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What is the diagnostic feature of acute pulmonary infarct?
Ischemic necrosis of lung within area of hemorrhage.
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Pulmonary blood pressure is usually __ of systemic blood pressure?
1/8.
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Pulmonary hypertension is most frequently secondary to?
Conditions that increase pulmonary blood flow, pressure, resistance, or left heart resistance to blood flow.
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Name some causes of pulmonary hypertension?
- COPD, interstitial lung diseases
- CHF
- Recurrent PE
- congenital or acquired heart diseases
- Primary or idiopathic - most common in young women.
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What is the pathogenesis of pulmonary hypertension?
Pulmonary endothelial cell and/or vascular smooth muscle dysfunction.
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What is bone morphogenetic protein receptor type 2 (BMPR2), and how does it affect pulmonary hypertension?
- A cell surface receptor that binds to several ligands of teh TGF-B pathway and has inhibitory effects on proliferation
- Loss of function mutation of gene leads to vascular endothelial and pulmonary smooth muscle proliferation.
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How does Serotonin transporter gene (5-HTT) affect pulmonary hypertension?
Polymorphisms lead to enhanced expression on vascular smooth muscle and proliferation.
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The diffuse alveolar hemorrhage syndromes present with the triad of?
- Hemoptysis
- Anemia
- Diffuse pulmonary infiltrates.
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What are the three diffuse alveolar hemorrhage syndromes?
- Primary immune mediated diseases
- Goodpasture syndrome
- Wegener's granulomatosis
- Idiopathic pulmonary hemosiderosis.
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What causes Goodpasture syndrome?
Antibodies to the non-collagenous domain of the alpha-3 chain of collagen 4.
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What is characteristically seen after an acute presentation of goodpasture syndrome?
Hemosiderin, either within macrophages or extracellularly.
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Wegener's granulomatosis (WG) is also known as?
Pulmonary angiitis and granulomatosis.
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90% of patients with WG test positive for?
c-ANCA.
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What are some manifestations of WG?
- Upper respiratory: epistaxis, chronic sinusitis, nasal perforation
- Pulmonary: cough, hemoptysis, chest pain.
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Lung lesions in WG are characterized by?
- Necrotizing vasculitis (angiitis)
- parenchymal necrotizing granulomatous inflammation.
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Acute bacterial pneumonias can present as?
- Bronchopneumonia: patchy distribution of inflammation with infection of bronchi, bronchioles and adjacent alveoli (usually involving more than one lobe)
- Lobar pneumonia: contiguous airspaces of part of all of a lobe homogenously filled with exudate.
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What is the most common cause of (community-acquired) pneumonia?
Streptococcus pneumoniae (pneumococcus).
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What are the four stages of pneumonia (gross and histology)?
- Congestion: Lung is heavy and red
- Red hepatization: Exudate with red cells, fibrin, and neutrophils fills alveoli
- Gray hepatization: Disintegration of red cells but persistence of fibrinopurulent exudate
- Resolution: enzymatic digestion of exudate.
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What is the most common cause of acute exacerbation of COPD?
Haemophilus influenzae.
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What is the most frequent cause of gram negative pneumonia?
- Klebsiella pneumoniae
- Seen in chronic alcoholics
- Thick and gelatinous sputum.
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what is the histologic presentation of mycoplasma pneumoniae?
- children and young adults
- inflammation reaction confined to the interstituim (exudate-free alveolar spaces).
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What caused SARS (severe acute respiratory syndrome)?
A novel coronavirus (single stranded RNA).
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What is the Ghon complex?
- Initial focus of primary TB infection
- Includes the parenchymal subpleural lesion and the caseous lymph nodes draining the focus
- Necrotizing, caseating granulomas.
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How do you diagnose TB?
Demonstration of acid-fast organism in sputum culture.
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What does mucormycosis look like histologically?
Non-septated hyphae with irregular branching.
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What does aspergillosis look like histologically?
Septated hyphae with 45 degree branching.
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Cryptococcosis usually presents in which patients?
- Opportunisitic infection in immunocompromised hosts
- pulmonary, CNS, or disseminated disease.
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Name another opportunistic infectious fungus?
- Pneumocystis jiroveci
- intra-alveolar, foamy exudate
- cup-shaped cyst walls on silver stain.
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What is the most common cause of peripheral arterial disease (PAD)?
Atherosclerosis.
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What is the most important modifiable risk factor for developing PAD?
- Smoking
- Diabetes is the other risk factor.
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What are five pathologies of PAD?
- Obstructive
- Embolic
- Aneurysm
- Pseudoaneurysm
- arterio-venous shunt.
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What are three different clinical syndromes caused by PAD?
- Intermittent claudication (IC): most common symptom, relieved at rest
- Critical limb ischemia (CLI)
- Acute limb ischemia (ALI).
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What are the most common sites of PAD causing IC?
- Femoral and popliteal arteries (lower limb)
- Brachiocephalic and subclavian can cause arm claudication (much less common).
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