Week 5 (Exam 2) Flashcards
(224 cards)
1
Q
Malignant glands invading lung tissue
A
Pulmonary Adenocarcinoma: Most common one
Stains positive for TTF-1
2
Q
Tests for all exudative effusions
A
pH, Glucose, WBC w/diff, Micro studies, cytology
3
Q
Mainstay of COPD
A
Bronchodilators, oral corticosteroids
O2 - at least 15 hours/day if below 88%
Inhaled corticosteroids for those at high risk
4
Q
How do you minimize alveolar collapse from ARDS-induced alveolar collapse / loss of surfactant?
A
Low tidal volumes combined with Positive end-expiratory Pressure
Place patient in Prone Position
5
Q
Intra- vs Extra-lobar Pulmonary Sequestration
A
Extralobar usually presents after birth, has independent vessels, pleura, possibly airways
6
Q
Viral Pneumonia in Children cause
A
Respiratory Syncytial Virus
7
Q
Langerhans Cell Histiocytosis
A
Young smokers (reversible) Progressive scarring leading to cysts, can rupture into pneumothorax
8
Q
Clinical use of Linezolid
A
Community and Hospital Acquired Pneumonia
Main species are Staph Aureus and Strep Pneumonia
Skin infections also caused by S Aureus
9
Q
Prostanoids (4)
A
Used for Pulmonary HTN
Epoprostenol, Treprostinil, Iloprost, Selexipag
10
Q
Fluoroquinolone MOA
A
DNA Gyrase Inhibitor (esp for G-)
Topo IV blockade (esp for G+ Respiratory)
11
Q
Structure of CPAM
A
Communicates with Tracheobrochial tree
Can be detected on fetal US
Can be deadly from hydros or pulmonary hypoplasia
Can be infected later in life
12
Q
Pneumoconiosis
A
Usually occupational inhalation of inorganic dusts causing inflammation responses
Restrictive pattern
13
Q
Plexiform Lesions
A
Pathognomonic of PAH
Focal proliferation of endothelial and SM cells
14
Q
Waves of inflammatory injury leading to fibrosis
A
Idiopathic pulmonary fibrosis
(different foci of fibrosis)
Usually have respiratory disease 3-5 years prior
15
Q
Criterion for Pulmonary Artery HTN
A
Sustained elevation of mPAP at or over 20mmHg at rest
normal is 14 +/- 3 mmHg
16
Q
Major bugs with MDR status
A
MRSA
VRE (vance-resistant enterococci)
17
Q
Molecular Testing associated with Adenocarcinoma
A
EGFR
ALK
PDL-1
18
Q
Acute ARDS develops rapidly and includes… (3)
A
Severe Dyspnea
Diffuse Pulmonary Infiltrates
Hypoxemia
19
Q
Paraneoplastic Syndromes Associated with Squamous Carcinoma
A
Hypercalcemia (PTH-Related Peptide aka PTRP)
20
Q
Thin red forms on Acid Fast stain
A
Mycobacterium Avium
21
Q
Metabolism of Ceftriaxone
A
Not Eliminated by the Kidney
22
Q
ALK gene rearrangements
A
Inflammatory Myofibroblastic Tumor
23
Q
Hamartoma Histology
A
Low Power: Marble with smooth edges
High Power: Fibrous, benign glandular epithelium around hyaline cartilage
24
Q
Clarithromycin side stuff
A
Less GI upset but still a CYP450 inhibitor
25
Why take tetracycline with plenty of water?
Can cause esophageal irritation and ulceration
26
Age distribution of olfactory neuroblastoma
Adolescence and Middle Age peaks
| Shaped like a dumb-bell
27
Atopic Asthma
Typically childhood
Elevated IgE (eosinophils, Mast Cells, Lymphocytes)
Triggered by allergens
28
What is the significance of neuromuscular blockage in ARDS?
Reduces mortality: most patients require sedation or even paralytics
29
Histology of Langerhans Cell Histiocytosis
Eosinophils
Immature Dendritic Cells (that's what they are) (S-100 and CD1a Positive)
Varying Fibrosis and Cysts
30
Bronchiectasis
Necrotizing end stage of Infection and Obstruction (ABPA, Cystic Fibrosis, Tb, Primary Ciliary Dyskinesia)
31
Imipenem MOA
b-Lactam: Penicillin stuff
32
Horner's Syndrome
```
Enopthalmos (sunken eyeball)
Ptosis (drooping eyelid)
Miosis (persistent small pupil)
Anhidrosis (no face sweating)
This is an Oculo-SYMPATHETIC palsy
```
33
Penicillins and Aminoglycosides
Dont combine them IV
34
What makes a PE unstable?
Hypotension!!
| RV strain, elevated cardiac enzymes
35
Exudative Phase of Pleural Effusion
Alveolar Edema and Neutrophil Inflammation
Diffuse Alveolar Damage
Atelactasis from edema, reduced lung compliance
Bilateral opacities on CXR
Hypoxemia, Tachypnea, Hypercarbia
36
Prevnar 13
S Pneumoniae Vaccine
37
How are pulmonary sequestrations mainly different from CPAM?
Lack of connection to tracheobronchial tree
| Independent (systemic) arterial supple
38
ECG of PAH
Right Ventricular Hypertrophy:
R Axis Deviation in V1
RAE in Lead II
Incomplete Bundle Branch Block
39
Toxicities of gentamycin
Black box warnings: Nephro-, Neuro- and Ototoxicity
| Neuromuscular blockade, superinfection
40
Labs of GPA
C-ANCA
41
Macrolide MOA
Binds 50S subunit to block peptide chain elongation
42
Blue Bloater Vs Pink Puffer
Chronic Bronchitis vs Emphysema
43
Treatment for Goodpastures
Plasmapheresis (and steroids and cyclophosphamide)
44
Reversal agent for LMWH
Protamine Sulfate
45
Ambrisentan Toxicities
Does NOT accelerate warfarin metabolism, oral contraceptives. Still use 2 though
46
Heerfordt's Syndrome
Anterior Uveitis, Parotitis, CN VII palsy, fever
| Seen in Sarcoidosis
47
Labs of PAH
Maybe more BNP
48
Indications for Thoracentesis (for Pleural Effusion)
All effusions with more than 1cm layering in decubitus
49
Guanylate Cyclase Sensitizer
Used for Pulmonary HTN
| Riociguat
50
Key diagnostic criteria for ARDS
PaO2 / FIO2 equal or less than 300mmHg
| aka Arterial Oxygen Pressure / Inspired O2 Fraction
51
Erythromycin side stuff
Can cause Epigastric Pain
| Inhibits CYP450 metabolism
52
Kohn Complex
Parenchymal Lesion with Hilar LN involvement
| Found in Tb
53
Common Tb finding in elderly
Lower lobe infiltrates (with or without Pleural Effusion)
54
Radiological differences between Hypersensitivity Pneumonitis and IPF
Hypersensitivity honeycombing spares the bases of the lungs
55
Types of Emphasema
Spontaneous PTX
a-1 Antitrypsin Def
COPD
Localized
56
Respiratory Bronchiolitis - Interstitial Lung Disease
Dose Dependent Smoking-Related (reversible if stopped)
Macrophages present to lesser extent
Peribronchiolar Metaplasia (abnormally in ciliated cells)
May lead to fibrosis
57
Keratin Pearls
Squamous Carcinoma of the lung
| orange cytoplasm
58
Endothelin Antagonists (3)
Used for Pulmonary HTN
| Bosnian, Ambrisentan, Macicentan
59
PE on EKG
Sinus Tach 44% of the time
RV strain: Inverted T in V1-V4, maybe inferior leads
sometimes RBBB
S1, Q3, T3 (Deep S in Lead 1 / Q wave in 3 / Inverted T in 3)
60
Major bugs with PDR status
P Aeruginosa
Acinetobacter Baumannii
Klebsiella
61
Airway Remodeling Associated with Asthma
Fibrosis
| Decreased Responses to Bronchodilators and Corticosteroids
62
What do you give with Pulmonary HTN and a Positive Vasopressor Test?
Calcium Channel Blocker: Nifedipine, Diltiazem, or Amlodipine
63
Progression of Squamous Cell Carcinoma of the lung
Normal to Squamous Metaplasia to Squamous Carcinoma in Situ to Invasive Squamous Carcinoma
64
Gentamycin MOA
Aminoglycoside
| Binds 30S ribosomal subunit: Misreading of tRNA, no protein synthesis
65
Etiology of Congenital Pulmonary Adenomatoid Malformation (CPAM)
Arrested development of pulmonary tissue with formation of intrapulmonary cystic masses
66
Clinical uses for gentamycin
Respiratory tract infections
67
LAM histology
Low power: Cell proliferation around cystic spaces
| High power: Small nests of tumor cells
68
Clinical use for Amoxacillin +/- Clavulanate
Community Acquired Pneumonia
69
What are the three etiologies of atelectasis?
Resorption
Compression
Contraction
70
Epoprostinol
Continuous IV, Needs to be kept cold, works like a prostacyclin to treat PAH
71
BMPR2
Known genetic mutation for PAH in patient or 1st degree relative
72
Treat naive PAH pt with WHO FC II or III that doesn't have evidence of rapid disease progression
1. Combo therapy: Ambrisentan and Tadalafil
| Alternative: Monotherapy macitentan, ambisentan, riociguat, sildenafil, tadalafil
73
Distinguishing feature of Hypersensitivity Pneumonitis
Plasma Cells
74
Allergic Bronchopulmonary Aspergillosis
Background of Asthma or Cystic Fibrosis
Increased Serum IgE
Positive Skin Test
Thick dark mucus in bronchi (w/ the hyphae)
75
Treat naive PAH pt with WHO FC III and evidence of rapid disease progression
1. Continuous IV Epoprostenol or Treprostinil, or SC Treprostinil
Alternative: Consider adding inhaled or oral prostanoid
76
Toxicity to Cefpodoxime + Cefditoren
b-Lactam allergy
| Superinfection
77
Transthoracic Echocardiogram
Estimates Pulmonary A systolic pressure via Tricuspid Regurgitation gradient
(also looks at RV, LV chamber size)
78
Diagnosis of ARDS
Clinical: Acute onset. Bilateral Infiltrates, Hypoxemia, HF exculsion
79
a-1 Antitrypsin normal function
Protects lungs from neutrophil elastase
| Without it, you get damage from neutrophils in the liver and lungs
80
Diffuse Alveolar Damage indicators
Edema + Fibrin + Cell Debris = Hyaline Membranes!
81
Red Man Syndrome
Vancomycin
82
Major 3rd generation oral cephalosporins
Cefditoren
Cefpodoxim
e-Proxetil
83
Risk factors for Increased mortality in MDR pathogens or HAP
Ventilatory support for HAP
| Septic Shock
84
PE echo findings
Long Axis: Large R resulting in compressed LV
| Short Axis: D-Shaped LV from RV enlargement
85
Proliferative phase of Pleural effusion
Most recover, some get progressive lung injury and fibrosis
86
How to treat adenovirus, parainfluenza, RSV
No vaccine, give abx for superinfections
87
CT imaging of Idiopathic Pulmonary Fibrosis
Honeycombing with traction bronchiectasis
88
Perivascular Epitheliod Cells maybe with a Pneumothorax
Lymphangioleiomyomatosis (LAM)
| LOF of TSC2 tumor suppressor
89
Gold standard for Obstructive Sleep Apnea dx
Polysonogram
90
Pharmacokinetics of Treprostinil
SubQ infusion
Longer half life, doesn't require refrigeration
QID inhalation
Oral XR
91
Cefpodoxime Clinical applications
Pneumonia, Community-Acquired Outpatient empric therapy (alternative agent)
92
Risk factor for MDR Pseudomonas / other G- Bacilli / MRSA
IV antibiotics within the past 90 days
93
Cup-Shaped yeast forms
Pneumocystis Jiroveci
| AIDS defining illness
94
Imipenem Clinical uses
Wide spectrum, Lower Respiratory Tract Infections
95
"pushing out" that causes pulmonary Edema
Mainly Left sided HF
96
iloprost pharmacokinetics
Inhalation 6-9x per day
97
Berylliosis
Associated with Alloy and Electronic manufacturing
Hilar LAD, diffuse infiltrates
Tx with steroids and getting out of exposure
98
Macitentan
Non-selective endothelin antagonist with an 18 hour half life for 1/day dosing
CYP450 effects similar to bosentan
99
Cefpodoxime + Cefditoren MOA
Penecillin (cell wall synthesis inhibition)
100
Alveolar Pores (of Kohn)
Allow aeration
| Allows exudate, cells bacteria to travel between alveoli
101
Azithromycin sides stuff
CYP450 is TOTALLY FINE
| Concentrates in cells. slowly releases bacteriostatic levels of drug: half-life of 2-4 days
102
Pulmonary Biopsy with Unusual Interstitial Pneumonia
Idiopathic Pulmonary Fibrosis
| Normal Areas + Inflammation + Fibroblast Foci + Peripheral Honeycombing
103
EBV tumors
Nasopharyngeal Carcinoma
| Extranodal NK/T cell lymphoma
104
Acute lung injury criteria
PaO2/FiO2 at or above 300
105
Asthma Mediator Soup
Leukotrienes C/D/E-4, Histamine, PGD2, Ach, ILs
| Bronchoconstriction, Mucous, Permeability, Inflammation
106
Alternative Regimens for MDR or high risk pneumonia
Linezolid
Aztreonam
Ceftolozane - Tazobactam
107
WHO subgroups of Pulmonary HTN
1. PAH - Primary Vascular Disease
2. Secondary to LHF
3. 2nd to Chronic Pulmonary Parenchymal Dz or Hypoxia
4. Secondary to Thromboembolic Pulmonary Dz
5. Multifactorial
108
How do you die from PAH?
Right ventricular overload, failure. ~2.5 years.
109
Prostanoid (prostacyclin-like) MOA
Binds GPCR to generate cAMP
| Vascular Relaxation, Supresses Vascular SM growth, ?Inhibits platelets
110
Where do Protein C and S act in the coagulation cascade?
Blocks VIII and V (factor V Leiden mutation prevents binding here)
111
Where does Antithrombin III act in the coagulation cascade?
II and X
112
Sildenafil MOA
This is Viagra
Blocks Phosphodiesterase type V
Potentiates cGMP mediated vascular relaxation
113
"Candlewax Drippings" on pleura, histologically showing hyalinized collagen
Asbestositis
114
Tetracycline MOA
Binds 30S Subunit, Bacteriostatic
| Kills those lacking a cell wall
115
Laryngeal Squamous Papilloma association
HPV 6 and 11
| Recurrent Respiratory Papillomatosis (probably acquired during birth)
116
Prostanoids Pharmacokinetics
Oral BID
| Super expensive
117
Riociguat MOA
Sensitizes sGC to NO
Directly stimulates sGC
Increases cGMP
118
Coccidiodes Immitis
Granulomatous Response w/ Eosinophils in lungs
| Southwest US and Mexico
119
Amoxacillin +/- Clavulanate clinical use
Pseudomonas
| Community, hospital acquired pneumonia
120
Predominant pathophysiologic mechanism of Chronic Bronchitis
Mucous Gland Hyperplasia: Damage to Airway Epithelium
121
Risk Factors for MRSA
Treatment in a unit in which more than 20 Percent of Staph Aureus isolates are Methicillin resistant
Treatment in a unit with unknown MRSA prevalence
Colonization with OR prior isolation of MRSA
122
Silicosis
"cristalline quartz" inhalation by occupation
Nodular lung disease and calcified hilar LN
Increased risk of Tb infection
123
Goodpasture Labs
Anti-Glomerular Basement Membrane antibodies (in the alveoli)
124
Major bugs with EXR status
Mycobacterium Tb
| Coagulase+ Staph, P Aeruginosa, Klebsiella
125
Bastomyces Dermatitides
Granulomatous lung response
| Broad Based Budding Yeast
126
Radiographic Stages of Sarcoidosis
I: Bilateral Hilar LAD (alone)
II: Hilar LAD + Parenchymal Infiltrates
III: Parenchymal infiltrates
IV: Fibrosis
127
Diagnosis of DAD
Pathologic: Hyaline Membranes, Interstitial Edema, Epithelial Necrosis
128
Cefditoren Clinical Applications
Community-Acquired Pneumonia
129
What are the three locations of foregut cysts?
Respiratory, Esophageal, Gastroenteric
| Seen along Hilum and Mediastinum
130
Symptoms of Typical Pneumonia
Abrupt
Respiratory Sx
Consolidation on CXR
Older adults or younger children
131
Macrolide Effectiveness
Most G+
Not really G-
No protozoa or fungi
132
Bugs of Otitis Media
Strep Pneumoniae
Moraxella Catarrhalis
Haemophilus Influenzae
(P Aeruginosa for chronic otitis media in diabetics)
133
Chest imaging of Reactive Tb
Cavitary Lesions
Discrete Nodules
Infiltrates: Apical/Posterior parts of Upper lobes, Superior parts of lower lobes
134
Primary Regimens for Low risk of MRSA, no risk factors for MDR pathogens
```
Cefepime
Piperacillin-Tazobactam
Meropenem (or Ertapenem)
Levofloxacin
add Vanco
```
135
Primary Ciliary Dyskinesia
Dysfunction of Dynein arm of Microtubules
Sinusitis + Bronchiectasis + Situs Inversus
Often Male Infertility
136
Histology of Non Specific Interstitial Pneumonia
Uniform Infiltrates and Fibrosis
| No Heterogeneity, No Fibroblast Foci, No Granulomas
137
Why should you be stingy with IV fluids in ARDS patients?
They have interstitial and alveolar edema already from the increased pulmonary vascular permeability
For the matter, avoid glucocorticoids and NO
138
Tadalafil
This is Cialis
| Longer 1/2 life than Sildenafil / Viagra, same MOA
139
How do you distinguish NE lung tumors?
DIPNECH (diffuse interstitial pulmonary neuroendocrine cell hyperplasia) is less than 5mm (tumorlet, precursor)
Carcinoid tumor is 5mm or bigger. These guys can metastasize
140
Major 3rd and 4th generation parenteral cephalosporins
Ceftriaxone (3)
| Cefepime (4)
141
Carotid Body stain
S-11 showing sustentacular supporting cells
142
Antifibrotics used for pulmonary Fibrosis
Pirfenidone (decreases fibroblast proliferation)
| Nintedanib (TK inhibitor)
143
Treatment of GPA
Steroids and Cyclophosphamide
144
Genetics of a-1 Antitrypsin
Pi gene on Chromosome 14
Z Allele is associated with decreasing levels
Homozygous PiZZ are fucked with emphysema (panacinar)
145
Sarcoidosis
Dx of exclusion + noncaseating granulomas in lung
146
3 Components of Asthma
Recurrent Airway Obstruction
Airway Hyper-Responsiveness
Airway Inflammation
147
Granulomatosis with Polyangiitis on the nasal passages
Ulcers, necrosis, perforation
| Classic "Necrobiotic" histology
148
Masson Bodies
Looks like Cotton Candy
Fibroblast Foci - Organizing plugs of CT
Found in Cryptogenic Organizing Pneumonia
149
Typical PAH patient
Young mother (happens more in women, can be any age)
150
What are the respiratory Fluoroquinolones?
Levofloxacin (3rd gen)
Gemifloxacin (4th gen)
Moxifloxacin (4th gen)
151
Cryptogenic Organizing Pneumonia Presentation
Superimposed on prior infection or inflammation
Pneumonia-Like Consolidations
50 - 60 y.o.
152
Clinical Presentation of Emphysema
Enlarged Lungs on CXR with flattened diaphragm
Barrel chest with increased AP diameter
Dimished breath sounds with Prolonged Expiratory Wheezes
Obstructive pattern
"Pink Puffer)
153
Stages of Lobar Pneumonia
Congestion
Red Hepatization
Grey Hepatization
Resolution
154
Clinical Application of Aztreonam
Only Gram- Stuff
| UTIs, RTIs, Septicemia, Skin infections, etc
155
Histoplasma Capsulatum
Midwest
Granulomatous response with Calficications or Coil Lesions on CXR
Pumpkin Seen Yeast Forms
156
Symptoms of Atypical Pneumonia
```
Slower Onset
Systemic Symptoms
Patchy Infiltrates on CXR
Young Adults / Teens / Older children
"walking pneumonia"
```
157
Restrictive Flow Volume Loop
Smaller, but shifted to the right
158
Alveolar Spaces stuffed with macrophages
Desquamative Interstitial Pneumonia: Restrictive Presentation
159
Chest imaging of primary Tb
Small Unilateral Infiltrates
Hilar and Paratracheal LN enlargement
Segmental Atelectasis
30-40% have pleural effusion (sometimes solely)
160
Major cause of resistance and allergies to Cephalosporins
B-Lactamases
161
Pneumonia with Abscess formation
Staph Aureus
| Common with IV drug users
162
Otosclerosis
Abnormal bony deposition at stepedIal footplate
Causes conductive hearing loss
Unknown, maybe AD, mechanism
163
How to dx Hypersensitivity Pneumonitis
History
164
Serious sides of Prostanoids
Sepsis due to chronic catheter, life threatening if clogged
| Flushing, N/V, Headache, Jaw Pain
165
Amoxacillin +/- Clavulanate MOA
Amoxacillin: Inhibits transpeptidation of cell wall synth
Clavulanate: Inhibits b-Lactamases
166
Risk factors for MDR Pseudomonas and other G-Bacteria
Structural lung disease
Respiratory Specimen Gram stain with numerous G-Bacilli
Colonization with OR prior isolation of MDR Pseudomonas or other G- Bacilli
167
Mild vs moderate vs severe ARDS
Mild is above 200, moderate is above 100, severe is below 100
168
How does Aspergillus stain?
H&E, Silver Stain
169
Histology of Pneumonia
Bacterial in Alveoli
| Viral in Interstitium (epidemics are common)
170
Adenocarcinoma Progression
Atypical Adenomatous Hyperplasia (AAH): Smaller than 5mm, dysplastic pneumocystis along alveoli with some interstitial fibrosis
Adenocarcinoma in Situ (AIS): Smaller than 3cm, dysplastic pneumocystis con fluently growing along alveoli
171
Influenza Treatment
Neuraminidase Inhibitors (especially if given within 48 hours)
172
Obstructive Flow Volume Loop
smaller, Squished on the top right, shifted to the left
173
Unstable PE tx
Resuscitation, Thryombolytics, maybe surgery
174
Potential therapies for Idiopathic Pulmonary Fibrosis
Lung Transplant
TK inhibitors
TGF-b Inhibitors
175
Clindamycin main use
C Diff
176
Oseltamivir (and Zanamivir)
Influenza vaccine
Works via Neuraminidase Inhibition (replication enz)
Only works if done within 48 hours of sx
177
Linezolid Pharmacokinetics
Oral or IV
| Inhibits Monoamine Oxidase (increases catecholamines)
178
Pulmonary Alveolar Proteinosis
Impaired Surfactant Metabolism
Defect of (and Treated With) GM-CSF
Shit tons of milky fluid in lungs
179
Branchial Cyst
Most frequently arises from 2nd branchial arch
180
Symptoms and associations of Pulmonary Hypoplasia
Impaired ability to inhale:
Oligohydramnios (renal agenesis)
Airway malformation (tracheal stenosis)
Chest wall disorders
181
Cholesteatoma
Cystic lesion in Chronic Otitis Media
Lined with benign squamous epithelium with keratin
Can enlarge and erode adjacent bone
182
Anti-Synthetase Syndrome
Myositis, Fever, Reynauds, Mechanic hands, arthritis, ILD
| Found in Dermatomyositis / Polymyositis
183
Linezolid MOA
Binds A Site of Ribosome, Blocking tRNA Binding
| Binds 23S RNA of 50S subunit. Prevents 70S initiation
184
Primary regimen for more severe pneumonia / high risk mortality / MDR G- suspected
Add Ciprofloxacin / Levofloxacin / Tobramycin / Amikacin
185
The 3 stages of ARDS
Exudative, Proliferative, Fibrotic (irreversible)
186
Indications for tetracycline
Community Acquired Pneumonia (doxycycline)
187
ARDS presentation
Abrupt onset
Hypoxemia: PaO2/FiO2 at or above 200
Bilateral Infiltrates
Non-Cardiac
188
Emphema
Inflammatory Exudate of pus in the pleural space
Creates Loculations: web-like traps for fluid
Usually a bacterial infection
189
Apnea criterion
SpO2 drop more than 3%
190
Non-Atopic Asthma
Often Older patients
Normal IgE (T Lymphocytes, Neutrophils)
Triggered by cold, exercise, infection
191
Velcro Lung
Prominent Inspiratory Crackles
| Idiopathic Pulmonary Fibrosis
192
Treatment for Sarcoidosis
Supportive Care
| Immunposuppression (steroids, methotrexate, azathioprine, cyclophosphamide, biologics: Etanercept and Infliximab)
193
Associations of Small Cell Neuroendocrine Carcinoma
Almost always with smoking
194
Samter's Triad
Aspirin Sensitive Asthma
Nasal Polyps
Recurrent Rhinitis
195
PDE 5 Inhibitors (2)
Used for Pulmonary HTN
Sildenafil
Tadalafil
196
Miliary imaging pattern
Tb
197
Treat PAH patient with WHO FC IV
1. Continuous IV Epoprostenol or Treprostinil, or SC Treprostinil
Alternative: Inhaled Prostanoid and Oral PDE-5 Inhibitor and oral ET-Antagonist
198
ARDS Histology
Endothelial Activation
Neutrophils
Formation of Hyaline Membranes
199
Stable PE tx
Heparin, Low Molecular Weight Heparin, K antagonists
200
Paraneoplastic Syndromes associated with Small Cell Carcinoma
SIADH
| Cushings (secretion of ACTH)
201
Common adverse effect of cefmetazole, cefoperazone, cefotetan, ceftriaxone
Bleeding tendencies
202
General presentations of bacterial vs viral pneumonia
Bacterial: Fever, Lobar/Consolidated, abrupt
Viral: Gradual, Epidemics, Diffuse CXR, Wheezes
203
Chronic Bronchitis Diagnostics
Persistent Sputum production for 3 Months out of 2 Consecutive Years
Blue Bloater: Overweight and Cyanotic, Edema, Elevated Hb, Ronchi and Wheezing
204
Benign neoplasm associated with FAP
Nasopharyngeal Angiofibroma
| Occurs in young men
205
Bosnentan Toxicities
Serious: Hepatotoxic, Teratogenesis
| Interacts with Oral Contraceptives (use 2 forms)
206
What stains distinguishes Mesothelioma from adenocarcinoma?
Calretinin
207
PE sx
Dyspnea, Chest pain, Cough
208
Radiological findings of Asbestositis
Multiple Nodular Opacities
Pleural Effusions and Fibrosis
Maybe blurring of diaphragm / cardiac silhouette
Found in Biopsy
209
Where does a Carotid Body Tumor arise from?
From NCC and Autonomic Paraganglia
Maybe Sporadically
Maybe with MEN 2
210
Warfarin reversal agents
Vit K
Prothrombin complex concentrate
Fresh frozen plasma
211
Aztreonam MOA
b-Lactam: Penecillin stuff
212
Laryngeal Carcinoma
Squamous
| Strong association with Smoking, EtOH, HPV
213
What makes atypical carcinoid tumors atypical?
Necrosis
214
What enzyme levels are elevated in Sarcoidosis?
ACE
215
PE sx
```
Chest Pain
Palpitations
Dyspnea
Syncope
Maybe Lower Extremity Edema
```
216
Direct oral Anticoagulant reversal agents
Xa inhibitors-Andexanet alpha
| Dabigatran-idarucizumab
217
Lung volumes Restrictive vs Obstructive lung disease
Restrictive: FEV1/FVC normal, FVC reduced
Obstructive: Low FEV1/FVC ratio (AIR TRAPPING)
218
Singers' Nodes
Squamous
| On the Vocal Cords
219
Findings in Sarcoidosis Granulomas
Asteroid Bodies
| Schaumann Bodies
220
Pulmonary Sequestration Etiology
Accessory Lung Bud usually in the Left Lower Lobe
221
Curschmann Spirals
Coiled Mucous Plugs associated with Status Asthmaticus
| Made of Eosinophils and Charcot Leyden Crystals
222
Imaging in PE
CT chest with contrast (gold standard)
| V/Q scan: second-line nuclear study
223
Light's Criteria
For Pleural Effusion, One of Three:
High Pleural Fluid Serum Protein Ratio (above 0.5)
Pleural Fluid LDH above 2/3 of upper limit normal
Pleural / serum LDH ratio above 0.6
224
Lofgren's Syndrome
Erythema Nodosum, Hilar Lymphadenopathy, fever, arthritis
| Seen in Sarcoidosis
