14 Lungs

q123456's version from 2016-06-01 16:33


Question Answer
respiratory difficulty or obstructionepiglottis (H influenza), parainfluenza virus (croup)
bronchitisRSV, H influenza, M pneumonia, C pneumoniae, bordetella pertussis
typical pneumoniameales
blood tinged or rusty>>>S pneumonia
CGD and CF>>>pseudomonas
foul smelling>>> anaerobes
Lung abscessStaphylococcus aureus
high fever, dyspnea and cavitary lesion in lung

Klebsiella pneumonia
lobar cavitation in alcoholics over 40 years of age with diabetes or obstructive lung disease
thick bloody sputum, nursing home, high fever
atypicalwalking pneumonia, atypical, dry cough>>>mycoplasma pneumonia

atypical, with diarrhea, air conditioning exposure, heavy smoker, drinker>>>legionella

HIV patients, sudden high fever, severe dyspnea and malaise>>>pneumocystic jiroveci

HIV+, Mycobacterium tuberculosis

histoplasma, coccidioides and blastomyces-fugus


Question Answer
ARDSNoncardiognic pulmonary edema, Pulmonary artery wedge pressure <18 mm Hg, Severe hypoxemia not responsive to O2 Therapy, Increased a-a gradient
Foreign material localizes to different portions of the lung, depending on the position of the patientIn the standing or sitting position, material localizes in the posterobasal segment of the right lower lobe; in the supine position, the superior segment of the right lower lobe(MOST COMMON)
Asbestos-related diseaseBenign pleural plaques, Diffuse interstitial fibrosis, Primary bronchogenic carcinoma, Malignant mesothelioma of pleura
SarcoidosisGranulomatous, Chronic interstitial frbriosis, Black/nonsmokers, women, 20-39 years, hilar nodes,Increased angiotensin-converting enzyme, hypercalcimia ( T cells>>>IFNr>>>1a-hydroxylase in macrophage (extrarenal)>>>D3), treatment: TNF inhibitors, corticosteroids, hydroxychloroquine
***scleroderma (systemic sclerosis) GI
Rheumatoid arthritiscause interstitial lung disease>>>pulmonary fibrosis
extracellular accumulation of serum amyloid A>>>ventricular wall is thickened and inelastic>>>restrictive cardiomyopathy
cheyne stoke respirationapnea>>>pCO2 high>>>stimulate respiratory >>>hyperventilatory>>>pCO2 low>>>apnea
M tuberculosisphagocytosed by alveolar macrophages>>>intracelluar bacterial proliferation>>>kill the macrophage and celluar lysis>>>infect additional macrophages
after 2-4weeks, T cells>>>IFN
lobar pneumoniascongestion, red hepatization, gray hepatization and resolution
mesotheliumnodular pleural thickening
pulmonary artery systolic pressure>25mm Hg at rest
idiopathic, hereditary, LHF, COPD, OBSTRUCTIVE SLEEP APNEA, HIV
greenish sputumOxygen>>>superoxide by NADPH oxidase
superoxide>>>hydrogen peroxide by superoxide dismutase
hydrogen peroxide>>>hypochlorite or Hypochlorous acid (HOCl) by myeloperoxidase
MPO is responsible for the characteristic green color of pus.


Question Answer
More common lung cancer?Carcinoma metastatic to the lung
Nonneoplastic proliferation of cartilage and adipose tissue. Appears as solitary “coin” lesion on chest radiograph; popcorn calcificationsBronchial hamartoma
Adenocarcinomamost common primary cancer,
Kras mutaion,
Squamous cell carcinoma of lungcentral
produced PTHrp
Small cell carcinoma------------------------------------------
neuroendocrine cells

cushing/SIADH/ Lambert-Eaton

excessive ADH secretion>>>increased water/hyponatremia>>>decreased aldosterone and increased Atrial natriuretic peptide (NOT Brain natriuretic peptide!!!)>>>increased urinary sodium excretion>>>sodium loss and normalization of extracelllar fluid>>>Normal extracellular fluid volume (No edema!!!)

autoantibody-mediated removal of a voltage gated Ca2+ channels
proximal muscle weakness, depressed tendon reflexes, ptosis, weakness/swallow difficulty/vision problem
*myasthenia gravis-AchR postsynaptic; botulism and lambert-presynaptic)
* myasthenia gravis autoantibody is against postsynaptic nicotinic Ach receptors at neuromuscular junction.

Neuroendocrine markers: L-MYC KA37-32. neuron specific enolase, chromogranin and synaptophysin
undifferentiated or oat cell carcinoma
cells arises from the basal layer of the brochial epithelium
Common sites for metastasisHilar lymph nodes most common site, Adrenal gland, liver, brain and bone
bronchioloalveolar carcinomaalveolar epithelium, peripehery of the lung
superior sulcus tumor (pancoast tumor)smokers
extreme apex of the lung
lower branchial plexus>>>severe pain in the shoulder
destruction of superior cervical sympathetic ganglion>>>horner's: ptosis, miosis and anhidrosis (sweating dysfunction)
subclavian vessels>>>upper extremmity edema
superior vena cava syndrome: the edema of head and neck


Question Answer
Cystic fibrosis (CF)AR, Chromosome 7, CFTR
1 Chloride ion permeability>>>decreased Cl-reabsorption in sweat glands.>>>Sweat Cl->40mmol/L in infant
2 decreased Cl- secretion, increased Na+reabsorption>>>water enters cells, dehydrated in bronchioles, pancreatic, bile duct and meconium

nasal polyps, more negative nasoepithelial surface than normal
respiratory infectious, pneumothorax
chronic pancreatitis>>>DM,malabsorption>>>supply fat soluble vitamins
vas deferens atresia>>> infertility,
meconium ileus in infants,
gallstones, bile duct obstruction>>>biliary cirrhosis
most common cause of death in heavily exposed asbestos workerBronchogenic carcinomas, mesothelioma is No 2
pleural thicening and calcificaitons along the lower lung field and diaphragm
respiratory distress in a premature neonatepulmonary surfactant deficiency>>>hyaline membrane disease>>>supplement oxygen>>>retinal damage

surfactant: dipalmitoyl phosphatidyl choline (lecithin)

lecithin:sphinogomyelin >2
the slide agglutination test:Antibody detection of phosphatidylglycerol
foam stability index: a test for fetal pulmonary maturity, determined by the ability of pulmonary surfactant in amniotic fluid to generate stable foam in the presence of ethanol after mechanical agitation.
chronic rejection of lung transplantationsmall bronchioles>>>inflammation and fibroisis of the bronchiolar walls>>>obstruction
acute rejection of lung transplatationpulmonary and bronchial vessels
peptostreptococcus and fusobacteriumnormal mouth flora>>>aspirate pneumoniae


Question Answer
Thymomamyasthenia gravis,hypogammaglobulinmia, pure RBC aplasia, grave's disease
myasthenia gravisfollicular B-cell hyperplasia in the thymus>>>synthesis of anti–acetylcholine receptor antibodies
maximum expiratory flow volume curveObstructive disorders: emphysema or asthma have increased lung volumes with air trapping
restrictive disorders: pulmonary fibrosis has reduced lung volumes
increase in stiffness of the lungs/increased radial traction of airways
KA 24-7 FIG
diffuse obstructive disorderdeep slow breathes
Decrease FEV1/FVC, significantly decreased FEV1(Expiratory flow rate)
dyspnea, prolonged expiration, air space enlargement, right sided heart failure
centriacinar emphysema:
more common than panacinar disease,
upper lobes in the apex
TGF-β, MMP-9 and MMP-12
toxic substances>>>neutrophils>>elastases, IL-8 and oxidants>>>alveolar parenchymal destruciton (epithelial injury, ECM degradation)

panacinar emphysema:lower lung, a1-antitrypsin deficiency
Liver+Pulmonary(destruction of alveolar walls>>>emphysema
Jaundice and exertional dyspnea in young patients
chronic bronchitis
thickening of the mucous gland layer and squamous metaplasia of lung epithelium.
persistent productive cough for at least 3 months in at least 2 years

PH 7.39, Pco2 55mmHg, Plasma bicarbonate 32 mEq/L, Which of the following is the major compensatory response to this patient's acid base disorder? b
a decreased renal bicarbonate ion excretion
b increased renal ammonium ion secretion
c hyperventilation
d hypoventilation
chromosome 5
beta-2 adrenergic receptor>>>cAMP accumulation in smooth muscle cells
atopic asthma: the most common type of asthma>>> slow deep breaths

serum radioallergosorbent tests (RAST): patient's serum contain IgE against specific antigen. Radiolabeled anti-human IgE antibody is added where it binds to those IgE antibodies (patients) already bound to the insoluble material (kit included).

type 2 helper T cells

the accumulation of mucus, eosinophilic inflammation and smooth muscle hyperplasia

Non-Atopic Asthma: rhinovirus, parainfluenza virus and inhaled air pollutants
=obstruction+chronic persistent infection
the permanent dilation of bronchi and bronchioles
cystic fibrosis, Kartagener syndrome
diffuse restrictive diseaserapid and shallow breathes
Decreased FVC, The expiratory flow rate is normal, FEV1/FVC is NEAR Normal
Severe obesity
guillain barre syndrome
interstitial fibrosis
4 capacity

Total lung capacity=vital capcity+residual volume
Functional residual capacity=residual volume+ERV
inspiratory capacity=TV+IRV
vital capacity=ERV+TV+IRV

4 volume

Tidal Volume=TV
residual volume
emphysema is different with interstitial fibrosisdestruction of alveolar walls without fibrosis, leading to enlarged air spaces
Cor pulmonaleright heart failure+ pulmonary hypertension
caused by pulmonary hypertension attributable to primary disorders of the lung parenchyma or pulmonary vasculature

progressive dyspnea
decreased breath sounds
dilation of the right ventricle/increased central venous pressure


Question Answer
Pleural effusionTransudates (CHF, Nephrotic syndrome), Exudates (increased vessel permeability in acute inflammation) such as pneumonia, tuberculosis, infarction and metastasis
Spontaneous pneumothoraxtall men smoke, sudden dyspnea with chest pain, absent breath sounds, apical subpleural blebs
Spontaneous pneumothoraxmarfan syndroe
Tension pneumothoraxknife wound
Total collapse of the lung>>> shift to the contralateral side Tension pneumothorax
Spontaneous pneumothoraxTrachea deviated to the side of the collapse

Section 7