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153 Cards in this Set
- Front
- Back
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when do lung buds develop |
week 4 |
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embryonic phase of lung development |
weeks 4-7 lung bud -> tertiary bronchi error = TE Fistula |
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pseudoglandular phase of lung development |
weeks 5-16 terminal bronchioles incompatable with life still |
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canalicular phase of lung development |
16-26 weeks terminal bronchioles -> alveolar ducts prominent capillary netowrk capable at 25 weeks |
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saccular phase of lung development |
26-birth terminal sacks develop pneumocytes develop + surfactant |
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alveolar phase of lung development |
32wks - 8 yrs terminal sacs to adult alveoli |
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pulmonary hypoplasia |
poorly developed bronchial tree with right lung most often involved associated with -congenital diaphragmatic hernia -bilateral renal agenisis - potter sequence |
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broncogenic cysts |
abnormal budding of the foregut and dialation of terminal and large bronchi discrete air filled densities on CXR they drain poorly & cause chronic infections |
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most common pneumonia in immunocompromised |
pneumocystitis jirovecii |
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most common cause of atypical pneumonia |
mycoplasma pneumonia |
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most common cause of pneumonia in alcoholics |
klebsiella pneumonia |
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cause of interstitial pneumonia in bird handlers |
chlamydophilla psittaci |
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pneumonia in pt with history of bats/bat droppings |
histoplasma |
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pneumonia in someone whos recently been to the SW USA |
coccidiodies |
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pneumonia and Q fever |
coxiella burnetti |
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pneumonia associated with air conditioners |
legionella |
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most common cause of pneumonia in kids less than 1yo |
RSV |
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most common cause of pneumonia in neonates (>1 month) |
GSB E.Coli |
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most common case of pneumonia in kids, young adults, college kids, military recruits, prison inmates |
mycoplasma pneumonia |
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most common cause of viral pneumonia |
RSV |
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most common cause of wool sorters disease |
bacillis anthracis |
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most common pneumonia in vent pt |
MRSA Pseudomonas |
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most common cause of pneumonia in CF pts |
Pseudomonas MRSA |
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name of ingredient of surfactant |
lecithin -dipalmitoylphosphatidylcholine |
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when does surfactant production begin & when are the lungs mature |
26weeks 35 weeks |
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club cells |
non -ciliated columnar/cubiodal -secretory granules actions -secrete parts of surfactant -degrade toxins -reserve cells |
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characteristic description of a CXR of a neonate with NRDS |
groundglass lungfields |
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L:S ratio predictive of NRDS |
<1.5 |
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complications of NRDS |
1.metabolic acidosis 2.PDA 3.necrotizing enterocolitis |
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Risk factors for NRDS |
Premature Maternal DM (due to high fetal insulin) C-section (decrased steroid release) |
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complication of O2 supplementation in NRDS |
RIB Retinopathy of prematurity Intraventricular hemorrhage Bronchopulmonary dysplasia |
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part of bronchial tree with least resistance |
terminal bronchioles |
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how far down do goblet cells & cartilage go |
end of bronchi |
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primary epithelium of upper airways & how far down does it go |
Psuedostratified ciliated columnar -to terminal bronchioles -work as the mucociliary escalator |
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how far down does smooth muscle go in the airways |
terminal bronchioles |
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tissue type in respiratory bronchioles |
cuboidal |
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where do cilia end |
respiratory bronchioles |
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if you aspirate a peanut sitting up where will it go |
inferior segment of right inferior lobe |
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if you asiprate a peanut while laying down where will it go |
superior segment of the right inferior lobe |
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where structures perforate the diaphragm |
I ate 10 eggs at 12 T8 - IVC T10 - esophagus & vagus T12 - Aorta, Azygous, Thoracic duct |
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common bifurcations |
biFOURcations C4 - common carotid T4 - trachea L4 - abdominal aorta |
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typical tidal volume |
500mL |
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inspiratory reserve volume |
amount that can be breathed in after normal inspiration |
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expiratory reserve volume |
air that can be breathed out after normal expiration |
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inspiratory capacity |
tidal volume plus all the extra you can breath in |
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functional residual capacity |
RV + ERV volume in lungs after normal expiration |
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vital capacity |
max volume that can be expired after max inhalation everything but RV |
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equation for physiologic dead space |
Vd = Vt x (PaCO2 - PeCO2 / PaCO2) vt = tidal volume Pa = arterial CO2 |
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normal respiratory rate |
12-20breaths/min |
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minute ventilation equation |
Ve- minute ventilation Ve = Vt x RR tidal volume x respiratory rate |
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alveolar ventilation equation (VA) |
VA = (Vt - Vd) x RR |
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values at FRC |
Airway & alveolar pressures are 0 intrapleural pressure = (-) |
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taut form of Hb |
T=tissues deoxygenated -low affinity for O2 -promotes unloading in tissues |
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R form of Hb |
relaxed - R=Receptive to O2 wants to bind O2 |
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things that favor the Taught form of Hb |
-shifts curve to the right -promotes O2 unloading H+ Cl- CO2 high Temp 2,3-BPG |
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Methemoglobin |
Fe3+ - ferric -does not bind O2 as well but binds CN- very well Presents -cyanosis -chocolate colored blood causes -nitrates from diet, pollution, high altitude water -benzocaine poisoining -nitrates, antimalarial, dapsone, sulfonamide, lidocaine, metoclopromide Tx -methylene blue -vitamin c + cimetidine for long term tx of drugs known to induce methemoglobin like dapsone & sulfonamides in HIV prophylaxis |
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Tx of CN- poisoning |
induce methemoglobinemia -Nitrites followed by thiosulfate -higher binding affinity for CN than for O2 |
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Carboxyhemoglobin |
CO poisoning -left shift on O2 dissociation curve = less unloading in tissues |
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equation for O2 content |
(1.34x Hb x SaO2) + (0.003 x PaO2) SaO2 = arterial O2 saturation PaO2 = partial pressure of O2 |
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normal amount of Hb in the blood |
15g/dL 1g of Hb can bind 1.34mL O2 |
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O2 binding capacity |
20.1mL O2/ dL blood |
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equation for O2 delivery to tissues |
cardiac output x O2 content of blood |
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Anemia affect on 1. Hb concentration 2.%O2 sat of Hb 3.PaO2 (dissolved) 4. Total O2 content |
1. Hb concentration - down 2.%O2 sat of Hb - normal 3.PaO2 (dissolved) - normal 4. Total O2 content - down |
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polycythemia affect on 1. Hb concentration 2.%O2 sat of Hb 3.PaO2 (dissolved) 4. Total O2 content |
1. Hb concentration - increased 2.%O2 sat of Hb - normal 3.PaO2 (dissolved) - normal 4. Total O2 content - increased |
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COPD affect on 1. Hb concentration 2.%O2 sat of Hb 3.PaO2 (dissolved) 4. Total O2 content |
1. Hb concentration - normal 2.%O2 sat of Hb - 3.PaO2 (dissolved) - low 4. Total O2 content - low |
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Perfusion limited |
normal (O2) CO2 N2O diffusion can be increased only with increased flow |
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diffusion limited |
O2 in emphysema or fibrosis or CO gas doesnt equilibrate by the end of the capillary |
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equation for pulmonary vascular resistance (PVR) |
PVR = Pressure in pulm A - Pressure in L atrium cardiac output |
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alveolar gas equation |
PaO2 = 150 - (PaCO2/0.8) needed to calculate A-a gradient to determine source of hypoxia |
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hypoxemia with a normal A-a gradient |
high altitude hypoventilation (opiod) |
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Hypoxemia with an elevated A-a gradeint |
V/Q mismatch Diffusion limitation (fibrosis) Right to left shunt |
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V/Q = O |
Oirway obstruction (shunt) = O 100% O2 doesnt help example = foreign body aspiration |
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V/Q = infinity |
blood flow obstruction = infinity 100% O2 helps |
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PA, Pa and Pv in different parts of lungs |
Top : PA > Pa > Pv Middle : Pa > PA > Pv Bottom : Pa > Pv > PA *big A moves to the right everytime |
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how CO2 is transported back to lungs |
1. HCO3- 2. Carbaminohemoglobin or HbCO2 -Co2 binds to N-terminus of globin (not heme) -favors taut form = releases O2 3. Dissolved Co2 |
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Haldane effect |
in the lungs O2 added to Hb dissociates the H+ -shifts towards formation of CO2 |
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Bohr effect |
increased H+ in tissues from metabolism shifts curve to right unloading O2 |
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Response to high altitude |
low PaO2 -> hyperventilation -> low CO2 = resp alkalosis 1. chronic increased ventilation 2.high EPO - increased Hct & Hb 3. high 2-3BPG 4.more mitochondria 5.more excretion of bicarb 6.vasoconstricted lungs & RV hypertrophy |
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physiologic changes in lungs during exercise |
no change in PaO2 & PaCO2 increased -venous CO2 -decrease venous O2 content |
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where do maxillary sinuses drain into |
middle meatus |
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causes of Rhinosinusitis |
1. acute viral URI 2. superimposed bacterial infection --strep pneumo --H. flu --M catarrhalis |
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where do epistaxis occur |
most common - anterior segment in Keisselbach plexus |
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location of life threatening nasal hemorrhage |
posterior segment -sphenopalantine artery (maxillary A branch) |
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most common type of head and neck cancer |
squamous cell |
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risk factors for head and neck cancer |
EtOH Tabacco HPV-16 (oropharyngeal) EBV - (nasopharyngeal) |
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fat emboli |
long bone fracture liposuction triad -hypoxemia -neurologic abnormalities -petechial rash |
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imaging test of choice for PE |
CT pulmonary angiography |
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length of time needed to diagnose chronic bronchitis |
productive cough for >3 months (not consecutive) for 2 years |
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complications of chronic bronchitis |
polycythemia pulmonary HTN (hypoxemia) cor pulmonale |
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centroacinar vs panacinar emphysema locations |
centro = upperlobes pan = lower lowbes |
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cause of emphysema |
increased elastase activity and decreased anti-trypsin activity to stop it |
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findings in asthma |
1. Smooth muscle hypertrophy 2. Curshmann spirals --shed endothelium forms whorled mucus plugs 3.Carcot-Leydig crystals --hexagonal double pointed needle like crystals fromed from breakdown of eosinophils in sputum |
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drugs known to cause restrictive lung disease |
Bleomycin -pneumonitis with infiltrates Busulfan -acute lung injury, chronic fibrosis, alveolar hemorrhage Amiodarone -pulmonary fibrosis Methotrexate -hypersensitivity like rxn |
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Idiopathic pulmonary fibrosis |
mutation in TELOMERASE or MUC5B risk - age, smoking, genetics survival - 3 years post dx presents -honeycomb lung -patchy intersitial fibrosis |
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Pulmonary langerhans cell histiocytosis |
eosinophillic granuloma associated with restrictive lung disease +birbeck granules (tennis racket) -young smoker , goes away if they stop |
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hypersensitivity pneumonitis |
can cause Restrictive lung disease mixed type 3/4 HS RXN to environmental antigen -dyspnea, cough, chest tightness, HA -farmers -exposed to birds |
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Caplan syndrome |
Rheumatoid arthritis + Pneumoconiosis with intrapulmonary nodules -silicosis, asbestosis, coal |
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asbestosis |
Shipbuilding, roofing & plumbing presents -calcified pleural plauques & on diaphragm -lower lobes -ferruginous bodies (golden dumbells) -->found in sputum on prussian blue stain complications -pleural effusion -bronchogenic carcinoma -laryngeal carcinoma -mesothelioma |
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Berylliosis |
Aerospace or high tech industry presents -noncaseating granulomas -upper lobes occasionally responsive to steroids |
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Coal workers Pneumoconiosis |
1. Anthracosis - asymptomatic in urban people black lung 2. simple - fibrous nodules 3. complex - progressive fibrosis Macrophages filled with carbon upper lobe |
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Silicosis |
miners, sandblasters -macrophages release fibrogenic factors -disrupts phagolysosome and impairs macrophages increasing RISK FOR TB & lungCA Presents -upper lobes -Egg shell calcifications of hilar lymph nodes |
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pathophysiology of ARDS |
Endothelial damage (neutrophillic substances, coag cascade, ROS) -> increased alveolar capillary permeability -> protein rich fluid into alveoli -> diffuse alveolar damage and non cardiogenic pulmonary edema (normal PCWP) ->hyaline membrane |
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sequelae of nocturnal hypoxia |
systemic/pulmonary HTN arrythmia (afib/aflutter) sudden death increased EPO |
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obstructive sleep apnea |
obesity snoring adenotonsillar hypertrophy in kids excess pharyngeal tissue adults |
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central sleep apnea |
No respiratory effort due to CNS injury, HF, opoids common in premature infants tx - CPAP, Resp stimulatory drugs, acetozolamide |
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Obesity hypoventilation syndrome |
BMI>30 -> low RR -> low PaO2 and high PaCO2 during sleep high PaCO2 during wakeful hours due to retention |
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normal mean pulmonary pressure definition of pulmonary HTN |
normal = 10-14mmHg HTN = >25mmHg |
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Heritable primary pulmonary HTN |
inactivation of BMPR2 -normally inhibits vasc smooth muscle proliferation -leads to increased resistance associated with kaposi sarcoma & HIV women under 30 usually |
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other causes of primary pulmonary HTN |
Drugs - meth/coke CT disease HIV Portal HTN Congenital HD Schistosomiasis |
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treatment for pulmonary HTN |
Bosentan/Ambrisentan - competitive antagonist of entothelin 1 (decrase pulm resistance) Prostaglandin analog Sidenafil Nifedipine |
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Physical findings with pleural effusion |
-decreased breath sounds -dull to percussion -low fremitus -tracheal deviation away if large enough |
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physical findings with atelectasis (bronchial obstruction) |
-decreased breath sounds -dull to percussion -low fremitus -trachea deviates TOWARD lesion |
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physical findings on simple pneumothorax |
-decreased breath sounds -hyperresonant -decreased fremitus |
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physical findings on tension pneumothorax |
-decreased breath sounds -hyperresonant -decreased fremitus -deviates away from lesion |
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lobar pneumonia findings on physical |
late inspiratory crackles dullness to percussion increased fremitus |
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superior vena cava syndrom |
obstruction of SVC that limits drainage presents -Jugular venous distention -upper extremity edema causes -pancoast tumor -thrombosis of indwelling catheter -increased ICP -increased aneurism or rupture risk |
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transudate |
transparent = no protein due to hydrostatic pressure increase or low oncotic presssure |
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exudate |
high protein content - cloudy causes -malignancy -pneumonia -trauma must be drained due to infection risk |
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primary spontaneous pneumothorax |
young tall thin male due to apical subpleural bleb |
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secondary sponteanous pneumothorax |
due to diseased lung -bullae in emphysema -mechanical vent -> barotrauma |
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traumatic pneumothorax |
due to a penetrating or blunt wound to the lung |
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most common cause of lobar pneumonia |
strep pneumo -intraalveolar exudate |
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most common cause of broncopneumonia |
Strep pneumo Staph aureus H. flu klebsiella acute inflammaory infiltrates patchy distribution involving less than a whole lobe |
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most common causes of interstital pneumonia |
Mycoplasma Chlamydia Leigonella Viruses diffuse patchy inflammation located to interstital areas |
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treatment for aspiration pneumonia |
clindamycin |
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presentation of aspiration pneumonia |
person is at risk (epilepsy, etoh) air fluid level on CXR often right lung |
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histology of mesothelioma |
Psammoma bodies Cytokeratin & calretinin + |
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where does lung cancer like to met to |
adrenals brain bone liver |
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gene mutations associated with small cell lung cancer |
-amplification of myc -TP53 -RB |
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histology of small cell lung cancer |
+ neuroendocrine cells - kulchisky cells (small dark blue cells) + chromogarnin A +neuron specific enolase |
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mutations associated with adenocarcinoma of the lung |
EGFR ALK KRAS ROS MET RET |
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histology associated with adencocarcinoma of the lung |
Glandular with mucin + staining |
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squamous cell lung cancer histology |
keratin pearls intracellular bridges |
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histology of large cell lung cancer |
pleomorphic giant cells can secrete B-HcG |
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bronchial carcinoid tumor histology |
nests of neuroendocrine cells chromogranin + |
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names of first generation antihistamines & MOA |
MOA - reversibly inhibition of H1 Diphenhydramine Dimenhydrinate Chlorpheniramine Hydroxizine |
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guanfinesin |
thins respiratory secretions |
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N-acetylcysteine |
mucolytic -liquifies mucus in COPD by disrupting sulfide bonds -also antidote for tylenol OD -also prevents contrast induced nephropathy |
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dextromethoraphan |
anti-tussive antagonizes NMDA glutamate receptor mild opiod efects in excess naloxone for OD May cause seritonin syndrome |
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Bosentan |
competitively antagonizes endothelin -1 receptors -reduces pulmonary vascular resistance S/E = hepatotoxic |
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Epoprostenol & Iloprost |
PGI2 with direct vasodialatory effect on pulmonary and arterial vascular beds inhibits platelet aggregation S/E - flushing & jaw pain |
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cyproheptadine |
antihistamine used as an appetite stimulant |
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promethazine |
antihistamine used for n/v |
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hydroxyzine |
antihistamine used for sedation & itchyness |
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meclizine |
antihistamine used for vertigo |
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inhaled corticosteroids |
fluticasone & budesonide -inhibit synthesis of all cytokines -inactivate nf-Kb (trascription factor that produces TNF-alpha first line for chronic asthma |
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ipatropium |
muscarinic antagonist - competitive -prevents bronchoconstriction used in COPD Tiotropium - long acting |
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montelukast and zafirlukast |
block leukotriene receptors CysLT1 esp good for asa induced asthma |
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Zileuton |
5-lipooxygenase pathway inhibitor -blocks conversion of AA to leukotrienes s/e = hepatotoxic |
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omalizumab |
anti-igE & blocks FceRI used in allergic asthma with high IgE levels resistant to inhaled steroids and long acting beta 2 agonists |
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theophylline |
methylxanthine -inhibits phosphodiesterase increaseing cAMP -narrow theraputic index s/e -cardiotoxic -neurotoxic -metabolized by cyto P450 -block adenosine action |
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long acting beta 2 agonits used in asthma |
salmeterol formoterol |
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short acting beta 2 agonsts used as rescue inhalers |
albuerol levalbuterol (slightly longer) |
