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Step 1 DIT > 10. Pulmonary > Flashcards

10. Pulmonary Flashcards

1
Q

What structures traverse the diaphragm, and at what vertebral levels do they pass through?

A

8: IVC
10: esophagus, vagus nerve
12: aorta, thoracic duct, azygos vein

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2
Q

What histological change takes place in the trachea of a smoker?

A

metaplasia (ciliated columnar –> squamous)

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3
Q

What cell type proliferates during lung damage?

A

type 2 pneumocytes

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4
Q

What amniotic fluid measurement is indicative of fetal lung maturity?

A

lecithin-sphingomyelin ratio >2

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5
Q

a young woman has infertility, recurrent URIs, and dextrocardia. Which of her protein is defective?

A

dynein

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6
Q

If a lung collapses, what happens to the intrathoracic volume?

A

Intrathoracic volume increases due to unopposed chest wall expansion

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7
Q

What gene mutation can cause primary pulmonary HTN?

A

BMPR-2 gene

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8
Q

What are some of the secondary causes of pulmonary HTN?

A
  • COPD
  • sleep apnea
  • frequent thromboembolism
  • mitral stenosis
  • Left-to-right shunts
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9
Q

What are some of the treatment options available for pulmonary HTN? (4)

A
  1. Bosentan
  2. Prostacyclin analogs
  3. Sildenefil (phosphodiesterase inhibitors)
  4. Nifedipine
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10
Q

What is the MoA of bosentan?

A

competitively antagonizes at the endothelin-1-receptor (decreasing pulmonary vascular resistance)

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11
Q

Which form of hemoglobin A has a high affinity for oxygen? Which has a low affinity for oxygen?

A 
R form (relaxed) - high affinity 
T form (taut) - low affinity
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12
Q

What substances tend to shift the oxygen-hemoglobin dissociation curve to the right? (5)

Does this favor oxygen loading or unloading?

A
  • CO2
  • acidosis
  • elevated 2,3-DPG
  • exercise
  • increased temperature
  • favor oxygen unloading
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13
Q

What is the treatment for methemoglobinemia?

A

methylene blue + vit C

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14
Q

What is the normal value for the A-a gradient?

A

10-15 mmHg

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15
Q

What might an elevated A-a gradient indicate? (5)

A
  • high FiO2
  • shunting of blood
  • pulmonary fibrosis
  • V/Q mismatch
  • advanced age
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16
Q

What changes occur in the oxygen content and saturation in anemia?

A
  • PaO2 normal
  • O2 sat normal
  • Total O2 content low
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17
Q

What is the V/Q at the apex of the lung? At the base of the lung?

A

apex: V/Q > 1
base: V/Q

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18
Q

What is the V/Q during airway obstruction? during blood flow obstruction?

A

airway obstruction: towards 0 (shunt)

blood flow obstruction: towards infinity

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19
Q

How is CO2 transported from the tissues to the lungs? (3)

A
  1. Bicarbonate
  2. Bound to Hgb as carbaminohemoglobin
  3. Dissolved in blood
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20
Q

How do CO2 levels in circulation change during exercise?

A
  • no change in PaCO2

- increase in venous CO2

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21
Q

How does the body compensate for hypoxia at high altitudes? (6)

A
  • increase ventilation (acute and chronic)
  • increase renal excretion of bicarb
  • increase number of mitochondria
  • increase EPO
  • increase RBC mass
  • increase 2,3-BPG (right-shift of curve –> unloading of O2)
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22
Q

At what positive G-force does visual “black-out” occur? Why does this occur?

A
  • 4-6G
  • due to force of pooling blood in abdomen and legs
  • insufficient pumping of blood to brain
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23
Q

What physiologically is taking place in decompression sickness?

A
  • as pressure decreases (by re-surfacing), dissolved nitrogen gas comes out of solution
  • leads to formation of bubbles that can occlude blood vessels
24
Q

By what physiological mechanism does acute mountain sickness cause acute cerebral edema and acute pulmonary edema?

A
  • cerebral edema: hypoxia induced vasodilation

- pulmonary edema: local vasoconstriction –> forces fluid out of capillaries

25
Q

A patient suffers a stroke after incurring multiple long bone fractures in a skiing accident. What caused the infarct?

A

fat embolus

- via PFO or via pre-capillary AV shunt in the lungs

26
Q

What are the hallmark characteristics of obstructive lung disease on PFT?

A
  • increased total lung volume
  • decreased FVC, FEV1
  • FEV1/FVC
27
Q

What are the hallmark characteristics of restrictive lung disease on PFTs?

A
  • decreased total lung volume
  • decreased FVC, FEV1
  • normal or slightly elevated FEV1/FVC ratio
28
Q

What is the Reid index?

A

= (thickness of glands layer) / (thickness of bronchial wall)

29
Q

How does emphysema caused by smoking differ from the emphysema caused by alpha1-antitrypsin deficiency?

A

smoking: centriacinar
- also, more often in upper lungs
a1: panacinar
- more often in lower lungs

30
Q

What asthma medication is the inhaled tx of choice for chronic asthma?

A

inhaled steroids

31
Q

What asthma medication is the inhaled tx of choice for acute exacerbations?

A

albuterol (short acting B2 agonist)

32
Q

What asthma medication has narrow therapeutic index, drug of last resort?

A

theophylline

33
Q

What asthma medication blocks conversion of arachidonic acid to leukotriene?

A

zileuton

34
Q

What asthma medication inhibits mast cell release of mediators, used for ppx only?

A

cromolyn

35
Q

What asthma medication is the inhaled tx that blocks muscarinic receptors?

A

ipratropium, tiotropium

36
Q

What asthma medication is inhaled long-acting B2 agonist?

A

salmetrol

37
Q

What asthma medication blocks leukotriene receptors?

A

montelukast, zafirlukast

38
Q

Which medications, if taken long term, can result in rebound nasal congestion?

A

alpha-adrenergic agonists (pseudoephedrine, phenylephrine)

39
Q

A preterm infant has difficulty breathing. An x-ray reveals diffuse air space and interstitial opacities, with air bronchograms. What is the diagnosis and what could have prevented this condition?

A

neonatal resp. distress syndrome

- prevent with maternal steroids given 24-48 hrs prior to delivery

40
Q

A lung biopsy from a plumber shows elongated structures with clubbed ends in tissue. What is the diagnosis, and what is he at increased risk for?

A

Asbestosis

- at increased risk for lung cancer, laryngeal cancer, mesothelioma

41
Q

What is elevated in the serum of pts with sarcoidosis? (2)

A

ACE inhibitors

hypercalcemia (due to excess vit D via macrophages)

42
Q

What do pts with silicosis need to be worried about? (2)

A
  • increased susceptibility to TB

- increased risk for bronchogenic carcinoma

43
Q

A patient develops bronchogenic lung cancer but has never smoked. He is a coal miner. Exposure to what substances has put him at risk for developing lung cancer? (2)

A
  • Radon

- Silica

44
Q

What are the 4 most common locations of lung cancer metastasis?

A
  • brain
  • bone
  • liver
  • adrenal gland
45
Q

Common cause of pneumonia in immunocompromised pts

A

PCP

46
Q

Can cause an interstitial pneumonia in bird handlers

A

Chlamydia psittaci

47
Q

Often the cause of pneumonia in a pt with a history of exposure to bats and bat droppings

A

Histoplasma

48
Q

Often the cause of pneumonia in a pt who has recently visited South California, New Mexico, or West Texas

A

Coccidioides

49
Q

Pneumonia associated with “currant jelly” sputum

A

Klebsiella

50
Q

Associated with pneumonia acquired from air conditioners

A

Legionella pneumophila

51
Q

Most common cause of pneumonia in children 1 yo or younger

A

RSV

52
Q

Most common cause of pneumonia in the neonate (birth-28 days)

A

GBS or E. coli

53
Q

What infectious agent causes wool-sorter’s disease (a life threatening pneumonia)

A

Bacillus anthracis

54
Q

Common pneumonia in ventilator pts and those with cystic fibrosis (2)

A

Pseudomonas, MRSA

55
Q

What infectious agent causes pontiac fever

A

Legionella pneumophila

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