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CPR II > Week 5 (Exam 2) > Flashcards

Week 5 (Exam 2) Flashcards

1
Q

Malignant glands invading lung tissue

A

Pulmonary Adenocarcinoma: Most common one

Stains positive for TTF-1

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2
Q

Tests for all exudative effusions

A

pH, Glucose, WBC w/diff, Micro studies, cytology

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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

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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

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5
Q

Intra- vs Extra-lobar Pulmonary Sequestration

A

Extralobar usually presents after birth, has independent vessels, pleura, possibly airways

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6
Q

Viral Pneumonia in Children cause

A

Respiratory Syncytial Virus

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7
Q

Langerhans Cell Histiocytosis

A 
Young smokers (reversible)
Progressive scarring leading to cysts, can rupture into pneumothorax
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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

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9
Q

Prostanoids (4)

A

Used for Pulmonary HTN

Epoprostenol, Treprostinil, Iloprost, Selexipag

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10
Q

Fluoroquinolone MOA

A

DNA Gyrase Inhibitor (esp for G-)

Topo IV blockade (esp for G+ Respiratory)

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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

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12
Q

Pneumoconiosis

A

Usually occupational inhalation of inorganic dusts causing inflammation responses
Restrictive pattern

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13
Q

Plexiform Lesions

A

Pathognomonic of PAH

Focal proliferation of endothelial and SM cells

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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

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15
Q

Criterion for Pulmonary Artery HTN

A

Sustained elevation of mPAP at or over 20mmHg at rest

normal is 14 +/- 3 mmHg

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16
Q

Major bugs with MDR status

A

MRSA

VRE (vance-resistant enterococci)

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17
Q

Molecular Testing associated with Adenocarcinoma

A

EGFR
ALK
PDL-1

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18
Q

Acute ARDS develops rapidly and includes… (3)

A

Severe Dyspnea
Diffuse Pulmonary Infiltrates
Hypoxemia

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19
Q

Paraneoplastic Syndromes Associated with Squamous Carcinoma

A

Hypercalcemia (PTH-Related Peptide aka PTRP)

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20
Q

Thin red forms on Acid Fast stain

A

Mycobacterium Avium

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21
Q

Metabolism of Ceftriaxone

A

Not Eliminated by the Kidney

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22
Q

ALK gene rearrangements

A

Inflammatory Myofibroblastic Tumor

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23
Q

Hamartoma Histology

A

Low Power: Marble with smooth edges

High Power: Fibrous, benign glandular epithelium around hyaline cartilage

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24
Q

Clarithromycin side stuff

A

Less GI upset but still a CYP450 inhibitor

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25
Q

Why take tetracycline with plenty of water?

A

Can cause esophageal irritation and ulceration

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26
Q

Age distribution of olfactory neuroblastoma

A

Adolescence and Middle Age peaks

Shaped like a dumb-bell

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27
Q

Atopic Asthma

A

Typically childhood
Elevated IgE (eosinophils, Mast Cells, Lymphocytes)
Triggered by allergens

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28
Q

What is the significance of neuromuscular blockage in ARDS?

A

Reduces mortality: most patients require sedation or even paralytics

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29
Q

Histology of Langerhans Cell Histiocytosis

A

Eosinophils
Immature Dendritic Cells (that’s what they are) (S-100 and CD1a Positive)
Varying Fibrosis and Cysts

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30
Q

Bronchiectasis

A

Necrotizing end stage of Infection and Obstruction (ABPA, Cystic Fibrosis, Tb, Primary Ciliary Dyskinesia)

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31
Q

Imipenem MOA

A

b-Lactam: Penicillin stuff

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32
Q

Horner’s Syndrome

A 
Enopthalmos (sunken eyeball)
Ptosis (drooping eyelid)
Miosis (persistent small pupil)
Anhidrosis (no face sweating)
This is an Oculo-SYMPATHETIC palsy
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33
Q

Penicillins and Aminoglycosides

A

Dont combine them IV

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34
Q

What makes a PE unstable?

A

Hypotension!!

RV strain, elevated cardiac enzymes

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35
Q

Exudative Phase of Pleural Effusion

A

Alveolar Edema and Neutrophil Inflammation
Diffuse Alveolar Damage
Atelactasis from edema, reduced lung compliance
Bilateral opacities on CXR
Hypoxemia, Tachypnea, Hypercarbia

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36
Q

Prevnar 13

A

S Pneumoniae Vaccine

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37
Q

How are pulmonary sequestrations mainly different from CPAM?

A

Lack of connection to tracheobronchial tree

Independent (systemic) arterial supple

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38
Q

ECG of PAH

A

Right Ventricular Hypertrophy:
R Axis Deviation in V1
RAE in Lead II
Incomplete Bundle Branch Block

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39
Q

Toxicities of gentamycin

A

Black box warnings: Nephro-, Neuro- and Ototoxicity

Neuromuscular blockade, superinfection

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40
Q

Labs of GPA

A

C-ANCA

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41
Q

Macrolide MOA

A

Binds 50S subunit to block peptide chain elongation

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42
Q

Blue Bloater Vs Pink Puffer

A

Chronic Bronchitis vs Emphysema

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43
Q

Treatment for Goodpastures

A

Plasmapheresis (and steroids and cyclophosphamide)

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44
Q

Reversal agent for LMWH

A

Protamine Sulfate

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45
Q

Ambrisentan Toxicities

A

Does NOT accelerate warfarin metabolism, oral contraceptives. Still use 2 though

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46
Q

Heerfordt’s Syndrome

A

Anterior Uveitis, Parotitis, CN VII palsy, fever

Seen in Sarcoidosis

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47
Q

Labs of PAH

A

Maybe more BNP

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48
Q

Indications for Thoracentesis (for Pleural Effusion)

A

All effusions with more than 1cm layering in decubitus

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49
Q

Guanylate Cyclase Sensitizer

A

Used for Pulmonary HTN

Riociguat

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50
Q

Key diagnostic criteria for ARDS

A

PaO2 / FIO2 equal or less than 300mmHg

aka Arterial Oxygen Pressure / Inspired O2 Fraction

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51
Q

Erythromycin side stuff

A

Can cause Epigastric Pain

Inhibits CYP450 metabolism

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52
Q

Kohn Complex

A

Parenchymal Lesion with Hilar LN involvement

Found in Tb

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53
Q

Common Tb finding in elderly

A

Lower lobe infiltrates (with or without Pleural Effusion)

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54
Q

Radiological differences between Hypersensitivity Pneumonitis and IPF

A

Hypersensitivity honeycombing spares the bases of the lungs

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55
Q

Types of Emphasema

A

Spontaneous PTX
a-1 Antitrypsin Def
COPD
Localized

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56
Q

Respiratory Bronchiolitis - Interstitial Lung Disease

A

Dose Dependent Smoking-Related (reversible if stopped)
Macrophages present to lesser extent
Peribronchiolar Metaplasia (abnormally in ciliated cells)
May lead to fibrosis

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57
Q

Keratin Pearls

A

Squamous Carcinoma of the lung

orange cytoplasm

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58
Q

Endothelin Antagonists (3)

A

Used for Pulmonary HTN

Bosnian, Ambrisentan, Macicentan

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59
Q

PE on EKG

A

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)

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60
Q

Major bugs with PDR status

A

P Aeruginosa
Acinetobacter Baumannii
Klebsiella

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61
Q

Airway Remodeling Associated with Asthma

A

Fibrosis

Decreased Responses to Bronchodilators and Corticosteroids

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62
Q

What do you give with Pulmonary HTN and a Positive Vasopressor Test?

A

Calcium Channel Blocker: Nifedipine, Diltiazem, or Amlodipine

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63
Q

Progression of Squamous Cell Carcinoma of the lung

A

Normal to Squamous Metaplasia to Squamous Carcinoma in Situ to Invasive Squamous Carcinoma

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64
Q

Gentamycin MOA

A

Aminoglycoside

Binds 30S ribosomal subunit: Misreading of tRNA, no protein synthesis

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65
Q

Etiology of Congenital Pulmonary Adenomatoid Malformation (CPAM)

A

Arrested development of pulmonary tissue with formation of intrapulmonary cystic masses

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66
Q

Clinical uses for gentamycin

A

Respiratory tract infections

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67
Q

LAM histology

A

Low power: Cell proliferation around cystic spaces

High power: Small nests of tumor cells

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68
Q

Clinical use for Amoxacillin +/- Clavulanate

A

Community Acquired Pneumonia

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69
Q

What are the three etiologies of atelectasis?

A

Resorption
Compression
Contraction

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70
Q

Epoprostinol

A

Continuous IV, Needs to be kept cold, works like a prostacyclin to treat PAH

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71
Q

BMPR2

A

Known genetic mutation for PAH in patient or 1st degree relative

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72
Q

Treat naive PAH pt with WHO FC II or III that doesn’t have evidence of rapid disease progression

A
  1. Combo therapy: Ambrisentan and Tadalafil

Alternative: Monotherapy macitentan, ambisentan, riociguat, sildenafil, tadalafil

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73
Q

Distinguishing feature of Hypersensitivity Pneumonitis

A

Plasma Cells

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74
Q

Allergic Bronchopulmonary Aspergillosis

A

Background of Asthma or Cystic Fibrosis
Increased Serum IgE
Positive Skin Test
Thick dark mucus in bronchi (w/ the hyphae)

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75
Q

Treat naive PAH pt with WHO FC III and evidence of rapid disease progression

A
  1. Continuous IV Epoprostenol or Treprostinil, or SC Treprostinil
    Alternative: Consider adding inhaled or oral prostanoid
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76
Q

Toxicity to Cefpodoxime + Cefditoren

A

b-Lactam allergy

Superinfection

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77
Q

Transthoracic Echocardiogram

A

Estimates Pulmonary A systolic pressure via Tricuspid Regurgitation gradient
(also looks at RV, LV chamber size)

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78
Q

Diagnosis of ARDS

A

Clinical: Acute onset. Bilateral Infiltrates, Hypoxemia, HF exculsion

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79
Q

a-1 Antitrypsin normal function

A

Protects lungs from neutrophil elastase

Without it, you get damage from neutrophils in the liver and lungs

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80
Q

Diffuse Alveolar Damage indicators

A

Edema + Fibrin + Cell Debris = Hyaline Membranes!

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81
Q

Red Man Syndrome

A

Vancomycin

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82
Q

Major 3rd generation oral cephalosporins

A

Cefditoren
Cefpodoxim
e-Proxetil

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83
Q

Risk factors for Increased mortality in MDR pathogens or HAP

A

Ventilatory support for HAP

Septic Shock

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84
Q

PE echo findings

A

Long Axis: Large R resulting in compressed LV

Short Axis: D-Shaped LV from RV enlargement

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85
Q

Proliferative phase of Pleural effusion

A

Most recover, some get progressive lung injury and fibrosis

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86
Q

How to treat adenovirus, parainfluenza, RSV

A

No vaccine, give abx for superinfections

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87
Q

CT imaging of Idiopathic Pulmonary Fibrosis

A

Honeycombing with traction bronchiectasis

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88
Q

Perivascular Epitheliod Cells maybe with a Pneumothorax

A

Lymphangioleiomyomatosis (LAM)

LOF of TSC2 tumor suppressor

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89
Q

Gold standard for Obstructive Sleep Apnea dx

A

Polysonogram

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90
Q

Pharmacokinetics of Treprostinil

A

SubQ infusion
Longer half life, doesn’t require refrigeration
QID inhalation
Oral XR

91
Q

Cefpodoxime Clinical applications

A

Pneumonia, Community-Acquired Outpatient empric therapy (alternative agent)

92
Q

Risk factor for MDR Pseudomonas / other G- Bacilli / MRSA

A

IV antibiotics within the past 90 days

93
Q

Cup-Shaped yeast forms

A

Pneumocystis Jiroveci

AIDS defining illness

94
Q

Imipenem Clinical uses

A

Wide spectrum, Lower Respiratory Tract Infections

95
Q

“pushing out” that causes pulmonary Edema

A

Mainly Left sided HF

96
Q

iloprost pharmacokinetics

A

Inhalation 6-9x per day

97
Q

Berylliosis

A

Associated with Alloy and Electronic manufacturing
Hilar LAD, diffuse infiltrates
Tx with steroids and getting out of exposure

98
Q

Macitentan

A

Non-selective endothelin antagonist with an 18 hour half life for 1/day dosing
CYP450 effects similar to bosentan

99
Q

Cefpodoxime + Cefditoren MOA

A

Penecillin (cell wall synthesis inhibition)

100
Q

Alveolar Pores (of Kohn)

A

Allow aeration

Allows exudate, cells bacteria to travel between alveoli

101
Q

Azithromycin sides stuff

A

CYP450 is TOTALLY FINE

Concentrates in cells. slowly releases bacteriostatic levels of drug: half-life of 2-4 days

102
Q

Pulmonary Biopsy with Unusual Interstitial Pneumonia

A

Idiopathic Pulmonary Fibrosis

Normal Areas + Inflammation + Fibroblast Foci + Peripheral Honeycombing

103
Q

EBV tumors

A

Nasopharyngeal Carcinoma

Extranodal NK/T cell lymphoma

104
Q

Acute lung injury criteria

A

PaO2/FiO2 at or above 300

105
Q

Asthma Mediator Soup

A

Leukotrienes C/D/E-4, Histamine, PGD2, Ach, ILs

Bronchoconstriction, Mucous, Permeability, Inflammation

106
Q

Alternative Regimens for MDR or high risk pneumonia

A

Linezolid
Aztreonam
Ceftolozane - Tazobactam

107
Q

WHO subgroups of Pulmonary HTN

A
  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
Q

How do you die from PAH?

A

Right ventricular overload, failure. ~2.5 years.

109
Q

Prostanoid (prostacyclin-like) MOA

A

Binds GPCR to generate cAMP

Vascular Relaxation, Supresses Vascular SM growth, ?Inhibits platelets

110
Q

Where do Protein C and S act in the coagulation cascade?

A

Blocks VIII and V (factor V Leiden mutation prevents binding here)

111
Q

Where does Antithrombin III act in the coagulation cascade?

A

II and X

112
Q

Sildenafil MOA

A

This is Viagra
Blocks Phosphodiesterase type V
Potentiates cGMP mediated vascular relaxation

113
Q

“Candlewax Drippings” on pleura, histologically showing hyalinized collagen

A

Asbestositis

114
Q

Tetracycline MOA

A

Binds 30S Subunit, Bacteriostatic

Kills those lacking a cell wall

115
Q

Laryngeal Squamous Papilloma association

A

HPV 6 and 11

Recurrent Respiratory Papillomatosis (probably acquired during birth)

116
Q

Prostanoids Pharmacokinetics

A

Oral BID

Super expensive

117
Q

Riociguat MOA

A

Sensitizes sGC to NO
Directly stimulates sGC
Increases cGMP

118
Q

Coccidiodes Immitis

A

Granulomatous Response w/ Eosinophils in lungs

Southwest US and Mexico

119
Q

Amoxacillin +/- Clavulanate clinical use

A

Pseudomonas

Community, hospital acquired pneumonia

120
Q

Predominant pathophysiologic mechanism of Chronic Bronchitis

A

Mucous Gland Hyperplasia: Damage to Airway Epithelium

121
Q

Risk Factors for MRSA

A

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
Q

Silicosis

A

“cristalline quartz” inhalation by occupation
Nodular lung disease and calcified hilar LN
Increased risk of Tb infection

123
Q

Goodpasture Labs

A

Anti-Glomerular Basement Membrane antibodies (in the alveoli)

124
Q

Major bugs with EXR status

A

Mycobacterium Tb

Coagulase+ Staph, P Aeruginosa, Klebsiella

125
Q

Bastomyces Dermatitides

A

Granulomatous lung response

Broad Based Budding Yeast

126
Q

Radiographic Stages of Sarcoidosis

A

I: Bilateral Hilar LAD (alone)
II: Hilar LAD + Parenchymal Infiltrates
III: Parenchymal infiltrates
IV: Fibrosis

127
Q

Diagnosis of DAD

A

Pathologic: Hyaline Membranes, Interstitial Edema, Epithelial Necrosis

128
Q

Cefditoren Clinical Applications

A

Community-Acquired Pneumonia

129
Q

What are the three locations of foregut cysts?

A

Respiratory, Esophageal, Gastroenteric

Seen along Hilum and Mediastinum

130
Q

Symptoms of Typical Pneumonia

A

Abrupt
Respiratory Sx
Consolidation on CXR
Older adults or younger children

131
Q

Macrolide Effectiveness

A

Most G+
Not really G-
No protozoa or fungi

132
Q

Bugs of Otitis Media

A

Strep Pneumoniae
Moraxella Catarrhalis
Haemophilus Influenzae
(P Aeruginosa for chronic otitis media in diabetics)

133
Q

Chest imaging of Reactive Tb

A

Cavitary Lesions
Discrete Nodules
Infiltrates: Apical/Posterior parts of Upper lobes, Superior parts of lower lobes

134
Q

Primary Regimens for Low risk of MRSA, no risk factors for MDR pathogens

A 
Cefepime
Piperacillin-Tazobactam
Meropenem (or Ertapenem)
Levofloxacin
add Vanco
135
Q

Primary Ciliary Dyskinesia

A

Dysfunction of Dynein arm of Microtubules
Sinusitis + Bronchiectasis + Situs Inversus
Often Male Infertility

136
Q

Histology of Non Specific Interstitial Pneumonia

A

Uniform Infiltrates and Fibrosis

No Heterogeneity, No Fibroblast Foci, No Granulomas

137
Q

Why should you be stingy with IV fluids in ARDS patients?

A

They have interstitial and alveolar edema already from the increased pulmonary vascular permeability
For the matter, avoid glucocorticoids and NO

138
Q

Tadalafil

A

This is Cialis

Longer 1/2 life than Sildenafil / Viagra, same MOA

139
Q

How do you distinguish NE lung tumors?

A

DIPNECH (diffuse interstitial pulmonary neuroendocrine cell hyperplasia) is less than 5mm (tumorlet, precursor)
Carcinoid tumor is 5mm or bigger. These guys can metastasize

140
Q

Major 3rd and 4th generation parenteral cephalosporins

A

Ceftriaxone (3)

Cefepime (4)

141
Q

Carotid Body stain

A

S-11 showing sustentacular supporting cells

142
Q

Antifibrotics used for pulmonary Fibrosis

A

Pirfenidone (decreases fibroblast proliferation)

Nintedanib (TK inhibitor)

143
Q

Treatment of GPA

A

Steroids and Cyclophosphamide

144
Q

Genetics of a-1 Antitrypsin

A

Pi gene on Chromosome 14
Z Allele is associated with decreasing levels
Homozygous PiZZ are fucked with emphysema (panacinar)

145
Q

Sarcoidosis

A

Dx of exclusion + noncaseating granulomas in lung

146
Q

3 Components of Asthma

A

Recurrent Airway Obstruction
Airway Hyper-Responsiveness
Airway Inflammation

147
Q

Granulomatosis with Polyangiitis on the nasal passages

A

Ulcers, necrosis, perforation

Classic “Necrobiotic” histology

148
Q

Masson Bodies

A

Looks like Cotton Candy
Fibroblast Foci - Organizing plugs of CT
Found in Cryptogenic Organizing Pneumonia

149
Q

Typical PAH patient

A

Young mother (happens more in women, can be any age)

150
Q

What are the respiratory Fluoroquinolones?

A

Levofloxacin (3rd gen)
Gemifloxacin (4th gen)
Moxifloxacin (4th gen)

151
Q

Cryptogenic Organizing Pneumonia Presentation

A

Superimposed on prior infection or inflammation
Pneumonia-Like Consolidations
50 - 60 y.o.

152
Q

Clinical Presentation of Emphysema

A

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
Q

Stages of Lobar Pneumonia

A

Congestion
Red Hepatization
Grey Hepatization
Resolution

154
Q

Clinical Application of Aztreonam

A

Only Gram- Stuff

UTIs, RTIs, Septicemia, Skin infections, etc

155
Q

Histoplasma Capsulatum

A

Midwest
Granulomatous response with Calficications or Coil Lesions on CXR
Pumpkin Seen Yeast Forms

156
Q

Symptoms of Atypical Pneumonia

A 
Slower Onset
Systemic Symptoms
Patchy Infiltrates on CXR
Young Adults / Teens / Older children 
"walking pneumonia"
157
Q

Restrictive Flow Volume Loop

A

Smaller, but shifted to the right

158
Q

Alveolar Spaces stuffed with macrophages

A

Desquamative Interstitial Pneumonia: Restrictive Presentation

159
Q

Chest imaging of primary Tb

A

Small Unilateral Infiltrates
Hilar and Paratracheal LN enlargement
Segmental Atelectasis
30-40% have pleural effusion (sometimes solely)

160
Q

Major cause of resistance and allergies to Cephalosporins

A

B-Lactamases

161
Q

Pneumonia with Abscess formation

A

Staph Aureus

Common with IV drug users

162
Q

Otosclerosis

A

Abnormal bony deposition at stepedIal footplate
Causes conductive hearing loss
Unknown, maybe AD, mechanism

163
Q

How to dx Hypersensitivity Pneumonitis

A

History

164
Q

Serious sides of Prostanoids

A

Sepsis due to chronic catheter, life threatening if clogged

Flushing, N/V, Headache, Jaw Pain

165
Q

Amoxacillin +/- Clavulanate MOA

A

Amoxacillin: Inhibits transpeptidation of cell wall synth
Clavulanate: Inhibits b-Lactamases

166
Q

Risk factors for MDR Pseudomonas and other G-Bacteria

A

Structural lung disease
Respiratory Specimen Gram stain with numerous G-Bacilli
Colonization with OR prior isolation of MDR Pseudomonas or other G- Bacilli

167
Q

Mild vs moderate vs severe ARDS

A

Mild is above 200, moderate is above 100, severe is below 100

168
Q

How does Aspergillus stain?

A

H&E, Silver Stain

169
Q

Histology of Pneumonia

A

Bacterial in Alveoli

Viral in Interstitium (epidemics are common)

170
Q

Adenocarcinoma Progression

A

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
Q

Influenza Treatment

A

Neuraminidase Inhibitors (especially if given within 48 hours)

172
Q

Obstructive Flow Volume Loop

A

smaller, Squished on the top right, shifted to the left

173
Q

Unstable PE tx

A

Resuscitation, Thryombolytics, maybe surgery

174
Q

Potential therapies for Idiopathic Pulmonary Fibrosis

A

Lung Transplant
TK inhibitors
TGF-b Inhibitors

175
Q

Clindamycin main use

A

C Diff

176
Q

Oseltamivir (and Zanamivir)

A

Influenza vaccine
Works via Neuraminidase Inhibition (replication enz)
Only works if done within 48 hours of sx

177
Q

Linezolid Pharmacokinetics

A

Oral or IV

Inhibits Monoamine Oxidase (increases catecholamines)

178
Q

Pulmonary Alveolar Proteinosis

A

Impaired Surfactant Metabolism
Defect of (and Treated With) GM-CSF
Shit tons of milky fluid in lungs

179
Q

Branchial Cyst

A

Most frequently arises from 2nd branchial arch

180
Q

Symptoms and associations of Pulmonary Hypoplasia

A

Impaired ability to inhale:
Oligohydramnios (renal agenesis)
Airway malformation (tracheal stenosis)
Chest wall disorders

181
Q

Cholesteatoma

A

Cystic lesion in Chronic Otitis Media
Lined with benign squamous epithelium with keratin
Can enlarge and erode adjacent bone

182
Q

Anti-Synthetase Syndrome

A

Myositis, Fever, Reynauds, Mechanic hands, arthritis, ILD

Found in Dermatomyositis / Polymyositis

183
Q

Linezolid MOA

A

Binds A Site of Ribosome, Blocking tRNA Binding

Binds 23S RNA of 50S subunit. Prevents 70S initiation

184
Q

Primary regimen for more severe pneumonia / high risk mortality / MDR G- suspected

A

Add Ciprofloxacin / Levofloxacin / Tobramycin / Amikacin

185
Q

The 3 stages of ARDS

A

Exudative, Proliferative, Fibrotic (irreversible)

186
Q

Indications for tetracycline

A

Community Acquired Pneumonia (doxycycline)

187
Q

ARDS presentation

A

Abrupt onset
Hypoxemia: PaO2/FiO2 at or above 200
Bilateral Infiltrates
Non-Cardiac

188
Q

Emphema

A

Inflammatory Exudate of pus in the pleural space
Creates Loculations: web-like traps for fluid
Usually a bacterial infection

189
Q

Apnea criterion

A

SpO2 drop more than 3%

190
Q

Non-Atopic Asthma

A

Often Older patients
Normal IgE (T Lymphocytes, Neutrophils)
Triggered by cold, exercise, infection

191
Q

Velcro Lung

A

Prominent Inspiratory Crackles

Idiopathic Pulmonary Fibrosis

192
Q

Treatment for Sarcoidosis

A

Supportive Care

Immunposuppression (steroids, methotrexate, azathioprine, cyclophosphamide, biologics: Etanercept and Infliximab)

193
Q

Associations of Small Cell Neuroendocrine Carcinoma

A

Almost always with smoking

194
Q

Samter’s Triad

A

Aspirin Sensitive Asthma
Nasal Polyps
Recurrent Rhinitis

195
Q

PDE 5 Inhibitors (2)

A

Used for Pulmonary HTN
Sildenafil
Tadalafil

196
Q

Miliary imaging pattern

A

Tb

197
Q

Treat PAH patient with WHO FC IV

A
  1. Continuous IV Epoprostenol or Treprostinil, or SC Treprostinil
    Alternative: Inhaled Prostanoid and Oral PDE-5 Inhibitor and oral ET-Antagonist
198
Q

ARDS Histology

A

Endothelial Activation
Neutrophils
Formation of Hyaline Membranes

199
Q

Stable PE tx

A

Heparin, Low Molecular Weight Heparin, K antagonists

200
Q

Paraneoplastic Syndromes associated with Small Cell Carcinoma

A

SIADH

Cushings (secretion of ACTH)

201
Q

Common adverse effect of cefmetazole, cefoperazone, cefotetan, ceftriaxone

A

Bleeding tendencies

202
Q

General presentations of bacterial vs viral pneumonia

A

Bacterial: Fever, Lobar/Consolidated, abrupt
Viral: Gradual, Epidemics, Diffuse CXR, Wheezes

203
Q

Chronic Bronchitis Diagnostics

A

Persistent Sputum production for 3 Months out of 2 Consecutive Years
Blue Bloater: Overweight and Cyanotic, Edema, Elevated Hb, Ronchi and Wheezing

204
Q

Benign neoplasm associated with FAP

A

Nasopharyngeal Angiofibroma

Occurs in young men

205
Q

Bosnentan Toxicities

A

Serious: Hepatotoxic, Teratogenesis

Interacts with Oral Contraceptives (use 2 forms)

206
Q

What stains distinguishes Mesothelioma from adenocarcinoma?

A

Calretinin

207
Q

PE sx

A

Dyspnea, Chest pain, Cough

208
Q

Radiological findings of Asbestositis

A

Multiple Nodular Opacities
Pleural Effusions and Fibrosis
Maybe blurring of diaphragm / cardiac silhouette
Found in Biopsy

209
Q

Where does a Carotid Body Tumor arise from?

A

From NCC and Autonomic Paraganglia
Maybe Sporadically
Maybe with MEN 2

210
Q

Warfarin reversal agents

A

Vit K
Prothrombin complex concentrate
Fresh frozen plasma

211
Q

Aztreonam MOA

A

b-Lactam: Penecillin stuff

212
Q

Laryngeal Carcinoma

A

Squamous

Strong association with Smoking, EtOH, HPV

213
Q

What makes atypical carcinoid tumors atypical?

A

Necrosis

214
Q

What enzyme levels are elevated in Sarcoidosis?

A

ACE

215
Q

PE sx

A 
Chest Pain
Palpitations
Dyspnea
Syncope
Maybe Lower Extremity Edema
216
Q

Direct oral Anticoagulant reversal agents

A

Xa inhibitors-Andexanet alpha

Dabigatran-idarucizumab

217
Q

Lung volumes Restrictive vs Obstructive lung disease

A

Restrictive: FEV1/FVC normal, FVC reduced
Obstructive: Low FEV1/FVC ratio (AIR TRAPPING)

218
Q

Singers’ Nodes

A

Squamous

On the Vocal Cords

219
Q

Findings in Sarcoidosis Granulomas

A

Asteroid Bodies

Schaumann Bodies

220
Q

Pulmonary Sequestration Etiology

A

Accessory Lung Bud usually in the Left Lower Lobe

221
Q

Curschmann Spirals

A

Coiled Mucous Plugs associated with Status Asthmaticus

Made of Eosinophils and Charcot Leyden Crystals

222
Q

Imaging in PE

A

CT chest with contrast (gold standard)

V/Q scan: second-line nuclear study

223
Q

Light’s Criteria

A

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
Q

Lofgren’s Syndrome

A

Erythema Nodosum, Hilar Lymphadenopathy, fever, arthritis

Seen in Sarcoidosis

CPR II (8 decks)

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