change
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Most common cause of a palpable breast mass in patients between 25 and 50
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Fibrocystic change
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Characterized by lumpy breasts and mid-cycle tenderness
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Fibrocystic change
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Fibrocystic change in the breast is usually _____, but can be asymmetrical
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bilateral
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Although a mammography may reveal areas of cysts and calcification, a ______ biopsy is the only way to establish a definitive diagnosis
|
biopsy
|
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Name the 4 types of benign breast tumors
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1. Fibroadenoma 2. Adenoma of the nipple 3. Intraductal papilloma 4. Phyllodes tumor (can also be malignant)
|
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Most common benign breast tumor
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fibroadenoma
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Fibroadenoma is the most common breast tumor in women under ___
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25
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A firm, rubbery, painless, well-circumscribed 2-5 cm mass
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fibroadenoma of the breast
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fibroadenoma of the breast does/does not undergo malignant change
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does not
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Benign tumor that presents with serous or bloody discharge and a palpable mass, can be mistaken for malignancy
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Adenoma of the nipple
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Benign tumor of the major lactiferous ducts, serous or bloody discharge, can mistaken for malignancy
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Intraductal Papilloma
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Benign, large, bulky tumor often w/ overlying ulceration of the skin. Cystic spaces w/ leaf like projections from the cyst wall & myxomatous contents
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Phyllodes Tumor
|
|
most common cancer in women
|
breast cancer
|
|
most common cause of cancer death in women
|
lung (breast cancer is 2nd)
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Most common cause of breast mass in post menopausal women, occurs most frequently in upper outer quadrant of the breast, & metastasizes generally by the lymphatics
|
malignant breast tumor
|
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malignant breast tumors can demonstrate the presence of _____ & ________ receptors in some tumors which correlates w/ a _______ prognosis
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estrogen & progesterone, better
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Most common type of malignant breast tumor is _______ ______ _______ (also called invasive ductal or scirrhous)
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infiltrating ductal carcinoma
|
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Several breast cancers induce ________ tissue response w/ the CT becoming dense and the tumor is firm and gritty. The dense CT pulls on adjacent tissue and ________ of the skin and ______ of the nipple.
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desmoplastic, puckering, retraction
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First 4 risk factors of breast cancer
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Age; First-degree female familial history (mut. In p53, BRCA-1 or 2); History of cancer in one breast or ovarian/endometrial cancer; Early menarche (menstruation) & late menopause
|
|
Other 6 risk factors for breast cancer
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obesity, nulliparity (no births), 1st preg. after 30, proliferative fibrocystic breast disease, high animal fat diet, caucasian (jewish)
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What is the biggest risk for breast cancer?
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Age (0-39 yrs: 1 in 231, 40-59yrs: 1 in 25, 60-79 yrs: 1 in 15, 90yrs: 1 in 7)
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Name the breast cancer type: Pre-invasive; Tumor cells fill ducts; Necrosis has cheese-like consistency
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Intraductal carcinoma in situ
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Name the breast cancer type: Most common type (2/3 of all breast cancers); Tumor cells in cords, islands, & glands in dense CT stroma; Dense CT is firm and is white and gritty on sectioning
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Invasive (infiltrative) ductal carcinoma (scirrhous carcinoma)
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Name the breast cancer type: Exzematous lesion of the nipple or areola; Underlying infiltrating ductal carcinoma almost always present; Large cells w/ clear halo invade epidermis
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Paget’s disease of the breast
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Name the breast cancer type: Clusters of neoplastic cells fill intralobular ductules & acini; May lead to invasive carcinoma; Often bilateral
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Lobular carcinoma in situ
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Name the breast cancer type: Multicentric or bilateral; Cells arranged in linear fashion; Better prognosis than infiltrating ductal
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Invasive lobular carcinoma
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Name the breast cancer type: Soft, bulky tumor w/ almost no CT; Sheets of tumor cells infiltrated by lymphocytes; Better prognosis than infiltrating ductal
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Medullary carcinoma
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Name the breast cancer type: Gelatinous consistency; Usually older women; Extracellular mucous material; Better prognosis than infiltrating ductal
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Mucinous (colloid) carcinoma
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Name the breast cancer type: Red, swollen, hot skin; Skin may be pitted; Lymphatic involvement of skin; Poor prognosis
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Inflammatory breast carcinoma
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The most accurate prognostic factor of breast cancer is
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stage
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What percentage of breast biopsies are cancerous?
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10%
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______ ______ asperation is 95% accurate by qualified cytopathologist
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fine needle
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What term means: Labored Breathing
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Dyspnea
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What term means: Physican wasting with loss of weight and musche mass caused by disease
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Cachexia
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What process takes place in pulmonary fibrosis or tuberculosis?
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Cavitation
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What is this process: Airless lung parenchyma due to incomplete expansion of lungs or collapse of previously infiltrated lung
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Atelectasis
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Premature infants commonly have respiratory problems due to insufficient pulmonary __________.
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surfactant
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What is the most significant congenital respiratory disease?
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Tracheo-esophageal fistula
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________ obstruction (in obstructive lung disease) is due to narrowing of airway (what disease) or loss of elastic recoil (what disease).
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Expiratory; asthma; emphysema
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Restrictive lung disease is due primarily to either _________ abnormalities or __________ damage.
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chest wall; parenchymal
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Increased responsiveness of bronchial tree to various stimuli is ________.
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asthma
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In Asthma, which is more difficult, expiration or inspiration?
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Expiration
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Is Asthma a restrictive or obstructive lung disease?
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Usually Obstructive
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T or F: Asthma is more common in children.
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TRUE. 10% of children get it, while 5% of adults get it.
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T or F: Asthma is more common in females.
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FALSE (males 2:1)
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What are the two types of asthma?
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Extrinsic and Intrinsic
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What type of asthma is associated with Type I hypersenistivity, allergens, atopic dermatitis and hay fever?
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Extrinsic
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T or F: Intrinsic asthma is immune-mediated.
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FALSE
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One of the MAIN causes (that he underlined) of INTRINSIC asthma is _______
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Psychological stress
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T or F: Aspirin is involved in Intrinsic asthma.
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TRUE
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________ asthma is associated with young-onset asthma.
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Extrinsic
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What immune cells are primarily involved in asthma?
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mast cells
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Is asthma considered acute or chronic?
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Acute (although the underlying process is more chronic)
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What 2 components of the bronchial wall are primarily involved in asthma? (undergo hyperplasia)
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Mucous glands (goblet cells); Smooth muscle
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T or F: Chronic inflammation is part of asthma.
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TRUE
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What Antibody is involved in extrinsic asthma?
|
IgE
|
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What clinical significance does multiple asthma medications have?
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More medications means more severe asthma
|
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What four complications can long term use of corticosteroids have?
|
Osteoporosis, immunosuppression, addisonian crisis (secondary adrenal insufficiency), diabetes
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|
What are the three major chronic obstructive pulmonary diseases (COPD)?
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Emphysema, Chronic Bronchitis, Bronchiectasis
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T or F: Many times COPD is a combination of chronic bronchitis and emphysema, not just pinned down to one systemic problem.
|
TRUE
|
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T or F: COPD is a reversible condition
|
FALSE
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Among patients with COPD in the US, the vast majority have __________ (14 million) and the remainder have __________ (2 million)
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Chronic Bronchitis; Emphysema
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What disease: Enlargement of airspaces distal to terminal bronchioles; destruction of alveolar walls; loss of elastic recoil; collapse of unsupported, enlarged air spaces on expiration; obstruction on expiration
|
Emphysema
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What is the characteristic difference of air sacs between healthy air sacs and air sacs with emphysema?
|
Emphysema: weakened and collapsed air sacs with Excess mucous
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What is the major cause of emphysema?
|
Cigarettes
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In extremely rare cases (1%) what can cause emphysema?
|
hereditary alpha1-antitrypsin deficiency (which protect the tissue from leukocyte proteases)
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|
The type of emphysema caused by smokers is called _________ emphysema.
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Centrilobular
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The type of emphysema caused by Alpha 1-antitrypsin deficiency is called _________ emphysema.
|
Panacinar
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Dyspnea, Cachexia, Barrel Chest, Cor Pulmonale, Congestive Heart Failure are clinical signs of what disease?
|
Emphysema
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"Barrel Chest" is a result of what?
|
attempt to increase ventilation
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Cor pulmonale causes _________ heart failure due to __________.
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Right-sided; Pulmonary hypertension caused by lung disease
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T or F: In Cor Pulmonale, The Right Ventricle hypertrophies due to congestion in the lungs.
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TRUE
|
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What disease: Excessive production of tracheobronchial mucous causing cough.
|
Chronic Bronchitis
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|
_____ % of Chronic Bronchitis cases are caused by _________.
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90%; Smoking (I know we all love percentages)
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What disease: Thickening of bronchial walls, mucous gland hyperplasia, chronic inflammation, fibrosis, mucous plugging.
|
Chronic Bronchitis
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T or F: Chronic Bronchitis results in Restriction.
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False; leads to obstruction
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One of the main characteristics (underlined in the notes) of chronic Bronchitis is ________.
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Fibrosis
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T or F: Chronic Bronchitis gives you the "pink puffer."
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False; gives you "Blue Bloater" (B for Bronchitis, Blue Bloater)
|
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T or F: Emphysema gives you the "pink puffer."
|
True (emphysema=pink puffer)
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What disease: purulent cough, dyspnea, hypoxia, cyanosis, peribronchial fibrosis, pulmonary hypertension, cor pulmonale, congestive heart failure.
|
Chronic Bronchitis
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Bronchitis, Emphysema, or Both: Productive cough
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Bronchitis
|
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Bronchitis, Emphysema, or Both: Cor Pulmonale
|
Both
|
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Bronchitis, Emphysema, or Both: Minimal Sputum
|
Emphysema
|
|
Bronchitis, Emphysema, or Both: Severe Dyspnea
|
Emphysema (Puffer=dyspnea)
|
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Bronchitis, Emphysema, or Both: Hypoxia, Cyanosis, polycythemia (increased rd blood cells)
|
Bronchitis
|
|
Bronchitis, Emphysema, or Both: Weight loss
|
Emphysema (cachexia)
|
|
Bronchitis, Emphysema, or Both: Pulmonary hypertension
|
Both
|
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Bronchitis, Emphysema, or Both: Frequent Upper Respiratory infections
|
Bronchitis
|
|
Bronchitis, Emphysema, or Both: Acute disease
|
Neither (trick question!)
|
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What potential complication arises from using N2O sedation on a patient with emphysema?
|
They can be dependent on LOW O2 levels as a primary stimulant to respiration; N2O has high concentration of O2 so it can lead to cease of respiration.
|
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T or F: N2O can diffuse into closed spaces
|
TRUE
|
|
If N2O diffuses into large gas-filled blebs in patients with COPD, what can happen?
|
They can rupture
|
|
What can be done in the dental office to prevent an attack of dyspnea during treatment?
|
Treat in semi-upright position; always have inhaler
|
|
What is ectasia?
|
dilatation or distension of hollow organs
|
|
What disease: Permanent dilatation of bronchi, can be secondary to persisting infection or obstruction
|
Bronchiectasis
|
|
What is the most common complication of chronic bronchitis?
|
Bronchiectasis
|
|
T or F: Tumors can be associated with bronchiectasis
|
TRUE
|
|
T or F: Cystic fibrosis can be associated with bronchiectasis
|
TRUE
|
|
T or F: A patient with Bronchiectasis presents with bronchi (and/or bronchioli) filled with mucopurulent material; this mucous can be cleared by coughing.
|
First statement true, second statement false
|
|
What disease is associated with low grade fever, malaise, fatigue, and clubbing of the fingers?
|
Bronchiectasis
|
|
What disease is associated with amyloidosis and recurrent pneumonias?
|
Bronchiectasis
|
|
Why do patients with bronchiectasis have clubbing of the fingers?
|
It is related to chronic hypoxia.
|
|
What is the only acute, restrictive lung disease?
|
Acute respiratory distress syndrome
|
|
Sepsis, shock, trauma, pneumonia, toxic lung injury, aspiration of fluids, and blood transfusions can all cause what disease?
|
Acute respiratory distress syndrome
|
|
Acute Respiratory Distress Syndrome is caused by a mechanism of either 1. Injury to the _________ _______ in pulmonary capillaries or 2. Injury to the ________ _________ _______.
|
1. Endothelial cells; 2. Alveolar lining cells
|
|
What are the 2 main pathways of pathogenesis for Acute Respiratory Distress Syndrome?
|
Damage to alveolar lining cells or damage to alveolar capillary endothelium--leads to interstitial edema, high protein exudation (hyaline membranes)
|
|
Which acute disease exhibits severe dyspnea, cyanosis, and hypoxia?
|
Acute respiratory distress syndrome
|
|
In this disease, fibrin is deposited along damaged alveolar lining , which leads to diffuse alveolar damage.
|
What is Acute respiratory distress syndrome? (jeopardy style baby)
|
|
Chronic Restrictive lung diseases are diseases of _________ ________.
|
Lung parenchyma
|
|
The end result of chronic restrictive lung diseases is _________.
|
Diffuse pulmonary fibrosis
|
|
Which chronic restrictive lung disease has no known cause?
|
Idiopathic pulmonary fibrosis
|
|
What disease invovles extrinsic allergic alveolitis caused by exposure to organic dust?
|
Hypersensitivity Pneumonitis
|
|
T or F: Hypersensitivity pneumonitis is only an acute disease.
|
False. It can also be a chronic disease.
|
|
Acute hypersensitivity pneumonitis is of _______ onset and is mediated (or affected) by _________ ________.
|
Sudden; antigen-antibody Complexes
|
|
Two of the causes of Hypersensitivity Pneumonitis (as stated in the notes) are: __________ Lung and _______ _________ Lung.
|
Farmer's Lung (moldy hay/grain); Pigeon Breeder's Lung (pigeon serum protein in droppings)
|
|
The two chronic restrictive lung diseases caused by occupational/environmental exposure are: 1.____, 2._________
|
Hypersensitivity Pneumonitis; Pneumoconioses (ie asbestosis)
|
|
Which chronic lung disease is caused by inhalation of fumes, dust, or particulate matter (inorganic)?
|
Pneumoconioses
|
|
What is the key element of the massive lung fibrosis that causes pneumoconioses?
|
Alveolar Macrophages
|
|
A particle that is less than ______ microns in size can enter alveoli, contributing to what disease?
|
5; Pneumoconioses
|
|
T or F: Pneumoconioses is caused by exposure to organic dust particles.
|
False; inorganic particles (organic--Hypersensitivity Pneumonitis)
|
|
What are 3 specific examples of Pneumoconioses?
|
1. Coal worker's lung (anthracosis); 2. Silicosis; 3. Asbestosis
|
|
T or F: Anthracosis usually leads to bronchogenic carcinoma.
|
False; Most=benign course
|
|
T or F: Anthracosis increases incidence of Tuberculosis.
|
TRUE
|
|
T or F: Silicosis can lead to bronchogenic carcinoma.
|
TRUE
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: Increased risk of TB
|
Anthracosis and Silicosis
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: Leads to Fibrosis
|
All Three
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: Increased risk of bronchogenic carcinoma
|
Silicosis (maybe asbestosis too, but mesothelioma is the characteristic sign of asbestosis
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: Can lead to mesothelioma
|
Asbestosis (this is the #1 characteristic of asbestosis)
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: increases risk of cancer 5 fold
|
Asbestosis
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: shows pleural plaques
|
Asbestosis
|
|
In asbestosis, what sets off a fibrogenic reaction?
|
Macrophages ingesting an asbestos fiber
|
|
What disease: Multi-system granulomatous disease of unknown etiology (presumably immune mediated)
|
Sarcoidosis
|
|
What immune related chronic restrictive lung disease affects blacks 10:1 and women 2:1?
|
Sarcoidosis
|
|
T or F: Sarcoidosis exhibits caseating granulomas
|
False; exhibit non-caseating granulomas
|
|
T or F: Sarcoidosis can affect any organ, not just the lungs.
|
TRUE
|
|
Sarcoidosis can affect any organ, but what does it affect especially, according to lecture (according to carranza….blah blah blah)
|
Especially Lungs, thoracic/neck lymph nodes, the skin, salivary glands, and lacrimal gland (dryness)
|
|
What % of patients with sarcoidosis have elevated ACE (angiotensin Converting Enzyme)?
|
60 % (another percentage baby)
|
|
What chronic lung disease is associated with elevated ACE?
|
Sarcoidosis
|
|
What is the definition of Pneumonia?
|
Any infection in the lung (acute or chronic)
|
|
Neutrophil/complement defects (humoral defects) result in increased incidence of ___________ ________.
|
Bacterial pneumonia
|
|
Cell-mediated immune defects result in increased incidence of (intracellular/extracelluar) ___________.
|
Intracellular parasites (ie TB, HSV, pneumocystis carinii)
|
|
What disease presents commonly following URTI, absent splenic function, chills, pleuritic chest pain, productive cough.
|
Pneumonia
|
|
Pneumonia is of Bacterial, viral, or fungal origin?
|
Any of the above.
|
|
What are the 2 main subclasses of pneumonia?
|
Lobar Pneumonia and Bronchopneumonia
|
|
What organisms cause community acquired acute pneumonias?
|
Haemophilus Influenzae; Moraxella catarrhalis; Staph Aureus; Klebsiella Pneumoniae; Legionella Pneumoniae
|
|
What organism causes Pneumococcus?
|
Streptococcus pneumoniae
|
|
What organism causes nosocomial pneumonia (according to lecture notes)?
|
Pseudomonas Aeruginosa
|
|
What is the primary cause for aspiration pneumonia?
|
Markedly debilitated; unconscious patients; abscesses frequent
|
|
Cytomegalovirus primarily affects who?
|
Immunosuppressed (AIDS), bone marrow transplant
|
|
Pneumocystis pneumonia affects who?
|
Immunosuppressed (AIDS)
|
|
What organism causes tuberculosis?
|
Mycobacteria Tuberculosis (causes chronic bacterial infection)
|
|
What chronic lung disease is associated with caseating granulomatous inflammation?
|
Tuberculosis
|
|
What types of cells are associated with TB?
|
epitheliod macrophages, multinucleated giant cells, lymphocytes
|
|
approximately how many of the world's population are infected with TB?
|
one-third
|
|
What is the "Ghon Complex"?
|
associated with localized lung inflammation in primary tuberculosis
|
|
The "ghon Complex" forms in which part of the lung and enlarges which lymph nodes?
|
lower part of upper lobe, upper part of lower lobe (right in the middle); enlarges hilar lymph nodes
|
|
What disease: non-specific mild pulmonary disease, low grade fever, 95% undiagnosed, ghon complex
|
Primary TB
|
|
What disease: Non-productive cough, low grade fever, malaise, night sweats, weight loss, hemoptysis
|
Secondary TB
|
|
What disease: widespread hematogenous seeding of bacteria; numerous granulomas in lungs or other organs (ie spleen)
|
Miliary TB
|
|
T or F: Disseminated TB can cause granulomas on pluera (causing pleuritis) and extrapulmonary TB
|
TRUE
|
|
T or F: a patient with latent TB is not infectious
|
TRUE
|
|
Coccidiomycosis, Aspergillosis, or Zygomycosis: Deep fungal lung disease
|
All of them (that better not have tricked you)
|
|
Cavitary lesions filled with pus.
|
Lung Abscess
|
|
________ abscesses have a fibrous capsule
|
chronic
|
|
What are lung abscesses a complication of?
|
Staphylococcal pneumonia; aspiration of foreign material (swallowing a crown, poor dental hygiene, etc.)
|
|
What is by far the most common type of lung cancer?
|
Bronchiogenic Carcinoma (90-95% of lung cancers)
|
|
List the 4 types of Bronchiogenic carcinomas.
|
1. SCCA (30%) 2. Adenocarcinoma (30%) 3. Large Cell undifferentiated (10%) 4. Small Cell (oat cell-20%)
|
|
What do small (oat) cells arise from?
|
Neuroendocrine cells
|
|
Which type of bronchogenic carcinoma has the worst prognosis, most aggressive, and not usually amenable to surgery?
|
Small Cell (oat cell)
|
|
What type of lung cancer arises from the terminal bronchioles?
|
Bronchioalveolar cancer
|
|
What type of lung cancer is associated with asbestos exposure, takes 25-40 yrs to develop, is pluera-derived, and has a poor prognosis?
|
Mesothelioma
|
|
T or F: Metastatic lung tumors are more common than primary lung tumors (single site)
|
TRUE
|
|
Fibrothorax, Pneumothorax, Empyema, Hemothorax, or chylothorax: encasement of lungs with fibrous tissue that obliterates pleural cavity.
|
Fibrothorax
|
|
Fibrothorax, Pneumothorax, Empyema, Hemothorax, or chylothorax: Entry of air or gas into pleural cavity; may cause atelectasis, compression, collapse of lung.
|
Pneumothorax (spontaneous vs trauma)
|
|
Fibrothorax, Pneumothorax, Empyema, Hemothorax, or chylothorax: Pockets of pus surrounded by fibrous tissue; caused by infection that spreads from the lung.
|
Empyema
|
|
Fibrothorax, Pneumothorax, Empyema, Hemothorax, or chylothorax: Collection of blood in space between chest wall and lung (pleural cavity).
|
Hemothorax (trauma vs. rupture of intrathoracic aortic aneurysm)
|
|
Fibrothorax, Pneumothorax, Empyema, Hemothorax, or chylothorax: Presence of lymphatic fluid in pleural space; secondary to leakage/obstruction of thoracic duct or main tributaries
|
Chylothorax (causes: lymphoma, surgical trauma)
|
|
Which MRTI is characterized by: acute viral illnes of larynx, especially affects ages 3-5 yrs., loud cough, barking seal (like chase in the mornings)
|
Croup
|
|
T or F: Croup is extremely life-threatening.
|
FALSE
|
|
Which MRTI is characterized by: acute, severe, life-threatening disease, presents as a child w/ fever +/- sore throat, clinical triad of drooling, dysphagia, distress
|
Epiglottitis
|
|
What organism causes Epiglottitis?
|
Haemophilus Influenzae
|
|
What MRTI is characterized by: acute infectious disease of lower respiratory tract (bronchi/bronchioles, not alveoli), mostly in young infants 2-24 mos.,
|
Bronchiolitis
|
|
What is main cause of Bronchiolitis?
|
Viral infection (80%--esp. respiratory synctial virus)
|
|
T or F: Bronchiolitis usually resolves in 7-10 days.
|
TRUE
|
|
What disease: persisten hoarseness, change in voice, stridor (high pitched crowing sound), rare under age 40
|
SCCA of larynx
|
|
evan is a redneck; he is also yellow-bellied
|
The first statement is true and the second statement is false
|
|
Hep ___ has no carrier state; no relation to cancer
|
Hep A
|
|
Hep __ & __ are transmitted by the oral-fecal route
|
Hep A & E
|
|
Hep __ is the most infectious of the bloodborne Hep virus
|
Hep B
|
|
_____ in serum more than 6 months = carrier stae
|
HBsAg
|
|
Hep ___ infection --> 85% proceed to chronic infection
|
Hep C
|
|
Hep __ requires Hep ___
|
Hep D, Hep B
|
|
_______ Hepatitis = fatty change, focal liver cell necrosis, neutrophil infiltrates, Mallory bodies
|
Alcoholic
|
|
Triad of diabetes mellitus, cirrhosis, & increased skin pigmentation
|
Bronze diabetes
|
|
Autosomal recesive disorder of copper metabolism, decreased serum ceruloplasmin, Kayser Fleischer rings in cornea, Liver disease ranging form chronic hepatits to cirrhosis, involvement of basal ganglia - motor signs
|
Wilson's disease
|
|
Benign tumor, related to oral contraceptive use, rupture can result in severe hemorrhage
|
Adenoma of liver
|
|
the most common PRIMARY malignancy of liver
|
Hepatocellular carcinoma
|
|
Associated w/ cirrhosis (especially Hep B & Hep C), Aflatoxin B, Inc serum alpha fetoprotein
|
Hepatocellular carcinoma
|
|
Associated w/ thorotrast dye, arsenic, or polyvinyl chloride
|
Hemangiosarcoma
|
|
Most common MALIGNANCY of liver
|
Metastatic malignancy
|
|
Predisposed by alcohol intake & gallstones, inc serum amylase, abdominal pain, hypocalcemia, 20% mortality
|
Acute pancreatitis
|
|
Progressive parenchymal fibrosis, associated w/ alchoholism/cholecystitis, can have calcifications & pseudocysts
|
Chronic pancreatits
|
|
Most often in the head of pancreas, causes obstructive jaundice, abdominal pain radiating to the back
|
Pancreatic carcinoma
|
|
pancreatic carcinoma generally has a good prognosis because late metastastes. (T/F)
|
FALSE (poor prognosis, early metastastes)
|
|
Lack of relaxation caused by spasms at the lower esophageal sphincter --> difficulty swallowing
|
Achalasia
|
|
______ hernia - Part of the stomach goes above the diaphragm
|
Hiatal hernia
|
|
A hernia where the cardia of the stomach is pulled through the esophageal hiatus (rollling or sliding)?
|
sliding hernia
|
|
epithelium undergoes metaplasia from squamous epithelium --> columnar epithelium w/ goblet cells --> possible adenocarcinoma, caused by gastric reflux
|
Barrett's esophagus
|
|
Squamous cell carcinomas occur in the ___ 2/3 of the esophagus while adenocarcinomas occur in the _____ 1/3
|
Upper, lower
|
|
What bacteria causes chronic gastritis
|
Helicobacter pylori
|
|
Chronic gastritis & NSAIDS toxicity can cause
|
peptic ulcers
|
|
______ ______ syndrome - tumors in pancreas & duodenum --> inc gastrin --> too much acid
|
Zollinger Ellison
|
|
H. pylori, nitrosamines (smoked meats), diet low in fruits/veggies, chronic gastritis are all causes of
|
stomach cancer
|
|
blind pouch in small intestines
|
Meckel's diverticulum
|
|
Meckel's diverticulum think rule of __'s
|
2's: 2% of population, 2 inches long, 60% under age 2, distal illium 2 ft from colon
|
|
caused by 1 congenital lack of ganglion cells --> obstruction --> distention of colon
|
Hirschprungs disease
|
|
______ infarction of entire bowel wall, usually fatal
|
transmural
|
|
Pseudomembrane over ulcers in the colon, antibiotics --> clostridium difficile
|
Pseudomembranous colitis
|
|
crypt abscesses, pseudopolyps, higher long term risk of cancer, only on the mucosal surface are features of Chron's or Ulcerative colitis
|
Ulcerative colitis (any other feature think crohn's)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sx's?..."
|
"Pouch in esophageal wall
|
|
2. define…"
|
"1. Sliding 80-90%, cardia (stomach) --> esophageal hiatus
|
|
lead to…"
|
Idiopathic lack of relaxation --> spasms, disphagia, dialated esophagus
|
|
risks…"
|
Cirumfrential mucosal folds --> dysphagia in middle aged woman
|
|
Due to…"
|
Dialated submucosal esoph viens due to hypertension & liver cirrhosis, fatal rupture
|
|
due to..."
|
"Severe vomiting -->Linear, longitudinal, lacerations of distal esophagus
|
|
1-3"
|
"1. GERD
|
|
leads to..."
|
"Common w/ hiatal hernia, assoc. w/ alcohol/tobacco,
|
|
% --> adenocarcinoma"
|
"Distal metaplasia (squam --> columnar ep), due to long term GERD,
|
|
"
|
"Ulcers due to immunocomprimised infection, irritants (alcohol, hot tea),
|
|
Esophageal neoplasms ? 2 types Benign
|
Papillomas, leiomyoma
|
|
2. Sx's, risk"
|
"1. Squamous cell carcinoma (90% of esoph cancer), upper 2/3 esoph, inc risk males, black, china, russia, iran.
|
|
leads to…"
|
"Palpable hypertrophy of pyloric circular muscle
|
|
causes…"
|
"Mucosal inflam. --> hemorrhage
|
|
Cause…"
|
"Helicobacter pylori --> inflam --> atrophy of glands --> meta/dysplasia
|
|
affected.."
|
"Antibodies to chief/parietal cells
|
|
Causes…"
|
"Defined, round, punched out lesion near lesser curvature.
|
|
1-4…"
|
"1. Hemorrhage
|
|
Tx…"
|
"50% cancerous tumors (abnormal tummor upressor gene, 30-60 yrs. age)
|
|
Loc…"
|
"Common in males > 50, blood type A, poor prognosis
|
|
assoc. w/…"
|
"total 4% malignant tumors
|
|
rule of 2's…"
|
"5 cm intestinal blind pouch
|
|
assoc. w/…"
|
"Congenital megacolon
|
|
1-5"
|
"1. Atresia / Stenosis
|
|
1-3"
|
"1. Ischemic bowel disease
|
|
90% ,mortality in..."
|
"atherosclerotic occ. of 2+ mesenteric arteries
|
|
Sx…"
|
"dialation of small vessels in mucosa/submucosa
|
|
causes…"
|
"dialated int/external anal venous plexus
|
|
types…"
|
"1. ecosystem disturbances (antibiotic resist = C. difficile --> pseudomemb. colitis)
|
|
"
|
"toxin prefromed in food or by lytic action in intestine
|
|
Sx.."
|
"Psuedomembranes cover ulcers
|
|
"
|
"G-, non-invsive enterotoxin, 50% mortality w/o fluid replacement
|
|
spread…"
|
"Invades epithelium of distal colon --> inflam & erosion --> dysentary
|
|
path…"
|
"1. Rotavirus = small intestine, children 6-24 mo.'s
|
|
%, spread.."
|
"1. Giardia lamblia - NON-invasive, small intest, fecal-H2O
|
|
"
|
"deficiency in nutrients
|
|
3 causes…"
|
"Maldigestion
|
|
Causes…"
|
"Intrinsic bowel disease
|
|
"
|
"Liver
|
|
Tx…"
|
"gluten (H2O-insoluble gliadin) sensitive enteropathy
|
|
Tx…"
|
"bacterial
|
|
@ risk.."
|
"Trophyeryma whippeli (G+ actinomycete) --> malabsrop --> chronic diarrhea.
|
|
"
|
"obstruction, neutrophilic infiltration of muscularis, rupture --> peritonitis
|
|
Tx…"
|
"enteric bacteria
|
|
chron's vs. ulcerative colitis similarities"
|
"idiopathic
|
|
Chron's disease
|
"mouth --> colon
|
|
Ulcerative colitis
|
"colon only
|
|
1-5"
|
"1. diverticulosis
|
|
@ risk…"
|
"mucosa lined false pockets (85% sigmoid) herniating --> muscle layer
|
|
complications…"
|
"bright red rectal bleeding, fever, inc WBC's, lower abdominal pain
|
|
4 types"
|
"adynamic (paralytic) ileus-disruption of innervation w/ fecoliths
|
|
terms…"
|
"1. non-neoplastic
|
|
genes involved…"
|
"1. genetic
|
|
3 types…"
|
"hyperplasia, inflam, abnormal mucosal maturation
|
|
malignancy…"
|
"80% recto-sigmoid, < 5mm d., multiple
|
|
caused by…"
|
"inflam and lymphoid infiltrates
|
|
2 types"
|
"1. Juvenile
|
|
age..."
|
"1-3 cm, solitary
|
|
inc risk…"
|
"multiple in small intestine and colon
|
|
"
|
"premalignant epithelial dysplasia / prolif.
|
|
3 types…"
|
"1. Tubular adenoma = small stalked, 20%
|
|
3 types…"
|
"increase
|
|
Colon cancer risk…"
|
"autosomal dom
|
|
inc risk of…"
|
"autosomal dom
|
|
"
|
rare, colon polyps + brain tumors
|
|
gene mutations…"
|
"50% recto-sigmoid area
|
|
A-D"
|
"A. not through muscularis >90% survive
|
|
"
|
"proximal right = polypoid exophytic masses w/ surface ulceration, obstruction not common
|
|
1-5"
|
"1. low fiber-high fat diet
|
|
carcinoid syndrome?..."
|
"neuroendocrine tumors of low malig
|
|
|
|
|
6 general liver functions:
|
"Excretory/detoxification (in bile)
|
|
General examples of substances stored in liver
|
vitamin K, iron, copper, fat soluble vitamins, glycogen
|
|
Examples of substances synthesized in liver
|
albumin, alpha I antitrypsin; proteins of coagulation cascade (fibrinogen, prothrombin, VIII,IX, X, XI, and Xli), bile
|
|
Liver failure becomes apparent when _______ of liver is destroyed or dysfunctional
|
80%
|
|
"
|
"Ast (aspartate amlno-transterase) and
|
|
7 general signs of liver failure:
|
"Jaundice, Hypoalbumenernia, Hepatorenal syndrome, Portal hypertension, Encephalopathy, Endocrine abnormalities (gynecomastia, spider angiomas), coagulopathy
|
|
Encephalopathy I liver failure is due to the failure of the liver to remover _________ from the blood.
|
ammonia
|
|
"
|
"Inflammation & Degeneration (reversible), necrosis, fibrosis, cirrhosis
|
|
2 major functions of hepatic bile
|
"elimination of bilirubrin and cholesterol
|
|
_______ occurs if blood bilirubin levels are greater than _______mg/dl.
|
Jaundice, 1.2
|
|
"
|
2.0-3.0 mg/dl.
|
|
Jaundice is best recognized in the __________.
|
sclera
|
|
"
|
"Conjugated bilirubin
|
|
Which type of bilirubin is tightly bound to albumin?
|
Unconjugated bilirubin:
|
|
Which type of bilirubin is water soluble?
|
Conjugated bilirubin
|
|
Which type of bilirubin can be excreted in urine?
|
conjugated
|
|
Conjugation of bilirubin takes place where?
|
Liver --No Eric, it is not the breast
|
|
"
|
Unconjugated, hemolysis
|
|
A manifestation of Gilbert's disease is:
|
Prehepatic (hemolytic) Jaundice = unconjugated bilirubinemia
|
|
Hepatic Jaundice is seen under what general conditions?
|
viral or drug-induced hepatitis, alcoholic hepatitis, tumors, and cirrhosis
|
|
T/F Hepatic Jaundice is associated with a buildup of conjugated bilirubin only.
|
False: It is mixed conjugated and unconjugated
|
|
Conjugated hyperbilirubinemia is manifest in what condition?
|
post-hepatic jaundice
|
|
post-hepatic jaundice is seen in _________ disorders such as gallstones, tumors of bile ducts, pancreas, or duodenum
|
obstructive
|
|
_________ is the accumulation of unconjugated bilirubin (usually> 20 mg/dl) in the brain causing severe neurologic damage
|
Kernicterus
|
|
Kernicterus can be seen in this condition that affects infants:
|
hemolytic disease of the newborn (erythroblastosis fetalis)
|
|
"
|
"2. Impaired/decreased conjugation
|
|
"
|
"Jaundice resulting from Predominantly conjugated hyperbilirubinemia:
|
|
Additional causes of jaundice:
|
"antifungals, high amounts of beta-carotene, medications
|
|
"
|
"A. chronic liver disease --> cirrhosis
|
|
Elevated ammonia levels in the blood from liver failure that lead to disturbances in consciousness ranging from behavioral abnormalities to coma is called:
|
hepatic encephalopathy
|
|
Hepatorenal syndrome:
|
liver fails--> kidneys fail drop in urine output, increase in urea nitrogen/creatine levels (in end-stage liver disease)
|
|
______ is synonymous with end-stage liver disease
|
Cirrhosis
|
|
T/F Cirrhosis is among the top ten causes of death I western society.
|
TRUE
|
|
"
|
"60% from alcohol abuse
|
|
Cirrhosis may take one to ___ years to develop.
|
20
|
|
What is the major pathologic process that accompanies cirrhosis?
|
"progressive fibrosis (regenerative firm nodular surface)
|
|
"
|
"Necrosis of liver cells
|
|
"
|
"portal cirrhosis
|
|
"
|
portal hypertension
|
|
"
|
"A. True
|
|
"
|
"A. True
|
|
"
|
formation of anastamoses (shunts) between the portal and systemic circulation (a result of portal hypertension)
|
|
"
|
"• Viral hepatitis
|
|
• Necrosis of hepatocytes (councilman bodies) are shrunken eosinophilic apoptotic anuclear fragments of hepatocytes)"
|
"Morphologic changes seen with viral hepatitis
|
|
• Hepatitis B— ground glass hepatocytes— due to accumulation of HBsAg; sanded nuclei due to abundant HBcAg"
|
"Morphologic changes seen with viral hepatitis
|
|
With viral hepatitis, what is the timeline established for acute vs. chronic infection?
|
"acute = resolves within 6 months
|
|
1 in __ patients is a carrier"
|
"4 million
|
|
"
|
Dark urine
|
|
characteristics of fulminant hepatitis include:
|
"severe acute iiver damage, encephalopathy, coaguiopathy with high risk of death approaching 80%
|
|
fulminant hepatitis develops within _____ weeks of the onset of liver disease.
|
8
|
|
"
|
"Jaundice of skin and eyes
|
|
• Blood donations not screened for Hepatitis A"
|
"Hepatits A:
|
|
• Can remain infective on operatory surfaces up to 7 days, cold sterilization ineffective"
|
"Hepatitis B
|
|
•9 documented cases of transmission from dental provider to patient over past 30 years"
|
"Hepatitis B
|
|
Fibroadenomas (benign) generally affect ______ _______
|
young women
|
|
Fibrocystic breast disease generally affects ______ _____
|
middle age
|
|
Breast cancer generally affects age ___ and older
|
45
|
|
__ in __ women in US will get breast cancer
|
1, 9
|
|
invasion by bacteria in the breast is usually caused by ____ or especially ____ in lactating women
|
strep, staph
|
|
"
|
Acute, lactating, stagnant milk, abscess
|
|
"
|
chronic, lumps
|
|
The spectrum of macroscopic and microscopic changes in the breast resulting from an exaggerated uncoordinated response of the mammary ducts and stroma to cyclic hormonal stimulation that occurs during the normal menstrual cycle
|
Fibrocystic change in the breast
|
|
Most common disorder of the breast
|
Fibrocystic change
|
|
Most common cause of a palpable breast mass in patients between 25 and 50
|
Fibrocystic change
|
|
Characterized by lumpy breasts and mid-cycle tenderness
|
Fibrocystic change
|
|
Fibrocystic change in the breast is usually _____, but can be asymmetrical
|
bilateral
|
|
Fibrocystic change in the breast is most likely to progress to invasive cancer if exhibiting ______ ______ _______ _______ and __________
|
atypical hyperplastic ductal epithelium, papillomatosis
|
|
_________ _________"
|
"Fibrosis
|
|
The epithelial changes that occur in fibrocystic change in the breast and may lead to invasive cancer are
|
"
|
|
Most common benign breast tumor
|
fibroadenoma
|
|
Fibroadenoma is the most common breast tumor in women under ___
|
25
|
|
A firm, rubbery, painless, well-circumscribed 2-5 cm mass
|
fibroadenoma of the breast
|
|
fibroadenoma of the breast does/does not undergo malignant change
|
does not
|
|
malignant breast tumors can demonstrate the presence of _____ & ________ receptors in some tumors which correlates w/ a _______ prognosis
|
estrogen & progesterone, better
|
|
Most common type of malignant breast tumor is _______ ______ _______ (also called invasive ductal or scirrhous)
|
infiltrating ductal carcinoma
|
|
Several breast cancers induce ________ tissue response w/ the CT becoming dense and the tumor is firm and gritty. The dense CT pulls on adjacent tissue and ________ of the skin and ______ of the nipple.
|
desmoplastic, puckering, retraction
|
|
First 4 risk factors of breast cancer
|
"Age
|
|
Other 6 risk factors for breast cancer
|
obesity, nulliparity (no births), 1st preg. after 30, proliferative fibrocystic breast disease, high animal fat diet, caucasian (jewish)
|
|
What is the biggest risk for breast cancer?
|
Age (0-39 yrs: 1 in 231, 40-59yrs: 1 in 25, 60-79 yrs: 1 in 15, 90yrs: 1 in 7)
|
|
Name the 8 types of malignant breast cancer.
|
"1. Intraductal carcinoma in situ
|
|
"
|
Intraductal carcinoma in situ
|
|
"
|
Invasive (infiltrative) ductal carcinoma (scirrhous carcinoma)
|
|
"
|
Paget’s disease of the breast
|
|
"
|
Lobular carcinoma in situ
|
|
"
|
Invasive lobular carcinoma
|
|
"
|
Medullary carcinoma
|
|
"
|
Mucinous (colloid) carcinoma
|
|
"
|
Inflammatory breast carcinoma
|
|
1 prognosis factor (emphasized in review) for breast cancer
|
"
|
|
QUESTIONS:
|
ANSWERS:
|
|
What two body systems does the ASA (MED) classification emphasize?
|
Cardiovascular and Respiratory
|
|
What ASA classification would a patient with mild to moderate systemic disease that does not interfere with day-to-day activity?
|
ASA II
|
|
Mild hypertension, some forms of diabetes melitus are characteristic of what ASA type?
|
II
|
|
T or F: It is necessary to consult with a physician prior to treating a ASA II patient.
|
FALSE
|
|
Name the ASA class: Severe systemic disease that limits activity but not incapacitating
|
ASA III
|
|
Moderate hypertension, angina pectoris, congestive heart failure are what ASA type?
|
III
|
|
T or F: ASA III patients can withstand most dental procedures with appropriate modifications.
|
TRUE
|
|
What ASA type(s) is it mandatory to consult with the physician first?
|
IV (III is wise, but not necessary)
|
|
What term means: Labored Breathing
|
Dyspnea
|
|
What term means: Physican wasting with loss of weight and musche mass caused by disease
|
Cachexia
|
|
Define Consolidation as it refers to the lungs.
|
Process of becoming solid (ie when lung becomes firm as air spaces are filled with exudate in pneumonia)
|
|
What process takes place in pulmonary fibrosis or tuberculosis?
|
Cavitation
|
|
What is this process: Airless lung parenchyma due to incomplete expansion of lungs or collapse of previously infiltrated lung
|
Atelectasis
|
|
Premature infants commonly have respiratory problems due to insufficient pulmonary __________.
|
surfactant
|
|
What 3 types of atelectasis are there?
|
Deficiency of surfactant; External compression of lung; resorption of air in lung, distal to an obstruction
|
|
What is the most significant congenital respiratory disease?
|
Tracheo-esophageal fistula
|
|
What are four examples of congenital respiratory diseases?
|
Tracheo-esophageal fistula, Bronchiogenic cysts, hypoplasia, vascular anomalies
|
|
In obstructive lung disease, Total lung capacity/forced vital capacity is _______ to ________.
|
Normal to Increased
|
|
In obstructive lung disease, there is a _________ in expiratory flow rate.
|
Decrease
|
|
________ obstruction (in obstructive lung disease) is due to narrowing of airway (what disease) or loss of elastic recoil (what disease).
|
Expiratory; asthma; emphysema
|
|
In restrictive lung disease, total lung capacity is __________.
|
decreased
|
|
Restrictive lung disease is due primarily to either _________ abnormalities or __________ damage.
|
chest wall; parenchymal
|
|
Increased responsiveness of bronchial tree to various stimuli is ________.
|
asthma
|
|
T or F: Asthma is a reversible airway obstruction.
|
TRUE
|
|
In Asthma, which is more difficult, expiration or inspiration?
|
Expiration
|
|
Is Asthma a restrictive or obstructive lung disease?
|
Usually Obstructive
|
|
T or F: Asthma is more common in children.
|
TRUE. 10% of children get it, while 5% of adults get it.
|
|
T or F: Asthma is more common in females.
|
FALSE (males 2:1)
|
|
What are the two types of asthma?
|
Extrinsic and Intrinsic
|
|
What type of asthma is associated with Type I hypersenistivity, allergens, atopic dermatitis and hay fever?
|
Extrinsic
|
|
T or F: Intrinsic asthma is immune-mediated.
|
False
|
|
One of the MAIN causes (that he underlined) of INTRINSIC asthma is _______
|
Psychological stress
|
|
T or F: Aspirin is involved in Intrinsic asthma.
|
TRUE
|
|
________ asthma is associated with young-onset asthma.
|
Extrinsic
|
|
What immune cells are primarily involved in asthma?
|
mast cells
|
|
Is asthma considered acute or chronic?
|
Acute (although the underlying process is more chronic)
|
|
What 2 components of the bronchial wall are primarily involved in asthma? (undergo hyperplasia)
|
Mucous glands (goblet cells); Smooth muscle
|
|
T or F: Chronic inflammation is part of asthma.
|
TRUE
|
|
What Antibody is involved in extrinsic asthma?
|
IgE
|
|
What bronchodilators are used to treat asthma?
|
Beta2-agonists; theophyline
|
|
What clinical significance does multiple asthma medications have?
|
More medications means more severe asthma
|
|
Greater than __ emergency room visits in the past year are a risk factor for treating a patient with asthma.
|
3
|
|
Use of greater than __ beta-agonist canisters per month is a risk factor for asthma patients.
|
2
|
|
T or F: current use of systemic corticosteroids is a risk factor for asthma pts.
|
TRUE
|
|
What is the major asthma medication which can cause complications with long term use?
|
Corticosteroids
|
|
What four complications can long term use of corticosteroids have?
|
Osteoporosis, immunosuppression, addisonian crisis (secondary adrenal insufficiency), diabetes
|
|
If a dental patient with asthma has had no attacks for several years, they are what ASA/MED?
|
II
|
|
If a dental patient with asthma has occasional attacks managed by bronchodilators they are what ASA?
|
III
|
|
If a dental patient with asthma has many/severe attacks they are what ASA?
|
IV
|
|
What medications should you avoid prescribing to asthma patients?
|
Beta blockers, aspirin, sulfites
|
|
What are the three major chronic obstructive pulmonary diseases (COPD)?
|
Emphysema, Chronic Bronchitis, Bronchiectasis
|
|
T or F: Many times COPD is a combination of chronic bronchitis and emphysema, not just pinned down to one systemic problem.
|
TRUE
|
|
T or F: COPD is a reversible condition
|
FALSE
|
|
Among patients with COPD in the US, the vast majority have __________ (14 million) and the remainder have __________ (2 million)
|
Chronic Bronchitis; Emphysema
|
|
What disease: Enlargement of airspaces distal to terminal bronchioles; destruction of alveolar walls; loss of elastic recoil; collapse of unsupported, enlarged air spaces on expiration; obstruction on expiration
|
Emphysema
|
|
What is the characteristic difference of air sacs between healthy air sacs and air sacs with emphysema?
|
Emphysema: weakened and collapsed air sacs with Excess mucous
|
|
What is the major cause of emphysema?
|
Cigarettes
|
|
In extremely rare cases (1%) what can cause emphysema?
|
hereditary alpha1-antitrypsin deficiency (which protect the tissue from leukocyte proteases)
|
|
In the Protease-antiprotease mechanism of emphysema, what 2 things does smoking do?
|
1. Inhibits antielastase; 2. favors recruitment of leukocytes and release of elastase (causing elastic damage to the tissue)
|
|
Other than the protease-antiprotease mechanism, what else does smoking do to cause emphysema?
|
Oxidant/antioxidant imbalance (free radicals released, induce cell damage)
|
|
The type of emphysema caused by smokers is called _________ emphysema.
|
Centrilobular
|
|
The type of emphysema caused by Alpha 1-antitrypsin deficiency is called _________ emphysema.
|
Panacinar
|
|
Dyspnea, Cachexia, Barrel Chest, Cor Pulmonale, Congestive Heart Failure are clinical signs of what disease?
|
Emphysema
|
|
"Barrel Chest" is a result of what?
|
attempt to increase ventilation
|
|
Cor pulmonale causes _________ heart failure due to __________.
|
Right-sided; Pulmonary hypertension caused by lung disease
|
|
T or F: In Cor Pulmonale, The Right Ventricle hypertrophies due to congestion in the lungs.
|
TRUE
|
|
What disease: Excessive production of tracheobronchial mucous causing cough.
|
Chronic Bronchitis
|
|
_____ % of Chronic Bronchitis cases are caused by _________.
|
90%; Smoking (I know we all love percentages)
|
|
What disease: Thickening of bronchial walls, mucous gland hyperplasia, chronic inflammation, fibrosis, mucous plugging.
|
Chronic Bronchitis
|
|
T or F: Chronic Bronchitis results in Restriction.
|
False; leads to obstruction
|
|
One of the main characteristics (underlined in the notes) of chronic Bronchitis is ________.
|
Fibrosis
|
|
T or F: Chronic Bronchitis gives you the "pink puffer."
|
False; gives you "Blue Bloater" (B for Bronchitis, Blue Bloater)
|
|
T or F: Emphysema gives you the "pink puffer."
|
True (emphysema=pink puffer)
|
|
What disease: purulent cough, dyspnea, hypoxia, cyanosis, peribronchial fibrosis, pulmonary hypertension, cor pulmonale, congestive heart failure.
|
Chronic Bronchitis
|
|
T or F: Chronic Bronchitis at times is not easily distinguished from Emphysema.
|
True; sometimes they go hand in hand
|
|
Bronchitis, Emphysema, or Both: Productive cough
|
Bronchitis
|
|
Bronchitis, Emphysema, or Both: Cor Pulmonale
|
Both
|
|
Bronchitis, Emphysema, or Both: Minimal Sputum
|
Emphysema
|
|
Bronchitis, Emphysema, or Both: Severe Dyspnea
|
Emphysema (Puffer=dyspnea)
|
|
Bronchitis, Emphysema, or Both: Hypoxia, Cyanosis, polycythemia (increased rd blood cells)
|
Bronchitis
|
|
Bronchitis, Emphysema, or Both: Weight loss
|
Emphysema (cachexia)
|
|
Bronchitis, Emphysema, or Both: Peribronchial fibrosis
|
Bronchitis
|
|
Bronchitis, Emphysema, or Both: Pulmonary hypertension
|
Both
|
|
Bronchitis, Emphysema, or Both: Frequent Upper Respiratory infections
|
Bronchitis
|
|
What 3 diseases included in COPD (chronic obstructive pulmonary disease)?
|
Emphysema, Chronic Bronchitis, Bronchiectasis (just a reminder)
|
|
Bronchitis, Emphysema, or Both: Acute disease
|
Neither (trick question!)
|
|
What are the main differences in the pathways for chronic bronchitis and emphysema?
|
Bronchitis: bronchiolar injury, hypersecretion of mucous; emphysema: destruction of alveolar walls early (bronchitis does it later)
|
|
What is the first step in treatment for bronchitis and emphysema?
|
Quit smoking
|
|
What treatment difference is there for bronchitis?
|
Use bronchodilators and antibiotics.
|
|
What treatment is there for the rare form of emphysema?
|
alpha 1-antitrypsin infusion
|
|
What potential complication arises from using N2O sedation on a patient with emphysema?
|
They can be dependent on LOW O2 levels as a primary stimulant to respiration; N2O has high concentration of O2 so it can lead to cease of respiration.
|
|
N2O (increases/supresses) pH as a stimulus to respiration, because N2O has a high O2 content.
|
supresses
|
|
T or F: N2O can diffuse into closed spaces
|
TRUE
|
|
If N2O diffuses into large gas-filled blebs in patients with COPD, what can happen?
|
They can rupture
|
|
What types of medications might patients with bronchitis or emphysema be on? List 5
|
Bronchodilators, corticosteroids, diuretics, alveolar surfactants, antibiotics
|
|
What can be done in the dental office to prevent an attack of dyspnea during treatment?
|
Treat in semi-upright position; always have inhaler
|
|
What ASA type is a patient with COPD and NO congestive heart failure?
|
ASA/MED III
|
|
What ASA type is a patient with COPD WITH congestive heart failure?
|
ASA/MED IV
|
|
What is ectasia?
|
dilatation or distension of hollow organs
|
|
What disease: Permanent dilatation of bronchi, can be secondary to persisting infection or obstruction
|
Bronchiectasis
|
|
What is the most common complication of chronic bronchitis?
|
Bronchiectasis
|
|
T or F: Tumors can be associated with bronchiectasis
|
TRUE
|
|
T or F: Cystic fibrosis can be associated with bronchiectasis
|
TRUE
|
|
T or F: A patient with Bronchiectasis presents with bronchi (and/or bronchioli) filled with mucopurulent material; this mucous can be cleared by coughing.
|
First statement true, second statement false
|
|
What disease is associated with low grade fever, malaise, fatigue, and clubbing of the fingers?
|
Bronchiectasis
|
|
What disease is associated with amyloidosis and recurrent pneumonias?
|
Bronchiectasis
|
|
Why do patients with bronchiectasis have clubbing of the fingers?
|
It is related to chronic hypoxia.
|
|
What is the only acute, restrictive lung disease?
|
Acute respiratory distress syndrome
|
|
Sepsis, shock, trauma, pneumonia, toxic lung injury, aspiration of fluids, and blood transfusions can all cause what disease?
|
Acute respiratory distress syndrome
|
|
Acute Respiratory Distress Syndrome is caused by a mechanism of either 1. Injury to the _________ _______ in pulmonary capillaries or 2. Injury to the ________ _________ _______.
|
1. Endothelial cells; 2. Alveolar lining cells
|
|
This disease was first widely recognized during the vietnam war (Da Nang Lung).
|
Acute respiratory distress syndrome
|
|
T or F: All patients affected with Acute Respiratory Distress Syndrome die during the acute stage.
|
False. 70% die during this stage, but the remainder progress to a chronic stage, where 10% may survive, and 20% eventually die from interstitial fibrosis
|
|
What are the 2 main pathways of pathogenesis for Acute Respiratory Distress Syndrome?
|
Damage to alveolar lining cells or damage to alveolar capillary endothelium--leads to interstitial edema, high protein exudation (hyaline membranes)
|
|
Which acute disease exhibits severe dyspnea, cyanosis, and hypoxia?
|
Acute respiratory distress syndrome
|
|
In this disease, fibrin is deposited along damaged alveolar lining , which leads to diffuse alveolar damage.
|
What is Acute respiratory distress syndrome? (jeopardy style baby)
|
|
Chronic Restrictive lung diseases are diseases of _________ ________.
|
Lung parenchyma
|
|
The end result of chronic restrictive lung diseases is _________.
|
Diffuse pulmonary fibrosis
|
|
Which chronic restrictive lung disease has no known cause?
|
Idiopathic pulmonary fibrosis
|
|
What disease invovles extrinsic allergic alveolitis caused by exposure to organic dust?
|
Hypersensitivity Pneumonitis
|
|
T or F: Hypersensitivity pneumonitis is only an acute disease.
|
False. It can also be a chronic disease.
|
|
Acute hypersensitivity pneumonitis is of _______ onset and is mediated (or affected) by _________ ________.
|
Sudden; antigen-antibody Complexes
|
|
Chronic Hypersensitivity pneumonitis is _______ ________, as opposed to acute which is mediated by antigen-antibody complexes.
|
Cell mediated
|
|
Two of the causes of Hypersensitivity Pneumonitis (as stated in the notes) are: __________ Lung and _______ _________ Lung.
|
Farmer's Lung (moldy hay/grain); Pigeon Breeder's Lung (pigeon serum protein in droppings)
|
|
The two chronic restrictive lung diseases caused by occupational/environmental exposure are: 1.____, 2._________
|
Hypersensitivity Pneumonitis; Pneumoconioses (ie asbestosis)
|
|
Which chronic lung disease is caused by inhalation of fumes, dust, or particulate matter (inorganic)?
|
Pneumoconioses
|
|
What is the key element of the massive lung fibrosis that causes pneumoconioses?
|
Alveolar Macrophages
|
|
A particle that is less than ______ microns in size can enter alveoli, contributing to what disease?
|
5; Pneumoconioses
|
|
Name the 5 factors that are considered in susceptibility to Pneumoconioses.
|
1. Size/shape of particle (<5 microns); 2. Composition of particles; 3. Duration of exposure; 4. Patients clearance mechanism; 5. Other irritants (ie smoking)
|
|
T or F: Pneumoconioses is caused by exposure to organic dust particles.
|
False; inorganic particles (organic--Hypersensitivity Pneumonitis)
|
|
What are 3 specific examples of Pneumoconioses?
|
1. Coal worker's lung (anthracosis); 2. Silicosis; 3. Asbestosis
|
|
T or F: Anthracosis usually leads to bronchogenic carcinoma.
|
False; Most=benign course
|
|
T or F: Anthracosis increases incidence of Tuberculosis.
|
TRUE
|
|
T or F: Silicosis can lead to bronchogenic carcinoma.
|
TRUE
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: Increased risk of TB
|
Anthracosis and Silicosis
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: Leads to Fibrosis
|
All Three
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: Increased risk of bronchogenic carcinoma
|
Silicosis (maybe asbestosis too, but mesothelioma is the characteristic sign of asbestosis
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: Can lead to mesothelioma
|
Asbestosis (this is the #1 characteristic of asbestosis)
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: increases risk of cancer 5 fold
|
Asbestosis
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: runs a benign course
|
Anthracosis
|
|
Anthracosis, Silicosis, or Asbestosis, all three, or none: shows pleural plaques
|
Asbestosis
|
|
In asbestosis, what sets off a fibrogenic reaction?
|
Macrophages ingesting an asbestos fiber
|
|
What disease: Multi-system granulomatous disease of unknown etiology (presumably immune mediated)
|
Sarcoidosis
|
|
What immune related chronic restrictive lung disease affects blacks 10:1 and women 2:1?
|
Sarcoidosis
|
|
T or F: Sarcoidosis exhibits caseating granulomas
|
False; exhibit non-caseating granulomas
|
|
T or F: Sarcoidosis can affect any organ, not just the lungs.
|
TRUE
|
|
Sarcoidosis can affect any organ, but what does it affect especially, according to lecture (according to carranza….blah blah blah)
|
Especially Lungs, thoracic/neck lymph nodes, the skin, salivary glands, and lacrimal gland (dryness)
|
|
T or F: Sarcoidosis is typically a fatal disease.
|
False; 10% mortality, 70% spontaneous recovery, 50% asymptomatic
|
|
What % of patients with sarcoidosis have elevated ACE (angiotensin Converting Enzyme)?
|
60 % (another percentage baby)
|
|
What chronic lung disease is associated with elevated ACE?
|
Sarcoidosis
|
|
What is the definition of Pneumonia?
|
Any infection in the lung (acute or chronic)
|
|
Neutrophil/complement defects (humoral defects) result in increased incidence of ___________ ________.
|
Bacterial pneumonia
|
|
Cell-mediated immune defects result in increased incidence of (intracellular/extracelluar) ___________.
|
Intracellular parasites (ie TB, HSV, pneumocystis carinii)
|
|
What disease presents commonly following URTI, absent splenic function, chills, pleuritic chest pain, productive cough.
|
Pneumonia
|
|
What ways can pneumonia be spread?
|
Inhalation of pathogens, aspiration of infection, aspiration of gastric contents, hematongenous spread (IV, septic emboli)
|
|
What are the possible complications of pneumonia?
|
Abscess formation; Plueritis, empyema (collection of pus); fibrosis--> chronic Dx
|
|
Pneumonia is of Bacterial, viral, or fungal origin?
|
Any of the above.
|
|
What are the 2 main subclasses of pneumonia?
|
Lobar Pneumonia and Bronchopneumonia
|
|
Bronchopneumonia or Lobar Pneumonia: Consolidation of multiple respiratory units surrounding individual bronchial branches
|
Bronchopneumonia
|
|
Bronchopneumonia or Lobar Pneumonia: Consolidation of entire Lobe of Lung
|
Lobar Pneumonia
|
|
What organisms cause community acquired acute pneumonias?
|
Haemophilus Influenzae; Moraxella catarrhalis; Staph Aureus; Klebsiella Pneumoniae; Legionella Pneumoniae
|
|
What organism causes Pneumococcus?
|
Streptococcus pneumoniae
|
|
What organisms cause community acquired atypical pneumonias?
|
Mycoplasma Pneumoniae, Chlamidia sp., Viruses
|
|
What is the death rate for SARS?
|
10% die
|
|
Give an example of a community acquired atypical pneumonia caused by a virus.
|
SARS
|
|
What organism causes nosocomial pneumonia (according to lecture notes)?
|
Pseudomonas Aeruginosa
|
|
What is the primary cause for aspiration pneumonia?
|
Markedly debilitated; unconscious patients; abscesses frequent
|
|
Cytomegalovirus primarily affects who?
|
Immunosuppressed (AIDS), bone marrow transplant
|
|
Pneumocystis pneumonia affects who?
|
Immunosuppressed (AIDS)
|
|
What organism causes tuberculosis?
|
Mycobacteria Tuberculosis (causes chronic bacterial infection)
|
|
What chronic lung disease is associated with caseating granulomatous inflammation?
|
Tuberculosis
|
|
What types of cells are associated with TB?
|
epitheliod macrophages, multinucleated giant cells, lymphocytes
|
|
approximately how many of the world's population are infected with TB?
|
one-third
|
|
What is the "Ghon Complex"?
|
associated with localized lung inflammation in primary tuberculosis
|
|
T or F: Primary TB usually heals spontaneously
|
TRUE
|
|
T or F: In primary TB, viable organisms can still persist after healing and calcification
|
TRUE
|
|
The "ghon Complex" forms in which part of the lung and enlarges which lymph nodes?
|
lower part of upper lobe, upper part of lower lobe (right in the middle); enlarges hilar lymph nodes
|
|
Granulomas in TB can produce cavities in the lungs which can cause hemoptysis. What is hemoptysis?
|
coughing up blood
|
|
T or F: The primary TB infection is more damaging than the secondary infection.
|
False (other way around)
|
|
What disease: non-specific mild pulmonary disease, low grade fever, 95% undiagnosed, ghon complex
|
Primary TB
|
|
What disease: Non-productive cough, low grade fever, malaise, night sweats, weight loss, hemoptysis
|
Secondary TB
|
|
What can be seen in a sputum test for TB?
|
Acid fast bacilli
|
|
How long after a Mantoux skin test should you be examined?
|
48-72 hrs.
|
|
T or F: the erythema around the indurated area of a PPD test is measured.
|
False. Only the induration is measured (normal = <10 mm)
|
|
What disease: widespread hematogenous seeding of bacteria; numerous granulomas in lungs or other organs (ie spleen)
|
Miliary TB
|
|
T or F: Disseminated TB can cause granulomas on pluera (causing pleuritis) and extrapulmonary TB
|
TRUE
|
|
T or F: a patient with latent TB is not infectious
|
TRUE
|
|
Who is most susceptible to deep fungal lung diseases?
|
Immunosuppressed, AIDS pts, uncontrolled diabetics, transplant pts, etc.
|
|
What fungal disease do all our professors like to talk about since it is widespread in the midwest?
|
Histoplasmosis
|
|
T or F: Most histoplasmosis infections go on to become chronic.
|
False; most are acute and then resolve
|
|
What are the risk factors for contracting histoplasmosis (other than living in this hell whole we call omaha….j/k)
|
exposure to soil contaminated with bird poo, preexisting COPD, compromised immunity
|
|
Histoplasmosis infection symptoms include: fever, chills, weight loss, cough (with/without) mucus or pus
|
WITH
|
|
How can histoplasosis be diagnosed?
|
sputum test, chest x-ray, biopsy of granulomatous tissue, complement fixation, urinary antigen test, immunodiffusion test
|
|
How is histoplasmosis treated?
|
Antifungals
|
|
T or F: Histoplasmosis ususally responds poorly to antifungal meds.
|
False; responds well
|
|
T or F: After treating histoplasmosis, fibrotic changes may still remain.
|
TRUE
|
|
T or F: Pulmonary Histoplasmosis progression to Disseminated Histoplasmosis is common.
|
FALSE; happens, but rarely
|
|
Coccidiomycosis, Aspergillosis, or Zygomycosis: Southwest
|
Coccidiomycosis
|
|
Coccidiomycosis, Aspergillosis, or Zygomycosis: Often in a hospital setting
|
Aspergillosis
|
|
Coccidiomycosis, Aspergillosis, or Zygomycosis: Especially in diabetics
|
Zygomycosis
|
|
Coccidiomycosis, Aspergillosis, or Zygomycosis: Deep fungal lung disease
|
All of them (that better not have tricked you)
|
|
Cavitary lesions filled with pus.
|
Lung Abscess
|
|
What bacteria predominantly causes Lung abscess?
|
S. Aureus
|
|
________ abscesses have a fibrous capsule
|
chronic
|
|
What are lung abscesses a complication of?
|
Staphylococcal pneumonia; aspiration of foreign material (swallowing a crown, poor dental hygiene, etc.)
|
|
What disease: erodes bronchial wall, eric-smelling sputum, chest pain, weight loss, chronic cough, fever, clubbing of fingers and toes
|
Lung Abscess *note, bronchiectasis also has clubbing of toes--the difference here is eroding of bronchial wall. Bronchiectasis is permanent dilatation of bronchial wall.
|
|
90% of all lung cancers are caused by smoking (150,000 deaths/yr). What are the other 10% caused by? (hint-variety of things)
|
Radon (radioactive gas=2nd leading cause--.20,000 deaths/yr); Air pollution; Radiation exposure; Asbestos exposure; Nickel and chromate exposure
|
|
T or F: Lung cancer usually has a poor prognosis with a 5 yr survival rate of 10-15%.
|
TRUE
|
|
Where are the most common sites of metastasis of lung cancers?
|
Brain and Liver mostly, occasionaly bone (mandible), rarely oral soft tissue
|
|
What is by far the most common type of lung cancer?
|
Bronchiogenic Carcinoma (90-95% of lung cancers)
|
|
List the 4 types of Bronchiogenic carcinomas.
|
1. SCCA (30%) 2. Adenocarcinoma (30%) 3. Large Cell undifferentiated (10%) 4. Small Cell (oat cell-20%)
|
|
What do small (oat) cells arise from?
|
Neuroendocrine cells
|
|
What type of hormones do small (oat) cell (bronchogenic carcinoma) express?
|
polypeptide hormones
|
|
Which type of bronchogenic carcinoma has the worst prognosis, most aggressive, and not usually amenable to surgery?
|
Small Cell (oat cell)
|
|
What type of lung cancer arises from the terminal bronchioles?
|
Bronchioalveolar cancer
|
|
What is a type of lung cancer that is a neuroendocrine tumor of low malignancy?
|
Carcinoid
|
|
What type of lung cancer is associated with asbestos exposure, takes 25-40 yrs to develop, is pluera-derived, and has a poor prognosis?
|
Mesothelioma
|
|
T or F: Metastatic lung tumors are more common than primary lung tumors (single site)
|
TRUE
|
|
What tumor-derived hormones are secreted in paraneoplastic syndrome associated with bronchogenic carcinoma?
|
Parathyroid-like polypeptide (hypercalcemia); ACTH-producing tumor (overstimulation of adrenals-->cushings syndrome); ADH-producing (water retention)
|
|
The _______ cavity is the space between viseral pleura and parietal pleura (separated by thin layer of fluid)
|
Pleural
|
|
3 general types of lesions of the pleura:
|
Inflammatory, traumatic, neoplastic
|
|
Name the types of Pleural Lesions:
|
Mesothelioma, Pleural effusions and plueritis, Pneumothorax, Hemothorax, Chylothorax
|
|
The presence of transudate in the pleural space is called ________
|
hydrothorax; caused by CHF and Left-sided heart failure especially
|
|
________ occurs as a result of an exudate (protein rich)
|
Pleuritis
|
|
What causes pleural effusion?
|
Microbial infection, cancer, pulmonary infarction, viral pleuritis
|
|
T or F: in a patient older than age 40, in the absence of systemic infection, lung complications should be assumed it is cancer until proven otherwise.
|
TRUE
|
|
Fibrothorax, Pneumothorax, Empyema, Hemothorax, or chylothorax: encasement of lungs with fibrous tissue that obliterates pleural cavity.
|
Fibrothorax
|
|
Fibrothorax, Pneumothorax, Empyema, Hemothorax, or chylothorax: Entry of air or gas into pleural cavity; may cause atelectasis, compression, collapse of lung.
|
Pneumothorax (spontaneous vs trauma)
|
|
Fibrothorax, Pneumothorax, Empyema, Hemothorax, or chylothorax: Pockets of pus surrounded by fibrous tissue; caused by infection that spreads from the lung.
|
Empyema
|
|
Fibrothorax, Pneumothorax, Empyema, Hemothorax, or chylothorax: Collection of blood in space between chest wall and lung (pleural cavity).
|
Hemothorax (trauma vs. rupture of intrathoracic aortic aneurysm)
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Fibrothorax, Pneumothorax, Empyema, Hemothorax, or chylothorax: Presence of lymphatic fluid in pleural space; secondary to leakage/obstruction of thoracic duct or main tributaries
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Chylothorax (causes: lymphoma, surgical trauma)
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What is usually the etiology of URTI's (common cold)?
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Viruses (ie rhinoviruses, coronavirus, RSV, parainfluenza, etc.
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Bacterial URTI's are not as common as viral, but when present exhibit what characteristics?
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PMN's and exudate formation; whitish yellow membranes in throat
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What is the name of the disease caused by URTI's?
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common cold
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What are the 3 main Middle Respiratory tract infections?
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1. Croup; 2. Epiglottitis, 3. Bronchiolitis
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Which MRTI is characterized by: acute viral illnes of larynx, especially affects ages 3-5 yrs., loud cough, barking seal (like chase in the mornings)
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Croup
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T or F: Croup is extremely life-threatening.
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FALSE
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Which MRTI is characterized by: acute, severe, life-threatening disease, presents as a child w/ fever +/- sore throat, clinical triad of drooling, dysphagia, distress
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Epiglottitis
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What organism causes Epiglottitis?
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Haemophilus Influenzae
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T or F: Now epiglottitis is more prevalent in children than adults.
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False. Other way around.
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What MRTI is characterized by: acute infectious disease of lower respiratory tract (bronchi/bronchioles, not alveoli), mostly in young infants 2-24 mos.,
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Bronchiolitis
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What is main cause of Bronchiolitis?
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Viral infection (80%--esp. respiratory synctial virus)
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T or F: Bronchiolitis usually resolves in 7-10 days.
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TRUE
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What Middle Respiratory Tract Tumor did we mention in class? (only one)
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SCCA (squamous cell carcinoma) of Larynx
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What is the main cause of SCCA of the larynx?
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Smoking and chronic alcohol use
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What disease: persisten hoarseness, change in voice, stridor (high pitched crowing sound), rare under age 40
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SCCA of larynx
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What is the treatment and survival rate for SCCA of the larynx?
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Radiation w/ or w/out surgery; 75% survival rate if early Dx.
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