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94 Cards in this Set
- Front
- Back
Where is cartilage present in the respiratory system?
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Only trachea and bronchi
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Where do the pseudostratified ciliated columnar cells extend to?
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Respiratory bronchioles (first part of respiratory zone)
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Where do the goblet cells extend to?
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Only to the bronchi
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Appearance of type II pneumocytes on histology?
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Cuboidal and clustered
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Cell type that proliferates during lung damage?
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Type II pneumocytes
- serve as precursors for type I and other type II cells |
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Functions and appearance of Clara cells?
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Secrete component of surfactant, degrade toxins, act as reserve cells.
Nonciliated, columnar with secretory granules. |
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Ratio that indicates fetal lung maturity?
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Lecithin-to-sphingomyelin ratio > 2 in amniotic fluid
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What travels with the esophagus through the diaphragm at T10?
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Vagus (2 trunks)
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What travels with the aorta through the diaphragm at T12?
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Thoracic duct and azygous vein
- Red, white, & blue: aorta, thoracic duct, and azygous vein |
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Pain from the phrenic nerve (diaphragm) is referred to where?
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Shoulder
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Components of a bronchopulmonary segment?
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Tertiary (segmental) bronchus/bronchiole
2 arteries (bronchial and pulmonary) Veins and lymphatics (at the border) |
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What is the function of the elastic walls of the pulmonary arterial circulation?
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Maintain pulmonary arterial pressure at relatively constant levels throughout the cardiac cycle
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Reason for inhaled foreign body on right side?
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Right main stem bronchus is wider and more vertical than the left
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Relationship of pulmonary artery to bronchus at each lung hilus?
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Right: Pulmonary artery ANTERIOR to bronchus
Left: pulmonary artery SUPERIOR to bronchus (R-A-L-S) |
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Fissure that separates right superior and middle lobes?
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Horizontal fissure
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What does the oblique fissure separate?
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Inferior and superior lobes of each lung
R front: inferior and middle lobe |
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Muscles that help with inspiration?
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External intercostals, scalene muscles, SCM
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Muscles that help with expiration?
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Rectus abdominis, internal and external obliques, transversus abdominis, internal intercostals
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Alveolar collapsing pressure equation?
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P = 2 (surface tension) / radius
- tendency to collapse on expiration as radius decreases |
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Factors that favor T over R form of hemoglobin?
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Increased Cl, H+, CO2, 2,3-BPG
(negative allostery) |
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T vs R form of O2?
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T (taut): low affinity for O2
R (relaxed): high affinity (300x) for O2 |
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What accounts for the sigmoid shaped O2 dissociation curve for Hgb?
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Positive cooperativity and negative allostery
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Pressures at FRC?
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Airway/alveolar pressure is 0 (atmospheric)
Intrapleural pressure is negative (~ -5) |
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Forces from chest wall and lungs at FRC?
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Chest wall is pulling outward (exerting negative airway pressure)
Lungs are pulling inward (exerting positive airway pressure) |
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Largest contributor of dead space in healthy lung?
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Apex of healthy lung (functional dead space)
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Dead space equation?
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VD = VT x (PaCO2 - PeCO2)/PaCO2
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Factors that shift O2-Hb dissociation curve to left?
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Decreased PCO2, temperature, H+, 2,3-DPG
Fetal Hgb Decreased metabolic needs |
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Factors that shift O2-Hb dissociation curve to right?
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Increased PCO2, temperature, H+, 2,3-DPG
High altitude Increased metabolic needs |
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What does pulmonary HTN result in?
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Atherosclerosis, medial hypertrophy, and intimal fibrosis of pulmonary artery
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Cause of primary pulmonary HTN?
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Inactivating BMPR2 mutation (normally inhibits vascular smooth muscle proliferation)
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Secondary causes of pulmonary HTN?
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COPD
Mitral stenosis Recurrent thromboemboli Autoimmune disease L to R shunt Sleep apnea or high altitude |
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Diffusion equation?
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Vgas = A/T x Dk(P1-P2)
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Perfusion limited gases?
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O2 (normal lung), CO2, N2O
Gas equilibrates early along the length of the capillary. Diffusion only increases if blood flow increases. |
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Diffusion limited gases?
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O2 (emphysema, fibrosis), CO
Gas does NOT equilibrate by the time blood reaches the end of the capillary. |
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Cardiac finding in people living in high altitude?
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RV hypertrophy (due to chronic hypoxic pulmonary vasoconstriction)
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General resistance equation?
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R = (8nl) / (pi) (r^4)
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Pulmonary vascular resistance equation?
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PVR = (P pulm artery - P L atrium) / cardiac output
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Deoxygenated Hb level for cyanosis to appear?
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Deoxygenated Hb > 5 g/dL
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Alveolar gas equation?
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PAO2 = PIO2 - PACO2/R
... = 150 - PACO2/0.8 |
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Where in the lung is V/Q ratio the highest?
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Highest in the apex (V/Q ~ 3)
(wasted ventilation) Base of the lung: V/Q ~ 0.6 (wasted perfusion) |
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What happens to the V/Q ratio with exercise?
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V/Q approaches 1
- vasodilation of the apical capillaries |
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What is the Haldane effect?
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Lungs: Oxygenation of Hb promotes dissociation of H+ from Hb --> shifts equilibrium toward CO2 formation --> CO2 released from RBCs and into alveoli
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What is the Bohr effect?
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Peripheral tissue: H+ from tissue metabolism shifts the curve to the right --> helps O2 unload
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3 forms of transport of CO2?
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1. HCO3 (90%)
2. Carbaminohemoglobin (bound to N terminal of globin) (5%) 3. Dissolved CO2 (5%) |
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What are the hilar nodes in sarcoid hilar lymphadenopathy referred to as?
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Potato nodes
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What can eosinophilic granuloma (histiocytosis X cause) in the lung?
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Interstitial lung disease - restrictive lung disease
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Drugs that can cause interstitial lung disease?
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Bleomycin, Busulfan, Amiodarone, Cyclophosphamide, Methotrexate, Nitrofurantoin, Nitrosourea
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Most abundant time of surfactant production?
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After 35th week of gestation
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Complication of neonatal respiratory distress?
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Persistent low O2 tension leads to risk of PDA
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Complication of therapeutic supplemental O2 in neonates?
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Retinopathy of prematurity and bronchopulmoary dysplasia
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CXR appearance of neonatal RDS?
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"Ground-glass" appearance
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Risk factors for neonatal RDS?
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- Prematurity
- Maternal diabetes (insulin decreases surfactant production) - Cesarean delivery (decreased glucocorticoid release) |
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Treatments for neonatal RDS?
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Maternal steroids before birth
Artificial surfactant for infant Thyroxine |
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Cause of initial damage in ARDS?
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Neutrophilic substances that are toxic to alveolar wall, activation of coagulation cascade, and O2-derived free radicals
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Criteria for ARDS?
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1. Non-cardiogenic pulmonary edema (wedge < 18)
2. Bilateral infiltrates on CXR 3. PaO2/FiO2 < 200 |
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Types of emboli?
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Fat
Air Thrombus Bacteria Amniotic fluid Tumor |
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Tests to diagnose PE?
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Helical CT, CT angio, V/Q scan, D-dimers
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What is Homans' sign?
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Resistance/pain/tenderness in calf muscle with dorsiflexion of the foot
- seen with DVT |
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What is the Reid index?
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Gland depth divided by total thickness of bronchial wall
> 50% in COPD (hypertrophy of mucus-secreting glands in bronchioles) |
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Clinical findings in COPD?
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Wheezing, crackles, cyanosis (shunting), late onset dyspnea
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Findings in paraseptal emphysema?
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Associated with bullae that can rupture and cause spontaneous pneumothorax
Often occurs in young, healthy males |
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What are Curschmann's spirals?
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Shed epithelium from mucus plugs
- Seen in asthma |
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Pathology of asthma?
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Bronchial hyper-responsiveness --> causes reversible bronchoconstriction with smooth muscle hypertrophy
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Clinical findings in emphysema?
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Dyspnea, decreased breath sounds, tachycardia, LATE onset hypoxemia (loss of capillary beds and alveolar walls), EARLY onset dyspnea
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What is bronchiectasis associated with?
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Bronchial obstruction, CF, poor ciliary motility, Kartagener's
--> can develop aspergillosis |
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Pneumoconiosis that affects lower lobes?
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Asbestosis
Coal miner's and silicosis both affect UPPER lobes. |
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What do asbestos bodies look like?
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Golden-brown fusiform rods (dumbbell-like), coated with ferritin, located inside macrophages
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Disease with "dust cells" and "black lung"? Complications?
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Coal miner's lung (anthracosis)
Complications: cor pulmonale, Caplan's syndrome |
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What happens to the pleura with asbestosis?
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Develop "ivory white" calcified pleural plaques
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Interaction of silica with macrophages?
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Macrophages respond by releasing fibrogenic factors --> fibrosis
- Silica disrupts phagolysosomes/impairs macs --> susceptible to TB |
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Associations with sleep apnea?
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Obesity, loud snoring, systemic/pulmonary HTN, arrhythmias, big tonsils, nasal septum deviation, possible sudden death
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Fremitus is increased in what?
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Lobar pneumonia
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Causes of tracheal deviation?
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Bronchial obstruction (w/ resorption atelectasis): deviates toward side of lesion
Tension pneumothorax or severe pleural effusion (w/ compression atelectasis): deviates away from side of lesion |
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Common metastases TO lung?
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Breast, colon, prostate, bladder, renal
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Common sites of metastasis FROM lung?
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Adrenals, brain, bone, liver
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"SPHERE" of complications of lung cancer?
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Superior vena cava syndrome
Pancoast's tumor Horner's syndrome Endocrine (paraneoplastic) Recurrent laryngeal symptoms (hoarseness) Effusions (pleural/pericardial) |
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Most common cause of superior sulcus tumor?
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Squamous cell
- also central, linked to smoking |
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Most common lung cancer in non-smokers?
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Adenocarcinoma
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Where does adenocarcinoma develop?
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Peripheral areas
- often in site of prior pulmonary inflammation or injury |
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Highly anaplastic undifferentiated tumor?
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Large cell carcinoma
- often found peripherally - pleomorphic giant cells with leukocyte fragments in cytoplasm |
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Neoplasm of neuroendocrine Kulchitsky cells?
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Small (oat) cell carcinoma
- undifferentiated can be very aggressive |
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Main difference between first and second generation H1 blockers?
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Second generation: far less sedating (decreased CNS entry)
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Names of first and second generation H1 blockers?
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1st gen: Diphenhydramine, dimenhydrinate, chlorpheniramine
2nd gen: Loratadine, fexofenadine, desloratadine, cetirizine |
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Common bugs in lung abscesses?
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S. aureus or anaerobes
- sometimes Prevotella, Fusobacterium, Klebsiella |
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What is Guaifenesin?
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An expectorant that removes excess sputum but does not suppress the cough reflex
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Most common causes of lung abscess?
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Bronchial obstruction (ie: cancer) or aspiration of oropharyngeal contents (esp alcoholics and epileptics)
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Common causes of bronchopneumonia?
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S. aureus, H. flu, Klebsiella, S. pyogenes
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Most common causes of interstitial (atypical) pneumonia?
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Viruses (RSV, adenovirus), Mycoplasma, Legionella, Chlamydia
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Mast cell stabilizer for prophylaxis of asthma attacks but NOT effective during an acute attack?
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Cromolyn
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Mechanism of Beclomethasone and Prednisone for asthma?
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Inhibit cytokine production, inactivate NF-kB (induces TNF-alpha)
- 1st line therapy for chronic asthma |
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Zileuton vs Zafir/Montelukast?
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Zileuton: inhibits production of leukotrienes
Zafir/montelukase: block leukotriene receptors - especially good for aspirin induced asthma |
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Theophylline mechanism and AE?
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Inhibit phosphodiesterase --> increase cAMP --> bronchodilation
- AE: cardio and neurotoxicity |
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AEs of Salmeterol?
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Tremor and arrhythmia
(long acting beta2 agonist) |
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Muscarinic antagonists and theophylline inhibit the actions of what and what?
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Muscarinic antagonists: inhibit ACh action
Theophylline: inhibit adenosine action - ACh and adenosine normally cause bronchoconstriction |