Hi Yield 7.1-10.0

mhewett's version from 2016-06-22 20:57

Section 7.1 Restrictive Lung Disease

Question Answer
What is restrictive lung disease?lung is restricted from taking in adequate amount of air; lung is small and not expandable
What are the PFTs for restrictive lung disease?normal/low FEV1, low TLC, normal FEV1/FVC ratio bc proportional decrease
What is sarcoidosis?norms non caseating granulomas in lung that become surrounded/replaced by fibrosing scars; on x ray may see bilateral hilar adenopathy +/- panda sign (bilat sarcoidosis of parotids)
What causes adult ARDS?diffuse injury to endothelium of the lung (like from sepsis, trauma, aspiration, etc.)
How is adult ARDS characterized?pulmonary edema, respiratory distress, hypoxemia
What causes neonatal ARDS?d/t insufficient surfactant (lecithin); occurs when lecithin:sphingomyelin ratio is <2.
What is pneumoconiosis?lung disease caused by habitual inhalation of non-degradable irritants
What is the process of pneumoconiosis development?macrophages phagocytose substance -> release ROS, enzymes, immune mediators -> macrophage dies -> fibrosis occurs -> process repeats over and and over
What is asbestosis?characterized by ferruginous bodies clubbed at ends; affects lower lobes and initially causes fibrotic plaques of pleura
What is anthracosis?(Coal worker's pneumoconiosis) affects primarily upper lung lobes; results in Black Lung Disease (bronchiectasis, pulm htn, severe restrictive lung disease, RHF, respiratory failure)
What is berylliosis?from high tech electronics and fluorescent light bulbs; affects lower lung lobes
What is silicosis?from chronic inhalation of quartz dust (from sandblasting, granite cutting); raises one's susceptibility to TB; affects upper lung lobes
What is hypersensitivity pneumonitis?aka extrinsic allergic alveolitis; from repeated inhalation of allergens
What is Goodpasture's syndrome?autoimmune disease mediated by anti-glomerular basement membrane ab; severe glomerulonephritis, pulmonary hemorrhage, dyspnea
What is pulmonary hemosiderosis?blood accumulates in interstitial space, causing significant inflammation followed by fibrosis
What is alveolar proteinosis?aka pulmonary proteinosis or pulmonary alveolar proteinosis; alveoli fill with proteinaceous and other material causing chronic inflamm and fibrotic development
What is eosinophilic pneumonia?develop eosinophilic pulm infiltrate; usually idiopathic but sometimes roundworms, drugs, fungi
What is diffuse idiopathic fibrosis?aka idiopathic pulmonary fibrosis or Hamman Rich syndrome or usual intersitital pneumonia; causes honeycomb lung; fatal

Section 7.2 Pneumonia

Question Answer
pneumoniatypically refers to infectious pneumonitis
infectious pneumonitisinfection of the lung parenchyma, including alveolar spaces & interstitial tissue
Risk factors for pneumoniaalcoholism, institutionalism, smoking, COPD, immune compromise, extremes of age
Bronchopneumoniaconfined to those alveoli contiguous to bronchi
rales and/or rhonchi on auscultation; peribronchial infiltrates on chest x-ray
primary etiologic agents: Hemophilus, pseudomonas, staphylococcus
Lobar pneumoniaconfined to the entire lobe
dullness to percussion; consolidation ("white out") demonstrated in that lobe on x-ray
Primary etiologic agents of lobar pneumoniapneumococcus (strep pneumoniae) and klebsiella
Process of Pneumococcus pneumonia1. congestion (lobe filled with bacteria and mucus)
2. Red hepatization (lobe filled with rbc's)
3. Grey hepatization (lobe filled with fibrin)
4. Resolution
Atypical pneumoniausually patchy pneumonia of lower lobes bilaterally
rales on auscultation; patchy bilateral pulmonary infiltrates on chest x-ray
primary etiologic agents of atypical pneumoniaviruses and mycoplasma pneumonia
atypical pneumonia top viral etiologies in childrenRSV, adenovirus, influenza
atypical pneumonia top viral etiologies in adultsinfluenza a and b
mycoplasma pneumoniaeaton agent
the most common lung pathogen in ages 5-35 (also causes bullous myringitis) causing pharyngitis, bronchitis, pneumonia
causes a type of atypical pneumonia termed "walking pneumonia"
triad of mycoplasma pneumoniamalaise, sore throat, dry cough that evolves over weeks to months to form a productive cough for mucupurulent sputum
Legionnaires Diseaseunilateral patchy segmental or lobar alveolar infiltrate on chest x-ray; rales on auscultation
Hi fever with relative bradycardia + diarrhea + productive cough
Usually affects middle aged males; 25% mortality without treatment
Etiologic agent of Legionnaires diseaseLegionella pneumophila
Aspiration pneumoniadue to aspiration of some substance or organism to produce acute inflammation +/- hypoxia +/- pulmonary infection
different causes of aspiration pneumoniagastric acid, anaerobic bacteria (from gingivae) and mechanical obstruction
Gastric acid aspiration pneumoniachemical pneumonitis
acute onset: SOB, pink frothy sputum, bronchospasm, cyanosis
usually due to aspiration of vomitus during inebriation or drug overdose
aspiration pneumonia d/t anaerobic bacteriafrom gingivae, insidious onset: cough, fever, purulent foul smelling sputum
due to aspiration of gingival organisms in saliva, secondary to decreased consciousness or decreased pharyngeal space/airway control (MS, ALS, stroke)
most common bacteria: peptostreptococcus sp, bacteroides spp., and fusobacterium
Mechanical obstruction aspiration pneumoniadrowning or aspiration of objects, acute sob, cyanosis

Section 7.3 Lung Tumors

Question Answer
primary lung tumors peak at45-70 years of age; 70-90% are due to smoking
3 types of benign lung masseshamartoma, adenoma, leiomyoma
benign hamartomaanomalous development of tissue natural to part or organ rather than a true tumor
benign adenomabenign tumor of glandular structure or glandular origin
benign leiomyomabenign tumor of smooth muscle
carcinoid lung massesa specialized serotonin and histamine producing benign or malignant tumor arising usually from the GI mucosa (such as stomach or appendix)
Carcinoid syndromeif lung mass metastasizes to the liver
causes flushing (from the collar up), diarrhea, bronchospasm, right heart valve lesions, hypotension
diagnosis of carcinoid syndrome24hr urinary 5'-HIAA (5' hydroxyindole acetic acid)
What is HIAA?(hydroxy indole acetic acid) metabolite of serotonin
carcinomamalignant tumor of epithelial origin
first symptom is typically new onset of cough or a change in the frequency or character of a per-existing cough
4 types of carcinomaadenocarcinoma, squamous cell carcinoma, large cell carcinoma, small cell (oat cell) carcinoma
adenocarcinomaassociated with pre-existing lung scar
occurs in peripheral lung fields
squamous cell carcinomaassociated with smoking
may paraneoplastically produce PTH-like peptide resulting in hypercalcemia
occurs in the area central to mediastinum
Large cell carcinomaassociated with smoking
occurs in the periphery of the lung
small cell (oat cell) carcinomaassociated with smoking
carries the worst prognosis
occurs near mediastinum ("centrally")
may paraneoplastically produce ADH to cause fluid overload
may paraneoplastically produce ACTH to cause cushing syndrome
may cause the autoimmune disease called Eaton-Lambert syndrome (proximal muscle weakness, antibody to presynaptic Ca channels on neurons of the neuromuscular junction)
Horner's syndromeany mass in the apex of the lung (pancoast tumor) or any injury to the lower neck/upper chest can cause ; a syndrome that is due to compression or damage to the cervical sympathetic ganglia.
Signs and symptoms are all a result of termination of sympathetic stimulus to that side of the head and face, and include sinking of the eyeball, miosis, ptosis, vasodilation and anhidrosis of face

Section 8.0 Renal Disease

Question Answer
What 3 areas of the kidney can renal disease affect?glomerulus, tubules, renal parenchyma

Section 8.1 Glomerular Disease

Question Answer
nephritic syndrome courseacute onset and rapid progression
nephritic syndrome due tothe inflammation of the glomerulus, and is associated with diffuse inflammatory changes of the glomerulus
all features are a result of inflammation of the glomerulus and a resulting decreased or absent filtering function of the glomerulus
examples of nephritic syndromepost-streptococcal glomerulonephritis
Good pastures syndrome
diffuse proliferative glomerulonephritis
Nephrotic syndrome courseprolonged onset, with severe prolonged increase in glomerular permeability to proteins
Nephrotic syndrome due tochanges in glomerular permeability (loss of size and charge selectivity); structural changes occur such that glomerulus no longer adequately limits filtration of proteins
all features are a result of massive protein loss through the kidney
Signs and symptoms of nephrotic syndromesevere proteinuria, frothy urine (due to proteins in urine), hypoalbuminemia, hyperlipidemia
edema (secondary to decreased oncotic pressure resulting from the loss of albumin
examples of nephrotic syndromeminimal change disease, membranous gn
signs and symptoms of nephritic syndromehematuria, red cell casts (pathognomonic), hypertension, edema, increased BUN and creatinine- representing azotemia (accumulation of nitrogenous compounds in blood)

Section 8.1.0 The Glomerular Syndromes: A Review

Question Answer
Acute Nephritic Syndromehematuria, azotemia (hi creatinine, bun), variable proteinuria, oliguria, edema, htn
Rapidly Progressive Glomerulonephritisacute nephritis, proteinuria, acute renal failure, severe oliguria, severe edema, htn, marked azotemia
Nephrotic Syndrome>3.5 gm proteinuria/day, hypoalbuminemia, hyperlipidemia, lipiduria
Chronic Kidney Diseaseazotemia with uremia progressing for years
Rapidly Progressive (Crescentic) Glomerulonephritissevere glomerular injury and is a severe form of acute nephritic syndrome; always has crescents (proliferation of epithelium of Bowman's capsule that surrounds glomerulus); 3 types
Type I RPGNantibody-mediated cytotoxicity
causes - idiopathic, Goodpasture's
Type II RPGNimmune complex disease
causes - idiopathic, SLE, Henoch-Schonlein, post-infective
Type III RPGNpseudo-immune --> +ANCA disorders
causes - idiopathic, Wegener's, microscopic polyangiitis, occasionally advanced terminal polyarteritis nodosa
Lupus nephropathy structural changeswire loop lesions, diffuse proliferation (IgM, IgG, C3)
Goodpasture's Disease structural changeslinear basement membrane deposits, IgG & C3
RPGN structural changeswrinkled BM & discontinuous BM (IgG, C3)
Diabetic nephropathy structural changesthick BM & mesangial growth = nodular sclerosis
Post-strep GN structural changes"lumpy bumpy" subepithelial IgG & C3
Membranous GN structural changesspike & dome, subepithelial IgG & C3
Minimal change disease structural changesfoot process loss
Membranoproliferative GN structural changesmesangial interposition ("tram track")
Alport's syndrome structural changesbasement membrane splitting

Section 9.0 Urolithiasis

Question Answer
What is urolithiasis?urinary calculi; kidney stones
Symptoms of urolithiasis?back pain, renal colic, N/V, abd distention, chills, fever, hematuria, frequency, CVA tenderness, restlessness
calcium stonesusually from dehydration
most common type of kidney stone
primary tx is hydration; thiazides can reduce potential bc they cause Ca++ uptake from renal tubule & K phosphate binds up Ca
Mg-NH4 Phosphate stoneaka triple stone, staghorn calculus, struvite
caused by urea splitting organisms (proteus, staph saprophyticus)
abx (SMX TMP or nitrofurantoin)
uric acid stoneuric acid crystals are core where Ca oxalate crystals deposit
caused by excessive consumption of purines, gout, leukemia, tumor lysis syndrome & other disorders of high cell turnover
cystine stonefrom cystinuria (AR disorder)
impaired tubular resorption of cysteine, ornithine, arginine, lysine (yielding COAL - black looking stone)

Section 10.0 Vulvovaginitis

Question Answer
vulvovaginitis with germ tubes and pseudohyphae with a bready odorcandidiasis
vulvovaginitis characterized by yellow green discharge and putrid odor?trichomoniasis
clue cells and fishy odor with + whiff test isbacterial vaginosis
DOC for candidiasismiconazole
DOC for trichomoniasismetronidazole
DOC for BVmetronidazole
overgrowth of what bacteria is associated with BVgardnerella and mobiluncus
candidiasis pH<4.5
trichomoniasis pH>4.5
bacterial vaginosis pH>4.5
candidiasis colorwhite
trichomoniasis coloryellow green
bacterial vaginosisgrey white