Week 2 Flashcards
(129 cards)
1
Q
oncogene(s) associated with small cell carcinoma
A
c-myc
2
Q
oncogene(s) associated with adenocarcinoma
A
K-ras, EGFR, ALK
3
Q
“coin” lesion on x-ray
A
lung cancer
4
Q
diagnose: R sided ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis, hoarseness
A
R sided Pancoast tumor
5
Q
what kind of cells are small cell carcinomas?
A
neuroendocrine
6
Q
paraneoplastic syndrome for small cell carcinoma
A
ACTH –> Cushing’s
ADH –> hyponatremia
Antibodies against presynaptic Ca2+ channels
carcinoid syndrome (serotonin)
7
Q
paraneoplastic syndrome for squamous cell carcinoma
A
PTHrP –> hypercalcemia
8
Q
histology: keratin pearls, intercellular bridges
A
squamous cell carcinoma
9
Q
most common lung cancer in nonsmokers
A
adenocarcinoma
10
Q
histology: lepidic spread (grows along alveolar septa, thickens alveolar walls)
A
bronchioalveolar carcinoma (subset of adenocarcinoma)
11
Q
sites of metastasis from lung cancer
A
mnemonic: BLAB Brain Liver Adrenals Bone
12
Q
only lung cancer not associated with smoking
A
carcinoid tumors
13
Q
describe the symptoms of the paraneoplastic syndrome associated with bronchial carcinoid tumors
A
carcinoid syndrome: serotonin secretion, leading to flushing and diarrhea
14
Q
diagnose: pain upon deep breathing/coughing, dullness on percussion, decreased/absent breath sounds
A
pleural effusion
15
Q
differential ddx: clear serous fluid in pleural effusion (4)
A
heart failure, pulmonary congestion, cirrhosis, renal failure
16
Q
pneumothorax is most commonly associated with what 3 lung conditions?
A
emphysema, asthma, and TB
17
Q
diagnose: unilateral chest pain, unilateral decreased tactile fremitus, unilateral hyperresonance
A
pneumothorax
18
Q
in tension pneumothorax, trachea deviates _____ the affected lung
A
away from
19
Q
type of pneumothorax that happens in tall, thin, young males
A
spontaneous pneumothorax, secondary to rupture of pleural blebs
20
Q
malignancy of pleura associated with asbestosis
A
mesothelioma
21
Q
latency period of mesothelioma
A
20-40 years
22
Q
gross appearance of mesothelioma
A
spreads along mesothelial surfaces, thickening the pleura and sparing the parenchyma
23
Q
what is granulomatous mediastinitis?
A
chronic disorder secondary to fungal or bacterial infection
24
Q
what mediastinal compartment will you find thymomas/thymic cancers?
A
anterior
25
what mediastinal compartment will you find neurogenic tumors?
posterior
26
what mediastinal compartment will you find cysts?
middle
27
diagnose: cancer in patient with ptosis, diplopia, and weakness due to autoantibodies against postsynaptic ACh receptors
thymic cancer (thymic hyperplasia, thymoma, thymic carcinoma)
28
thymic neoplasms are associated with what diseases? (2)
myasthenia gravis, pure RBC aplasia
29
difference between Type A and Type B thymomas
Type A: spindle cells
| Type B: round cells
30
diagnostic method to identify a DVT
Doppler ultrasound
31
diagnostic methods to identify a PE (2)
ventilation perfusion scan, CT pulmonary angiogram
32
name the Group I and Group IV classifications of pulmonary hypertension
Group I: pulmonary arterial hypertension
| Group IV: chronic thromboembolic disorders
33
diagnostic method to identify pulmonary hypertension
echocardiogram
34
poor prognosis criteria for pulmonary hypertension
right atrial pressure (RAP) > 10 mmHg
| cardiac index < 2.2
35
criteria for pulmonary arterial hypertension
pulmonary artery pressure > 25 mmHg, with a normal wedge pressure
36
pathogenesis of primary pulmonary hypertension
inactivating mutation in BMPR2 gene on chromosome 2
37
diagnose: medial hypertrophy, "plexiform lesion" in small vessel
pulmonary arterial hypertension
38
pulmonary arterial hypertension:
______ prostacylcin
______ endothelins
______ nitric oxide synthase
decreased, increased, decreased
39
3 major diseases that cause capillaritis and alveolar hemorrhage
Goodpasture's syndrome, Wegener's granulomatosis, collagen vascular diseases (SLE)
40
classic triad of alveolar (capillary) hemorrhage syndromes (Goodpasture's syndrome, Wegener's granulomatosis, collagen vascular diseases (SLE))
hemoptysis, pulmonary infiltrates, anemia
41
diagnose: hemoptysis, pulmonary infiltrates, anemia
alveolar (capillary) hemorrhage syndrome (Goodpasture's syndrome, Wegener's granulomatosis, collagen vascular diseases (SLE))
42
diagnostic method to identify alveolar (capillary) hemorrhage syndromes, expected finding
bronchoalveolar lavage; hemosiderin-laden macrophages
43
diagnose: sinusitis, otitis media, hemoptysis, joint pain, fever
Wegener's granulomatosis
44
patients with Wegener's have an increased risk for what?
DVT
45
expected gross lung findings of Wegener's
lung necrosis and cavitation, hemorrhage
46
gram positive organisms
staphylococcus, streptococcus, corynebacterium
47
gram positive diplococci
strep pneumo
48
gram negative diplococci
neisseria meningitidis
49
alpha-hemolytic (doesn't completely lyse RBCs)
strep pneumo
50
beta-hemolytic (completely lyses RBCs)
strep pyogenes
51
bacterium that possesses adhesins FHA and pertactin
bordetella pertussis
52
mechanism of pertussis toxin (PTx)
overactivates adenylate cyclase by ADP-ribosylating Gi, causing increased cAMP and increased secretions and mucus production
53
bacterium arranged in palisades
corynebacterium diphtheriae
54
mechanism of diphtheria toxin (DTx)
inactivates EF-2 by ADP-ribosylation --> inhibits protein synthesis
55
bacterium that causes pharyngitis with grayish-white pseudomembranes in throat
corynebacterium diphtheriae
56
vaccine against corynebacterium diphtheriae
formalin-inactivated diphtheria toxoid
57
neisseria meningitidis: catalase _____, oxidase _____
positive, positive
58
gram negative bacterium with capsules
neisseria meningitidis and haemophilus influenzae
59
strep pyogenes: catalase ______
negative
60
staph aureus: catalase ______
positive
61
virulence factor unique to staph aureus
protein A
62
pneumolysin functions
1. destroys ciliated epithelial cells
2. activates alternate complement pathway
3. suppresses phagocyte oxidative burst
63
virulence factors unique to strep pneumo (2)
pneumolysin and secretory IgA protease
64
haemophilus influenzae requires what for growth?
heme and NAD+
65
bacterium with no cell wall, bound by triple layered membrane
mycoplasma pneumoniae
66
virulence factor unique to mycoplasma pneumoniae
P1 adhesin
67
pseudomonas aeruginosa: oxidase _____
positive
68
opportunistic pathogens (2)
pseudomonas aeruginosa and legionella pneumophila
69
bacterium maintained in water supplies or amoeba in environment
legionella pneumophila
70
mechanism of legionella pneumophila infection
survives inside alveolar macrophages
71
mechanism of mycobacterium tuberculosis
survives and persists within host-generated granulomas
72
three most common secondary bacterial infections of influenza virus
strep pneumo, staph aureus, haemophilus influenza
73
mechanism of antiviral therapy for influenza
neuraminidase inhibitor (inhibits release of progeny virus) = oseltamivir
74
second most prevalent cause of common cold
coronovirus
75
diagnose: coughing with the sound of barking seal
croup, caused by parainfluenza virus
76
infects virtually everyone by age 2
RSV (respiratory syncytial virus)
77
RSV treatment for otherwise healthy infants
oxygen, IV fluids, nebulized cold stream
78
RSV treatment for premature/immunocompromised infants
aerosolized ribavirin, immunization with anti-RSV Ig and humanized monoclonal antibodies
79
_____ most common cause of death in young children with measles
pneumonia
80
describe the dimorphism of histo, blasto, and cocci
all exist as free-living molds in the environment; in the host, histo and blasto convert to budding yeast, while cocci convert to large endosporulating spherule containing many endospores
81
where is histo found in the environment?
soil containing bird feces
82
fungus with narrow bud neck
histo
83
fungus that exists as micro- and macro-conidia in the environment
histo
84
outline histo infection
microconidia convert to yeast inside macrophages that engulf them
85
where is blasto found in the environment?
rich moist soil around rivers and streams
86
fungus that exists only as microconidia in the environment
blasto
87
fungus with broad bud neck
blasto
88
outline blasto infection
microconidia are inhaled and convert to yeast at body temperature
89
which of the three fungi has the longest incubation period?
blasto
90
where is cocci found in the environment?
soil rich in organic material in hot, arid climates (southwestern US and western hemisphere)
91
outline cocci infection
arthroconidia that break off from hyphae convert into large spherules that contain numerous small endospores inside host
92
fungal infection that happens after earthquakes or excavation
cocci
93
antifungal therapy for pulmonary infections vs. disseminated disease
pulmonary: none or itraconazole
disseminated: amphotericin B + itraconazole
94
risk factors for otitis media (5)
daycare, smoke exposure, lack of breastfeeding, Native American heritage, cleft palate
95
3 common agents of otitis media
mnemonic: HMS
haemophilus influenza
moraxella catarrhalis
strep pneumo
96
first and second line treatment for otitis media
1st: amoxicillin
2nd: ear tubes
97
treatment for systemic candidiasis
fluconazole
98
nasopharynx can be obstructed by _______
adenoids
99
oropharynx can be obstructed by _______
palatine tonsils
100
hypopharynx can be obstructed by _______
lingual tonsils
101
diagnose: pediatric airway obstruction, sitting up, drooling
epiglottitis caused by haemophilus influenza type B
102
compare the treatments for the two common causes of airway obstruction in pediatrics
epiglottitis (bacterial): antibiotics
| croup (viral): racemic epi, steroids
103
define CURB-65 criteria
prognosticating mortality of CAP; the presence of each of these factors is 1 point:
-Confusion ("mental status changes")
-Urea (BUN) > 19
-Resp rate > 30
-BP (systolic < 90 or diastolic < 60)
-age > 65
score of greater than or equal to 3 --> admit/ICU
104
bacteria that causes pulmonary infections in diabetics
staph aureus
105
best diagnostic tool for influenza
NAAT from nasopharyngeal swab
106
diagnose: oral ulcers, Tzanck test shows multinucleation, molding, margination
HSV-1
107
difference between vocal cord nodules and polyps
nodules are bilateral on middle third of vocal cord and polyps are single in the ventricle or Reinke's space
108
risk factors for squamous cell carcinoma of oral cavity and larynx (4)
tobacco
alcohol
HPV infection
leukoplakia/erythroplakia
109
pathogenesis of nonkeratinizing squamous cell carcinoma
associated with high-risk strains of HPV (16, 18), whose proteins inactivate tumor suppressor genes p53 and Rb
110
concern when you see a young patient (30s-40s) with a neck mass
nonkeratinizing squamous cell carcinoma (spreads to local lymph nodes early)
111
where do nonkeratinizing squamous cell carcinomas occur?
Waldeyer's ring (at base of tongue)
112
diagnose: tumor arising in superior/lateral mucosa of nose, histology shows "salt and pepper" chromatin, EM shows neurosecretory granules, positive for synpatophysin and chromogranin
olfactory neuroblastoma (esthesioneuroblastoma)
113
salivary gland that is mostly mucinous
sublingual
114
salivary gland that is mostly serous
submandibular
115
salivary gland that is exclusively serous
parotid
116
most common salivary gland tumor
pleomorphic adenoma
117
diagnose: mixed tumor with epithelial, myoepithelial, and mesenchymal cells
pleomorphic adenoma
118
diagnose: tumor in salivary gland, microscopy shows bilayered oncocytic (pink) epithelial cells and lymphocytes
Warthin tumor (benign)
119
most common MALIGNANT tumor of salivary gland
mucoepidermoid carcinoma
120
diagnose: tumor in salivary gland, histology shows mixture of squamoid, mucous, and intermediate cells
mucoepidermoid carcinoma
121
diagnose: tumor in salivary gland, histology shows perineural invasion and cribiform architecture
adenoid cystic carcinoma
122
diagnose: tumor along the anterior border of the SCM, filled with cheesy, mucoid material
branchial cleft cyst
123
risk factors for pseudomonal CAP (4)
1. bronchiectasis
2. steroids
3. broad spectrum antibiotics for > 7 days
4. malnutrition
124
criteria for draining a parapneumonic effusion
any one of these:
1. large free flowing effusion taking up more than half the chest
2. loculated effusion
3. positive culture or gram stain
4. pus
5. pH < 7.20
125
in spontaneous pneumothorax, trachea deviates _____ the affected lung
toward
126
virus family that includes rhinovirus
picornavirus
127
virus family that includes influenza
orthomyxoviridae
128
what viruses are in paramyxoviridae family? (4)
```
PaRaMMyxoviridae:
Parainfluenza
RSV
Metapneumovirus
Measles
```
129
what causes increased tactile fremitus?
consolidation (lobar pneumonia, pulmonary edema)
