If you or a loved one was diagnosed with Mesothelioma, you may be entitled to financial compensation
Tobacco smoking worsens the effects of all inhaled mineral dust, but particularly those caused by this inhaled particulate
What is asbestos?
Slide 5
Plumbers, shipyard workers, construction workers
This type of embolus occurs at the bifurcation of the pulmonary trunk
What is a saddle embolus?
Slide 9
The risk of HAP is greatest amongst patients on this medical device
What is mechanical ventilation?
Slide 40
This is the MOA of beta-lactam antibiotics
What is binding to PBPs?
Slide 7
Active against gram + and H. influenzae
Amoxicillin, Amox/clav, Cefuroxime (2nd gen CS)
Active against gram -
Pip/Tazo, Cefepime (4th gen CS), Imipenem, Meropenem
This type of lung tumor can present with hypercalcemia via the release of PTHrp
Bonus: Which type of lung tumor can present with gynocomastia?
What is squamous cell carcinoma?
Slide 21
p5s mutation, keratin pearls, intercellular bridges, IHC markers -> p40, p64, and CK5/6
Bonus: Large cell carcinoma
- Pleomorphic (anaplastic) cells
Histologically, the lesions seen in this pneumoconiosis is characterized by a central area of whorled collagen fibers with peripheral dust-laden macrophages
What is Silicosis?
Slide 17
"Eggshell Calcifications" on Hilar lymph nodes
Sandblasters, stone carvers, stressed denim
INCREASED SUSCEPTIBILITY TO TB and lung cancer
Familial pulmonary hypertension is caused by mutations in this gene
What is BMPR2?
Slide 26
These 2 organisms are the most common pathogens related to HAP and VAP
What are S. aureus and P. aeruginosa?
Slide 45
These 2 antibiotics are used against MRSA
Bonus: What are their MOAs?
What are Vancomycin and Linezolid?
Slide 16
Bonus:
Vanco -> Binds to D-Ala-D-Ala
Lin -> Binds to 23S rRNA (part of 50S)
This type of tumor develops at the apex of the lung and can cause Horner's syndrome and ulnar nerve pain
What are Pancoast tumors?
Slide 17
These well-circumscribed densities seen on chest radiographs are the most common manifestation of asbestos exposure
What are pleural plaques?
Slide 28
Most frequently on the anterior & posterolateral aspects of the parietal pleura and over the domes of the diaphragm
An abnormal buildup of glycogen within tissues triggers slow remodeling of small blood vessels in the lungs in this storage disorder
What is von Gierke disease?
Slide 24
Pompe's -> PH from hypoventilation (muscle weakness)
Gaucher's -> Lipid-laden macrophages infiltrate capillary beds and physically obstruct blood flow
Pneumonia caused by this organism often follows influenza infection or occurs in hospitalized patients and may cause rapidly progressive pneumonia with cavitary lesions
What is S. Aureus?
Slide 18
› Mycoplasma pneumoniae:
– Young adults, crowded settings, gradual onset, persistent dry cough, low-grade fever, headache and pharyngitis. Chest radiograph showing infiltrates that are more impressive than the physical examination findings ("walking pneumonia")
› Streptococcus pneumoniae:
– Typically presents with an abrupt onset of high fever, productive cough, pleuritic chest pain, and focal lobar consolidation rather than a prolonged dry cough with diffuse interstitial infiltrates
› Klebsiella pneumoniae:
– Classically affects patients with alcoholism, diabetes, or chronic illness and produces severe lobar pneumonia with thick, blood-tinged sputum
› Haemophilus influenzae:
– More common in patients with COPD or chronic smoking history- usually causes productive cough rather than an atypical syndrome
This macrolide antibiotic doesn't interfere with P450 enzymes
Bonus: What is the MOA of macrolides?
What is azithromycin?
Slide 8
Bind to 50S subunit
These are the four most common locations that lung tumors spread to
What are the adrenals (>50%), liver (30-50%), brain, and bone?
Slide 9
This is the most innocuous coal-induced pulmonary lesion in coal miners
What is Anthracosis?
Slide 9
This microscopic feature of a clot proves it was formed before death
What are lines of Zhan?
Slide 12
This PSI score would warrant hospitalization
What is 3 or greater?
Slide 30
Mild - PSI 1-2, CURB-65 0 (1 if >65)
Mod - PSI 3 or higher, CURB-65 of >1 (>2 if >65)
Sev - Mechanical ventilation, sepsis requiring vasopressor, presence of 3 criteria outlined on slide 31
A patient with a MDR HAP ends up also getting MRSA. This is an appropriate drug regimen
Beta-lactam against gram -
Pip/Tazo, Cefepime, Imipenem, Meropenem
Aminoglycoside or levofloxacin
Amikacin, Tobramycin, Gentamycin
Anti-MRSA
Vancomycin, Linezolid
Slide 13
Aminoglycosides bind the 30S subunit
Along with carcinoid and SVC syndrome, small cell carcinoma is related to these other 3 paraneoplastic syndromes
What are SIADH, Ectopic ACTH, and Lambert-Eaton syndrome?
Slide 20
Radiosensitive, p53 and Rb, NE tumor -> Chromogranin and synaptophysin
These are the two forms of asbestos fibers?
Bonus: Which is more fibrogenic and carcinogenic?
What are Amphiboles and Serpentine Chrysotiles?
Slide 31
Bonus: Amphiboles
Serpentine fibers are more common in the industry, but amphiboles are stiffer and straighter -> penetrates further down the respiratory tract
Silica also comes in 2 forms, crystalline and amorphous
In Goodpasture syndrome, you can see this within macrophages under a microscope
What is hemosiderin?
Slide 42
• Focal necrosis with intra-alveolar hemorrhage
• Fibrous septa
• Hypertrophy of type II pneumocytes
Crescenteric GN, linear immunofleuorescence
Atypical pneumonia causing organisms are intrinsically resistant to this type of antibiotic
What are β-lactam antibiotics?
Slide 13
Treated with a macrolide, fluoroquinolone, or tetracycline
These 2 classes of drugs oral absorption are impaired by divalent and trivalent cations
Bonus: What are their MOAs?
What are fluoroquinolones and tetracyclines?
Slide 9 and 10
Bonus:
Fluoro: inhibition of DNA gyrase and Topoisomerase 4
Exs. Levofloxacin and Moxifloxacin
Tetra: Binds to 30S subunit
Exs. Doxycycline
Both contraindicated in pregnant and breastfeeding patients
Those with carcinoid syndrome can present with a deficiency of this vitamin
What is Niacin (B3)?
Slide 27
All the Tryptophan is used to produce serotonin
Only about 10% of bronchial carcinoid tumors give rise to carcinoid syndrome
- Episodic skin flushing, severe diarrhea, wheezing, over time left-sided heart valve damage