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132 Cards in this Set
- Front
- Back
What is the formula for the alveolar-arterial gradient?
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PAO2 = % O2 (713 mm Hg) + (arterial PCO2/0.8)
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What does hypoxemia of pulmonary origin do to the A-a gradient?
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increases
(NOTE: gradient normally increases with age) |
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What is a medically significant value for the A-a gradient?
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30 mm Hg
(NOTE: ideal gradient value is 5 mm Hg) |
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What are four causes of hypoxemia with an increases A-a gradient?
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1) Ventilation defect
2) Perfusion defect 3) Diffusion defect 4) Right to left shunt |
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What are three causes of hypoxemia with a normal A-a gradient?
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1) Depression of respiratory center in the medulla
2) Upper airway obstruction 3) Chest bellows (muscles of respiration) dysfunction |
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What volumes are not directly measured by spirometry?
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TLC, FRC, RV
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What is the normal FEV1/FVC?
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4-5 L
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How do you calculate RV?
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FRC - ERV
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In a flow-volume loop, what is seen in obstructive disease?
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expiratory curve shifts to the left of the normal curve, increasing both TLC and RV
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In a flow-volume loop, what is seen in restrictive disease?
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expiratory curve shifts to the right of the normal curve, decreasing both TLC and RV
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What is Choanal atresia?
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bony septum between nose and pharynx; newborn cannot breathe through nose and turns cyanotic when breast-feeding
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What are the most common type of nasal polyps in adults?
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IgE-mediated allergic polyps
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What is the clinical triad association with nasal polyps?
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aspirin, asthma, nasal polpys
(NOTE: Nasal polyps in child, order sweat test to rule out cystic fibrosis) |
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What is Obstructive sleep apnea (OSA)?
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excessive snoring with intervals of breath cessation (apnea)
(NOTE: obesity is a very common cause of it) |
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What lab findings are associated with OSA?
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apnea causes respiratory acidosis and hypoxemia
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What is a serious complication associated with OSA?
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pulmonary hypertension leading to right ventricular hypertrophy (AKA cor pulmonale)
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What is the confirmatory test for OSA?
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Polysomnography (a sleep study)
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Where are the common locations for sinus infections in adults and in children?
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maxillary in adults
ethmoid in children |
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What is the most common cause of sinusitis?
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Viral upper respiratory infection; reason why antibiotics not recommended
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What is the most common bacterial pathogen causing sinusitis?
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Streptococcus pneumoniae
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What is the most sensitive test for diagnosing sinusitis?
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CT scan (especially if surgery is recommended)
(NOTE: Gold standard for bacterial culture is sinus aspiration) |
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What is the pathogenesis of sinusitis?
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Blockage of sinus drainage in nasal cavity
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What is nasopharyngeal carcinoma associated with?
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EBV
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What is the most common cause of laryngeal carcinoma?
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smoking
(NOTE: HPV virus type 6 and 11 associations) |
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What are common clinical findings with laryngeal carcinoma?
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persistent hoarseness bc most are on the true vocal cords
(NOTE: majority are squamous cell carcinomas) |
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What are three kinds of atelectasis?
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1) Resorption
2) Compression 3) Surfactant loss |
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What is the most common cause of a fever 24-36 hr post surgery?
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Resorption atelectasis bc airway obstruction by thick secretions prevents air from reaching alveoli and mucus plugs form after surgery
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What are two examples of compression atelectasis?
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1) tension pneumothorax where air compresses lung
2) pleural effusion |
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What cell type synthesizes surfactant?
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type II pneumocytes
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What increases and what decreases surfactant?
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increases: cortisol and thyroxine
decreases: insulin |
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What causes Respiratory Distress Syndrome in infants?
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decreased surfactant in lung caused by:
1) Prematurity (b4 28th week) 2) Maternal diabetes (fetal hyperglycemia with increased insulin) 3) Cesarean section (lack of stress induced increase in cortisol from vaginal delivery) |
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How can you induce increased fetal surfactant?
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maternal intake of glucocorticoids
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What are some clinical findings with RDS?
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grunting, tachypnea, intercostal retractions, "ground glass" appearance on chest x-ray
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What are some complications of RDS?
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blindness (free radical damage from O2 therapy), bronchopulmonary dysplasia (damage to small airways), hypoglycemia in newborns bc excess insulin in response to fetal hyperglycemia)
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What is the most common cause of pulmonary edema?
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Left heart failure
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What is a form of noncardiogeniic pulmonary edema?
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Acute respiratory distress syndrome (ARDS)
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What are some risk factors associated with ARDS?
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Gram (-) sepsis (40%), gastric aspiration (30%), trauma with shock (20%), hantavirus, heroin, acute pancreatitis, etc
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What is the pathogenesis of ARDS?
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acute damage to alveolar capillary walls and epithelial cells
alveolar macrophages release cytokines |
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What do the neutrophils damage in ARDS?
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type I and II pneumocytes
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How can you distinguish cardiogenic pulmonary edema vs noncardiogenic pulmonary edema?
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PA wedge pressure <18 mm Hg
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What causes the increase in A-a gradient with ARDS?
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intrapulmonary shunting
diffusion abnormalities (capillary damage causes leakage of protein rich exudate producing hyaline membranes) |
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What is the most common cause of typical community-acquired pneumonia?
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Streptococcus pneumoniae
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What is bronchopneumonia?
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begins as acute bronchitis and spreads locally into the lungs
lung has microabscesses present in areas of consolidation |
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What will you see clinically with typical pneumonia?
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sings of consolidation (alveolar exudate)
(NOTE: gold standard for diagnosis is chest x-ray) |
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T/F: Positive gram stain is more useful than bacterial culture
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true
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What is the most common cause of atypical pneumonia?
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Mycoplasma pneumoniae
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Do you see alveolar spaces with exudate in atypical pneumonia?
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No, free of exudate
You see a patchy interstitial pneumonia and mononuclear infiltrate |
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What is the most common source of infection in nosocomial pneumonia?
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respirators
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What is the gram negative pathogen associated with respirator infection?
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Pseudomonas aeruginosa
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What is the most common pathogen causing pneumonia in AIDS?
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Pneumocystis jiroveci
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What is the acid-fastness of TB stain due to?
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Mycolic acid
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What is the TB virulence factor?
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Cord factor
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Does PPD test distinguish active from nonactive TB?
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No
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Where does primary TB affect?
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upper part of lower lobes or lower part of upper lobes
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Where does reactivation TB affect?
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upper lobe cavitary lesions
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What are some clinical signs of TB?
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drenching night sweats, fever, weight loss
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What is the most common extrapulmonary site in TB?
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kidney
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What is TB in the vertebra called?
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Potts disease
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What is the most common TB in AIDS?
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Mycobacterium avium-intacellulare complex
(NOTE: occurs when CD4 counts < 50) |
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What are lung abscesses most often due to?
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aspiration of oropharyngeal material
(NOTE: risk factors include dental work, alcoholism) |
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What is the most common site for aspiration?
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Superior segment, right lower lobe
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What is the most likely source of pulmonary thromboembolism?
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femoral vein (95%)
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What protects the lungs from infarction?
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bronchial arteries
(NOTE: pt with normal bronchial artery flow, only 10% of pulmonary embolus will produce infarction) |
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Where do the bronchial arteries arise from?
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from aorta and intercostal arteries
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What is a large embolus occluding the main branches of the pulmonary artery?
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saddle embolus, which is associated with sudden death
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What is the diagnosis standard for PE?
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V/Q scan + d-dimer; also spiral CT
(NOTE: normal ventilation scan, abnormal perfusion scan, increased d-dimers) |
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What is the main cause of secondary pulmonary hypertension (PH)?
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respiratory acidosis and hypoxemia
(NOTE: chronic respiratory acidosis can be caused by chronic bronchitis or obstructive sleep apnea) |
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What is a common pathological finding of PH?
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atherosclerosis of main pulmonary arteries
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What is the most common clinical symptom with PH?
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exertional dyspnea
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What is Cor pulmonale?
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PH + RVH
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What is clinically seen with Goodpasture's syndrome?
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hemoptysis followed by renal failure
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What is the earliest manifestation of interstitial fibrosis leading to restrictive lung disease?
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alveolitis
(leukocytes release cytokines, which stimulate fibrosis) |
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What do you see in lung compliance and elasticity with restrictive lung disease?
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decreased compliance
increased elasticity |
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What is the definition of pneumoconioses?
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inhalation of mineral dust into the lungs leading to interstitial fibrosis
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Where does a particle size of 1-5 um settle? How about < 0.5 um?
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1-5 um = bifurcation respiratory bronchioles and alveolar ducts
0.5 um = alveoli |
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What is the source of Coal worker's pneumoconiosis (CWP)?
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anthracotic pigment (carbon pigment from breathing dirty air of coal mines, large urban centers, tobacco smoke)
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What are alveolar macrophages with anthracotic pigment called?
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dust cells
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What is complicated CWP referred to as?
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Black lung disease (progressive massive fibrosis)
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T/F - There is no increased risk for incidence of TB or primary lung cancer with CWP
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True
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Caplan syndrome can occur with CWP. What is it?
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pneumosoniosis and cavitating rheumatoid nodules
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What is the most common occupational disease in the world?
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Silicosis
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What is silicosis?
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chronic exposure to quartz (crystalline silicone dioxide) often in foundries, sandblasting, working in mines
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What is the pathogenesis of silicosis?
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Quartz is higly fibrogenic and activates alveolar macrophages to release cytokines that stimulate fibrogenesis
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T/F There is no increased risk for developing lung cancer and TB with silicosis
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False
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Where do asbestos fibers deposit into?
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Respiratory bronchiles, alveolar ducts, alveoli
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What are ferruginous bodies?
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iron coated asbestos fibers
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What is the most common asbestos related cancer?
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Bronchogenic carcinoma
(NOTE: risk further increases in smokers) |
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What is an asbestos-related disease that has no etiologic relationship with smoking and arises from serosa of lung pleura?
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Malignant mesothelioma
(NOTE: occurs 25-40 years after first exposure) |
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Is there risk for TB in patients with asbestos?
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No
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T/F - In patients exposed to the nuclear or aerospace industry, berylliosis does not increase risk for lung cancer.
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False
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What is the most common noninfectious granulomatous disease of the lungs?
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sarcoidosis (accounts for 25% of cases of chronic interstitial lung disease)
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What is the likely pathogenesis of sarcoidosis?
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CD4 TH cells interact with unknown antigen, which releases cytokines causing the formation of noncaseating granulomas
(NOTE: skin nodules on pts. will have granulomas on biopsy) |
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What is the most common noninfectios granulomatous disease of the liver?
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Sarcoidosis
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What is a nonspecific lab finding in pts with sarcoidosis?
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increase ACE (60%)
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What can the hypercalcemia in sarcoidosis be caused by?
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increased synthesis of 1-alpha hydroxylase in granulomas (hypervitaminosis D)
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What is the pathogenesis of idiopathic pulmonary fibrosis?
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repeated cycles of alveolitis trigger unknown
lung has honeycomb appearance |
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What are three Collagen vascular diseases associated with interstitial fibrosis?
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systemic sclerosis, SLE, RA
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If you have young female pt with pleural effusion, consider this?
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SLE (Interstitial lung disease occurs in 50% of patients)
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What is the antigen causing hypersensitivity pneumonitis in farmers lung?
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thermophilic actinomyces in moldy hay
(NOTE: Farmer's lung is type III and chronically type IV HYP) |
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What is Silo filler's disease?
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immediate HYP associated with inhalation of gases (oxides of nitrogen)
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What is Byssinosis?
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Contact with cotton, linen, hemp products produces HYP
Workers feel better over weekend bc no exposure, then develop depression on Mondays bc symptoms returns "Monday blues" |
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What drugs are commonly associated with interstitial fibrosis?
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amiodarone, bleomycin, cyclophoshamide, methotrexate
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What does emphysema target?
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respiratory bronchioles, alveolar ducts, alveoli
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What is the most common cause of emphysema?
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smoking
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What happens to compliance and elasticity in emphysema?
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increased compliance and decreased elasticity
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What is the pathogenesis of cigarette smoke in emphysema?
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acts as a chemotactic to neutrophils; releases free radicals and elastases; inactivates AAT and glutathione
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What does the destruction of the elastic tissue cause in emphysema?
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loss of radial traction and the small airways collapse
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Where is the destruction occuring in centriacinar emphysema?
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distal terminal bronchioles and upper lobe
(most common type in smokers) |
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Where is the destruction occuring in panacinar emphysema?
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distal terminal bronchiloles and the entire respiratory unit; lower lobe
(most common type in AAT deficiency) |
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What do you see in a serum protein electrophoresis with panacinar emphysema?
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absent alpha-1 globulin peak
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What are some things you see on chest x-ray with emphysema?
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increased AP diameter, vertically oriented heart, depressed diaphragms
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What do you see with lung volumes and ABG's in emphysema?
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increased TLC, RV; decreased FEV1/FVC; decreased PCO2 (respiratory alkalosis)
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What does paraseptal emphysema put you at risk for?
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spontaneous pneumothorax
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What is irregular emphysema associated with?
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scar tissue, does NOT produce obstructive airway disease
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What is definition of chronic bronchitis?
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productive cough at least 3 months for 2 consecutive years
(NOTE: smoking is most common cause) |
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What kind of acid/base disturbance is seen in chronic bronchitis?
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chronic respiratory acidosis and metabolic alkolosis
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What is a basic definition of asthma?
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episodic and reversible airway disease
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What type of hypersensitivity is extrinsic asthma? Intrinsic asthma?
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Extrinsic is Type 1 HYP
Intrinsic is nonimmune |
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What role do IL-4 and IL-5 play in the pathogenesis of asthma?
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IL-4 stimulates isotype switching to IgE production
IL-5 stimulates production & activation of eosinophils |
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What do eosinophils release?
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major basic proteins and cationic protein that damage epithelial cells & airway constriction
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What are LTC-D-E4?
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Potent bronchoconstrictors
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What are curschmann spirals?
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spiral shaped mucus plugs that are shed in epithelial cells
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What do crystalline granules in eosinophils coalesce to form?
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Charcot-Leyden crystals
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What does someone with bronchial asthma initially present with? (think acid/base)
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Respiratory alkalosis bc of the increased breathing efforts
(progress to respiratory acidosis if does not improve) |
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What is the definition of bronchiectasis?
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permanent dilation of the bronchi and bronchioles
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What is the most common cause of bronchiectasis?
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cystic fibrosis (CF)
(NOTE: most common fatal hereditary disorder in whites in US) |
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What is clinically seen in patients with broncheictasis?
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productive cough (sometimes cupfuls of sputum) and hemoptysis
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What is the genetics of CF?
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AR and 3 nucleotide deletion on chrom 7 coding for phenylalanine
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Where is the defective CFTR Cl- degraded in?
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golgi apparatus due to defectvie protein folding
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What are some clinical associations with CF?
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Nasal polyps
respirtory infections (most common cause of death in CF) malabsorption and type 1 diabetes infertility, esp in males meconium ileus and rectal prolapse |
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How can you screen infants for CF?
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immunoreactive trypsin increased levels at birth
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What is a diagnositc test for CF?
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sweat test (>60 in children and >80 in adults)
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