Test 2 Week 2 Flashcards
What are the adverse effects of macrolides?
GI disturbance, cholestatic jaundice, prolonged QT interval
What is considered the active sleep center of the brain?
thalamus and hypothalamus
What are the adverse effects of rifampin?
- rashes, thrombocytopenia, nephritis and impairment of liver function - harmless orange coloration of body fluids
major cytP450 inducer–> increases metabolism of a lot of drugs
Which neurotransmitters are involved in keeping you awake?
histamine, ACh, NE, serotonin, dopamine
Which fluoroquinolones are the “respiratory quinolones”?
Levofloxacin and Moxifloxacin
Which neurotransmitters are active when you are awake AND asleep?
ACh and glutamate
What is the marker that is typically strongly expressed in squamous cell carcinomas but not as much in adenocarcinomas of the lung?
p63
What combination therapy is used with inpatient CAP, non-ICU?
combo of beta lactam and a macrolide
What is considered the arousal center of the brain?
brainstem
SIADH is most closely associated with which lung cancer type?
small cell lung cancer
What are the risk factors for head and neck cancer?
smoking, heavy alcohol use, and in some cases exposure to human papillomavirus types 16,18
What are the adverse effects of Pyrazinamide?
hepatotoxicity, hyperuricemia, GI upset, malaise, fever
What is this an image of?
BENIGN PULMONARY HAMARTOMA
What’s the equation for pulmonary vascular resistance?
PVR= mPAP-PCWP/ CO
mPAP= mean pulmonary artery pressure
PCWP= pulmonary capillary wedge pressure
CO= cardiac output
Chronic thromboembolic pulmonary hypertension (CTEPH)
group 4 pulmonary hypertension
Most common bacterial pathogens causing uncomplicated acute bacterial sinusitis:
◦Streptococcus pneumoniae
◦Hemophilus influenzae
◦Moraxella catarrhalis
Lung Adenocarcinoma is usually due to what genetic alterations?
EGFR and ALK genetic alterations
What’s the gold standard for diagnosing lung cancer?
biopsy
What are the adverse effects of fluoroquinolones?
GI upset, QT interval prolongation, hypo/hyperglycemia, photosensitivity, CNS stimulation (headache, dizziness, insomnia)
What’s the MOA of Isoniazid?
inhibits the synthesis of mycolic acid, required for the mycobacterial cell wall.
Rifampin can increase the ___ of other drugs.
rifampin can increase the metabolism of other drugs by being a strong inducer of CYP450
Which prostacyclin analog is an FDA approved therapy for pulmonary artery hypertension?
Epoprostenol
What is the one non-stimulant drug given for daytime sleepiness?
sodium oxybate; improves quality of sleep so you won’t be so tired when you get up
Which neurotransmitters are responsible sleep?
GABA
What are the immunostaining results for the majority of adenocarcinomas stained with CK7, CK20, and TTF1?
CK7 positive TTF-1 positive CK20 negative
Vocal fold immobility (another cause of hoarseness) is caused by injury to which nerve?
◦Injury to the recurrent laryngeal nerve or its nerve of origin, the vagus nerve (CN X)
pulmonary arterial hypertension
Group 1 pulmonary hypertension
what is seen on histology of mesothelioma?
Psammoma bodies
How do we test for ALK rearrangement?
FISH
What is the main center for sleep?
VLPO in the hypothalamus. It secretes GABA
What med is used for prophylaxis treatment (e.g., for exposed family members)?
isoniazid
What’s the most common presenting symptom of Squamous cell carcinoma of the larynx?
hoarseness
What’s the most common benign tumor of the lung?
pulmonary hamartoma
What are the most common immunostains used for an adenocarcinoma workup?
CK7, CK20, and TTF1
which lung cancer is associated with hypercalcemia?
squamous cell carcinoma; due to tumor production of PTHrP
What’s the MOA of Pyrazinamide?
blocks bacterial trans-translation [Ubiquitous and essential bacterial process that resolves stalled translational complexes and recycles ribosomal subunits.]
What are the most active first line agents for TB?
rifampin and isoniazid
How are obstructive sleep apnea and central sleep apnea different (in terms of definition)?
- obstructive sleep apnea: respiratory effort against airway obstruction (throat is collapsed)
- central sleep apnea: throat is open but no respiratory effort (due to CNS injury/toxicity)
What are the adverse effects of Ethambutol?
optic neuritis (decreases visual acuity and causes red-green color blindness)
often presents with a mass with a central cavitation
squamous cell carcinoma of the lung
How can you alleviate peripheral neuropathy caused by Isoniazid?
give b6 (pyridoxine)
When should you order sputum tests?
- patients with CAP who are at risk for pseudomanas (COPD patient on prednisone) or unusual bacterial pathogen (like legionella)
- patients with HAP, HCAP, VAP
- if you suspect fungus or TB
Histologic features that are considered characteristic of squamous cell carcinomas:
- Evidence of keratinization (production of pink keratin globs) 2. Prominent intercellular bridges (represent desmosomal connections between squamous cells)
What are the endothelin receptor antagonists used to treat pulmonary artery hypertension?
Bosentan and Ambrisentan
Which neurotransmitters play a vital role in stabilizing the waking/arousal center?
orexin/hypocretin
List the first line agents for treating TB
rifampin, isoniazid, pyrazinamide, ethambutol RIPE
Which gene mutation is present in Congenital Central Alveolar Hypoventilation Syndrome?
mutation of PHOX2B gene
Benzodiazepine receptor agonists are used as sleep meds instead of benzos themselves. Why?
benzo receptor agonists don’t have as long of half lives, and they work on specific sites of sleep which minimizes side effects
Most common type of lung cancer in never or light smokers
adenocarcinoma
Pulmonary hypertension owing to left heart disease
group 2 pulmonary hypertension
What’s the gold standard test for pulmonary hypertension?
right heart catheterization to directly measure pulmonary artery pressures
what’s the most common cause of obstructive sleep apnea in healthy normal weight children?
adenotonsillar hypertrophy
What’s the best screening test for pulmonary hypertension?
echocardiogram b/c it is non invasive
What causes laryngeal papilloma?
HPV 6 & 11
How is pulmonary hypertension defined?
mean pulmonary artery pressure (mPAP) > 25mmHg at rest
What problems result from Pancoast syndrome?
-Severe pain in the shoulder region radiating toward the axilla and scapula along the ulnar aspect of the muscles of the hand -Atrophy of hand and arm muscles -Horner syndrome
What are the adverse effects of Isoniazid?
hepatotoxicity and toxicity in the peripheral and central nervous system AND drug induced lupus
What’s the MOA of ethambutol?
Inhibits mycobacterial arabinosyl transferase, an enzyme involved in cell wall synthesis.
What’s the treatment for obstructive sleep apnea?
- weight loss
- CPAP
- surgery to remove tonsils, adenoids, or excess pharyngeal tissue to open up airway
Which macrolides are commonly used for RTI’s?
Clarithromycin, Azithromycin, Erythromycin
How do we test for EGFR? (epidermal growth factor receptors)
PCR
What’s the recommended strategy for treatment of latent TB infection?
isoniazid for 9 months or rifampin for 4 if the patient doesn’t tolerate isoniazid or has isoniazid resistant bacteria
Pulmonary hypertension with unclear multifactorial mechanisms
group 5 pulmonary hypertension
Primary pulmonary hypertension has familial forms that are related to inactivating mutations of _____, leading to ______,
BMPR2 leading to proliferation of vascular smooth muscle
MOA of rifampin?
inhibits bacterial (but not human) DNA- dependent RNA polymerase –bactericidal
What will superior vena cava syndrome cause in a patient?
-facial plethora -jugular venous distention in neck -edema in upper extremities
Which Phosphodiesterase-5 inhibitors are approved to treat pulmonary artery hypertension?
sildenafil and tadalafil
What causes Pancoast syndrome?
malignant neoplasm of the superior sulcus of the lung (lung apex) with destructive lesions of the thoracic inlet and involvement of the brachial plexus and cervical sympathetic nerves (stellate ganglion).
What is this an image of?
classic carcinoid tumor
What is this an image of?
squamous cell carcinoma
Pulmonary hypertension owing to lung diseases and/or hypoxia
group 3 pulmonary hypertension
potential cause of dyspnea on exertion
pulmonary hypertension
What is carcinoid syndrome? What causes it?
characterized by intermittent attacks of diarrhea, flushing, and cyanosis (presents as wheezing). Due to production and release of serotonin by tumor cells
What clinical features predict sensitivity to treatment aimed at the EGFRs?
female, adenocarcinoma, Asian, never smoked
What is required for the usual definition of pneumonia (gold standard)?
abnormal imaging
What’s the MOA of fluoroquinolones?
inhibit DNA gyrate (topoisomerase II) and topoisomerase IV [inhibit DNA replication]
What is this an image of?
small cell carcinoma of lungs
