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101 Cards in this Set
- Front
- Back
COPD characteristics
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obstruction of air flow resulting in air trapping in lungs. hallmark of FEV1/FVC < 80%
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Characteristics of chronic bronchitis COPD
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hypertrophy of mucus-secreting glands in bronchioles (Reid index > 50%). Productive cough for >3 consecutive months in >/= 2 years. disease of small airways
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Emphysema characteristics
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enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls. increase in elastase activity and increased compliance
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causes of emphysema
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smoking, alpha-1-antitrypsin deficiency
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findings in chronic bronchitis
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wheezing, crackles, cyanosis
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findings in emphysema
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dyspnea, decreased breath sounds, tachycardia, decreased I/E ratio
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where is the damage in emphysema caused by smoking?
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centriacinar
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where is the damage in emphysema caused by a-1-antitrypsin deficiency
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panacinar
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what are the associations with paraseptal emphysema
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bullae --> can rupture --> spontaneous pneumothorax; often in young, healthy males
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characteristics of asthma
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bronchial hyperresponsiveness causes reversible bronchoconstriction. smooth muscle hypertrophy, curschmann's spirals
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findings in asthma
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cough, wheezing, dyspnea, tachypnea, hypoxemia, decreased I/E ratio, pulsus paradoxus, mucus plugging
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Bronchiectasis characteristics/findings
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chronic necrotizing infection of bronchi --> permanently dilated airways, purulent sputum, recurrent infections, hemoptysis
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bronchiectasis is associated with what conditions?
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bronchial obstruction, CF, poor ciliary motility, Kartagener's syndrome
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what infection does bronchiectasis predispose to?
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aspergillosis
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What is Kartagener's syndrome
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Triad: situs inversus, chronic sinusitis, bronchiectasis; AR; defective dynein in ciliated epithelium (respiratory tract,eustachian tube, middle ear, fallopian tube, sperm)
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restrictive lung disease general characteristics
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decreased FVC and TLC. PFTs are normal (FEV1/FVC > 80%)
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What are the two main categories of restrictive lung diseases?
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Poor breathing mechanics (extrapulmonary, peripheral hypoventilation) and interstitial lung diseases
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Causes of RLDs due to poor breathing mechanics
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poor muscular effort (polio, myasthenia gravis, Duchenne MD), poor structural apparatus (scoliosis, morbid obesity)
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causes of interstitial lung diseases (x9)
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ARDS, Neonatal RDS, Pneumoconioses, Sarcoidosis, Idiopathic pulmonary fibrosis, Goodpasture's syndrome, Wegener's granulomatosis, Eosinophilic granuloma (histiocytosis X), Drug toxicity
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causes of pneumoconioses?
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Anthracosis from inhalation of carbon dust, Coal worker's pneumoconiosis, Progressive massive fibrosis, Silicosis, Asbestosis
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black teenager has noncaseating granulomas, involving multiple organ systems. patient has bilateral hilar lymphadenopathy, interstitial lung disease with diffuse reticular densities. what is the diagnosis?
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sarcoidosis
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what are the lab abnormalities in sarcoidosis?
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hypercalcemia and hypercalciuria, hypergammaglobulinemia, increased activity of serum ACE
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immunologic phenomena in sarcoidosis?
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reduced sensitivity to skin test antigens (characteristic negative PPD), and polyclonal hyperglobulinemia
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hemorrhagic pneumonitis and glomerulonephritis caused by antibodies against glomerular basement membranes
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goodpasture's syndrome
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characteristics of asbestosis
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diffuse interstitial fibrosis, mainly of lower lobes. ferruginous bodies (prussian blue stain), dense hyalinized fibrocacific plaques of the parietal pleura.
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To what cancers does asbestosis predispose? Which has an additive effect with smoking?
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bronchogenic carcinoma (smoking is additive) and malignant mesothelioma
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silicosis often seen in what professions?
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miners, glass manufacturers, and stone cutters
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pathogenesis of silicosis?
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alveolar macrophages ingest silica dust. damage to macrophages initiates inflammatory response mediated by lysosomal enzymes.
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a1-antitrypsin deficiency genetics?
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variants in proteinase inhibitor (pi) on chromosome 14
in homozygous state (piZZ), associated with a1-antitrypsin deficiency, panacinar emphysema and hepatic cirrhosis |
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ARDS findings
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produced by diffuse alveolar damage with increased capillary permeability and leakage of protein-rich fluid into alveoli. Marked by formation of intra-alveolar hyaline membrane
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predisposing factors to neonatal RDS
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prematurity, maternal diabetes, birth by caesarean section
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localized proliferation of alveolar histiocytes. tennis-racket-like inclusion bodies on EM
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eosinophilic granuloma (associated with Letterer-Siwe, Hand-Schuller-Christian and histiocytosis X)
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common causes of secondary pulmonary hypertension
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COPD (most common), increased pulmonary blood flow, increased resistance within the pulmonary circulation (emboli, hypoxic vasoconstriction) increased blood viscosity (polycythemia)
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pulmonary hypertension can lead to what
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RV hypertrophy, cor pulmonale
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symptoms of bacterial pneumonia
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chills, fever, productive cough, blood-tinged sputum, pleuritic pain, hypoxia with dyspnea, sometimes cyanosis. Also neutrophilic leukocytosis with an increase in band neutrophils (left shift)
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Lobar pneumonia
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Strep pneumoniae, characterized by intra-alveolar exudate, may involve entire lobe
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patchy distribution of one or more lobes, with inflammatory infiltrate extending from bronchioles into adjacent alveoli
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bronchopneumonia
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causes of interstitial pneumonia
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mycoplasma pneumoniae or viruses, Rickettsial pneumonias (Q fever), Ornithosis
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Mycoplasma pneumonia
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inflammatory condition confined to interstitium, no exudate, intraalveolar hyaline membranes. associated with nonspecific cold agglutinins reacitve to red cells
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methods of diagnosing mycoplasma pneumonia
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sputum cultures and complement fixation
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giant cell pneumonia cause
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measles virus
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most common viral pneumonia
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influenza viruses
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atypical pneumonia in a person who works with cattle or sheep or drinks unpasteurized milk
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rickettsial pneumonia (Coxiella burnetii)
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atypical pneumonia from inhalation of dried bird shit
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Chlamydia psittacosis
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most common pneumonia in AIDS patients
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pneumocystis jiroveci (PCP)
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pneumonia caused by gram negative infections....which are most common bugs and what is the major virulence factor?
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Klebsiella, Pseudomonas aeruginosa, E. coli; endotoxins are most important virulence factor
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a localized area of suppuration within the parenchyma, usually resulting from bronchial obstruction or from aspiration of gastric contents
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lung abscess
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what organisms can cause lung abscesses?
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Staph, strep pyogenes, Pseudomonas, Klebsiella or Proteus (often in combination with anaerobes)
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how do lung abscesses present?
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fever, foul-smelling purulent sputum, and x-ray evidence of a fluid-filled cavity
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four stages of lobar pneumonia
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congestion, red hepatization, gray hepatization, resolution
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organisms causing bronchopneumonia
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staphylococcus aureus, H. influenzae, Klebsiella pneumoniae, Strep. pyogenes
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Strep. pneumoniae patients
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most common in elderly or debilitated patients, malnourished or with cardiopulmonary disease
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post-viral bacterial pneumonia in IV drug user
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staph aureus
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complication of measles or influenza
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strep. pyogenes
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bacterial pneumonia in infants and children. may also have epiglottitis and meningitis
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H. influenzae
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PE shows localized absence of breath sounds, decreased resonance and fremitus and tracheal deviation to the Right
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bronchial obstruction (Right sided)
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PE shows localized decrease in breath sounds, dullness to percussion, decreased fremitus
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pleural effusion
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PE shows bronchial breath sounds, dullness to percussion, increased fremitus
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lobar pneumonia
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PE shows decreased breath sounds, hyperresonance, absent fremitus and tracheal deviation to right
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pneumothorax (left sided)
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primary tuberculosis findings
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Ghon complex in central and lower lobes with hilar lymph node involvement. granulomatous inflammation with central caseous necrosis and langerhans giant cells
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pathologic changes in secondary tuberculosis
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localized lesions in apical segments of upper lobes and hilar lymph node involvement. Also, cavitary lesions from expulsion of caseous necrotic tissue
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symptoms of secondary Tb
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hemoptysis, pleural effusion, generalized wasting (also fever and progressive disability)
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spread of Tb is called what? Where does it go?
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miliary tuberculosis may cause meningitis, Pott diseas of the spine, paravertebral abscess or psoas abscess
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cause of acute epiglottitis
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H. influenzae (inflammation of epiglottis)
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harsh cough followed by inspiratory stridor
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Croup, inflammation fo the larynx, trachea and epiglottis due to viral infection
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immigrant from SE asia or East Africa, get EBV, predisposes to what tumor of Upper respiratory tract
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nasopharyngeal carcinoma
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most frequently occurring malignant nasal tumor
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squamous cell carcinoma
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what is a singer's nodule?
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benign laryngeal polyp due to excessive use of voice and associated with heavy cigarette smoking.
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where do singer's nodules occur?
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localized to true vocal cords
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what causes laryngeal papillomas?
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HPV, may progress to malignancy in adults
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most common malignant tumor of larynx?
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Squamous cell carcinoma
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man over 40 who is chronic alcoholic and has been smoking since his twenties presents with persistent hoarseness
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squamous cell carcinoma of larynx
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nocardia characteristics
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gram-positive, aerobic, filamentous, weakly acid-fast bacteria that may disseminate to brain and meninges. closely associated with actinomyces
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Histoplasmosis characteristics
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clinically similar to Tb, results in multiple pulmonary lesions with late calcification, may disseminate. see infiltrates of macrophages filled with fungal yeast forms
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coccidiomycosis characteristics
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fungal spherules containing endospores found within granulomas
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What are the centrally appearing cancers of the lung?
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Squamous cell and Small Cell (oat cell) carcinoma
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What are the peripherally appearing cancers of the lung?
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Adenocarcinoma (bronchial and bronchioloalveolar), and Large cell carcinoma
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What lung cancers are directly related to smoking?
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squamous cell carcinoma
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What are the complications of bronchogenic carcinoma?
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SPHERE: SVC syndrome, Pancoast's tumor, Horner's syndrome, Endocrine (paraneoplastic), Recurrent laryngeal symptoms, Effusions
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most common lung cancer in nonsmokers and females?
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adenocarcinoma
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hilar mass arising from bronchus. ectopic PTHrP production. what do you see histologically'?
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squamous cell carcinoma --> keratin pearls
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lung cancer that develops on site of prior inflammation or injury. histologically see type II pneumocytes and multiple densities on chest x-ray
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bronchial adenocarcinoma
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columnar-to-cuboidal tumor cells line alveolar walls; multiple densities on x-ray, mimicking pneumonia
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bronchioloalveolar adenocarcinoma
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very aggressive undifferentiated cells that appear dark blue. have ectopic production of ACTH or ADH what is the cancer? what type of cell is malignant?
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small-cell. cells are called Kulchitsky cells. they are neuroendocrine in origin
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What is Lambert-Eaton syndrome and what cancer is it associated with?
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autoantibodies against calcium channels; associated with small cell carcinoma
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carcinoid tumor characteristics?
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located in major bronchi, spreads by direct extension, secretes serotonin
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exposure to what can lead to bronchogenic carcinoma?
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smoking, air pollution, radiation, asbestos, nickel and chromates
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common paraneoplastic syndromes associated with lung cancers
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ACTH (small cell, most common), SIADH (small cell), PTHrP (SCC)
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what is a pancoast tumor?
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involvement of apex of the lung manifests as horner syndrome (ptosis, miosis, anhidrosis)
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SVC syndrome is what?
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compression or invasion of SVC resulting in facial swelling and cyanosis with dilation of the veins of head, neck and upper extremities.
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H1 histamine antagonists (first generation)
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diphenhydramine, dimenhydrinate, chlorpheniramine
Clinical uses: allergy, motion sickness, sleep aid Toxicity: sedation, antimuscarinic, anti-a-adrenergic |
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2nd gen. H1 histamine antagonists
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Loratadine, fexofenadine, desloratadine, cetirizine
clinical uses: allergy toxicity: little CNS tox |
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Isoproterenol
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non-specific Beta agonist; relaxes bronchial smooth muscle (B2); tachycardia from B1
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Albuterol and Salmeterol
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B2 specific agonists; albuterol for acute asthma exacerbation and salmeterol for prophylaxis; may cause tremor and arrhythmias
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Theophylline (use, mechanism, toxicity)
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Methylxanthine that causes bronchodilation by inhibiting phosphodiesterase --> increases cAMP t(1/2). narrow therapeutic index
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ipratropium
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muscarinic antagonist, prevents bronchoconstriction. used for COPD and asthma
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Beclomethasone, prednisone mechanism
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stops production of TNF-a by inactivating NF-kappaB
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Zileuton mechanism
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antileukotriene that blocks conversion of arachidonic acid to leukotrienes
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Zafirlukast, montelukast mechanism and use
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block leukotriene receptors. good for aspirin-induced asthma
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Guaifenesin mechanism
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removes excess sputum but large doses necessary
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N-acetylcysteine class and uses
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mucolytic --> can loosen mucous plugs in CF patients. also used as an antidote for acetaminophen overdose
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