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Question 1

Linear lung opacity, could be seen in Asbestosis

⬛◻️متلازمات◻️⬛

🔘🔘🔘🔘Anatomy🔘🔘🔘🔘
Upper 6th costal cartilage
اسمها 
Pump handle movement 
وهي نفسها الحركة توسع ال 
Anteroposterior diameter 

والحركة الثانية من 7th-11th
Bucket handle movement
ونفسها الحركة توسع ال
Transverse diameter

Ophelmic artery /
بيعطي 
Medal and lateral surface of nose 
Focal artery /
بيعطي 
Alar of nose 
Lable of nose 
.......
Ophelmic nerve /
بيعطي 
Apex of nose 
External area of nose 

Mixllary nerve /
Alar of nose
دول في أول صفحه في nose 
احتمال ضعيف تيجي 
اهم اشي في nose 
Bourders 
Venus supply 
Nerve supply

🔘🔘🔘🔘Histo🔘🔘🔘🔘
1/تختفي cartilage عند bronchioles .

2/ تختفي mucous عند bronchioles .

3/ تختفي smooth muscle ما بعد alveolar duct بمعنى انو alveolar sacs لا توجد فيها smooth muscle .

4/تختفي goblet cells قبل cilia
بمعنى انو goblet cell تختفي عند bronchioles
بينما cilited cell تختفي ما بعد bronchioles
يعني عند terminal bronchioles .

5/ يتغير epithelium اللي كان نوعه pseudo stratified colmnur cilited with goblet cell
بدايه من bronchioles ليصبح simple colmnur cilited epithelium .

6/ نوع epithelium of larynx is pseudo strifid colmnur cilited with goblet cells
Except
-true vocal cord
-upper part of epiglotis
-lingual surface of epiglotis
نوعهم( stratified squamous non keratinous epithelium ).

7/ tracheal mucus comes in gland of sub mucous not lamine propria.

8/ tracheal muscle is smooth muscle,

vocal muscle is skeletal muscle .
9/ pneumocyst type 1 (GAS exchange ),
Pneumocyst type 2 ( synthesis of surfactant ).

10/Clara cell not cilial
وظيفتها انتاج ماده شبيهه في surfactant like protein
ولكن اللي المصنع الأساسي ل surfactant
هو pneumocyst type 2 (granular pneumocyst) مهمه جدا

11/trapping the fine practicles in nose by mucus secreted by goblet cell

12/mositening of practicles in nose by mucoserous gland

🔘🔘🔘Micro🔘🔘🔘🔘

**اشياء لازم تكونوا عارفينها لانو ممكن يلعب فيها في MCQ//

1_Rhino virus and coxsackie A/
SSRNA *non envelope(naked) * +ve sense

2_Adeno virus /
DSDNA non envelope (naked )
3para influenza /
SsRNA *non-segmented * ve sense ‘ envelope
4_Epstein Barr virus and cytomegalovirus/
DSDNAenvelope
……….

هو Rhino virus (main virus in common cold )
Non vaccine and non serology
No treatment by antibiotics ( لا يأتي عن طريق بكتيريا )’ mcq’
يتكاثر عن درجه حراره 33 ° (no 37°)
…….

Para influenza 
( the main in laryngitis and tracheitis )
يحتوي 
4 serotype ( serotype 1and 2 ..croup )
يحتوي على 2 glycoprotein 
Heamagglutnin 
Fusion .....cases syncytia 
Croup in children (narrow airway and immunology immature)
Common cold in adult 
اول ما تشوف في cases 
كلمه stridor بمعنى croup يقصد para influenza 
..............

Epstein Barr virus (non treatment and no vaccine)
يسبب 
Pharyngitis and tonsillitis 
Infection mononuclear syndrome 
Nasopharyngeal carcinoma (mcQ) 
Burkett lymphoma 
Hepatomegaly and spleenmegaly
Atypical lymphcytes 
Latent by (B _ lymphcytes ).
طريقه التشخيص / 
(PCR ) more sensitive  
Serology // antibodies (+ ve mono spot ) 

……

Cytomegalovirus 
نفس  Epstein Barr virus 
الاختلاف بينهم // 
انو بيتشخص في ( ve mono spot_ )
ويسبب infection mononuclear syndrome 
Latent by (monocytes ).
........

Streptococcus pyogenic
(The main bacteria in pharyngitis and tonsillitis) MCQ
Gram (+) cocci in chains
catalase (_)
Sensitive
The main virulence is M protein (anti _ phagocytic )
Capsule is hyaluronic acid (anti phagocytic non immunogenic )
Toxic
1-Strepolysis O
Labile O2 and antigen
Increase diameters in B hemolytic ( on anaerobic ).

2- Strepolysis S
Stable O2 and non antigen 
Responsible in B hemolytic .
Cases / (non invasion )
Acute follicular tonsillitis 
scarlet fever ..... (strawberry tongue )
(Post streptococcus )
Rheumatic fever 
G nephritis 
.........

Corynebacterium diphylidium
*Gram (+) bacci club ( تشبه Chinese )

تسبب pharyngitis and tonsillitis
Diphtheria
Non invasion in blood ( no bacteremia)

Path / exotoxin (A_B Toxic )
Inhibitor of protein synthesis of elongated factor 2.
يعمل pseudo membrane .

اول ما تشوف في cases //
Sore throat and enlarged L.N cervical and Nerve paralysis and myocarditis 
اعرف انو بيتكلم على corynebacterium diphylidium 
اهم تشخيص //
Loeffler Sarum 
تشخيص لل toxic //
Elek's test and EliSA and PCR 
........

Borrelia Venice (mouth floae )
تسبب  ' Vincent angina ' pharyngitis
( Ulcerative gengivostomatitis) by fusibacterium and Borrelia Venice 
Pseudomembrane 
Gram (_) bacci in anaerobic
........

heamophilus influenza 
(  The main cases in epiglotitis )
Virulence factors ( capsule polysaccharide type B . Pili and IGA protease )
* Gram (_) bacci plemorphic + pus cell
...........
( Cases questions ) (very important)
**اهم معلومات قد تواجهها في cases **//
1/ يقلك في pili swimming and pharyngea conjunctive fever قصدوا على adeno virus 

2/ يقلك foot and hand vesicles
Or herpangina
قصدوا على coxsackie A (عائله picorna)

3/ يقلك في strawberry tongue قصدوا على scarlet fever يعني المسبب streptococcus pyogenic

4/ يقلك عندو dysphagia and odynophagia
قصدوا على epiglotitis يعني المسبب heamophilus influenza

4/ bad smell and sinus pain
قصدوا otitis media and sinusitis
المسبب الرئيسي ( streptococcus pneumoniae )

5/ يقلك عندوا مشكله في الصوت hoarseness in voice
قصدوا على para influenza virus (croup )

6/ كلمه stridor في cases يعني croup
قصدوا para influenza virus

7/ لا نستخدم مضادات حيوية antibiotics لعلاج common cold )
Non antibiotics ( because no causes by bacteria )
المسبب الرئيسي Rhino virus

8/ معلومه مهمه المسبب الرئيسي في pharyngitis and tonsillitis عن بكتيريا streptococcus pyogenic
ويسبب sore throat بنسبه 70٪ عن طريق virus

9/ المسبب الرئيسي لمرض laryngitis and tracheitis
هو para influenza virus

10/ المرض اللي ينتقل عن طريق قله المناعه و سوء التغذية و إهمال في نظافه الشخصيه
هو Vincent angina عن طريق Borrelia Venice

11/ بيقلك corynebacterium diphylidium
لا تسبب bacterima
( no invasion in blood )

•can be detected by urine test: s.pneumoniae , legionella , histoplasma capsulatum

•have no person to person transmission :
Legionella , coxeilla burnetti , bacillus anthracis , hanta virua

• human pathogen only :
Chlamydia puemoniae , mycoplasma

Typical peumonia :
●G+ cocci :: s.pneumoniae
●G- bacilli :: klebsiella peumoniae , pseudomonas aeruginosa

Atypical pneumonia :
●G- like bacteria :: mycoplasma
●G-bacilli : legionella
●G+bacillu: B.anthracis

H.influenza + B.pertussis :: G- cocobacilli

Pneumonia
1 .Typical pneomonia (4 organisms )
1 . S. Pneumoni … Gram+ diplococci
-Polysaccharide capsule
-Pneumolysin “ membrane damage enzyme “
-Autolysin
-IgA1 protease
Lab diagnosis….
-draughtsman colonis
-Quellung reaction “ swelling capsule reaction “
2 . H . influenzae
Pilli - IgA protease - polysaccharide capsule
lab diagnosis ….
-Chocolate agar with factors ten “X” & five “ V”
- satellitism “ شكل متفرع زى النجوم “ around s . aureus
* Most verulante sero type is “b”
3. Klebsiella Gram - bacili
- huge polysaccharide capsule
- adhesins
* Currant jully Red sputum
lab diagnosis …
- lactise fermenter “ MacConckey agar “ لونها بينك 💗
4. Pseudomonas aeraginosa “””” Exopegment “”””
- Endotoxin & Exotoxin A
-Enzymes * protease & elastase
-pyacyanin exopigment “ لونها أخضر 💚”
lab diagnosis …
-nutrant agar “greenish colonization “
- non lactose fermentar “ MacConckey agar
2 . atypical pneumonia
1. Mycoplasma pneumoniae
- No cell wall ➡️ No gram stain but Giemsa& Leshman stains
-Community acquired Respiratory Distress syndrome toxin
- products hydrogen peroxide

lab diagnosis …
-IgM detection
- isolation “ fride . egg appearance 🍳”
2. Legionella pneumophila
* No person to person transmetion + موجودة ف المية 💧+ بيكون مصحوب ب hyponatremia & renal impirment
lab diagnosis …
“”"”No organism detected by gram stain “”””
-In calture ➡️ buffered charcoat yeast extract

** Direct detection **
-in respiratory spesimen ➡️ direct fluorescent
- in urine specimen ➡️ ELISA or RIA
3. Inhalational anthrax “”’ No person to person transmetion “”” بتتنقل بسبب عمال البنا
- (((polypeptide))) capsule
- Anthrax toxin
lab diagnosis ➡️ PCR

🔘🔘🔘🔘Patho🔘🔘🔘🔘
-Rhinitis …inf.nasalmucosa
-Hypertrophic Rhinitis …. allergic nasal polyp … esoniphil
-Angiofibroma… benign tumor of the pharynx ….highly vascular fibroma
-undefferiniated carcinoma (lymphoepithelioma)..EBV
-Quinzy ….peritonsillar abcess
-diphtheria… pseudomembranous …. exotixin …. complicated by suprarenal necrosis and Zenker’s degeneration (due to toximia)
-laryngeal polyp… signer’s nodule ….middle third of the vocal cords …أقل من 5cm …. hyalinosis
Juvenile papillomatosis …HPV 6,11… reccurent … non-malignant
-but the HPV that cause larngeal carcinoma is 16,18
-lung collapse (2ry atelectasis )
-pleural inflammatory effusion …exudate fluid
-hydrothorax….. transudate … generalized edema
-sarcomastoid mesothelioma ….spindle cell sarcoma …arranged in storiform pattern
-tumor marker of the mesothelioma…WT1+ve ,
Calretinin+ve and cytoceratin 5and 6+ve
-2ry metastatic tumor of pleura is more common than mesothelioma …..
Microscopic : hemorrhagic (sanginous) effusion
☑️Pink puffers➡️Barrel shaped chest
Hunched over position
Associated with emphysema
☑️Raspberry or mamilation is associated with laryngeal sqamous cell papiloma
☑️ Alpha one anti trypsin ➡️pan acinar emphysema
☑️Smog laden➡️chronic bronchitis
☑️ Reid index➡️increase in chronic bronchitis
☑️Reid index ➡️is the ratio of thickness of the submucosal gland layer to that of the bronchial wall
☑️Chronic bronchitis ➡️small airway disease
☑️bronchiolitis oblitranss➡️chronic bronchitis
☑️Goblet cellmetaplasia➡️chronic bronchitis
☑️Submucosal fibrosis➡️chronic bronchitis
☑️ Blue bloaters➡️chronic bronchitis
☑️Cor pulmonale ➡️ chronic bronchitis
☑️ Hypercapnia &hypoxemia➡️chronic bronchitis
☑️ Immotile cilia syndrome or primary ciliary dyskinesia and cystic fibrosis are associated with bronchiectasis
☑️ Peribronchial fibrosis ➡️ bronchiectasis
☑️Curschmann spirals &charcot crystals ➡️bronchial asthma
☑️Airway remodling➡️bronchial asthma

Pink buffer : diacoloration of skin in patient with Emphysema due to polycythemia

Blue bloater: cyanosis due to hypoxia , could be seen in chronic bronichitis

Kartegner diseases: is CONGENITAL not acquired

Obstruction of bronchi by forign body or clots&raquo_space; leads to absorption (resorption) collapse

Basement membrane thickening is seen in bronchial Asthma

Bronchiactasis does not affect large bronchi

Increased elastase ,, leads to Emphysema

A case of nasal mass or nasal obstruction , could be :

• Allergic nasal polyp (Allergy)
• Rhinoscleroma (infection)
• Tumor (rare)

A case of change in voice (hoarseness) could be :

• Laryngeal nodule (singer or teacher)
• Laryngeal papilloma ( adult or juvenile)
• Laryngeal carcinoma ( ulcer or fungating polypoid or infiltrative)

Smoking in the case could be a key for:

• Cancer larynx
• Emphysema and chronic bronchitis
• Anthracosis

In chronic bronchitis , increased Reaids index

Diphteria is oseudomembranous inflammation

Curshman spirals are seen in Asthma

A case of Smoker + increased antero posterior diameter of chest = Emphysema

A case of Interstetial fibrosis (opacity) in lower lobe + Restrictive symptoms = Asbestosis

A case of lung nodularty or collagen nodules + Sandblasting = Silicosis

child + Hoarseness of voice + multiple larynx nodules = juvenile papilloma (recurrent)

A Well defferentiated type with Good prognosis

A case of female with lung nodularities (granulomas) + enlarged LN + No bacteria = SARCoidosis

Calcified plurleral plaques are associated to cases of mesothelioma

🔘🔘🔘🔘Pharma🔘🔘🔘🔘
●Azithromycin for 5 DAYS 
●ACETAMINOPHEN OR IBUPROFEN FOR 3 DAYS
●CEFTRIAXONE 3 DAYS
● INTRANASAL DECONGESTANT FOR 3 DAYS
● ORAL CORTICOSTEROIDS FOR PRESISTANT COUGH MORE THAN 14 DAYS 
●FLUROQUNIOLONE FOR 5 DAYS
1_زي duration ان كله بديه من 7-10 ايام ما عدا Levofloxacin و Azithromycin دول 5 ايام. 

2_When pseudomonas is suspected ▶️ combination theraby

3_Daptomycin is containdicated in pneomonia as it is inactiveed by surfactant

4_In ORSA(oxacillin resistant staph aureus)▶️ give Vancomycin or Linezolid

5_ بكمل العلاج لو culture _ve المده العادية للعلاج 7-14 يوم
لو culture +ve بكمل لحد ما تبقى _ve و7_14 يوم بعدها

6_ فى حالات aspiration بيكون فيه بكتريا anaerobic من GIT فبدي Clindamycin علشان يموت البكتريا anaerobic

بالتوفيق يدكاتره ♥️🤍