MIDTERM Flashcards
1
Q
increased airway resistance due to a narrowing or blockage at some point along the air path
A
Obstructive Lung Disease
2
Q
Problem breathing out =
beathing = SLOW and DEEP
A
Obstructive Lung Disease
3
Q
Decrease in respiratory compliance making the lungs more difficult to expand
A
Restrictive Lung Disease
4
Q
Problem breating IN
breathing is rapid and shallow
A
Restrictive Lung Disease
5
Q
Fibrotic tissue is made up of elastin fibers. When lungs undergo fibrosis, there is an increasse in elastin fibers, what happens to the recoil force?
A
Greater Recoil Force
6
Q
4 Main Obstructive Lung Diseases
A
Asthma
Chronic Bronchititis
Emphysema
COPD
7
Q
alveolar damage leading to hyperinflated lungs and less recoil pressure, air cannot get out = air trapping
A
Empysema
8
Q
Obstructive Lung Disease
What happens to
PEFR
TLC
RV
FRC
A
PERF Decreases
TLC Increases
RV Increases
FRC Increases
9
Q
PAINT mnemonic
A
Pleural
Aveolar
Interstitial
Neuromuscular
Thoracic
DEC COMPLAINCE
10
Q
What happens to TLC, RV and PEFR in restrictive lung disease?
lungs do not want to inflate
A
TLC Decrease
RV Decrease
PEFR Decrease
11
Q
FEV1/VC of 0.8 or greater =
A
Normal or Restrictive Disease
12
Q
FEV1/VC of < 0.7 =
A
Obstructive Disease
13
Q
Flow - Pressure - Resistance Formula?
A
Q = P/R
14
Q
TPR = formula
A
TPR = MAP - CVP / CO
15
Q
How is the left atrial pressure estimated?
A
pulmonary artery wedge pressure
16
Q
The minimum resistance is at ____?
A
FRC = func residual capacity
17
Q
Blood Flow Maximum is at __?
A
FRC
18
Q
Where is the least resistance and the most blood flow in the lung?
A
BASE
q
19
Q
Hypoxic Pulmonary Vasoconstriction
When oxygen levels drop, the lung will shunt blood to working alveoli in order to maintain the best V/Q match caused by what?
A
Local Hypoxia
20
Q
lung capillary flow is
A
Pulsatile
21
Q
As youre taking a deep breath, what happens to pulm. vasc. resistance?
A
INCREASES
22
Q
You go from standing to suprine, what happens to lung base vascular resistance?
A
INC
23
Q
Increasing transmural pressure in the pulm. artery does what to vascular resistance?
A
DEC
24
Q
During inspiration starting at FRC what happens to vascular resistance of alveolar capillaries?
A
INC
25
Alveolar Ventilation Eqn. =
| Finds CO2
PaCO2 = K(VCO2 / QA)
| k = 0.863 VCO2 = exhaled PACo2 = in the alveoli
26
When PACO2 rises =
PACO2 falls =
Rises = HYPOventilation
Falls = HYPERventiliation
27
Aveolar Gas Equation
| Finds O2
PAO2 = 150 -1.2 (PACO2)
28
CO2 = HIGH
O2 = LOW
What is V/Q ratio?
LOW V/Q ratio
Hypoventilation
You are retaining CO2
29
At **HIGH V/Q ratio**, what is your breathing pattern?
**Hyper**ventiliation
**Blowing off** all the CO2
Low CO2, HIGH O2
30
Anatomic Dead Space vs. Aveolar Dead Space
Anatomic Dead Space -- No Gas Exchange
Aveolar Dead Space -- No perfusion
31
Blood passes through with NO gas exchange ... what type of shunt?
Intrapulmonary Shunt
| occurs when there is an **airway obstruction**
32
Will **100% O2** adminstration correct **tetralogy of fallot**?
| **Right to Left Shunt**
NO
33
Will **100% O2** adminstration correct **intrapulmonary shunts**?
| blood travels through lungs without being oxygenated
YES
34
A-a Gradient =
P**A**O2 - P**a**O2
| A-a should be **less** than **(Age + 10)/4**
35
Hypoxemia vs Hypoxia
Hypoxemia = measured in blood LOW PaO2
Hypoxia = refers to low O2 delivery to tissues PaO2 = normal
36
flora of the **oral** cavity
| associated with **dental caries and endocarditis**
Viridans streptococci
37
Most common cause of bacterial **meningitis, pneumonia and ear infections**
Streptococcus pneumoniae
38
What **3** are primarily responsible for **rhinosinusitis**?
Strep pneumo
Haemophilus influenzae
Moraxella catarrhalis
39
# Nasal Smear
**Allergic** Rhinitis vs **Acute** Rhinosinusitis
Allergic -- eosinophils
Acute -- PMN
40
Most common cause of **acute bronchitis**
VIRUSES
41
**pathophysiology** of acute bronchitis
1. APCs pick up antigen
2. Present to **CD4+** T Cells --> **produce cytokines --> Flu Like Symptoms**
3. Cytokines activate CD8+
4. CD8+ T cells kill infected cells (**Immune mediated cellular injury -- reason for long recovery**)
42
In **adults** **HRSV** presents as **vs.** in **children**?
Adults -- common cold -- pneumonia
Kids -- pneumonia -- **bronchiolitis**
43
# Pathogenesis of RSV
Inc vascular permeability -- Influx of PMNs
Mast Cells activate and release -->
leading to the formation of
Release Histamine --> Syncytica = multinucleated cells
44
**Parainfluenza** virus can cause what in **KIDS**?
Laryngotracheobronchitis (Croup)
45
# Name the virus
negative sense **8 segment** ssRNA virus
Influenza
46
# pathogenesis
What virus **replicates in GI tract without lysis of respiratory epithelia**?
Enterovirus
47
What virus is responsible for the most common cause of **common cold in summer**
Enterovirus
48
What is the **most common viral agent in humans**?
Rhinoviruses
| most common cause of common cold in fall/winter
49
What are **coronaviruses** able to form to **impair function of cilia**?
Syncytia
50
What aids the **survival of coronavirus in the GI tract**?
Glycoprotein "Corona"
detected in stools
51
# What virus?
Histology shows **intranuclear inclusions without cell enlargement**
Adenovirus
52
# Name the virus
Patient was recently clearning a cabin ... c/o of fever, muscle aches, cough
Hantavirus
53
**Hantavirus** **attaches** to what of BV?
endothelium of pulm BV
54
**Hantavirus** impairs pulm. endothelium causing what?
Capillary Dilation -- EDEMA --> Interstital Pneumonitis
55
you see **blunting of the costophrenic angle**
pleural effusion
| will move into the left lateral decubitus
56
air filled bronchioles (black) against the opacified background of the lung (white)
air bronchogram
57
if the right heart border is obscured where is the consodlidation?
Right middle lobe
58
Where will consolidations not move into?
Left Lateral Decubitus
59
What findings do we see with cardiogenic pulmonary edema during interstitual edema?
**Kerley B Lines** = thickening of the interlobular septa -- seen on outer 1cm of ungs perpendicular to pleura
**Ground Glass opacities**
60
in pulmonary embolisms what defect is seen?
Is ventilation normal?
Segmental perfusion defects (wedge shaped)
Ventilation = normal
61
Chest XRAY shows a patchwork quilt appearance ... you suspect?
Bronchopneumonia
62
# Causes of Acute bronchitis in CF patients
**5-18** years of age =
**> 18** years =
5-18 = pseudomonas aeruginosa
>18 = burkholderia cepacia
63
microbial infection resulting in pus collection within the pleural cavity
EMPYEMA
64
**Virus** causing **pneumonia** in a **healthy** host =
Influenza (MC)
RSV, Adenovirus, Parainfluenza
65
**Virus** causing **pneumonia** in **immunocompromised** hosts
**Herpesviruses**, Influenza
66
Possible **etiology** of **pneumonia** in a **NEONATE**
GBS, Klebsiella pbeymonia, E.coli, S. pneumo, S. pyogenes, S.aureus
67
Possible **etiology** of **pneumonia** in a **1mo -- 2yr**
VIRUSES (RSV)
68
Possible **etiology** of **pneumonia** in a **2-5yr**
VIRUSES
69
Possible **etiology** of **pneumonia** in a **5-18yr**
S. pneumoniae
70
If you see a LOBAR pattern ....
S. pneumoniae
71
If you see a PATCHY pattern ...
Atypical bacteria
72
If you see an INTERSTITAL pattern ...
Viruses/mycoplasma
73
If you see a CAVITARY pattern ....
Anaerobic GNB
74
**pseudomonas aeruginosa** virulence factor which has **blue pigment that suppresses other bacterial growth; some cytotoxicity in leukocytes**
PYOCYANIN
75
3 virulence factors of Strep pneumo
Choline binding protein
**Capsule**
**Pneumolysin**
76
strep pneumo releases this upon lysis of bacteria, cytotoxic to endothelial cells for to permit dissemintation of bacteria
- suppresses neutrophila nd macrophage phagocytosis
- supresses proinflam cytokine prod.
PNEUMOLYSIN
| impairs cilia action
77
4 phases of lobar pneumo
Congestion
Red Hepatization
Grey Hepatization
Resolution
78
**Complication** of Lobar Pneumonia
Bacteremia
* infective endocarditis
* cerebral abscess
* septic arthritis
79
What allows **klebsiella** pneumoniae to **protect** itself **from phagocytes**?
Polysaccharide Capsule
80
**Virulence** for **Haemophilus influenzae type B**
polyribitol phosphate capsule
| adherence, imparis cilia, prevents phagocytosis of bacteria
81
What allows **mycoplasma pneumoniae to bind directly to ciliated resp. epithelia** -- impairs ciliary action
| VIRULENCE FACTOR
P1 adhesion
| also toxic metabollites
82
Agents of HAP
Pseudomonas aeruginosa ( >4 days on vent)
Actinetobacter baumannii (prolonged vent/antibiotic resistance)
S. aureus
83
Immunocomproised Pneumonia agents
Pneumo jiroveci
Nocardia = gram + /acid fast
Herpesvirus
84
What allos **mycobacteria** to **block gram staining but bind to carbofuschin** in acid fast staining?
Mycolic Acid
85
**mycobacterium tuberculosis** establishes **residence** within what?
macrophages
86
If our immune system **cannot clear** an infection of **mycobacterium tuberculosis** it will form what?
form a **granuloma** to prevent expansion
87
What is the most common **cause** of **diffuse alveolar damage and cytokine storm**?
Viruses
Results in **Hyaline Membrane Formation**
88
**diptheria** toxin can be cleaved into what **2 fragments**?
| laryngitis
A = catalytic domain
* ADP-ribosylation of elongation factor-2 inhibit ribosome function -- preventing protein synthesis -- cell death
B = binding
89
**Ghons complex/caseous granuloma** is associated with
Primary tuberculosis
90
**secondary** tuberculosis commonly **resides** where
apex of lung -- O2 is greater here
91
**fungal** pathogen endemic to **ohio** and central **mississipii** river valleys
Histoplasmosis
92
**fungal** pathogen endemic to **southwestern** regions, infection is known as **valley fever**
| nonbudding spherules
Coccidiomycosis
93
**Loffler**'s syndrome is due to an **accumulation** of what in the lung d/t a **parasitic** infection?
Eosinophils
94
Who are the **culprits** of **lofflers** syndrome or a **parasitic** infection of the resp tract?
**Ascaris lumbricoides**
Strongyloides stercoralis
95
What is the most common **clinical** cause of **ARDS**?
Diffuse alveolar damage (DAD)
96
What two **respiratory cell groups** are present in the **medulla**?
VRG = Expiratory center
DRG = Inspiratory Center
* contains nucleus tractus solitaris/recieves input from CN IX and CNX
97
What 2 **respiratory cell groups** are in the **PONS**?
Apneustic Center -- prolongs respiration
Pneumotaxi Center -- inhibits apneustic center -- turns off inspiration
98
Both the **central** and **peripheral** receptors sense **pH and CO2**, which one **also senses O2**?
Peripheral Receptors
99
what is the **central pattern generator**?
Medulla
100
Aortic Bodies --> Aortic Nerve --> **what nerve** --> DRG in medulla (NTS)
CN X
101
Carotid bodiies --> Hering nerve --> what nerve --> DRG in medulla (NTS)
CN IX
102
Where is the **carotid body** located?
**bifurcation** of common carotid arteries
103
What contains a collection of **glomus cells surrounded by fenestrated capillaries**?
Carotid Body
104
What happens with an INFLUX of Ca
EFFLUX of K+
Influx Ca = DEPOLARIZATION
Efflux K+ = REPOLARIZATION
105
**Repolarization can be inhibited** by what?, which results in the **glomus cells continuously being depolarized** ...
inhibited by HIGH CO2 and Low pH
106
Which **fiber** receptors are **sensitive to changes in distension of capillaries**?
C-Fiber Receptors = Juxtacapillary or J Receptors
DEC Distenstion -- DEC Ventilation (pulm embolism obstructs flow to capillaries)
| INC Distension --> INC Ventilation (pulm congestion by LV failure)
107
**Herring Breuer Inflation reflex** is active in adults and infants if there **tidal volume** is >
> 800ml
108
**Rapid/Over inflation** would activate what? -- which **sends inhibitory signals to DRG via CN X**
activate SAR --> REDUCED Respiration, TV and RR
109
**Hering-Breuer DEFLATION reflex** is active during what?
Pneumothorax, trigger for sighs, maintain infant FRC
| **ACTIVATES RAR** -- promote inspiration
110
Most common cause of **Pharyngitis**
* Fever, Swollen anterior LN, Tonsillar exudates/swelling
VIRAL Infection
| does not respond to antibiotics -- R/O strep before calling it URI
111
What **lower respiratory infection** must you rule out before calling it **bronchitis**?
Pneumonia
| Consolidation on XRAY, dullness to percussion, INC Tact frem/tachy - SOB
112
**Peripheral Cyanosis** indicates ...
| fingers/toes
INC O2 uptake in tissues
113
**Central** **Cyanosis** indicates ...
| skin, mucous membranes, mouth
indicates lung pathology -- LOW arterial O2
114
**Clubbing** is a result of what?
| **Normal = Schamroths window**
Chronic hypoxemia
115
**dullness on percussion** would indicate?
Fluid present in pleural
116
volume of air still in lungs after maximal forced expiration =
FRC
Forced Vital Capiacity
117
a **NORMAL FEV1/FVC ratio** is a sign of what type of lung disease?
RESTRICTIVE
118
a **DECREASED FEV1/FVC ratio** is a sign of what type of lung disease?
OBSTRUCTIVE lung disease
| there is inc airway resistance in expiration -- air cant get out in 1 se
119
bronchoprovocation testing
Methacholine Test
- muscarinic agonist -- constricts airway
| Used to diagnose asthma
120
**asthma** is most common in what type of **demographics**?
blacks, females and children
121
disorder of bronchial airways characterized by **REVERSIBLE** bronchospasm
asthma
122
as age INC asthma begins to mimic what?
COPD
123
Astma Vs. COPD Pathophisology
Cell Markers ...
CD4 = Asthma
CD8 = COPD
124
**mainstay** of asthma treatment in children and adults
| LONG TERM
Inhaled corticosteroids
125
used as **adjunctive** asthma therapy
| LONG TERM
Long Acting Beta Agonist (LABAs)
formoterol, salmeterol
126
used in **excercise induced** asthma
| LONG TERM
leukotriene modifers
monntelukast, zafirlukast
127
**Drug of choice** for **acute relief** of asthma symptoms
Short Acting Beta Agonists
Albuterol
128
Obstructive disease diagnosed based on **clinical features vs. morophologic and radiologic features**
Chronic bronchitis vs Emphysema
129
# pathogenesis
in larger airways -- **hyperplasia** and **hypertrophy** of submucosal mucous glands
* reid index = > **0.5 (50%)**
| smaller airways -- mucous plugging of bronchiolar lumen
Chronic bronchitis
130
Patient comes in with a **productive cough** and is a **cigarette smoker**
He is **cyanotic** and has **peripheral edema**
Chronic bronchitis
| progressive dx may lead to **cor pulmonale** / right heart failure
131
INC vascular resistance or blood pressure in the lungs (**Pulm HTN**) due to chronic lung disease --> **Hypertrophy of right ventricle**
Cor pulmonale
132
COPD characterized by **permanent enlargement of airspaces distal to terminal bronchioles** due to **destruction of the alveolar walls** and the pulm capillaries required for gas exchange
EMPHYSEMA
| cig. smoking / inherited anti trypsin deficiency
133
**pathogenesis of emphysema**:
there is an **imbalance** between what two factors in smokers?
**elastase** and elastase inhibitor **a1-antitrypsin**
| non-smokers - homozygous inactivating mutation of a1-AT
## Footnote
no inhibiton of elastase
134
**Centriacinar** vs **Panacinar** Emphysema
Centriacinar -- **smokers** / **upper** lobes of lungs
Panacinar -- **inherited** / **lower** lobes
135
What type of **emphysema** is most commonly seen in **young adults with spontaneous pneumothroax**?
Distal Emphysema
- sometimes form cysts --> bullae
| parencyhma is not affected
136
60 yo patient presents with a **barrel chest and pursed lips /
Tachypnea**
Emphysema
| Pink Puffers
137
What **cytokine** is responsible for **Ig class switching in B cells to IgE**
IL4
| IL5 = recruits eosinohphils
138
in a **smear of sputum of an astmatic** patient, you see **two** hallmark features:
Curschmann's spirals
Charcot-Leyden crystals
139
**permanent dilation** of bronchi and bronchioles caused by **destruction of smooth muscle and supporting elastic tissue**
Bronchiectasis
| infection/obstruction
139
**permanent dilation** of bronchi and bronchioles caused by **destruction of smooth muscle and supporting elastic tissue**
Bronchiectasis
| infection/obstruction
140
what **microtubule protein is essential for cillary movement**?
Dynein
141
**Kartagener's syndrome** is found in some patients with **ciliary dyskinesia** that present with a **triad** of signs:
Situs inversus
Chronic sinusitis
Bronchiectasis
142
In **advanced stages**, chronic diffuse restrictive pulm diseases are difficult to diferentate bc **all result in diffuse scarring and gross destruction** =
Honey Comb Lung
= end stage lung
143
unknown etiology, now considered to be the **result of repetitive local, micro injuries to ageing alveolar epithelium by env. factors**?
Idiopathic pulm fibrosis
144
# What chronic interstital lung disease
macroscopic hallmark = **cobblestoned pleural surfaces**
microscopic hallmark = **patchy interstital fibrosis**
Idiopathic Pulm Fibrosis
145
50 yo pt presents with dry non prod cough
on ausculation you hear "**dry velcrolike" crackles at the lung bases**
Idiopathic pulm fibrosis
146
chronic bilateral interstital lung disease of unknown etiology that is freq. **associated with collagen vascular disorders** such as RA
Non-specific interstial pneumonia
147
non specific interstial pneumonia has fibrosis and inflammation in varying proproptions with **no temporal heteregeneity.** **Two** major **patterns** can be found:
Cellular - lymphoid infiltration of alveolar septa
Fibrosing -- collagen deposition without fibroblastic foci
148
3 types of pneumoconisoses
Coal Workers pneumoconiosis
Silicosis
Asbestosis
149
on a radiologic scan, you see the upper lober with nodules and **eggshell like calcification of hilar lymph nodes**
Silicosis Pneumoconisoses
150
asbestos fibrers are coated by:
IRON and protein within macrophages
151
clot stuck in the pulm trunk at the bifurcation
saddle embolus
152
Patient has a **pulm. embolism**; what **heart sound is louder** and what else do you hear on ausculation?
2nd Heart Sound (S2) = DUB
Wheezes and Crackles
| normally LUB is louder
153
You sent a patient for **labs** ... now you diagnose them with a **pulm embolism** because you saw an **increased** value of ...?
Plasma D Dimers
154
Under a **microscopic** you see what type of **lines** in a **thrombus**?
Zahn Lines
155
**Cardiogenic pulm congestion** can cause what type of heart disease?
Left Heart Disease
- blood backs up in pulm vasculature --> INC pulm hydrostatic pressues
- fluid moves out of capillaries into space of lungs --> edema
156
**surfactant deficiency** causing alveolar collapse and impaired gas exchange
| disease of premature infants
Hyaline Membrane Disease
157
What type **pneumocytes** produce surfactant?
Type 2
158
# pathogenesis of **ARDS**
injury to the walls of alveoli by inflammatory cellls, who are hearlded to the area by :
IL8
159
50 yo male presents with slowly progressing **dyspnea**, nonproductive **cough**. **End expiratory crackles and digital clubbing** ....
Idiopathic Pulm Fibrosis
| poor prognosis -- survival is 3 years
160
multisystem disease characterized by **noncaseating epitheloid granulomas**
Sarcoidosis
161
A patient diagnosed with **sarcoidosis** had lab work done, you see **elevated** what?
elevated serum ACE levels
162
a **pulmonary function test** for a patient with **sarcdoidosis**, you expect to see...
Restrictive pattern
163
Upon imaging, you see **bilateral hilar adenopathy/reticular opacities in the upper lung zones**
Sarcoidosis
164
Patient presents with **saddle nose deformity**, you suspect ....
| hemoptysis, hematuria (TRIAD)
Granulomatosis with Polyangiitis
165
diagnosis of **granulomatosis with polyangiitis** via what **seromarker**
**C-ANCA**
cytoplasmic antineutrophil cytoplasmic Abs
166
**P-ANCA** is a seromarker for what ?
eosinophilic granulomatosis with polyangiitis
| alergic rhinitis, severe asthma, eosinophilla
167
looking at a radiologic scan you see confluent nodules in upper lung fields with **egg shell** hilar nodes, you suspect ...
Silicosis [Pneumoconiosis]
168
bronchial relaxation is mediated by what ?
cAMP
169
patient no longer responds to **albuterol or salmeterol** for his asthma, what can you give him to restore responsiveness?
| **Alb = SABA** / **Sal = LABA**
Corticosteroids
170
these drugs **activate adrenergic receptors**, are helpful in **relieving mucosal edema, upper airway congestion and acute bronchospasms**
Catecholamines:
Epinephrine = rescue drug
Isoproterenol -- dangergous cardaic effects
171
key function of these drugs is to **reduce the inflammatory/immune components of asthma**
Inhaled corticosteroids
172
What's an **adverse effect of inhaled corticosteroid**?
Oral Candidasis
173
What is the **longest acting LABA with a half life of 24 hours**?
Vilanterol = LABA
| vilians have long laughs
174
# MOA
competitive anatgonists at muscarinic cholingergic receptors which causes a **DECREASE in cGMP and therefore less bronchoconstriction --> Bronchodilation**
Anticholinergics
175
# SAMA
What is the only approved **anti-cholinergic for acute bronchodilation**
| inhalation and nasal spray for acute asthma and COPD
Ipratropium (SAMA)
176
# **LAMA + LABA combo**
**combo maintenance treatment for COPD**
for bronchodilation and bronchoprotection
| Given once daily
Tiotropium + Olodaterol
| Ola Tio
177
what can **inhibit phophodiesterases PDE III (bronchodilation) and PDE IV (anti inflam**)
Theophylline
- used for control of asthma
| AE = tremors and diurersis
178
What group of drugs **prevents histamine release**, by inhibiting IgE induced calicum influx on mast cells
Mast Cell inhibitors
| Cromolyn = OTC nasal soln for allergic rhinitis and Nedocromil
179
this leukotriene anatgonist **inhibits the activity of cytochrome isoenzymes CYP3A4 and CYP2C9**
Zafirlukast
given orally for persistent astma
180
this **leukotriene anatgonist** has **minimal CYP inhibition** and can cause **systemic eosinophilia and vasculitis**
Montelukast
good for aspirin induced asthmas
181
this biologic **binds IgE Fc receptors preventing the binding of IgE to mast cells and triggering of allergic response**
Omalizumab
both early and late allergic response phases are prevented
182
this biologic has **PDE4 inhibiton** (anti-inflam) -- given orally for COPD and astma
Roflumilast
183
IV medication that inhibits smooth muscle contraction, DEC histamine release from mast cells and inhibits acetycholine release
| for pts with severe airflow compromise are unresponseive to std. trtmt
Magnesium sulfate
| very useful in acute mgmt of refractory asthma in a hospital setting
184
**Penny** brought a **case** of **cheese** to the **racquet**ball courts
Cheese Washers disease
Penicillum casei/roqueforti
Cheese Mold
185
**Lyco** the **giant** **puffball**
Lycoperdonosis
Lycoperdon periatum
Sport dust from mature puffballs
186
Canadian **crypt** / **maple** leaf
Maple bark strippers disease
Cryptostroma corticale
Moldy maple bark
187
The **ostr**iches stepped on the **mushroom** **growers** mushroms
Mushroom growers lungs
Pleurotus ostreatus
188
What **type** hypersensitivity reaction is **hypersensitivity pneumonitis**?
Type 3 or 4
inflammation of the interstital space
189
What makees **pneumocystis jirovecii** an **atypical** **fungus**?
cell wall contains cholesterol instead of ergosterol
190
# pathophysiology
**Pneumocystic jirovecii** multiplies in lung tissue forming what and is lined with what?
forms granuloma lined with hyaline membrane
| CYST
191
What is the **treatment for pneomcystosis** (PCP)
TMP-SMX (Co trimoxazole)
| only fungus that responsed to antibiotics
192
**Mucormycosis** is caused by what opportuntistic **mold**?
Rhizopus
193
**Cutaneous** **murcormycosis** presents as cellulitis --> **dermal necrosis** --> ??
Black eschars
194
What **morphological** presentation is seen with **mucormycosis**?
Broad angled hyphae
195
**Invasive pulmonary aspergillosis** usually **invades bloodstream** and has a **mortality >70%**?
What **histology** presentation can confirm diagnosis?
45 degree branching hyphae
196
**Blastomycosis** has a greater **incidence** in areas that border what?
great lakes
197
**Broad based budding** is associated to which **systemic** fungal pathogen?
Blastomyces dermatidisis
198
staining of sputum revealed **many yeast inside of phagocytes** ... you suspect which **systemic fungal** pathogen?
Histpolasmosis
| **lives intracellularly -- can disseminate -- BM involvement**
199
Patient presents with **erythema multiforma/nodosum**, he was recently in **SW USA** during the late summer. On microscopy you see **thin walled-spherule with endospores** .... you suspect?
Coccidiomycosis
200
Sphenoidal + posterior ethmoid sinus -->
Superior meatus
201
Maxillary, Frontal and Anterior ethmoid sinus -->
Middle meatus
202
Nasolacrimal duct -->
Inferior meatus
203
the **osteomeateal complex** is found **between the maxillary sinus**
anterior ethmoid air cells and the frontal sinus
204
when you hear **echinococcosis** think of
hydatid cyst
205
dog tapeworm/cestode =
echinoccus granulosus
206
**pulmonary echinococcosis [hydatid cysts**] forms primarliy in what **organ**?
LIVER
| 20-30% in lungs
207
What happens if the hydatid cyst ruptures in the lung?
| **Right lower lobe**
hypersensitivity reaction -- anaphylaxis
| Tx: PAIR
208
**lung fluke/trematodes** =
paragonimius westermanii
| undercooked crustaceans
209
Pt recently had undercooked crab, now presents with **cough, chest pain, dyspnea/hemopytsis**. CXR shows **cavitated nodules**.
Microscopy shows **paragonimus eggs** in sputum/feces
How do you treat?
Praziquantel
| Pulm Paragonimiasis
210
**blood fluke** trematode =
schistosoma mansoni
211
# Pulmonary Schistosomiasis
skin penetration by **cercaria** --> migrates to **lungs then liver** via what?
Portal blood
212
**Katayama fever** is associated to?
pulm schistosomiasis
213
on a **CXR** we see **pulm nodules** with **ground-glass halos** and **ill defined borders** .. you suspect
Pulm Schistosomias
| s TX: praziquantel
214
Child presents with a **seal-like barking cough** .. you suspect?
| Autunum
Laryngotracheobronchietis (CROUP)
215
on a CXR you see a **STEEPLE sign** ...
Laryngotracheobroncheietis CROUP
