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1
Q

Which pneumocytes produce surfactant

A

T2

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2
Q

Max development of surfactant IuL

A

35th week

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3
Q

HMD treatment

A

Mild- CPAP

Severe- IMV+ surfactant replacement

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4
Q

Types and pathology of PAP

A

Impaired clearance of surfactant by macrophage

Primary- GMCSF Ab ( x macrophages)

Secondary- silicosis (x macrophages)

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5
Q

Investigations in PAP

A

BAL- Milky white/ PAS +

CXR- Diffuse fine reticulo-nodular infiltrates radiating from the hilum**

CT- CRAZY PAVING

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6
Q

MC bronchus for BXIS

A

Left main bronchus
(Horizontal, narrow—stasis of secretions-inflammation )

MC in babies

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7
Q

Mc lobe for aspiration overall/supine

A

RLL Superior&raquo_space; RUL Posterior

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8
Q

Mc lobe for aspiration standing/sitting

A

RLL Posterior

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9
Q

Mcc if hemoptysis

A

TB

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10
Q

Mcc if massive hemoptysis

A

BXIS

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11
Q

Massive hempotysis criteria

A

> 150ml/ episode

> 400-600ml/day

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12
Q

Mccd hemoptysis

A

Aspiration of blood clot

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13
Q

Mx persistent hemoptysis

A

Brochial artery embolization

Resection of affected lobe

Pulmonary artery embolization (rare)

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14
Q

Pneumocytes having dividing capability

A

T2

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15
Q

Majority of pneumocytes

A

T2

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16
Q

Pneumocytes covering maximum area of lung

A

T1

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17
Q

Airway obstruction is prominent during?

A

Expiration (exp wheeze)

Inspiration is an active process- can overcome obstruction easily comparatively

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18
Q

Factors preventing collapse of alveoli

During expiration

A

Elastase—(a1 antitrypsin)

Surfactant

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19
Q

Emphysema features

A

Early- bulla, air trapped in alveoli/ inc RV FRC TLV

Late-Complete encircling of inflammation—decreased oxygen transport to blood

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20
Q

Ideal o2 flow rate and sat for COPD

A

1-2L/min

88-92%

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21
Q

Mechanisms of hypoxia

A

VP mismatch (emph/pte)

Shunt (cardiac/pulmonary)
(Pulm= pneum/ILD/Fibrosis/Atelectasis—damaged alveoli)

Diffusion defect (T1RF)

Hypoventilation(T2RF)

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22
Q

Rx for Intra pulmonary shunt/ damaged alveoli

A

IMV

Supplementary oxygen doesnt work

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23
Q

DLCO normal range and formula

A

Inhaled CO-Exhaled CO

70-90%

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24
Q

Alveolar conditions causing decreased DLCO

A

Emphysema
ILD
Fibrosis
Pneumonia

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25
Blood conditions causing decreased DLCO
Anemia PHTN PTE
26
Increased DLCO?
PCV Alveolar haemorrhage** ASTHMA** (Eosiniphilic inflammation—increased NO production—inc vessel size) Exercise
27
V/P ration is a measure of? Max Min
Alveolar oxygen tension Max= apex Min= base (Max venti and max perfusion at BASE)
28
Tb 1° and 2° location
1= middle/lower zone (max ventilation) 2= apex (max v/q)
29
Volume at which outward recoil of chest equals inward recoil of lung?
FRC
30
FeV1 value
70-80%
31
FVC normal value
>80%
32
PEFR significance | MEFR significance
P= flow in large airways (air first moves out of large airways) —-ASTHMA M= average flow calculated during mid expiration (SMALL AIRWAY)—COPD/EMPHYSEMA
33
Measurement of RV
Helium dilution N2 washout Body plethysmograph ***
34
Obstructive LD spirometry
FeV1 decreases FVC normal RV = INCREASED*** Fev1/FVC = DECREASED
35
Restrictive LD spirometry
Fev1 DECREASED FVC DECREASED Fev1/FVC = normal/increased
36
Intrinsic RLD
Fibrosis ILD OLD SARCOIDOSIS*** RV/TLC= normal****** (As alveoli gone)
37
Extrinsic RLD
Kyphoscoliosis NM diseases (polio/GBS/MG/AL) Diaphragm palsy RV/TLC= INCREASES**** (RV normal/ TLC decreases)
38
Obstructive LD
Asthma COPD BXIS Bronchiolitis
39
Breathing sounds in Consolidation Cavity Large cavity
Tubular Cavernous Amphoric
40
Causes if rhonchi | Narrow lumen/free liquid/mucus
``` Asthma P. Edema COPD Foreign body Tumour ```
41
Increased vocal resonance is called
BRONCHOPHONY
42
Increased whispered sounds on steth?
PECTORLIQUOY
43
E—->A change in sound pronunciation
AEGOPHONY
44
Wheeze types
Monophonic- Tumor Polyphonic- COPD/ Asthma
45
Wheeze heard mainly during?
EXPIRATION | If during inspirtation—severe obstruction
46
Coarse crepts cause
BXIS | Airflow into secretions
47
Fine crepts cause
ILD Fibrosis Pneumonia P Edema (Popping of alveoli)
48
Velcro crepts due to?
Interstitial FIBROSIS | Aka cellophane crackles/ Bi-basilar
49
Stony dull note present in
Plef
50
No push pull lesion with positive breath sounds
Consolidation | AIRBRONCOGRAM++
51
Cf of HYDROPNEUMOTHORAX
Straight line (not meniscoid) Shifting dullness Succusion splash
52
T1RF PAO2 PaO2 PaCO2 A-a
Normal Decreased Normal>>increased (Good diffusion) A-a= INCREASED
53
T2RF PAO2 PaO2 PaCO2 A-a
Decreased Decreased Increased (RESP ACIDOSIS) Normal
54
T1RF causes
ILD Alveolar flooding (pneumonia/ards) Fibrosis PTE
55
T2RF causes- Hypoventilation / decreased respiratory effort | COPD
Central : brainstem injury/ narcotics Obstructive: COPD (mc) / FB Peripheral: NMJ Diseases Diaphragmatic injury
56
Rx RF
IMV (in T1) NIV (T2)
57
C/I NIV
UNCONCIOUS*** ``` Altered sensorium/ unco-op Cardiac arrest Hemo unstable Nasal sx Active GIBleed ```
58
ARDS Cardinal features
SOB Hypoxemia Pulmonary infiltrates Reduced lung compliance (HALLMARK= DAD)
59
Other names of ARDS
Shock lung Blast lung Traumatic wet lung
60
Direct causes of ARDS | FANTTS
``` Fat embolism Toxin Transplant (reperfusion injury) Near drowning Aspiration Severe Pneumonia ```
61
Indirect causes of ARDS
``` CABG High altitude Pancreatitis Narcotic poisoning Head injury Sepsis (mc) BT ```
62
Normal PCWP
6-12
63
Pcwp in Cardiogenic PE
>18 Interstitial edema 18-25 Alveolar edema >25
64
Which never occurs in T1 RF
HYPERCAPNEA
65
Berlin criteria for ARDS
Acute SOB Pul. Infiltrates Non cardiogenic PE PaO2/Fio2 < 300. Or. PaO2<60’mmHg
66
Criteria for Resp failure
PaO2 < 60 | PaCO2 > 45
67
Types of RF
1 Hypoxic 2 Hypercapneic 3 Peri-operative-Atelectasis-GA 4 Shock (Hypoperf of resp muscles)
68
Mild mod sever ards criteria
PaO2/FiO2 ``` 200-300 = mild 100-200 = mod <100 = sev ```
69
Rx ARDS
Low TV MV (4-6ml/kg/min) Adequate PEEP Steroids
70
Newer Rx ARDS
ECMO PRONE VENTILATION (12-16 hrs)- decreased diap compression of alveoli
71
Misc causes of ARDS | HELD
Hanging Eclampsia LF Renal failure
72
Presentation time of PTE
cin 2 weeks
73
Predisposing genetic factors for PTE
Protein C S def F5L mutation Hyper- Homocystinemia
74
R/F PTE
DVT (estrogen pills) Varicose veins Trauma Prolonged immobilization Pregnancy Malignancy Nephrotic syndrome (AT3 excretion)
75
Lung pathology PTE
HEMOPTYSIS Platelet thrombus—serotonin—BRONCHOSPASM LUNG ISCHEMIA (Pleuritis/Plef/dyspnea/tachypnea)
76
Mc sign and symptom of PTE
Sign TACHYPNEA | Syp DYSPNEA
77
Cardio Pathology of PTE
RVH—pushed septum in LV—decreased BP—shock
78
Cor pulmonale types | RV dysfn due to 1° resp cause excluding causes of keft heart
Acute—-PTE Chronic- COPD (mc)/ ILD / CF / OSA / BXIS
79
CXR Findings of COR PULMONALE
Kerley B lines (LAP > 20 then KBL++) Prominent ULobe veins Cardiac shadow B/L plef
80
Well’s scoring PTE | SAPHHaI-C
``` Signs and symptoms = 3 Alternative Diagnosis no? = 3 Prior PE/DVT = 1.5 Hemoptysis = 1 HR> 100 Immobilisation > 3 days or Sx cin 3wk =1.5 Cancer =1 ``` If >4 = CTA with contrast(IxoC) >>V/Q Scan
81
Low score Mx of PTE
D-dimer (95% sensitive) If positive. CTA Otherwise r/o PTE
82
ECG PTE
Mc= Sinus tachycardia Msp= S1Q3T3 2nd Mc = inv T wave in V1-4
83
CXR PTE
Mc = normal**** WESTERMARK SIGN (Focal oligaemia) HAMPTON HUMP (Wedge opacity) PALLAS SIGN (Dil. R descending Pul. Artery)
84
Other Ix PTE
ECG CXR LL usg (r/o DVT) D-dimer CTA (Ixoc) INVASIVE PUL ARTERIOGRAPHY (GST) V/Q scan (prenancy/RenalF/Contrast intol
85
Rx Massive PE | Shock+RV dysfn
500ml NS Vasopressors Anticoagulants Definitive: Thrombolysis >> sx embolectomy
86
Rx submassive(RV dysfunction) and Minimal PE (normal RV and BP)
S= > 70 years = Anticoagulant—Tlysis | < 70 years = Thrombolysis
87
Mcc of preventable hospital death/ Mccd in post sx patient
Acute PE
88
Anticoagulant? Thrombolysis? (Drugs)
Heparin bridge warfarin Heparin f/b dabigatran (DTI) Xa inhibitors Thrombolysis : Alteplase >> streptokinase
89
Rx Pul Edema
Furosemide + NTG sublingual (HR>100) F + NE/DP (HR<100/ Shock -) F + DOBUTAMINE (HR<100 / Shock +)
90
New tx for PTE
Catheter directed thrombolysis (CDT)
91
PHTN diagnosis
MPAP > 25 Pul.Vascular Resistance > 3 WOOD UNIT
92
PHTN sex and age predisposition
F>>M | Child bearing age
93
Mc symptom if PHTN
SOB
94
Initial Ix of PHTN
ECHO
95
Most accurate method of Ix
Pul. Artery Catheterization
96
WHO classification PHTN
1 DIRECT INVOLVEMENT 2 CARDIOGENIC 3 1° RESP D/O 4 Chronic Thromboembolic events 5 Miscellaneous
97
Group 1 causes PHTN
Genetic : BMPR2 gene (Inc BV smooth muscle) AID : Ssc >> RA , SLE Toxin : Rapseed oil/ Fenfluramine High Altitude
98
GROUP 3 causes PHTN
``` COPD BXIS ILD OSA Hypoventilation ``` (Hypoxia—vasoconstriction)
99
Group 5 causes PHTN
``` Sickle cell Sarcoidosis Langerhans cell histiocytosis Lymphangio leiomyomatosis Morbid obesity ```
100
Rx PHTN | P3EG
PDE5= Sildenaf/Taladafil ETRA= Ambrisentan/Bosentan Prostacyclin = Iloprost (i.n) Prostacyclin antagonist = Selexipag Guanyl Cyclase + = Riociguat
101
Emergency PHTN RX
I.v EPOPROSTENOL
102
Regimen PHTN
ETRA + PDE5 Fail? Add prostacyclin
103
Rx Airway remodelling in chronic untreated asthma
Bronchial thermoplasty
104
Main types of asthma
Atopic- Children/skin test+/ mild / IgE inc (Mcc= dermatophagoides) Idiosyncratic- Adults/ all normal/ severe
105
What structures does asthma involve
Large airway and small airway | NEVER ALVEOLI
106
Ix in Asthma
Spirometry (main)- Bronchodilator reversal PEFR variability in a day (>20%) Broncho-provocation by methacholine (fev1 dec by >20%)
107
Bronchodilator reversal % diagnostic of asthma
Fev1 increase by 12% or 200’ml
108
C/f status asthmaticus
``` SOB at rest Single words Hr > 120 Rr>30 B/l wheeze Accessory muscles Resp acidosis Pulsus paradoxus ```
109
Diagnosis of status asthmaticus
PEFR <50% of expected PaO2 < 60 SpO2< 90
110
Life threatening signs of SA
``` Altered sensorium Silent chest (collapsed bronchus) Dec resp effort (cyanosis) Bradycardia Pulsus paradoxus Hypotension ```
111
Rx status asthmaticus
O2 + SABA + SAMA (IpBro) + ICS I.v steroid Trial of MgsO4 Last resort- IMV : High flow (correct hypoxia)+ Prolonged expiratory time(dec hypercapnea)
112
Is inverse ratio ventilation useful in status asthmaticus?
No Normal I:E = 1:3 IRV= 2:1
113
Rescue Rx asthma
LDICS + LABA
114
Type of drugs in asthma
Controllers : SABA LABA SAMA (bronchodilators) Relievers : ICS LT (dec inflammation)
115
Step1-step 5 asthma mx
``` 1 - 2 LDICS + Anti LT 3 LDICS + LABA + Anti LT 4 MDICS+ LABA + Anti LT + Tiotropium 5 HDICS + LABA + Oral steroids + Tio ``` Fail? Anti IgE Anti IL5– MEPOLIZUMAB /RESLIZUMAB
116
DOC Exercise induced asthma
Short term : SABA Long Term : ICS RECOVERY TIME= 30 min
117
Samters triad
Asthma+ nasal polyp + aspirin sensitivity
118
AERD quatrad
Samters triad + Rhinosinusitis | Aspirin Exacerbated Respiratory Disease
119
Brittle asthma types
1- freq fluctuations/ HDICS+ oral steroids+ continuous B agonists 2- severe sudden anaphylaxis / inj ADR
120
Chronic bronchitis definition
Cough > 3 months for 2 consecutive years
121
C/f of chronic bronchitis
COUGH** : purulent/blood Cyanosis (BLUE BLOATERS) Pulmonary Edema (cor pulmonale-RVF) Crackles and wheeze OBESE
122
Chronic bronchitis index?
Reid Index Thickness of mucus/Thickness of bronchial wall
123
Type of failure in CB
T2RF (bronchioles get damaged, not enough PAO2) T2= Hypercapneic—-> RESP ACIDOSIS
124
DLCO in CB
NORMAL
125
Etiology Emphysema
Smoking (xElastase) A1 antitrypsin deficiency Pollution Coal exposure
126
A1AT Deficiency features
Chr 14 A/w Liver disease Young AOE Family H/o
127
Cf Emphysema
DYSPNEA** ``` Pursed lip breathing (accessory muscles) Pink skin (PINK PUFFER) Lean build (cachexia dt inc WOB) HOOVER SIGN (Paradox CW movement) Inc AP Diameter ```
128
Type of RF in emphysema
T1RF—-> normal paCo2—RESPIRATORY ALKALOSIS
129
Organisms responsible for acute exacerbation of COPD
Moraxella S. Pneumoniae H. Influenzae
130
Types of emphysema***
Centrilobular Panlobular Paraseptal Distal Acinar
131
Pan lobular v/s Centrilobular (mc)
All resp tree. Central bronchioles Lower Lobe. Upper Lobe + Up LL A1AT. Smoking
132
GOLD Staging COPD (Fev1)
Mild >80% Mod 50-80 Sev 30-50 Vsev <30
133
Prognostic index COPD | BODE
BMI Obstruction Dyspnoea Exercise Capacity (6MWT)
134
Rx COPD | STOP-BASS M
Smoking cessation Tx (ILD>> COPD) O2 PDE5 (ROFUMILAST- dec inflammation) Bronchodilator(LAMA>LABA) Abx (Azithro—against H.infl—mc in exacerbations) Sx (bullectomy—c/I in diffuse emph) Steroids (systemic+ ics) Mucolytics (N Acetyl Cysteine)
135
Bronchodilators in COPD Drugs
LABA- Indacetrol, Olodetrol LAMA- Tio Umclinidium Glycopyrronium
136
Best modality to reduce mortality in COPD
Low flow O2 | 14-15 hr/day
137
COPD ABCD Rx
``` A- SABA/SAMA B-LABA/LAMA C-LAMA D-LAMA——fail—-LAMA+ LABA —-asthma?—-LABA+ ICS ``` + ROFULMILAST + AZITHROMYCIN
138
BXIS vicious cycle
Initiating event—Abn clearance of airway secretions—stasis and obst—Infection and inflammation (PSEUDOMONAS)—destruction and dilatation of airway—abn clearance—
139
Three layered sputum in BXIS
Serous—Mucus—-Pus
140
C/f BXIS
Mc- PRODUCTIVE COUGH Coarse crepts Dilated airway
141
Mccd BXIS
RHF | Cor pulmonale
142
Etiology of BXIS | GOBII
OBSTRUCTION BRONCHIAL INJURY TRACTION BXIS GENETIC IDIOPATHIC
143
Obstructive causes of BXIS
Intraluminal: Cancers / Carcinoid / FB Extraluminal: TB lymph node—RML collapse = BROCKS SYNDROME (BXIS + RML Collapse)
144
Bronchial injury causes BXIS
Infection : TB Adenovirus Bacterial CTD: SLE RA Ssc
145
Genetic causss BXIS
Yellow nail syndrome (cong lymphedema+ plef + yellow nails) BXIS Sicca (KARTAGENER)— Situs+polyp+BXIS CF WILLIAM CAMPBELL SYN (Airway cartilage defect)
146
Lobes of BXIS preference
LL>>RML>>Lingula
147
Diseases and lobes | PACTS CM ICI
UL) Post Radiation / AnkSpond / ABPA / CF / TB / Sarcoidosis ML) Ciliary Dyskinesia / Myco Avium LL) IPF (busalfan, bleomycin) /Chronic Aspiration/ Idio BXIS/ SLE/ RA
148
Ix BXIS
Volumetric multidetector CT >> HRCT
149
HRCT App of BXIS
Tram track/Tree bud/ Bronchial wall thickening
150
Rx BXIS
Airway clearance- mucolytics + physio Abx (during exacerbations) O2 (if hypoxia) Resection (If localized) Tx (if diffuse)
151
Prophylactic abx in BXIS
Inhaled : Colistin/ Genta/ Tobra | Oral : FQ/ Azithro
152
Eosinophilic lung diseases pathology wise classification
UNKNOWN: AEP/ CEP / Hyper Eosinophilic syndrome / Churg -Strauss KNOWN: Loffler syndrome (parasite infection) / ABPA / Drugs (NSIP) / TPE NSIP= Nitrofurantoin Sulfonamide INH Penicillamine
153
TPE cause
Lymphatic filariasis +++ D/t immune reaction to filariae
154
TPE c/f
Paroxysmal wheeze/cough Eosinophilia > 3000 CXR- Diffuse miliary lesions MOTTLED OPACITIES Restrictive LD spirometry Microfilaria ABSENT on PBS (Cleared in lungs only)
155
Triad of Idiopathic Pulmonary Hemosiderosis
IDA + HeMoptysis + Alveolar infiltrates RECURRENT EPISODES OF. DAH (Alveolar capillary tortuosity)
156
AEP v/s CEP
``` Smokers. - - Asthma + - Peripheral Eo+ >25%. > 40% eosi on BAL RespF+ - ```
157
Radiological features of CEP
REVERSE BAT WING APP PHOTOGRAPHIC NEGATIVE OF P. EDEMA
158
ABPA HSr
1 3 4
159
Ix ABPA
(H/o asthma OR CF) Peripheral Eosinophilia (1000ng/ml) SKIN TEST + for aspergillus fumigatus Aspergillus sensitive IgE and IgG CXR= UPPER ZONE INFILTRATES CT= Para hilar BXIS (central)
160
Cf ABPA
Hemoptysis Bronchispasm BXIS
161
Rx ABPA
Steroids | Itraconazole
162
INVASIVE PULMONARY ASPERGILLOSIS | CT findings
(Trans bronchial angio-invasion) Active phase : Halo sign (centre fungus- peripheral blood) Recovery phase : Air crescent sign( immunity clearing the central fungus) Rx VORICONAZOLE
163
Aspergilloma other name and CT finding + rx
Saprophytic Pulmonary Aspergillosis CT- 1) Monads sign ( crescent) 2) shifting ball on decubitus Rx- resection
164
Which conditions can aspergilloma be present in
TB Sarcoidosis Histoplasmosis
165
Hypersensitivity Pneumonitis features
D/D ABPA or Asthma Aka Extrinsic Allergic Alveolitis HSR 3,4 NO PERIPHERAL EOSINOPHILIA Skin test +ve for aspergillus Ag
166
Biopsy of HS Pneumonitis
Non caeseating GRANULOMAS Cellular bronchiolitis Inflammation of INTERSTITIUM
167
Diagnostic criteria for HSPneumonitis
Serum precipitins against known Ag Inspiratory creeps Weight loss Infection + on re-exposure Occurrence of symptoms in 4-8 hours Exposure to known Ag
168
Farmers lung? | Source and organism
Mouldy hay- Micropolyspora faeni
169
Hot tub lung?
HSPneumonitis d/t mycobacterium avium Source- contaminated h2o
170
Bagassosis lung?
Sugarcane dust— Thermoactinomyces sacchari
171
Malt worker lung?
Mouldy barley—— Aspergillus clavatus
172
Bird fancier’s lung?
Pigeon excreta—- Avian protein
173
Etiology ILD
INHALATIONAL (Organic-HSPneumonitis ; Inorganic-Silica ,Asbestos) DRUGS (NABB) (Nitrofurantoin/ Amiodarone / Bleomycin /Busalfan) AID (SLE/RA/Ssc) ``` SYSTEMIC DISEASES (Sarcoidosis/IBD) ``` IDIOPATHIC (mc)
174
Clf ILD
Progressive dyspnea End expiratory Bi-basilar fine crepts**
175
Types of ILD | CAR LUND
UIP (aka IPF) NSIP ( Non specific) AIP (Acute) COP (Cryptogenic Organising) Respiratory Bronchiolitis ILD LIP (Lymphocytic) DIP (Desquamative)
176
ILD IxOC
HRCT GGO(early)—-> Consolidation(late)—-> Interstitial Fibrosis——> Traction BXIS——-> ADVANCED ILD
177
Features of ADVANCED ILD
Honeycombing Sub-pleural involvement Worst prognosis ( inc chance of PNTx)
178
C/f UIP Vs NSIP
``` M. F. Smoker. Non smoker Chronic. Sub-acute Clubbing+. Clubbing+ Fine crepts. Fine crepts. ```
179
Biopsy UIP vs NSIP
Fibroblastic foci. Rare | Heterogeneous. Lymphocytic
180
CT UIP vs NSIP
Honeycombing+. Rare Low zone GGO Taction BXIS (both)
181
Rx UIP
PIRFENIDONE** Ninentanib
182
Rx NSIP
STEROIDS
183
HAMAN RICH SYNDROME??
AIP SOB+ Hypoxemia+ diffuse infiltrates High mortality
184
Massons’s bodies seen in?
COP Accumulation of granulation tissue B/L consolidation Rx STEROIDS
185
ILD s a/w smoking
``` UIP RBILD DIP LCH Pulm Hemorrhage syndrome ```
186
ILD rare in smokers
Sarcoidosis HSPneumonitis
187
Sarcoidosis main feature?
Multi system disorder with non caeseating granulomas
188
Etiology sarcoidosis?
TB AID Propioniibacterium**
189
MC site of involvement of Sarcoidosis
Lungs
190
Scadding staging of Lung (Sarcoidosis)
1 Hilar LN B/L 2 Lung infiltrates + Hilar LN 3 Lung infiltrates only 4 Fibrosis CAVITATION IS NEVER SEEN IN SARCOIDOSIS
191
Sarcoidosis syndromes
LUPUS PERINIO (Rash under eyes and cheek) LOFGREN SYNDROME—good px (ENL+ Uveitis+ Arthritis + Hilar LN) HEERFORDT SYNDROME (Uveitis+Parotiditis+CN7 palsy+ Fever) (
192
Ix Sarcoidosis
CBC- Lymphopenia (sequestration of lymphocytes in lung) S.ACE- Increased*** Vit D- Increased—Hypercalcemia CT- Uniform hilar lymphadenopathy (TB= central necrosis) BAL***- CD4/CD8 ratio increase (NOT BLOOD) Ixoc= BIOPSY- NC GRANULOMAS GALLIUM SCAN- 1) Panda sign (parotid&lacrimal gland) 2) Lambda sign (Mediastinal LN) KVIEM SLITZBACH TEST (Skin test-anergy test)
193
Rx sarcoidosis
Self resolution (asymptomatic) HCQ/Steroids/Mtx (symptomatic)
194
Mc OLD
Silicosis
195
Malignancy OLD order
Asbestosis > silicosis > cwp
196
1st symptom in byssinosis
Chest tightness
197
Asbestosis occupation
Ship building Construction
198
Silicosis occupation
Sand blasting Stone crushers
199
Asbestosis radiology
Lower zone Fibrosis HOLLY LEAF APPEARANCE** Pleural plaques (msp but asymptomatic) Benign plef*
200
Asbestosis Cx
Mesothelioma—pleural+ peritoneal (msp) | Lung Ca- Adenocarcinoma / SCC Smoking is a synergist
201
Silicosis radiology
Upper zone nodules—-merge—PMF Egg shell calcifications with B/L Hilar lymphadenopathy
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Silicosis cx
Silico-TB Lung Ca SLE, Ssc
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CWP Radiology
Upper zone lesions—merge —-PMF
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CWP cx
COPD CAPLAN syndrome (RA + silica/coal) Never CANCER*****
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Silicosis D/D
PAP
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Apnea vs hypopnea
> 10s no breathing >30% reduction in airflow a/w >3% fall in SpO2
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Types of Sleep Apnoea Syndromes
Central Sleep Apnoea (CSA) (No effort/ CHF, Narcotic use) Obst Sleep Apnoea (OSA) (Obesity/ inc effort/ upper airway close/ SNORING**)
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Pathophysiology OSA
Apnea—hypoxia—p. Vasoconstriction—PHTN Apnea—Arousal—catecholamines—CAD/MI/Stroke/ Uncontrolled glycemic status/ arrythmias/ SCD Apnea—arousal—decreased sleep— behaviour changes/RTA/Depression
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R/f OSA
Obesity Acromegaly ( large tongue) Males Cranio-facial abnormalities
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IxOC OSA
POLYSOMNOGRAPHY (sleep study)
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Rx OSA
Depends upon episodes < 5 = normal 5-14 = LSM 15-30 = CPAP (mxoc) > 30 = CPAP/ Sx Sx= UVULO-PALATO-PHARYNGO-plasty
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Pickwickian syndrome?
OBESITY HYPOVENTILATION SYNDROME
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Lung Adenocarcinoma features
Peripheral location Females and young Males Non smokers Asbestos+ Clubbing ++ (Last stage- Hypertrophic Osteoarthropathy) Hematological Paraneoplastic syndromes Trosseau syndrome (migratory thrombophlebitis) Mets to opposite lung ++ Mutation in EFGR
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Lung SCC features | C5PAA
Central Cigarette smoking a/w Clubbing +++ hyperCalcemia (Life threatening) Cavity formation (also + in LCC Lung) Polyuria (Ca++ effect on tubules) Abdominal pain (PTH related peptide) Altered Sensorium
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Features of Small CC Lung
Central Strongest a/w smoking Chemo and radiosensitive*** Rapid recurrence SVC obstruction +++ Poorest prognosis Paraneoplastic syndromes
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Horner syndrome? | SAMPLE
+ve in lung ca. ``` Sympathetic ganglion Anhidrosis Miosis Ptosis Loss of CilioSpinal rfx Enopthalmos ```
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Mets of Lung Ca
Mc BRAIN | Msp ADRENALS
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Rx NSCLC
Resectable (1 to 3A) —- SX Non resectable (3b-4) —- Chemo SCC= Gemcitabine + Cisplatin/Paclitaxel Adeno= Cisplatin + Pemetrexed/Bevacizumab
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Rx SCLC
Chemo CISPLATIN + ETOPSIDE
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Targeted Rx Adenocarcinoma Drugs
EGFR x = Erlotinib/Gefitinib ALK x = CRIZOTINIB
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New immunotherapy drugs in Lung Cancer
Anti PD4 antibodies NIVOLUMAB PEMBROLIZUMAB PD4 is a brake protein of T cells, cancer cells attach to this protein and disable T cells.
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Pancoast tumor histology
SCC>> Adenocarcinoma
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Pancoast Syndrome?
Horner + 1&2 rib destruction + C8T1T2 (pain and weakness @ ulnar distribution)
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Pancoast tumor Ixoc
MRI
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Lung Ca GST
Biopsy
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Paraneoplastic syndrome Small cell
SIADH (decreased Na) ACTH (decreased K) Calcitonin (decreased Ca) Lamberton Eaton (Ab against cancer cell similar to P/Q Presynaptic Ca++ channels) Gonadotropins (Gynecomastia) Vasopressin AnF GRp (Gastrin releasing peptide)

Pulmonology (1 decks)

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