pulmo

Question 1

what causes a rigth shift in the oxy. diss. curve?

Answer 1

co2, h+, 2,3bp and temp increase

Question 2

what causes a left shift in the oxy. diss. curve?

Answer 2

co2, h+, 2,3bp and temp decrease

Question 3

epistaxis occurs?

Answer 3

kiesselbach plexus, anterior segment of the nostril

Question 4

Mediastinis cause that is very commen?

Answer 4

histoplasma capsulatum

Question 5

What is assci. with asthma?

Answer 5

charcot-leyden crystals

Question 6

what guaifenesin?

Answer 6

exspectorant, thins the secretion but not the cough reflex?

Question 7

what is phenylephrine?

Answer 7

alpha-adrenergic agonist, for nasal cogestion

Question 8

what is dextromethorphan?

Answer 8

antitussive that antago. NMDA glutamate recepteos, mild opoidd effect

Question 9

endothlin receptor antagonist are used?

Answer 9

antagoninizes endothlin-1 reducin pulmonary vascular resistance

Question 10

protacycline analoges are used?

Answer 10

PGI2 (prostacycline) with direct vasodilation on pulmol and systemic, inhibilts aggregation

Question 11

what is albuterol?

Answer 11

short acting beta 2 agonist, can cause arrhytmia

Question 12

what are salmeterol, fometerol

Answer 12

long acting beta2 agonist, can cause tremor + arrhytmias

Question 13

tiopropium is ?

Answer 13

competetive muscarinic antagonist, long acting

Question 14

what is fluticasone, budisonide?

Answer 14

coticosteroids inactivate NFkapa

Question 15

Transudate

Answer 15

Transudate is extravascular fluid with low protein content and a low specific gravity (< 1.012)

Question 16

Adnocarcinoma

Answer 16

Most common, more Females none smoker, EGFR, KRAS, ALK mutations, location: peripheral, hist: Glands and mucine

Question 17

SCC

Answer 17

30%, Smoker, TP53 CDKNZA, mutation, paraneoplastic: PTHrP, located: centrally, histo: Spinosom: Desmosomes (intracellular bridges), keratin whorls/pearls

Question 18

Small cell carcinoma

Answer 18

15%, TP53 RB mutation, smokers,

Paraneoplastic: SIADH=decreased Na+, or Antibodies agianst presynatic Ca2+, ACTH=cushungs

location: centrally, Hist: small cells (kulchitsky cells—> small dark blue cells, chromogranin A, synaptophysin

Question 19

Large cell

Answer 19

highly undiff. tumor

Hist: huge cells: Pleomorphic giant cells/Anaplastic cell with allot of cyplasm

Question 20

Brochial carcinoid

Answer 20

carcinoid sy.: flushing, wheezing, valve fibrosis and diarrhea

Hist: well organized
trabecula/ nest of neuroendocrine cells
low mito. rate

Question 21

Mesothelioma

Answer 21

associ. abestos, location pleural thickining

histo: (Psammoma bodis), calretinin

Question 22

Lung cancer

complications
and metastases

Answer 22

complications: SPHERE
Sup. vena cava
Pancoast tumor
Honer syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal nerve compression (horseness)
Effusion

Metastases:

Love Affecting BONEheads and BRAINcs

Liver, Adrenal, Bone, Brain

Tumors that metas. to the lung are: Breast, Colon, Postate and bladder

Question 23

Pancoast tumor

Answer 23

superio sulcus tumor. Carcinoma that appears at the apex of the lung. causes pancoast sy. by invading/ compressing local structures
causing:

hoarseness,
horner syn. (stellate ganglion), SVC syndrome, brachiochephalic sy.,
brachial plexus sy.

Question 24

SVC

Answer 24

obstruction of the SVC impairs blood draininge frpm the head (facial plethora), jug. venous dist., upper edema

cause: malignancy (mediast. mass, pancoast tumor

Emergency: can cause ICP increase—-> headaches, dizziness, increased risk of aneurism/ rapture of the intracraneal arteries

Question 25

Rhinosinusistis

Answer 25

superior meatus---> drains spenoid, post. ethmoid middle meatus---> drains frontal, maxillary and anterior ethmoid inferior---> drains nasolascrimal duct

Question 26

VC

Answer 26

TV+IRV+ERV

Question 27

FRC

Answer 27

RV+ERV

Question 28

OLD

Answer 28

only: RV increases, TLC increases FEV1 decreased FEV1/ VC= decrease because VC is increased decrease in elastin and therefore recoil

Question 29

RLD

Answer 29

all volumes are decrease FEV1 decreased FEV1/ VC= normal because all volumes are decreased

Question 30

pleural effusion

Answer 30

lung sounds decrease and the fremitus will reduce

Question 31

Consolidation

Answer 31

increased fremitus/ solid, dullness to percussion

Question 32

pulmonary edema is

Answer 32

crackels

Question 33

obstruction

Answer 33

``` wheezing= obstruction of expiration Strider= same soud on expiration/ its the upper airways ```

Question 34

Pulmonary Edema

Answer 34

Hydrostatic forces equation= J=K(H-O) O= OSI Cirrhosis Nephrosis Gastrosis >= Albumen will be low ``` H= Clot Cancer Compression Cuts Cirrhosis !CHF! ``` K= Inlammation: Infec. or Cancer !ACI!

Question 35

Pulmonary Edema | cardiogenic

Answer 35

1 Cariogenic: Transudate: protein are low, cells are low Hydrostatic cause increase in PCWP ( estimates the left atrial pressure/ brach of the pulmonary artery) CHF symp. dyspne on exsurgen, parox. dyspnoe, orthopnea, JVD, per. edema Hist: Hemoseriderin laden marophages

Question 36

noncardiogenic effusion

Answer 36

hyaline membrane around the alveoli Exudative effusion (increased protein and increased cells): Cause is leaky capillaries ALI=ARDS=DAD=hyaline membrane no CHF/ no volume overload ALI: occurs in SIRS: Septic Shock, Pancreatisis, Transfusion related Lung Injury SIRS--->vasodil---> neutro. fibro,macro----->hyline membranes----> collagen

Question 37

Pleural Effusion

Answer 37

horizontal minicus on x-ray, Transudate: (H)ydrostatic, (O)ncotic Exudate: K (vascular permeability), Cancer, Inf.

Question 38

pneumothorax

Answer 38

vertical lung shadow on x-ray: large simple

Question 39

tensionpneumo

Answer 39

the collpased lung and shift of organs hypotension, obstruction of the IVC=JVD, tracheal divation

Question 40

Asthma

Answer 40

rev. airway remod.

Question 41

COPD

Answer 41

irrv. Ephysem, Bronchitis

Question 42

Brochitis

Answer 42

conducting airways Path: inflam. of the Large Airways

Question 43

Bronchitis

Answer 43

conducting airways ``` Path: inflam. of the Large Airways Old, Smoker chronic productive cough > 3months, 2yrs Cyanosis, pulm. HTN, CHF, peri. edema, JVD "blue bloaters" ``` Hist: Hypertrophy +hyperplasia of submucosal glands =Reed index Reed in index> 40%= mucosal hyperplasia

Question 44

Emphysema

Answer 44

Path: Alveoli, loss of elastin/septa=loss of recoil pt: smoker=centriacinar Apixes prologe exp. phase, purged lips, intercoastal hypertrophy, cachexia, icreased AP diamether XR: Hyperinflation, Chronic CO2 retainers, Ph normal, co2 elevated, increased bicarb 1Inflammation: Debris--->PMN-->Proteases---> decrease elastin 2) Antitryprotease=Panacinar lower lobes Alpha1 anti D.-----> cirrhosis and emphysema ((((3)Apoptosis?= loss of septa VFGF-endothelial Rtp80l- mTor NRF2 oxidant stress)))))) pink puffer

Question 45

Astma

Answer 45

rev. broncho, typeI, IGE, Mast, Eo Wheeze, Dyspnea, Cough, low O2 1) Early Phas=Bonchocontriction Histamine=vasodilation leukotriane= brochcontriction Vagus--->M3---->Brochcon. ``` 2late Phase=Mucus Th2:---->IL4 class switch IgE ---->IL5 eosiniphiles( Chorcot layden Cry) summoning (MBP)--->epithelial detashments ---->IL13 Mucous (Plug= Cruschmann spirals) ``` Air Remodeling: Submocosal Hyperplasia and trophy, goble hyplasia, smooth muscle hypertrophy leading to subbasement fibrosis

Question 46

pulmonary hypertension

Answer 46

10-14mmhg, above 25 is hypertension

Question 47

Pulmonary arterial hypertension | Class1

Answer 47

2° PAH---- intimal thickining, fibroblast prol, collagen--collapse of the lumen iPAH---Plexoform lesions, BMRP-2 Young weman Treament works only for iPAH (of fibro. prolif): PDE-5 inhib, Entholin inhitors Bosentan, Epoprostal inhibits procyclin

Question 48

Class 2

Answer 48

LV dysfunction ``` will lead to pulmonary venous HTN, venous medial thickening, arterialization, CHF SxS, Pulmonary Edema hemosideren macrophages ```

Question 49

Class 3

Answer 49

Hypoxic Lung D. Medial thickining+Hyperplasia, OLD, RLD, OSA

Question 50

Classs 4

Answer 50

CTE, Chronic Thrombpembolic Hx:DVT/PE V/A scan

Question 51

RLD diff.

Answer 51

DLCO (assess the diff barrier) DLCO is normal: mucular or Obesity DLCO is low: fibrotic: ILD=DPLD IPF Asbestosis etc

Question 52

Idiopathic pulm fibrosis

Answer 52

Path: progressive firo. in the septa, never smoke HRCT: subpelural fibrosis, lower lobes, Honey combing histo: usu intersti. pneumonia, subpleural fibrosis, progressive sparing of central alveoli

Question 53

Hypersensitivity pneumonitis

Answer 53

typeII/III hyper. due to enviro. antigen seen in farmers and those exposed to birds