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