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*First Aid in Brainscape* > AAW - respiratory > Flashcards

AAW - respiratory Flashcards

1
Q

BMPR2

A

gene mutation causing primary pulmonary hypertensions

normally it functions to regulate vascular smooth muscle proliferation.

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2
Q

when do you see plexiform lesions on histology slides

A

long standing pulmonary hypertension

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3
Q

tumor that may give you hypercalcemia

why does it do it

A

squamous cell carcinoma (lung)

tumor can produce PTHrP (parathyroid hormone related peptide)

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4
Q

eaton-lambert syndrome is assc with what cancer

A

small cell carcinoma

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5
Q

where do you see clara cells

A

bronchioles only

aka club cells

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6
Q

lung cancers not related to smoking

A

bronchioalveolar cacinoma (an adenocarcinoma), carcinoid tumor

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7
Q

when would you see something that is chromogranin positive

A

with neuroendocrine cells (like in a carcinoid tumor or small cell)

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8
Q

what is a carcinoid tumor

A

tumor of the lung - well differentiated neuroendocrine cells, chromogranin positive, classically forms a polyp-like mass in proximal bronchus, low grade malignancy

john wayne had it

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9
Q

when do you see columnar cells replacing alveolar cells in the lung

A

bronchioalveolar carcinoma

resembles pneumonia

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10
Q

when do you see keratin pearls/intercellular bridges?

A

squamous cell carcinoma

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11
Q

What does TGF-beta do pathologically in the lung

A

release from pneumocytes can cause idiopathic pulmonary fibrosis

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12
Q

when do you see honeycomb change to the lung

A

idiopathic pulmonary fibrosis

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13
Q

what does amiodarone do to the lungs

A

idiopathic pulmonary fibrosis

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14
Q

what does bleomycin do to the lung

A

idiopathic pulmonary fibrosis

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15
Q

silicosis of the lung presents where

What does the mech of damage in silicosis

increased risk of what

A

upper lobes

silica impairs the phagolysosome formation

get increased risk of TB

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16
Q

calcified pleural plaque =

A

asbestosis

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17
Q

if you see little bodies of iron in macrophages of the lung that look like pearls on a string, what are you thinking

A

asbestosis

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18
Q

psittacosis - get it from what

A

can get Chlamydia psittaci infection from birds

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19
Q

serum test associated with sarcoidosis

A

increased ACE

also hypercalcemia

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20
Q

SE of steroids (long course)

A

avascular necrosis of hips

osteoporosis

glucose intolerance

increased risk of infection (esp fungal)

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21
Q

what shows up as PAS positive in the liver in a lung disease

A

hepatocytes in the liver in alpha 1 antitrypsin are PAS positive (this is where the misfolded A1AT accumulates)

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22
Q

how to Tx cyanide poisoning

A

use nitrites to oxidize hemoglobin to methemoglobin (which binds cyanide)

also use thiosulfate to bind cyanide

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23
Q

what drug can you give prophylactically to someone who is going to go to a high altitude area and why

A

acetazolamide, CA inhibitor

this causes an increased renal excretion of bicarb to compensate for the respiratory alkalosis (get alkalotic because your are breathing faster and blowing off more CO2)

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24
Q

what is the ried index

A

measuring the thickness of the glandular portion of the airway on histology

if >50%, then you have chronic bronchitis

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25
Q

charcot leyden crystals

A

seen in asthma

result of breakdown of eosinophils in sputum

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26
Q

what does it mean to be methacholine positive

A

it means you have asthma

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27
Q

farmer with exposure to birds has dyspnea, cough, chest tightness, headache. what is causing?

A

mixed type III/IV hypersensitivity pneumonitis reaction to antigen

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28
Q

Caplan syndrome

A

RA and pneumoconiosis with intrapulmonary nodules

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29
Q

white, calcified pleural plaques are what

A

asbestos

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30
Q

anthracosis

A

collection of carbon-laden macrophages (from coal classically) that is not clinically significant

can see it in smokers too

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31
Q

what pneumoconiosis increases your susceptibility to TB

A

silicosis

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32
Q

when do you see “eggshell calcification” of the hilar lymph nodes

A

silicosis

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33
Q

squamous cell carcinoma histology

A

sheets of large, dysplastic squamous cells surrounding dark, pink keratin pearls

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34
Q

psammoma bodies seen on histology mean what

A

mesothelioma

and other cancers

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35
Q

common causes of transudate in the lungs

A

CHF, cirrhiosis, nephrotic syndrome

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36
Q

dimenhydrinate

A

H1 blocker, 1st gen

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37
Q

first gen H1 blockers

A

diphenhydramine, dimenhydrinate, chlorpheniramine

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38
Q

second gen H1 blockers

A

usually end in “adine”

Loratadine, fexofenadine, desloratadine,
cetirizine.

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39
Q

expectorants

A

Guaifenesin (mucinex) - thins the sputum

N-acetylcysteine - used to loosen mucus plugs in patients with CF - this is also the antidote for acetaminophen overdose

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40
Q

Dextromethorphan

A

Antitussive (antagonizes NMDA glutamate receptors). Synthetic codeine analog. Has mild opioid
effect when used in excess. Naloxone can be given for overdose. Mild abuse potential

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41
Q

alpha agonists used to releave stuffiness

A

Pseudoephedrine, phenylephrine

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42
Q

steroids used in asthma and mech of action

A

fluticasone (flonase), beclomethasone, budesonide

inhibit the synthesis of virtually all cytokines, inactivate NF-kB

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43
Q

what inhibits 5- lipoxygenase and what does that do

A

zileuton, blocks synthesis of leukotrienes

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44
Q

omalizumab

A

monoclonal anti-IgE antibody, binds mostly unbound serum IgE and blocks binding to FceRI. used in allergic asthma resistant to inhaled steroids and long acting beta 2 agonists

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45
Q

what do you use in a bronchial provocation challenge, and what is it used to diagnose

A

methacholine, used to diagnose asthma

it’s a muscarinic receptor agonist

46
Q

bosentan

A

used to treat pulmonary arterial hypertension. competitively antagonizes endothelin-1 receptors, decreases pulmonary vascular resistance.

47
Q

what happens to arterial O2 sat in someone who lives at very high altitudes

A

their O2 sat may be very low (~70%) but their hematocrit is up to compensate.

48
Q

major source of blood supply to the nasal mucosa

A

sphenopalatine artery, the terminal branch of the maxillary artery (off external carotid)

49
Q

right recurrent laryngeal artery loops under what

left recurrent laryngeal artery loos under what

A

right subclavian artery

left loops under the ligamentum arteriosum

50
Q

common viral pneumonia in immunocompromised patients and pearls about it as well as viral characteristics

A

CMV

owls eye on histo

dsDNA (belongs to herpes virdae), enveloped, icosahedral virus

all herpes virdae are also icosahedral except for pox virus

51
Q

viral characteristics of adenovirus

A

dauble stranded DNA, naked, icosahedral

52
Q

what can you give to mommy to stop ARDS in the baby

A

glucocorticoids

they induce the synthesis of surfactant lipids

53
Q

generally, what types of lung cancers cause coin lesions

A

the peripheral ones, so the ones besides squamous and small cell

54
Q

what lung cancer is related to lung scarring due to old granulomatous disease

A

adenocarcinoma

makes sense because adenocarcinoma and granulomatous lung disease are more common in women!

55
Q

what lung cancer can cause cushing syndrome

A

small cell - can cause release of ACTH

56
Q

what disease will make smokers develop emphysema faster

A

A1AT

57
Q

bronchiectasis

A

dilated airways

58
Q

what bacteria have K capsule and what does it do

A

E. coli

causes pneumonia in newborns (got it from mommy)

59
Q

what lung volumes cannot be measured on spirometry

A

RV - Residual lung volume (its whats left after you breath out all you can muster)

FRC - functional residual capacity (its the RV plus the expiratory reserve volume (what you can push out if you really try hard))

60
Q

6 month old boy with recurrent pneumonia, foul smelling stool

what is it and how does it work

why the smelly stool

A

Cystic fibrosis

autosomal recessive defect in CFTR gene

get fat soluble vitamin deficiency, mucous plugs lungs

defective chloride ion channel (a gated ion channel that involves ATP hydrolysis regulated by protein kinase A phosphorylation)

foul smelling stool is because of meconium ileus (meconium plug obstructs the ilius)

61
Q

mitral obstruction does what - causes obstructive or restrictive lung disease

A

causes restrictive lung disease (decreased compliance)

62
Q

3 main obstructive lung diseases

A

emphysema, chronic bronchitis, asthma

63
Q

What tends to be the smallest yeast that infects the lungs and what does it look like on histology

A

histoplasmosis, it hides within macrophages, is around 2-5 micrometers in diameter,

64
Q

this fungus exhibits broad base budding

A

blasto broadly buds

65
Q

this fungal lung infection of the lung can spread to skin and bones

A

blasto blasts your bones

but also coccidiomycoses

66
Q

this fungal lung infection also causes painful red bumps classically on the shins. name both

A

coccidiomycosis

erythema nodosum

67
Q

what are you thinking if you have a lung infection and the tissue has a captain’s wheel appearance on histology

A

paracoccidioidomycosis

68
Q

squamous cell mneumonic

A

sQuamous

hyperCalcemia (PTHrP)
Cavitation
Cigs
Keratin pearls

(hard C sound)

69
Q

mneumonic for small cell

A

smAll cell

produces
ACTH
ADH
Antibodies agaisnt presynaptic Ca channels (lambert-eaton myasthenic syndrome)

Amplification of myc oncogenes

70
Q

what are you thinking if you see white exudate in the pleural cavity

A

lymphoma

if it was pneumonia it would been green or yellow

71
Q

when do you see Mycobacterium avium-intercellular infections

A

only when CD4 counts are like below 100

so FBA

(Full Blown Aids)

72
Q

gram positive diplococci in the lung

what are they
antibiotic?

A

strep pneumo

macrolide

73
Q

if you are using an aminoglycoside all on its own what are you probably trying to kill

A

aerobic gram - bacilli

74
Q

what happens to an asthmatics’ TLC,

A

it tends to increase because of hyperinflation due to air trapping

75
Q

cushings disease is assc with what cancer

A

small cell

76
Q

things other than horners assc with pancoast tumors

A

squamous cell
ulnar nerve pain due to compression of brachial plexus
SVC syndrome

77
Q

Epstein barr virus is assc with what respiratory cancer in what type of patient

A

nasopharyngeal carcinoma

chinese adults and african kids

78
Q

what types of lesions do you see in primary TB and what kind in secondary

A

primary - subjacent to the pleura usually in the middle region of the lung or in the mediastinal nodes
secondary - apex

79
Q

anthracosis

A

heavy black pigment deposition in the lung tissue from tobacco

seen in emphysema

80
Q

diaphragm is innervated by this nerve

A

phrenic

81
Q

respiratory infection that tests positive for cold agglutinins

A

mycoplasma pneumonia

82
Q

ceftazidimide

used for

A

3rd gen cephalosporine used for pseudomonas infections

83
Q

if your ventilation rate doubles and your CO2 production remains the same, your arterial pCO2 changes by ________

if ventilation triples?

A

vent doubles, pCO2 halves

vent triples, pCO2 is now 1/3

84
Q

equation for alveolar ventilation rate

A

RR * (tidal volume - dead space)

85
Q

signs other than respiratory distress suggesting that you have a fat embolism from a broken long bone

A

cerebral signs, petechial rash, retinal fat globules

86
Q

what type of cell mediates damage in Adult respiratory distress syndrome

What type of stuff forms in the lung

A

neutrophils release substances that damage the alveolar wall, causes activation of coagulation cascade, oxygen free radials

results in formation of a intra-alveolar hyaline membrane

87
Q

long acting beta 2 agonists

A

Salmeterol
Formoterol
Bambuterol

88
Q

BCG vacciene

A

for TB

can cause a false positive TB skin test

89
Q

cavitation in the lung differential

A

squamous cell
primary bacterial pneumonia
fungi
TB

maybe wegeners

90
Q

patient presents with cough, hemoptysis, hylar mass and mediastinal packing with adenopathy on CXR, hyponatremia

what is it

why the hyponatremia

A

small cell

hyponatremia because the tumor can produce ADH (causing SIADH)

91
Q

what drug can you use to obliterate the pleural space

what is the science name for obliterating the pleural space

A

Talc slurry
Tetracycline
Bleomycin

Called a pleurodesis

92
Q

patient has diarrhea, flushing, and bronchospasm

what are you thinking

A

carcinoid syndrome

(results from secretion of serotonin by a carcinoid tumor)

if the tumor is in the intestines, you don’t get symptoms because of metabolism of the serotonin

93
Q

Nedocromil and cromolyn

A

prevent bronchoconstriction by decreasing the release of mediators of mast cells

94
Q

pertussis toxin

mech of what it does

effects on the body

A

AB toxin
ADP ribosylates Gi leading to increased levels of cAMP:

increased insulin production -> hypoglycemia
increased histamine sensitivity

95
Q

a kid with a crazy bad cough and gram negative encapsulated organisms

A

pertussis

96
Q

heart changes with borrelia burgdorferi

A

first degree heart block (increased PR interval)

97
Q

premature infant with respiratory distress and a biopsy showing surfactant-rich exudate and silver-staining cysts

what disease

A

Pneumocystis jiroveci

98
Q

vasculitis assc with hep b

A

polyarteritis nodosa

99
Q

most common pneumonia in CF patients

A

Pseudomonas aeruginosa

gram-negative bacillus, aerobic, oxidase positive, polysaccharide capsule (most important, prevents phagocytosis)

also causes hot tub folliculitis (to survive in the hot tub, you have to be aerobic because all the bubbles, oxidase positive to combat the harsh chemicals, and have a capsule so you can survive when they put the cap on the hot tub) its a mneumonic, w/e

also has a fruity odor

100
Q

angiotensin converting enzyme elevated

patient has noncaseating granulomas in the lungs

what are you thinking

A

sarcoid - 60% of patients have elevated ACE

provided the granulomas are negative for fungi or bacteria

101
Q

another name for diffuse alveolar damage

what causes it

what is characteristcally seen on histo

A

adult respiratory distress syndrome (ARDS)

trauma, sepsis, shock, gastric aspiration

get hyaline membranes within the alveolar cavities (proteinaceous material of plasma origin and necrotic debris from desquamated epithelium)

102
Q

red, thick, dark bloody sputum in someone with lobar pneumonia

organism is gram _____
oxidase _____
coccus or bacillius

A

Gram negative, oxidase negative bacillus

klebsiella

103
Q

what type of bacteria most likely cause a lung abcess (and a pneumonia that progresses slowely)

A

S. aureus, and all of the anaerobic bacteria of the oral flora (bacteroides, peptococcus, fusobacterium)

Klebsiella, on the other hand, will cause an abrupt onset of symptoms and not normally makes an abcess

104
Q

lecithin:sphingomyelin ratio

A

in amniotic fluid

L-S ratio of 2 or more indicates fetal lung maturity

L-S ratio of 1.5 or less is assc with fetal respiratory distress syndrome

105
Q

what is deficient in the lungs of a newborn with respiratory distress, specifically

A

mostly dipalmitoylphosphatidylcholine (DPPC)

106
Q

most common opportunistic lung infection in AIDS patients and how to treat

A

Pneumocystis j.
AKA PCP (PneumoCystisPneumonia)
treat with Bactrim

I.D. with silver stain, honeycomb appearance on H&Estain, ground glass appearance on chest x ray

start prophylaxis when CD4 counts are below 200

107
Q

what are the types of cells that define a granuloma

A

epithelioid histiocytes (aka macrophages)

108
Q

zileuton

A

5-lipoxygenase pathway inhibitor. blocks conversion of arachidonic acid to leukotrienes. hepatotoxic. used in asthma

109
Q

pentamidine

A

used to treat pneumocystis j. in people who cannot tolerate TMP-SMX because of sulfa allergy

110
Q

montelukast

A

leukotriene receptor antagonist

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