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UWorld > 1 Pulm T > Flashcards

1 Pulm T Flashcards

1
Q

What is the progression of Idiopathic Pulmonary HTN

A

muscularization -> medial hypertrophy -> intimal fibrosis -> plexiform lesions

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2
Q

What is Bosentan?

A

endothelian-receptor antagonist; decreases pulmonary HTN

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3
Q

What is occurring within the nucleolus?

A

Primary site of rRNA transcription (RNA Poly I) and ribosomal subunit assembly

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4
Q

What does RNA Poly II synthesize?

A

mRNA

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5
Q

What does RNA Poly III synthesize?

A

tRNA

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6
Q

What gives elastin it elastic property?

A

lysine cross linking via lysol hydroxylase; very little hydroxylation compared to collagen

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7
Q

What is Varenicline?

A

A partial nicotine agonist to help withdrawal

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8
Q

What two things does H inf. require to grow?

A

Factor X (hematin) and Factor V (NAD+)

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9
Q

What are the two tests for NADPH oxidase?

A

Nitroblue Tetrazolium (NBT) & Dihydrorhodamine (DHR)

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10
Q

What does missense, silent, frameshift, and nonsense mutations mean?

A

missense - change aa used
silent - change third codon doesn’t matter
frameshift - change sets of three
nonsense - early stop codon

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11
Q

What controls RR in healthy people vs COPD pts?

A

Healthy - PaCO2 - central chemoreceptors

COPD - PaO2 - peripheral chemoreceptors

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12
Q

What is the V/Q at the apex vs the base?

A

Roughly 2.5 at the apex and 0.6 at the base assuming non-exertional upright status

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13
Q

What are some risks of uncorrected sleep apnea?

A

Pulm HTN w/ cor pulmonale

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14
Q

What type of tissue do hamartomas have?

A

cartilage; they are the most common benign lung tumors

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15
Q

What is a common prophylaxis for lung transplant patients?

A

valganciclovir for CMV

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16
Q

What mediates the cough reflex?

A

CN X; internal laryngeal nerve, a branch of the superior laryngeal nerve

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17
Q

What is atopic asthma controlled by?

A

LTC/D/E4 antagonists

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18
Q

What do small cell carcinomas often show evidence of?

A

neuroendocrine markers

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19
Q

Aspirgillus branches at what angle?

A

45 degrees

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20
Q

What does HCO3- exchange with in RBCs to maintain electroneutrality in tissues as they take on CO2?

A

Cl-

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21
Q

What are the dimorphic fungi?

A

1) sporothrix 2) coccidioides 3) histoplasma 4) blastomyces 5) paracoccidioides

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22
Q

Where does S. aureus typically colonize?

A

Ant. Nares

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23
Q

Name the anti-IgE antibody

A

Omalizumab

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24
Q

What is Cheyenne-Stokes breathing?

A

CHF patients who alternate between hypocapnic/hypercapnic episodes resulting in apnic-to-hyperventalatory responses.

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25
Q

What are some common features of SCID?

A

no thymic shadow; mucocutaneous candida; failure to thrive; hypogammaglobulinemia: B and T cell dysfunction

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26
Q

Why is sputum green?

A

myeloperoxidase; contains a blue-green heme pigment

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27
Q

Why do people with panic attacks pass out?

A

hypocapnia can decrease cerebral blood flow

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28
Q

What is lead-time bias?

A

An apparent increase in survival time with better screening tools when the prognosis is exactly the same

29
Q

Which bacteria has the glutamic acid capsule?

A

bacillus anthracis

30
Q

What mm is at the 5th intercostal space in the midaxillary line?

A

serratus anterior

31
Q

In what bacteria are sulfitides and what purpose does it serve?

A

TB/mycobacteria; it is a virulence factor allowing survival in macrophages

32
Q

What type of cells cover the true vocal cords?

A

stratified squamous epithelium; HPV can cause warty growths

33
Q

Where is stratified squamous epithelium found?

A

oropharynx; laryngopharynx; ant epiglottis; upper half of post epiglottis; true vocal cords

34
Q

What does nocardia often present with?

A

cavitary lung lesions, often misdiagnosed as TB: Tx w/ TMP-SMX

35
Q

When is the work of breathing minimized in restrictive Dx? Obstructive Dx?

A

Restrictive - low TV high RR

Obstructive - high TV low RR

36
Q

How long does it take the Th1 cells to begin to produce IFN-g after TB infection?

A

2-4weeks

37
Q

What are the signs of 1* and 2* TB infection?

A

1* - Ghon complex

2* - Fibrocaseous lesion in the upper pole

38
Q

What particles deposit in the base of the lung? The apex?

A

coal/silica in the apex

asbestos in the base

39
Q

Species with budding yeast and thick capsule

A

Cryptococcus

40
Q

Species with pseudohyphae and blastoconida

A

Candida

41
Q

Species with septal hyphae and dichotomous V-shaped branching

A

Aspirgillis

42
Q

What are some functions of Club/Clara cells?

A

They help detox inhaled substances with P450; secrete surfactant components

43
Q

Where do 10-15um particles get trapped in the lungs?

A

URT

44
Q

Where do 2.5-10um particles get trapped in the lungs?

A

trachea/bronchi

45
Q

What happens to inhaled

A

phagocytosed in terminal respiratory bronchioles

46
Q

What are the signs of fat embolism?

A

Triad 1) hypoxemia 2) petechial rash 3) fractured long bone

occurs 24-72h post fracture

47
Q

Explain the two types of pneumonia vaccines and their respective responses

A

PPV23 is just polysaccharide and induces T-independent B-cell response
PPV13 is conjugated to diptheria toxin and induces a T-dependent B-cell response

48
Q

What type of drug is theophylline?

A

PDE inhibitor - increases cAMP (similar to B-agonists)

49
Q

What is a typical ABG of a PE patient?

A

PCO2 is decreased as you hyperventilate. This causes a resp. alkalosis. PaO2 is decreased as well as you have V/Q mismatch and a shunt

50
Q

What is a potential complication to a selective Ig deficiency?

A

Pt will make antibodies to the missing Ab and you can have reactions to transfusions

51
Q

What are H1 antagonists useful/not useful for?

A

They are useful for hives and allergic symptoms but NOT asthama

52
Q

CFTR proteins serve what functions?

A

They block the ENaC channel and promote Cl- secretion which adds salt and water to the mucus. If lacking, the mucus becomes dehydrated and viscous

53
Q

What are some signs of MAC?

A

pallor, hepatosplenomegaly, clear CXR, elevated alk phosphate: grow optimally at 41*C

54
Q

What is azithromycin used to prophylactically treat in HIV with a CD

A

Azithromycin is used to prophylactically treat MAC

55
Q

Bronchioloalveolar carcinoma is what cell type and where is it located?

A

It is columnar cells and it lines alveoli so it is in the periphery. It spreads aerogenously.

56
Q

What are lamellar bodies?

A

They are within TII pneumocytes and store the surfactant

57
Q

What does IL-4/IL-5 do?

A 
IL-4 causes IgE class switching
IL-5 causes IgA class switching and eosinophil activation
58
Q

What are the signs of sarcoidosis?

A

Hilar LAD, elevated ACE, skin nodules, arthralgia. Causes scattered granulomas

59
Q

Explain what happens after a bronchus obstruction

A

Trapped air will get reabsorbed and lead to atalectasis

60
Q

What are the signs of cystic fibrosis?

A

recurrent sinopulmonary infections, pancreatic insufficiency, GI malabsorption,

61
Q

What is the mutation leading to CFTR?

A

A 3 bp deletion which leads to abnormal post translational processing

62
Q

What are some side effects of using methotrexate?

A

interstitial pneumonitis and fibrosis

63
Q

Where does the aspirate go 1) upright and 2) laying down?

A

1) Upright - basilar segments of lower lobe 2) Laying down - posterior segments of the upper lobe

64
Q

MCC of spontaneous pneumo in young patients?

A

apical subpleural blebs

65
Q

Which bacteria is bile soluble and optochin sensitive?

A

S. pneumo

66
Q

What give germ tubes (true hyphae) when grown at 37C?

A

Candida

67
Q

What is the first signs of CREST?

A

Intimal thickening of the Pulmonary arteries

68
Q

What are the four phases of pneumonia and their characteristics?

A

Congestions - bacteria
Red - RBCs, Neutrophils, Fibrin
Grey - RBC disintegration, Neutrophils, Fibrin
Resolution - clear

69
Q

Acute pancreatitis can cause what resp. issue?

A

ARDS

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