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Pulmonary

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resexuwe's version from 2017-07-26 01:40

Pulmonary

Question Answer
List four types of cells in the lungs?1) Goblet cells – Mucus production, 2) Type I Pneumocyte – Macrophages (95%), 3) Type II Pneumocyte – Surfacatant production Lamellar Bodies, 4) Clara/Dust (Macrophages) – ingest dust particles
What is the histology of the trachea?1) Top 1/3 – Stratified Squamous Epithelium (protect against abrasions), 2) Middle 1/3 – mixture, 3) Lower 1/3 – Tall columnar pseudo-stratified ciliated epithelium
What are the muscles needed to breath in?1) Innermost intercostals (Contralateral chest wall), 2) External Intercostals (Ipsilateral chest wall), 3) Diaphragm
What are the muscles needed to force air in?1) Scalenes, 2) SCM – sternocleidomastoid, 3) Trapezius, 4) Pectoralis major/minor
What are the muscles needed to breath out?Passive – recoil
What are the muscles needed to force air out?1) Internal/External Oblique, 2) Rectus Abdominus, 3) Transverse abdominus, and 4) Quadratus Lumborum
What is the difference between a carotid body and a carotid?Carotid “Body” – Chemoreceptor vs. Carotid “Sinus” – Baroreceptor
What color is air on an X-ray?Black “radio-lucent”
What color is fluid/solid on an X-ray?White “radio-opaque”
What disease has a steeple sign on neck film?Croup
What disease has a “Thumb-sign” on neck film?Epiglottitis
What is a “Blue-bloater”?Bronchitis (Chronic)
What is a “Pink-puffer”?Emphysema
What diseases have pulmonary eosinophilia?(1) Aspergillosis, (2) Strongyloides
What drugs cause pulmonary eosinophilia?(1) Nitrofurantoin, (2) Sulfonamides
What are the risk factors for lung cancer?Smoking, Radon, 2nd hand smoke, and pneumoconiosis (except anthracosis)
What diseases have hemoptysis?1) Bronchiectasis, 2) Bronchitis, 3) Pneumonia, 4) TB, 5) Lung cancer
What is a Bokdalek hernia?Back of diaphragm
Where is a Morgagni hernia?Middle of diaphragm
What diseases have Respiratory Alkalosis?Restrictive Lung Diseases (Anxity, pregnancy, Gram (-) sepsis, and PE)
What diseases have Respiratory Acidosis?Obstructive Lung Diseases
What diseases have Metabolic Alkalosis?Low Volume State (Vomiting, Diuretics, GI blood loss)
What diseases have Metabolic Acidosis?Acid production (MUDPILES, RTA-II, diarrhea)
What is the obstructive pattern of blood gasses?(1) Increases pCO2 → Decreases pH, (2) Increases RR → Increases pO2
What is the obstructive pattern of blood gasses?(1) Decrease pO2 → Increases RR → Decreases pCO2 → Increases pH
What does stridor tell you?Extrathoracic narrowing → narrows when breath in → neck X-ray
What does wheezing tell you?Intrathoracic narrowing → narrows when breath out → chest X-ray
What does rhonchi tell you?Mucus in airway → obstructive lung disease
What does grunting tell you?Blows collapsed alveoli open → restrictive lung disease
What does dull percussion tell you?Something b/w airspace and chest wall absorbing sound (fluid or solid)
What does hyper-resonance tell you?Lungs hyperinflated with air
What does tracheal deviation tell you?Away from pneumothorax OR toward atelectasis “air-phobic”
What does fremitus, and ego-phony?Consolidation → Pathognomonic for Pneumonia
What is Restrictive lung disease?Small stiff lungs, and trouble breathing in
What is Obstructive lung disease?Big mucus-filled lungs, trouble breathing out
What is Epiglottitis?X-ray with “Thumb-sign”, and drooling
What is Croup?X-ray with “Steeple sign”, and barking cough
What is Tracheitis?Look toxic, grey pseudomembrane, leukocytosis
What is Asthma?Wheeze on expiration, IgE, eosinophils
What is Bronchiolitis?Asthma in kids <2 y/o
What is Maxillary Sinusitis?Teeth pain worse with bending forward
What is Bronchiectasis?Bad breath, purulent sputum, and hemoptysis
What is Chronic Bronchitis?Lots of sputum, “Blue Bloater”
What is Emphysema?Restrictive to Obstructive pattern, “pink-puffer”
What is Laryngomalacia?Epiglottis roll in from side-to-side
What is Pneumonai?Consolidation of airway
What is Pneumothorax?Air outside of lungs; Hyper-resonance on same side
How do you detect a Pulmonary Embolus?Tachypnea, Increased V/Q scan, EKG: S1Q3T3
What is Tamponade?Decreased breath sounds/BP; Increased JVD; Fluid in pericardial sac
What is Tracheo-malacia?Soft cartilage, stridor since birth
What is Cystic Fibrosis?Meconium Ileus, Steatorrhea, and Bronchiectasis
What is Aspergillosis?Allergy to mold, dead plants, and compost piles
Who gets Asbestosis?Shipyard workers, Pipe filters, brake mechanics, and insulation installers
Who gets Silicosis?Sandblasters, and glassblowers
Who gets Byssinosis?Cotton workers
Who gets Beryliosis?Radio, TV welders, those working with bulbs
Who gets Anthracosis?Coal workers, and massive fibrosis
What is Sarcoidosis?Non-caseating granulomas, eggshell calcification on lymph node
What is Carcinoid syndrome?Flushing, Diarrhea, and Wheezing
What is Small Cell CA?At carina, malignant, Cushing's, SIADH, SVC syndrome
What is Large Cell CA?Large stuff
What is Squamous cell CA?Smoker, High PTH, and high Ca2+
What is Bronchealveolar CA?Looks like pneumonia; due to Pneumoconiosis
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GASTO-INTESTINAL

Question Answer
What diseases has a corkscrew x-ray?Esophageal spasm
What diseases has an apple core x-ray?Cancer
What diseases has a stacked coin x-ray?Intussusception
What diseases has a thumbprint x-ray?Toxic megacolon
What diseases has an abrupt cutoff x-ray?Vovulus
What diseases has a barium clumping x-ray?Celiac sprue
What diseases has a bird's beak x-ray?Achalasia
What diseases has a string sign x-ray?Pyloric Stenosis
What diseases have solid dysphagia?Schatzki's ring, stricture, and cancer
What diseases have solid and liquid dysphagia?Esophageal spasm, Scleroderma, and Achalasia
What is Barrett's Esophagus?Metaplasia, and Increase Adenocarcinoma risk
What are Esophageal Varices?Vomit blood everywhere, and Portal HTN
What is Mallory-Weiss?Tear LES mucosa, and Chronic vomiters
What is Boerhaave's?Tear all layers of Esophagus, Left-sided pneumo/pain/effusion
What is Achalasia?Lost LES Auerbach's, Bird's beak, Chaga's, and Choke on solids
What is Hirschprung's?Lost rectum Auerbach's, no meconium passages
What is Zenker's diverticulum?Cough undigested food from above UES, and Helitosis
What is Traction diverticulum?Eat big bolus → gets stuck above LES
What is Plummer-Vinson syndrome?Esophageal webs, spoon nails, and Fe- (iron) deficiency anemia
What is Schatzki rings?Esophageal webs in lower esophagus
What is a Trachea-esophageal (TE) fistula?Choke w/ each feeding; cough w/ each feeding
What is an Esophageal atresia w/ Trachea-esophageal fistula?Vomit w/ 1st feeding, and huge Gastric bubble
What is Duodenal atresia?Bilious vomiting w/ 1st feed, Double-Bubble sign, and Down's.
What is Pyloric Stenosis?Projectile vomiting (3-4 wk old), RUQ “Olive mass”
How does Choanale atresia present?Turns blue with feeding
How is the Tetrology of Fallot presentation different?Turns blue with crying
What makes Scleroderma unique?Decrease LES pressure
What makes Esophageal spasms unique?Increase “Peristalsis”
What makes Achalasia unique?Decrease Peristalsis and Increase LES pressure
What diseases has a RUQ olive mass?Pyloric Stenosis
What diseases has a RLQ sausage mass?Intussusception
What is a Bezoar?Mass of hair or vegetables → “Antrum obstuction”
What is Gastritis type A?Upper GI bleed, anti-parietal cell Ab
What is Gastritis type B?Upper GI bleed, spicy foods, and H.pylori
What is a Duodenal Ulcer?1) Too much acid, 2) pain after meal/ at night, 3) type O blood, 4) H.pylori, and 5) pain relieved by eating
What is a Gastric Ulcer?1) Broken mucus layer, 2) Pain during meal, 3) NSAIDs, and 4) Type A blood
What is a Sliding hiatal hernia?Fundus slides from esophageal hiatus to thorax → sucks acid into thorax
What is a Rollling hiatal hernia?Fundus sticks through hole in diaphragm, and strangulates bowel “rolls”
What is Menetrier's disease?Protein-losing, thick stomach rugal folds
What defines Constipation?< 3 Bowel movement (BM) per week
What defines Diarrhea?> 200g loose stool per day
What is Osmotic Diarrhea?Watery diarrhea
What is Secretory Diarrhea?Laxative use
What is Inflammatory diarrhea?Blood, & pus
What is Celiac sprue?Jejunum, wheat allergy, villous atrophy, and “anti-gliadal anti-body”
What is Tropical sprue?Illeum Celiac sprue
What is Mesenteric Ischemia?Pain out of proportion to exam
What bugs causes bloody diarrhea?“CASES” → Campylobacter, Amoeba (E. histolytica), Shigella, E. coli, and Salmonella
What is the difference b/w Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis?(1) Primary Biliary Cirrhosis → (anti-mitochondrial Ab), bile ductules destroyed, and Xanthelesma. VS (2) Primary Sclerosing Cholangitis → (p-ANCA antiboy), bile duct inflammation, beading, onion skinning, and associated w/ UC (ulcerative colitis)
What is Asending Cholangitis?Common duct stone gets infected
What are the sings of alcoholic cirrhosis?Spider angioma, palmur erythema, Dupuytren's contractions
What is Hepatorenal syndrome?Pts w/ Liver disease build up liver toxins that cause renal failure
What is Cholangitis?Inflammation of bile duct → Charcot's triad, Reynold's pentad
What is Cholecystitis?Inflammation of gall bladder → Positive Murphy's sign
What is Cholelithiasis?Formation of gallstones → RUQ colic pain
What is Choledocholithiasis?Gallstone obstructs bile duct
What is Cholestasis?Obstruction of bile duct → pruritis, jaundice, and increase ALP (alkaline phosphatase)
What is Conjugated bilirubin?Water soluble “Direct”
What is Unconjugated bilirubin?Fat soluble “Indirect”
What is the most common type of gallstone?Cholesterol (can't see on X-ray)
What type of gallstone can be seen on X-ray?“Ca-bilirubinate”
What is a Xanthoma?Cholesterol buildup (elbow or Achilles)
What is Xanthelesma?Triglyceride buildup (under the eyes)
What does high cholesterol cause?Atherosclerosis
What does high TG cause?Pancreatitis
What is Type 1 Hyperlipidemia?Bad Liver LL (CM)
What is Type 2A Hyperlipidemia?Bad LDL or B-100 receptors → trapped in ER (LDL only)
What is Type 2B Hyeprlipidemia?Less LDL/VLDL receptors (LDL/VLDL)
What is Type 3 Hyperlipidemia?Bad Apo E (IDL/VLDL)
What is Type 4 Hyperlipidemia?Bad Adipose LL (VLDL only)
What is Type 5 Hyperlipidemia?Bad C2 (VLDL/CM) b/c C2 stimulates LL
What is Crigler-Najjar?Unconjugated bilirubin, usually in “infant”
What is Gilbert's syndrome?Glucoronyl Transferase is saturated → stress unconjugated bilirubin
What is Rotor's?Bad bilirubin storage → Conjugated bilirubin
What is Dubin-Johnson?Bad bilirubin excretion → “Black Liver”
What is Cullen's sign?Bleed around “umbilicus” → due to Hemorrhagic pancreatitis
What is Turner's sign ?Bleed into “flank” → due to Hemorrhagic pancreatitis
What tests are used for following pacreatitis?Amylase → sensitive, breaks down carbohydrates
What does Ranson's criteria tell you?Poor prognosis for pancreatitis pts
What is Ranson's criteria at presentation?“WAGLA” → (1) WBC: >16K/ul (Infection), (2) Age: >55 (usually multiple illnesses), (3) Glucose: >200 mg/dL (islet cells are fried), (4) LDH: >350 IU/L (cell death), and (5) AST: >250 IU/L (cell death)
What is Ranson's criteria at 48hrs?“BuCH was a SOB” → (1) BUN - increase >5mg/dL (decrease RBF), (2) Ca2+ <8 mg/dL - (Saponification), (3) Hct: drops >10% (bleed into pancrease), (4) Sequester >6L fluid → 3rd spacing, (5) pO2: <60mm Hg (Fluid/protein leak → ARDS), (6) Base deficit >4mEq/L (diarrhea → pancreatic enzymes are dead)
What is Carcinoid syndrome?Diarrhea, Flushing, Wheezing
What produces Current Jelly Sputum?Klebsiella
What produces Currant Jell stool?Intussuception
What is Gardeners syndrome?Familial polyposis w/ bone tumors
What is Turcots syndrome?Familial polyposis w/ brain tumors
What is familial polposis?100% risk o colon cancer, APC defect -> annual colonoscopy at 5 y/o
What is Peutz-Jegher syndrome?Hyperpigmented mucosa -> dark gums/vagina w/hyperplastic polyps
What is Crohns Disease?IBD W/ cobblestones, melena, creeping fat, fistulas
What is ulcerative colitis?IBD w/ peusdopolyps, hematochezia, lead pipe colon, toxic megacolon
What is intussuception?Currant jelly stool, stacked coin appearance on enema, sx come and go
How does diverticulosis present?Bleed
How does diverticulitis present?Hurts
How does spastic colon present?Intermittent severe cramps
How does IBS present?Alternating diarrhea/constipation
How do external hemorrhoids present?Pain
How do internal hemorrhoids present?No pain
What is Pseudomembranous colitis?Overgrowth of C.difficile due to normal flora being killed off, usually by clindamycin use
What is whipples disease?T.whippleii destroy GI tract then spread causing malabsorption
What color is an upper GI bleed?Black
What color is a lower GI bleed?Red
What adds color to stool?Bilirubin
What is the default color of stool?Clay-colored
What is the default color of urine?Tea-colored
Rectum, microabcesses within the crypts and depletionof mucus from goblets cellsUlcerative colitis
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