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76 Cards in this Set
- Front
- Back
What is the term for the obstruction of sinus drainage into the nasal cavity, leading to inflammation and pain over the affected area? What is the most likely affected area? |
Rhinosinusitis |
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What happens in Rhinosinusitis? What is the most common cause? |
- Obstruction of sinus drainage into the nasal cavity, leading to inflammation and pain over the affected area (usually maxillary sinuses in adults) |
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What is the most common acute cause of rhinosinusitis? |
Viral URI |
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What are the most common causes of superimposed bacterial infection on rhinosinusitis? |
- S. pneumoniae |
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What predisposes to a deep venous thrombosis? |
Virchow's Triad: |
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What can cause hypercoagulability? What is this a component of? |
- Eg, defect in coagulation cascade proteins, most commonly Factor V Leiden |
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What are the characteristics of endothelial damage that is a component of Virchow's triad? |
Exposed collagen triggers clotting cascade |
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What is the most likely location for pulmonary emboli to arise from? |
Deep leg veins |
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What is the Homan sign? |
Dorsiflexion of the foot → calf pain |
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What drug can be used to prevent deep vein thrombosis? |
Heparin |
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What drug can be used for acute management of deep vein thrombosis? |
Heparin |
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What drug can be used for long-term prevention of deep vein thrombosis recurrence? |
Warfarin |
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What are the signs / symptoms of Pulmonary Embolism? |
- V/Q mismatch → hypoxemia → respiratory alkalosis |
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What are the types of Pulmonary Emboli? |
"An embolus moves like a FAT BAT" |
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What are fat pulmonary emboli associated with? |
Associated with long bone fractures and liposuction |
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What is the classic triad of fat emboli? |
- Hypoxemia |
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What can an amniotic fluid emboli lead to? |
Can lead to DIC, especially post-partum |
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Who is likely to get gas emboli? How do you treat them? |
Nitrogen bubbles can precipitate in ascending divers; treat with hyperbaric oxygen |
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What is the best way to image a patient you think has a pulmonary embolism? What do you look for? |
CT pulmonary angiography (look for filling defects) |
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What is this gross image of? |
Pulmonary Embolism |
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What does this image show? |
Pulmonary Thromboembolus |
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What can you look for to determine whether a thrombus formed pre-mortem or post-mortem? |
Lines of Zahn are interdigitating areas of pink (platelets, fibrin) and red (RBCs) found only in thrombi formed BEFORE death |
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What are the consequences of obstructive lung diseases? |
- Leads to air trapping in the lungs |
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What can chronic, hypoxic pulmonary vasoconstriction lead to? |
Cor Pulmonale |
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What are the types of obstructive lung diseases? |
- Chronic Bronchitis ("blue bloater") |
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What happens to the pulmonary function tests in patients with obstructive lung disease? |
- ↓↓ FEV1 |
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What are the types of COPD? |
- Chronic Bronchitis |
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What happens pathologically in patients with Chronic Bronchitis? |
Hyperplasia of mucus-secreting glands in the bronchi → Reid index >50% |
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What is the Reid Index? Utility? |
Ratio of thickness of gland layer / total thickness of bronchial wall |
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What are the diagnostic criteria for Chronic Bronchitis? |
Productive cough for >3 months / year (not necessarily consecutive) for >2 years |
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Chronic bronchitis is a disease of what airways? |
Small airways |
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What signs and symptoms does a patient with Chronic Bronchitis have? |
- Wheezing |
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What happens pathologically in patients with Emphysema? |
- Enlargement of air spaces |
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What are the types of emphysema? What is each associated with? |
- Centriacinar: associated with smoking |
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What causes increased lung compliance in patients with emphysema? |
↑ Elastase activity → loss of elastic fibers → ↑ lung compliance |
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How do patients with emphysema breathe? |
Exhale through pursed lips to increase airway pressure and prevent airway collapse during respiration |
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What is the pathology responsible for asthma? |
Bronchial hyperresponsiveness causes reversible bronchoconstriction |
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What are the histologic findings of asthma? |
- Smooth muscle hypertrophy |
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What is the term for shed epithelium that forms mucus plugs? What pathology is it a sign of? |
Curschman Spirals - sign of asthma |
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What is the term for the crystals formed by the breakdown of eosinophils in the sputum? What pathology is it a sign of? |
Charcot-Leyden crystals - sign of asthma |
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What can trigger asthma? |
- Viral URIs |
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What test can you use to diagnose asthma? |
Methacholine challenge |
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What are the findings of asthma? |
- Cough |
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What pathology is seen in Bronchiectasis? |
Chronic necrotizing infection of bronchi → permanently dilated airways, purulent sputum, recurrent infections, and hemoptysis |
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What part of the respiratory tract is affected by bronchiectasis? How is it affected? |
Bronchi: chronic necrotizing infection |
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What is bronchiectasis associated with? |
- Bronchial obstruction |
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What are the characteristics of all restrictive lung diseases? |
Restricted lung expansion causes: |
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What are the types of restrictive lung disease? |
- Restrictive lung disease due to poor breathing mechanics |
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What are the characteristics of restrictive lung diseases due to poor breathing mechanics? Causes? |
- Extrapulmonary, peripheral hypoventilation, normal A-a gradient |
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What are the characteristics of interstitial lung diseases? |
- Pulmonary ↓ diffusing capacity |
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What are the types of interstitial lung diseases? |
- Acute Respiratory Distress Syndrome (ARDS) |
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What histologic finding is characteristic of neonatal respiratory distress syndrome? |
Hyaline membrane (disease) |
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What are the findings in Sarcoidosis that affects the lungs? |
Restrictive lung disease |
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What are the characteristics of idiopathic pulmonary fibrosis? |
Restrictive lung disease |
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What kind of granulomas occur in Langerhans Cell Histiocytosis? |
Eosinophilic Granulomas |
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What drugs can cause restrictive lung disease? |
- Bleomycin |
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What type of reaction causes hypersensitivity pneumonitis? |
Mixed type III/IV hypersensitivity reaction to environmental antigens |
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Which symptoms occur in hypersensitivity pneumonitis? |
- Dyspnea |
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Who is most likely to get hypersensitivity pneumonitis? |
- Farmers |
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What are the types of pneumoconioses? |
- Asbestosis |
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What do Coal Workers' Pneumoconiosis, Silicosis, and Asbestosis increase the risk for? |
- Cor pulmonale |
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What is Caplan Syndrome? |
Rheumatoid Arthritis and Pneumonconioses with Intrapulmonary Nodules |
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What lung pathology is associated with shipbuilding, roofing, and plumbing? |
Asbestosis |
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What are the characteristic findings on imaging of asbestosis? |
"Ivory white" calcified pleural plaques are pathognomonic of asbestos exposure, but they are not precancerous |
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What are these findings associated with? |
Asbestosis: |
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What part of the lungs are affected by asbestosis? |
Affects lower lungs: |
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What is the appearance of asbestos histologically? |
Asbestos (ferruginous) bodies are golden-brown fusiform rods resembling dumbbells |
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What part of the lungs are affected by silicosis? |
Affects upper lobes: |
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What part of the lungs are affected by coal? |
Affects upper lobes: |
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What is the other name for "black lung disease"? |
Coal Workers' Pneumoconiosis |
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What happens if someone has prolonged exposure to coal dust? |
Macrophages become laden with carbon → inflammation and fibrosis → Coal Workers' Pneumoconiosis |
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What condition is found in many urban dwellers exposed to sooty air? Symptoms? |
Anthracosis - asymptomatic |
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What is associated with foundries, sandblasting, and mines? |
Silicosis |
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What happens if someone has exposure to silica? |
- Macrophages respond to silica and release fibrogenic factors → fibrosis → Silicosis |
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What is there increased risk of in patients with Silicosis? |
- Increased susceptibility to TB |
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What is the characteristic appearance of silicosis? |
"Eggshell" calcification of hilar lymph nodes |