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Block 13 Respiratory

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klau253's version from 2017-05-14 19:11

Section

Intrathoracic malignancy

 

Adenocarcinoma
Question Answer
EGFR mutationcommon in non-smokers
KRAS mutationcommon in smokers
Differentiationsglandular with mucin production, lined by columnar epi
precursor lesionatypical alvelolar cell hyperplasia, lined by cuboidal epi
Txtyrosine kinase inhibitor for EGFR mutation, crizotinib for ALK mutation
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Squamous cell carcinoma
Question Answer
Most common mutationTP53
memorize

 

Small cell carcinoma
Question Answer
Common mutationTP53 and RB1
differentiationneuroendocrine
Tx(limited stage and advanced stage)chemo + radio
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Malignant mesothelioma
Question Answer
Causeasbestos
Latent period50 years
Txno known cure
FeaturesM>F, pleural effusion+chest pain, met to hilar lymph nodes
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Histology
Question Answer
Normal resp epitheliumpseudostratified columnar ciliated
Squamous metaplasiacolumnar --> squamous
Dysplasiadisordered growth, non-uniformity, pleomorphic hyperchromatic nuclei, increased mitotic figures
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Local effects of lung CA and its pathology
Question Answer
Pneumonia/abscess/lobar collapsetumor obstruction of airway
lipid pneumoniatumor obstruction
pleural effusionmet to pleura
Hoarsenessrecurrent laryngeal
diaphragm paralysisphrenic nerve
Dysphasiaoesophageal invasion
rib destructionchest wall invasion
SVCcompression
Horner syndromesympathetic ganglia
Pericarditis, tamponadepericardial involvement
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Systemic effects of lung CA and consequences
Question Answer
Lung met toBrain, liver, bone, skin, adrenal gland
ADHhyponatremia
PTHhypercal
Calcitoninhypocal
ACTHcushing
Gonadotrophingynaecomastia
serotonin and bradykinincarcinoid syndrome
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Other systemic effects
Question Answer
Lambert-Eaton myasthenic syndromeautoAb against neuronal Ca2+ channels
Nerveperipheral neuropathy
Dermatologicalacanthois nigrans
haematologicalleukaemoid reaction
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Non-small cell tx
Question Answer
Stage I&IIsurgical resection
Stage III&IVpalliative chemo and radio
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Pneumonia

Question Answer
nasal pathogenstaph aureus
pharynx pathogen Staph aureus, strep. pneumoniae, H. influ, Neisseria meningitidis
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LRT pathogens
Question Answer
definitely infectiongroup A streptococcus, legionella, mycoplasma pneumoniae, chlamydophila pneumoniae
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other causes of pneumonia
Question Answer
viralinfluenza A,B, resp syncytical virus
mycobacteriaTB
Parasiticascaris lumbricoides
Fungalaspergillus spp, pneumocystis jirovecii
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Bronchitis
Question Answer
main causesinfluenza, adenovirus, rhinovirus, coronavirus
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Types of pneumonia
Question Answer
typicalstrep. p, H. influ, Moraxella
Atypicallegionella, mycoplasma, chlamydia
Bronchoinfants and elderly, any organism
Lobarstrep. p, klebsiella
cavitatingstaph. a, klebsiella, mycobacterial
Interstitialatypical, pneumocystis jiroveci, viral
community acquiredmainly strep. p
hospital acuqiredklebsiella and pseudomonas
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Lung diseases

Ventilation and Perfusion (V/Q mismatch)
Question Answer
decreased ventilation/normal perfusionshunt deoxy blood to system, Ex:COPD and asthma, pneumonia, pneumothorax
Normal ventilation/decreased perfusionincreased alveolar dead space Ex:PE, Rt to Lt cardiac shunt
Poiseuille's lawresistance inversely proportional to radius^4
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Obstructive
Question Answer
Spirometry findingdecreased FEV1/FVC ratio and FEV1, normal FVC
Examplesasthma, COPD, bronchiectasis
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Restrictive
Question Answer
Spirometry findingnormal or elevated FEV1/FVC ratio, decreased FEV1 and FVC
Examplepulmonary fibrosis, obesity, chest wall/neuromuscular disorders
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Respiratory Failure
Question Answer
Type Ihypoxaemic, low PO2, low/normal PCO2
Type IIhypercapnic with hypoxia, low PO2, increased PCO2
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Acute asthma
Early stage --> type I resp failure
Question Answer
pHelevated/normal
PO2decreased
PCO2decreased
HCO3normal
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Late stage --> type II resp failure
Question Answer
pHnormal/decreased
PO2decreased
pCO2normal/increased
HCO3normal
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COPD
Early stage --> type I resp failure
Question Answer
pHnormal
PO2decreased
PCO2normal
HCO3normal
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Late stage --> type II resp failure(decompensated)
Question Answer
pHdecreased
PO2decreased
PCO2increased
HCO3normal
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Late stage --> type II resp failure (compensated)
Question Answer
pHnormal
PO2decreased
PCO2increased
HCO3increased
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