Small Cell Carcinoma

What a great show.

Small cell carcinoma: known for it's high N:C ratio and salt and pepper chromatin coloration!

Ventilation-Perfusion Ratio (V/Q)

"You have smoked yourself retarded." - Dave Chappelle from Half Baked

Is it just me or does the ventilation-perfusion ratio (V/Q) pictures in physiology books (BRS Physiology in particular) look like a bong?

I'm not an advocate of marijuana or any other mind-altering substance for the matter, but I can't help but place stoner comedies in my top three favorite movie genres. The best stoner films I've seen to date? 1. Half Baked 2. Pineapple Express 3. Harold and Kumar go to White Castle. 

As for actual learning points: when the V/Q ratio approaches 0, arterial blood gas numbers begin to look more like venous blood gas numbers. When the V/Q ratio approaches in infinity (WHO DIVIDES BY ZERO?! WHY WOULD YOU DO THAT?), alveolar blood gas numbers look like the gas numbers found in inspired air. 

Psittacosis (And Alcoholism)

"Calling all captains!"

In our recent lower respiratory infections lecture, I only remembered two things.

Firstly, having pneumonias with a history of bird exposure (eg. parrots, parakeets, turkeys - happy early Thanksgiving) makes it likely you have Pscittacosis. 

Second, alcoholics are likely to have pneumonias caused by Klebsiella, normal oral flora, S. aureus, or S. pneumoniae. 

And if you're exposed to both (a Captain Morgan-swigging pirate parrot for example)... who knows what caused your pneumonia!

Tension Pneumothorax

"It rubs the lotion on its skin or it gets the hose again." - Buffalo Bill (Silence of the Lambs)

Since all the pulmonologists here seem to go absolutely mental over the fact buffaloes have communicating lung pleura (which apparently made it really easy for Native Americans to ARROW them back in the day), here's a buffalo for your viewing pleasure. I know what you're thinking: it looks like an ox with a fro or an ox with its brains splattered out. Or maybe even a pig.

Anyway here's the fact of the day: a tension pneumothorax occurs where there is a penetrating tear to the pleura. This tear looks like a flap and acts as a check valve in that it allows air into the pleural cavity but not out. Thus with each breath, there is an increase in pleural cavity pressure.

Hypersensitivity Pneumonitis

Watch Hitchcock's "The Birds"! Or North by Northwest. 

When I hear hypersensitivity pneumonitis, I think of bird fancier's disease. I also think of the time back in middle school when my school had a really bad seagull problem and I got bird poo splat all over me a frequent basis. They finally put wires across the buildings to keep the birds out, but not before putting fake owls on top of classrooms to "scare" off the gulls.

Primary Ciliary Dyskinesia

"You can learn a lot of things from the flowers..." - Alice in Wonderland

There are a couple of disorders resulting in bronchiectasis: cystic fibrosis, infections, bronchial obstruction, allergic bronchopulmonary aspergillosus, and also primary ciliary dyskinesia.

In primary ciliary dyskinesia, there is an absence of dynein arms in cilia. Dynein arms contain ATPase for the movement of cilia. As you might guess, the lack of dynein arms will impair the ability of the ciliated epithelial cells in the respiratory tree to clear up mucus and other respiratory secretions.

Kartagener's syndrome is a subset of primary ciliary dyskinesia. It features symptoms including bronchiectasis, situs invertus, and sinusitis. Situs invertus occurs when there's a mirror image of the major organs. CRAZY!

Usual Interstitial Pneumonia (UIP)

The really ugly mascot for Post's Honey Comb cereal!

Honey-combing is found in radiographic images of patients with Usual Interstitial Pneumonia.

Desquamative Interstitial Pneumonia (DIP)

Macrophages on the Fun Dip Stick!

Bronchiolitis Obliterans Organizing Pneumonia (BOOP)

Never really got the appeal to Betty Boop.

Bronchiolitis Obliterans Organizing Pneumonia (BOOP), also known as Cryptogenic Organizing Pneumonia (COP). 

I haven't studied this much yet... wait for some information tonight!

Right Upper Lobe Bronchus

Free Willy!

At the request of an awesome friend/classmate, here's an inaccurately drawn CT scan of the thorax (totally not going to be a radiologist) cutting through the right upper lobe bronchus at around the level just below the carina. The right upper bronchus looks like a whale!

Remember when Shamu at Sea World killed that trainer last year?!

The Black Lung

"What is this? A center for ants?"

Derek Zoolander after being in a coal mine for a day: "I think I'm getting the Black Lung, Pop. It's not very well ventilated down there."

I do realize this is a BAD drawing of Zoolander but I can't stop quoting from the movie. *high pitched cough*


Causes of nocturnal cough: GERD, bronchial asthma
Causes of productive cough: chronic bronchitis, bacterial pneumonia, bronchiectasis
Drugs causing cough: ACE inhibitors, aspirin

Respiratory Epithelium: Goblet Cell

Harry Potter and the Goblet of Mucus.

Yesterday, no one came to microanatomy class. I did though, and this is what I kind of learned:

Respiratory epithelium differs based on where you are along the respiratory tract. In the nasal mucosa, you'll find pseudostratified columnar epithelium with the following cells: goblet cells, ciliated cells, and basal cells. Underneath this is a vascularized lamina propria with mucous/serous glands. 

Goblet cells secrete mucin, ciliated cells beat up all the junk in your airway towards the pharynx, and basal cells are stem cells. 

Down the respiratory tract you'll lose the goblet cells and then you'll see all the cool lung-y stuff. 

Also, I'M TIRED.

Pulmonary Fun Facts

It should really be Woo-Tang Clan. 

Just began studying the respiratory system and what better way to start it off than with a review of structures that pierce through the diaphragm?!

Level at which things pierce through the diaphragm:

T8: Inferior Vena Cava

T10: Esophagus 

T12: Aorta 

The lungs remind me of an upside down Wu-Tang Clan symbol. Word.