Lung Flashcards

Question

Which of the following may have infection in the absence of fever? (Choose as many as required)

Answer 1

●Patients receiving glucocorticoid therapy #Steroids suppressمهار می‌کنند.: Cytokine synthesis Prostaglandins Hypothalamic response ●Newborns#Neonates have: Immature immune system Poor thermoregulation Infections often present with hypothermia or normal temperature ●Elderly patients#Aging → immunosenescence → reduced cytokine response → blunted fever ●Patients with renal failure#Uremia → immune dysfunction → altered febrile response. ●Patients with liver failure#Liver failure → impaired acute phase response and cytokine metabolism. ●Patients receiving anti-TNF alpha therapy *Fever requires: Functional immune cells Cytokine production (IL-1, IL-6, TNF-α) Prostaglandin E₂ production in hypothalamus If any part of this pathway is impaired → no fever.

Answer 2

☆Homan's sign☆Tachycardia☆Cyanosis☆Shock

Answer 3

✅ 1. Maximal expiratory pressure is decreased in neuromuscular diseases — CORRECT MEP measures expiratory muscle strength (abdominals + intercostals). In neuromuscular diseases (ALS, myasthenia, muscular dystrophy): Muscles are weak Pressure generation is reduced ✅ 2. FVC is decreased in restrictive lung diseases — CORRECT Restrictive diseases = ↓ lung compliance or expansion → Total lung volume ↓ → Forced vital capacity ↓ Examples: Pulmonary fibrosis Chest wall disease Neuromuscular disease ✅ 3. FEV1/FVC is decreased in obstructive lung diseases — CORRECT Obstructive disease = airflow limitation → FEV1 drops much more than FVC → Ratio decreases (<70%) Examples: COPD Asthma ✅ 4. DLCO is decreased in idiopathic pulmonary fibrosis — CORRECT IPF: Thickened alveolar-capillary membrane Increased diffusion distance → ↓ CO diffusion → ↓ DLCO ❌ 5. DLCO is increased in emphysema — WRONG Emphysema: Destruction of alveolar walls ↓ Surface area for gas exchange ↓ Capillary bed → DLCO DECREASES DLCO increases only when: Surface area ↑ (e.g. polycythemia, pulmonary hemorrhage) One-line exam rules (حفظی) Restriction → FVC ↓ Obstruction → FEV1/FVC ↓ Parenchymal disease → DLCO ↓ Muscle disease → pressures ↓, DLCO normal

Answer 4

آتلکتازی یعنی فروریختن آلوئول‌ها به‌علت باز نشدن ریه یا از دست رفتن هوا. سه نوع اصلی دارد: انسدادی فشاری اسکاری / انقباضی (cicatricial) Inside the airway → obstructive Outside pressure → compressive Scar → cicatricial

Answer 5

Mucus plug → OBSTRUCTIVE atelectasis Inside the airway → obstructive Outside pressure → compressive Scar → cicatricial

Answer 6

Pleural effusion → compressive atelectasis Inside the airway → obstructive Outside pressure → compressive Scar → cicatricial

Answer 7

Tuberculous sequelae – cicatricial atelectasis Irradiation – cicatricial atelectasis Inside the airway → obstructive Outside pressure → compressive Scar → cicatricial

Answer 8

🔹 pH English Normal pH = 7.35 – 7.45 🔹 pCO₂ (respiratory component) English Normal pCO₂ = 35 – 45 mmHg ↑ pCO₂ (>45) → Respiratory acidosis ↓ pCO₂ (<35) → Respiratory alkalosis 🔹 HCO₃⁻ (metabolic component) English Normal HCO₃⁻ = 22 – 26 mEq/L ↓ HCO₃⁻ (<22) → Metabolic acidosis ↑ HCO₃⁻ (>26) → Metabolic alkalosis 🔹 pO₂ (oxygenation – bonus) English Normal pO₂ = 80 – 100 mmHg

Answer 9

A long post‑antibiotic effect (PAE): bacteria remain suppressed for hours even after drug levels fall below the MIC. A post‑antibiotic leukocyte enhancement (PALE): after exposure to the drug, bacteria become easier for neutrophils/macrophages to phagocytose and kill, so host immunity prolongs the effect even further.

Answer 10

Adenocarcinoma ♧There are two types of peripherally located lung carcinomas: adenocarcinoma and large cell carcinoma. Adenocarcinoma has histologic subtypes as acinar, lepidic, papillary, micropapillary, solid.

Answer 11

Anteroinferior septum Most common epistaxis area is Kiesselbach’s plexus ( also known as Little's area ). This area is located anteroinferior septum. This area is an anastomosis of 5 arteries: anterior ethmoidal artery, posterior ethmoidal artery, sphenopalatine artery, greater palatine artery, and the septal branch of the superior labial artery. Kiesselbach’s plexus: Is superficial Has thin mucosa Contains a dense arterial anastomosis Is exposed to dry air, trauma (nose picking), inflammation So it bleeds easily. It is an anastomosis of 5 arteries: Anterior ethmoidal artery Posterior ethmoidal artery Sphenopalatine artery Greater palatine artery Septal branch of superior labial artery

Answer 12

Chronic bronchitis = BLUE BLOATER English Hypoxemia → cyanosis CO₂ retention Productive cough Edema (cor pulmonale) Overweight #Overweight or obesity Crackles and wheezing Peripheral edema Cyanosis Chronic bronchitis is a long‑term inflammatory disease of the bronchi defined clinically as a productive cough with sputum on most days for at least 3 months per year, for 2 consecutive years, after excluding other causes. It is usually caused by chronic inhalation of irritants—especially cigarette smoke—which leads to mucus‑gland enlargement, goblet‑cell hyperplasia, and airway narrowing, and it represents one major phenotype of COPD (the classic “blue bloater”). Emphysema = PINK PUFFER English Hyperventilation Cachexia Barrel chest Decreased breath sounds Pink skin Emphysema is a chronic lung disease in which the air spaces beyond the terminal bronchioles (the alveoli and acini) become abnormally and permanently enlarged, and their walls are destroyed, without significant fibrosis. This loss of alveolar walls removes a huge area for gas exchange and destroys the elastic fibers that normally help small airways stay open during expiration, so the lungs become over‑inflated and it becomes progressively harder to breathe out.

Answer 13

Administer sympathomimetic drugs to stimulate beta-2 ARs or anticholinergic drugs that decrease parasympathetic activity. ■Both asthma and COPD cause: Airway narrowing Increased bronchial smooth muscle tone So treatment must: Relax bronchial smooth muscle Reduce bronchoconstriction Two direct ways: 1#Stimulate β₂ receptors → bronchodilation 2#Block parasympathetic (muscarinic) tone → bronchodilation ✅ Sympathomimetics (β₂ agonists) OR anticholinergics English This is the shared first-line bronchodilator strategy: β₂ agonists → relax smooth muscle Anticholinergics → block vagal bronchoconstriction Used in: Asthma ✅ COPD ✅ If the question says “asthma AND COPD” → think BRONCHODILATORS Specifically: β₂ agonists Anticholinergics

Answer 14

●Pulmonary hypertension occurs in severe PE cases ●Trauma is a risk factor for PE development ●PE is usually a recurrent disease ●Hereditary risk factors should be assessed especially in young PE cases with no other risk

Answer 15

SPN is a radiologic definition, not a diagnosis. Definition: Single lesion ≤ 3 cm Rounded opacity Completely surrounded by lung parenchyma No atelectasis, no lymphadenopathy, no pleural effusion ●Should not be associated with atelectasis ●Should be less than 3 cm in diameter ●Should be single ●Should be intraparenchymal

Answer 16

Tend to grow large airways of the lungs Association with smoking Symptoms often occur early due to obstruction in the airways Tumor is characterized by the presence of keratinization and/or intercellular bridges Small cell lung carcinomas tend to grow near the central airways of the lungs and tend to metastasize early. There is a high association with smoking. Tumor cells comprised of cells with finely granular nuclear chromatin which are known as salt and pepper chromatin. Adenocarcinomas tend to grow in periphery of the lungs therefore the first symptoms with these tumors may only include unintentional weight loss or shortness of breath. They show glandular differentiation or mucin production by the tumor cells. Squamous cell carcinomas tend to grow in large airways therefore symptoms often occur early due to obstruction in the airways that can lead to a cough or coughing up blood. Tumor is characterized by the presence of keratinization and/or intercellular bridges. The tumor also has association with smoking.

Answer 17

Odynophagia Odynophagia (pain on swallowing) Dysphagia (difficulty in swallowing) Dysphonia (Hoarseness) (difficulty with voice) Dyspnea (difficulty in breathing) Sore Throat (pain, scratchiness or irritation of the throat) Trismus (limitation in mouth opening)

Answer 18

Types of lactic acidosis Type A Tissue hypoxia / hypoperfusion Type B Drugs, liver disease, malignancy Type D Short bowel, bacterial overgrowth Lactic acid ↑ → H⁺ ↑ → HCO₃⁻ consumed → Metabolic acidosis

Answer 19

English – Core principles Treat infection, not colonization Obtain cultures before antibiotics if possible Start empiric therapy based on likely pathogens De-escalate to narrowest spectrum Avoid unnecessary antibiotics Asymptomatic bacteriuria = bacteria in urine without symptoms General rule: ❌ DO NOT treat Exceptions: ✔ Pregnancy ✔ Before urologic procedures with mucosal bleeding

Answer 20

pineal gland-----melatonin

Answer 21

■Squamous cell metaplasia ■Hyperplasia of the bronchial mucous glands and smooth muscles ■Chronic inflammation and edema of the airways ■Destruction of cilia ■Bronchial wall thickening and development of fibrosis Hyperplasia of the bronchial mucous glands and smooth muscles (the major change), chronic inflammation and edema of the airways, destruction of cilia, squamous cell metaplasia, bronchial wall thickening and development of fibrosis are the changes that are observed in chronic bronchitis. Destruction of the alveolar walls is observed in emphysema.

Answer 22

She is in class II shock

Answer 23

🔹 FVC (Forced Vital Capacity) English FVC = total air exhaled after full inspiration In restrictive disease → lung volume ↓ → FVC ↓ 🔹 FEV1 (Forced Expiratory Volume in 1 second) English FEV1 may be: normal or decreased (because total volume is reduced) But it is not increased. 🔹 FEV1/FVC ratio English Both FEV1 and FVC ↓ But FVC ↓ more → Ratio is normal or increased → typically > 0.8

Answer 24

Like COPD Asthma Bronchiectasis Emphysema 🔹 FEV1 (خیلی مهم) English FEV1 = air exhaled in first second In obstructive disease → narrowed airways → FEV1 ↓↓↓ (markedly decreased) 🔹 FVC English FVC = total exhaled air In obstructive disease: May be normal Or mildly decreased (air trapping) 🔹 FEV1/FVC ratio (نقطهٔ مرگ و زندگی در امتحان) English FEV1 ↓↓↓ FVC ↓ or normal → Ratio decreases ✔ FEV1/FVC < 0.7 (or <70%) ♡Obstructive pattern FEV1 ↓↓↓ FVC normal or ↓ FEV1/FVC ↓ (<0.7)

Answer 25

T helper 2

Answer 26

Low income Unemployment Low level of education Tobacco use Income inequality

Answer 27

Pulmonary infarcts are classically hemorrhagic Pulmonary infarcts are classically hemorrhagic due to dual blood supply and venous congestion.

Answer 28

Reduced lung expansion and decreased total lung capacity Restrictive lung diseases are characterized by reduced lung expansion and decreased total lung capacity, leading to proportional reductions in FEV₁ and FVC with a normal or increased FEV₁/FVC ratio.

Answer 29

The most common etiology of acute rhinosinusitis is a viral infection, and bacterial infection occurs in only 0.5 to 2 percent of episodes The most common risk factor for acute otitis media in children is a preceding upper respiratory tract infection; adenoid hypertrophy , allergy and daycare attendance being some of the other risk factors The goal of treatment of Strep. pyogenes pharyngitis is to prevent acute rheumatic fever, reduce the severity and duration of symptoms, and prevent transmission Majority (40%) of the pediatric pharyngitis cases are viral and are self-limiting, often require only supportive treatment Streptococcus pyogenes pharyngitis is very rare in children younger than 2 years,pharyngitis at this age group is mostly viral

Answer 30

Streptococcus pneumoniae

Answer 31

Squamous cell carcinoma 🌏Squamous cell carcinoma is strongly associated with smoking, typically arises in central airways, and shows keratinization and squamous pearls. Adenocarcinoma is usually peripheral. Small cell carcinoma lacks keratinization. Large cell carcinoma is undifferentiated.

Answer 32

Activation of β2-adrenergic receptors leading to increased cAMP Short-acting β2 agonists (SABAs, e.g., albuterol) are first-line for acute asthma attacks. They stimulate adenylyl cyclase → ↑cAMP → bronchodilation. Leukotriene antagonists (montelukast) and mast cell stabilizers (cromolyn) are prophylactic, not for acute relief.

Answer 33

Narrow therapeutic index with adenosine receptor antagonism and PDE inhibition

Answer 34

Spirometry

Answer 35

Lung cancer COPD Coronary artery disease Hair loss Myopia

Answer 36

Pulmonary arterial hypertension

Answer 37

Histology and stage

Answer 38

Mitral valve disease 🏛 Polycythemia vera Anti-phospholipid syndrome Active cancer Immobility Polycythemia vera

Answer 39

Increase in H+ concentration

Lung Flashcards

(65 cards)