classic three symptoms of PE
- sudden onset of chest pain
- dyspnea
- tachypnea
hemoptysis, cough, wheezing. Diagnosis?
lung cancer
*buzzword: hemoptysis (highly vascularized tumor)
Although it sounds like COPD (wheezing), COPD does NOT present with hemoptysis
Equation for calculating alveolar O2? (thus Aa gradient)
PAO2= Air O2 (PIO2) - PaCO2/R
= 150- PaCO2/0.8
150= (760-PH2O)*0.21
* R: respiratory quotient, question may give different number
Describe mechanism regarding how Acetazolamide can be used for high altitude sickness
high altitude -> respiratory alkalosis
acetazolamide induces acidosis by inhibiting carbonic anhydrase -> less HCO3- reabsorption/ H+ secretion
-> promotes renal compensatory mechanism of HCO3- excretion
Lab findings of pulmonary consolidation.
- breath sounds
- percussion
- fremitus
- tracheal deviation
What are two examples of pulmonary consolidation? How to differentiate these two?
- decreased breath sounds
- dullness to percussion
- INCREASED fremitus (consolidation is ONLY thing that increases fremitus)
- no tracheal deviation
- lobar pneumonia
- pulmonary edema
pulmonary edema usually has preceding HF, while lobar pneumonia shows signs of bacterial infection
( Strep.pneumo, Klebsiella, legionella)
1st line for chronic asthma
inhaled corticosteroids
What is pulmonary shunt? V/Q value? Will 100% O2 be helpful?
- obstruction
- V/Q equals to 0
- 100% O2 will NOT be helpful
Silicosis: what is impaired? Increased risk for what two?
histologic finding?
Silica is deposited in MACROPHAGE, disrupting phagolysosome -> increased risk for TB
Also increased risk for bronchogenic carcinoma
histologic finding: “eggshell” calcification of hilar lymph node
Abscess
- what is it?
- chest x-ray finding of lung abscess?
- What bugs (3) should I think about?
- treatment?
- pus (neutrophil infiltrate) within parenchyma
- air-fluid level cavity (black hole) on chest x-ray
- Klebsiella (TV on sketchy), S.aureus (camel back on sketchy), anerobes (bacteriodes, fusobacterium, peptostreptococcus)
- clindamycin (antibiotics for above diaphragm)
List three histologic markers for small cell lung cancer
- chromogranin
- enolase
- neural cell adhesion molecule (NCAM)
How to calculate dead space with given
- arterial pCO2
- expired pCO2
- tidal volume
dead space = tidal volume * [PaCO2-PeCO2]/PaCO2
- this makes sense: with zero expired pCO2 (which means no gas exchange occurs), dead space= tidal volume
Which asthmatic drug can result in immediate relief?
beta 2 agonist
beta 2 -> Gs -> increased cAMP ->PKA
- > inhibition of PLCK (smooth muscle)
- > bronchodilation
Phrenic nerve root?
C3-C5
Rib location of right middle lobe?
between 4th and 6th rib
Emphysema: etiology of each type? affected region?
- panacinar
- centriacinar
- panacinar: alpha1 antitrypsin deficiency
ENTIRE acini from respiratory bronchiole to alveoli is uniformly messed up - centriacinar: smoking
only central region is messed up
Where is respiratory center located in CNS?
medulla
What week does surfactant begins to synthesize? What weeks are needed to achieve mature surfactant level?
surfactant synthesis starts at week 26
> 35 weeks are required to achieve mature surfactant level
female, non-smoker: what lung cancer? central or peripheral?
adenocarcinoma
peripheral
what is atelectasis? X-ray finding?
bronchial airway collapse
tracheal deviation toward lesion on x-ray
* this is the only pathology that shows tracheal deviation toward lesion on x-ray
