AAW - respiratory Flashcards
BMPR2
gene mutation causing primary pulmonary hypertensions
normally it functions to regulate vascular smooth muscle proliferation.
when do you see plexiform lesions on histology slides
long standing pulmonary hypertension
tumor that may give you hypercalcemia
why does it do it
squamous cell carcinoma (lung)
tumor can produce PTHrP (parathyroid hormone related peptide)
eaton-lambert syndrome is assc with what cancer
small cell carcinoma
where do you see clara cells
bronchioles only
aka club cells
lung cancers not related to smoking
bronchioalveolar cacinoma (an adenocarcinoma), carcinoid tumor
when would you see something that is chromogranin positive
with neuroendocrine cells (like in a carcinoid tumor or small cell)
what is a carcinoid tumor
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
when do you see columnar cells replacing alveolar cells in the lung
bronchioalveolar carcinoma
resembles pneumonia
when do you see keratin pearls/intercellular bridges?
squamous cell carcinoma
What does TGF-beta do pathologically in the lung
release from pneumocytes can cause idiopathic pulmonary fibrosis
when do you see honeycomb change to the lung
idiopathic pulmonary fibrosis
what does amiodarone do to the lungs
idiopathic pulmonary fibrosis
what does bleomycin do to the lung
idiopathic pulmonary fibrosis
silicosis of the lung presents where
What does the mech of damage in silicosis
increased risk of what
upper lobes
silica impairs the phagolysosome formation
get increased risk of TB
calcified pleural plaque =
asbestosis
if you see little bodies of iron in macrophages of the lung that look like pearls on a string, what are you thinking
asbestosis
psittacosis - get it from what
can get Chlamydia psittaci infection from birds
serum test associated with sarcoidosis
increased ACE
also hypercalcemia
SE of steroids (long course)
avascular necrosis of hips
osteoporosis
glucose intolerance
increased risk of infection (esp fungal)
what shows up as PAS positive in the liver in a lung disease
hepatocytes in the liver in alpha 1 antitrypsin are PAS positive (this is where the misfolded A1AT accumulates)
how to Tx cyanide poisoning
use nitrites to oxidize hemoglobin to methemoglobin (which binds cyanide)
also use thiosulfate to bind cyanide
what drug can you give prophylactically to someone who is going to go to a high altitude area and why
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)
what is the ried index
measuring the thickness of the glandular portion of the airway on histology
if >50%, then you have chronic bronchitis
charcot leyden crystals
seen in asthma
result of breakdown of eosinophils in sputum
what does it mean to be methacholine positive
it means you have asthma
farmer with exposure to birds has dyspnea, cough, chest tightness, headache. what is causing?
mixed type III/IV hypersensitivity pneumonitis reaction to antigen
Caplan syndrome
RA and pneumoconiosis with intrapulmonary nodules
white, calcified pleural plaques are what
asbestos
anthracosis
collection of carbon-laden macrophages (from coal classically) that is not clinically significant
can see it in smokers too
what pneumoconiosis increases your susceptibility to TB
silicosis
when do you see “eggshell calcification” of the hilar lymph nodes
silicosis
squamous cell carcinoma histology
sheets of large, dysplastic squamous cells surrounding dark, pink keratin pearls
psammoma bodies seen on histology mean what
mesothelioma
and other cancers
common causes of transudate in the lungs
CHF, cirrhiosis, nephrotic syndrome
dimenhydrinate
H1 blocker, 1st gen
first gen H1 blockers
diphenhydramine, dimenhydrinate, chlorpheniramine
second gen H1 blockers
usually end in “adine”
Loratadine, fexofenadine, desloratadine,
cetirizine.
expectorants
Guaifenesin (mucinex) - thins the sputum
N-acetylcysteine - used to loosen mucus plugs in patients with CF - this is also the antidote for acetaminophen overdose
Dextromethorphan
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
alpha agonists used to releave stuffiness
Pseudoephedrine, phenylephrine
steroids used in asthma and mech of action
fluticasone (flonase), beclomethasone, budesonide
inhibit the synthesis of virtually all cytokines, inactivate NF-kB
what inhibits 5- lipoxygenase and what does that do
zileuton, blocks synthesis of leukotrienes
omalizumab
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
what do you use in a bronchial provocation challenge, and what is it used to diagnose
methacholine, used to diagnose asthma
it’s a muscarinic receptor agonist
bosentan
used to treat pulmonary arterial hypertension. competitively antagonizes endothelin-1 receptors, decreases pulmonary vascular resistance.
what happens to arterial O2 sat in someone who lives at very high altitudes
their O2 sat may be very low (~70%) but their hematocrit is up to compensate.
major source of blood supply to the nasal mucosa
sphenopalatine artery, the terminal branch of the maxillary artery (off external carotid)
right recurrent laryngeal artery loops under what
left recurrent laryngeal artery loos under what
right subclavian artery
left loops under the ligamentum arteriosum
common viral pneumonia in immunocompromised patients and pearls about it as well as viral characteristics
CMV
owls eye on histo
dsDNA (belongs to herpes virdae), enveloped, icosahedral virus
all herpes virdae are also icosahedral except for pox virus
viral characteristics of adenovirus
dauble stranded DNA, naked, icosahedral
what can you give to mommy to stop ARDS in the baby
glucocorticoids
they induce the synthesis of surfactant lipids
generally, what types of lung cancers cause coin lesions
the peripheral ones, so the ones besides squamous and small cell
what lung cancer is related to lung scarring due to old granulomatous disease
adenocarcinoma
makes sense because adenocarcinoma and granulomatous lung disease are more common in women!
what lung cancer can cause cushing syndrome
small cell - can cause release of ACTH
what disease will make smokers develop emphysema faster
A1AT
bronchiectasis
dilated airways
what bacteria have K capsule and what does it do
E. coli
causes pneumonia in newborns (got it from mommy)
what lung volumes cannot be measured on spirometry
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))
6 month old boy with recurrent pneumonia, foul smelling stool
what is it and how does it work
why the smelly stool
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)
mitral obstruction does what - causes obstructive or restrictive lung disease
causes restrictive lung disease (decreased compliance)
3 main obstructive lung diseases
emphysema, chronic bronchitis, asthma
What tends to be the smallest yeast that infects the lungs and what does it look like on histology
histoplasmosis, it hides within macrophages, is around 2-5 micrometers in diameter,
this fungus exhibits broad base budding
blasto broadly buds
this fungal lung infection of the lung can spread to skin and bones
blasto blasts your bones
but also coccidiomycoses
this fungal lung infection also causes painful red bumps classically on the shins. name both
coccidiomycosis
erythema nodosum
what are you thinking if you have a lung infection and the tissue has a captain’s wheel appearance on histology
paracoccidioidomycosis
squamous cell mneumonic
sQuamous
hyperCalcemia (PTHrP)
Cavitation
Cigs
Keratin pearls
(hard C sound)
mneumonic for small cell
smAll cell
produces
ACTH
ADH
Antibodies agaisnt presynaptic Ca channels (lambert-eaton myasthenic syndrome)
Amplification of myc oncogenes
what are you thinking if you see white exudate in the pleural cavity
lymphoma
if it was pneumonia it would been green or yellow
when do you see Mycobacterium avium-intercellular infections
only when CD4 counts are like below 100
so FBA
(Full Blown Aids)
gram positive diplococci in the lung
what are they
antibiotic?
strep pneumo
macrolide
if you are using an aminoglycoside all on its own what are you probably trying to kill
aerobic gram - bacilli
what happens to an asthmatics’ TLC,
it tends to increase because of hyperinflation due to air trapping
cushings disease is assc with what cancer
small cell
things other than horners assc with pancoast tumors
squamous cell
ulnar nerve pain due to compression of brachial plexus
SVC syndrome
Epstein barr virus is assc with what respiratory cancer in what type of patient
nasopharyngeal carcinoma
chinese adults and african kids
what types of lesions do you see in primary TB and what kind in secondary
primary - subjacent to the pleura usually in the middle region of the lung or in the mediastinal nodes
secondary - apex
anthracosis
heavy black pigment deposition in the lung tissue from tobacco
seen in emphysema
diaphragm is innervated by this nerve
phrenic
respiratory infection that tests positive for cold agglutinins
mycoplasma pneumonia
ceftazidimide
used for
3rd gen cephalosporine used for pseudomonas infections
if your ventilation rate doubles and your CO2 production remains the same, your arterial pCO2 changes by ________
if ventilation triples?
vent doubles, pCO2 halves
vent triples, pCO2 is now 1/3
equation for alveolar ventilation rate
RR * (tidal volume - dead space)
signs other than respiratory distress suggesting that you have a fat embolism from a broken long bone
cerebral signs, petechial rash, retinal fat globules
what type of cell mediates damage in Adult respiratory distress syndrome
What type of stuff forms in the lung
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
long acting beta 2 agonists
Salmeterol
Formoterol
Bambuterol
BCG vacciene
for TB
can cause a false positive TB skin test
cavitation in the lung differential
squamous cell
primary bacterial pneumonia
fungi
TB
maybe wegeners
patient presents with cough, hemoptysis, hylar mass and mediastinal packing with adenopathy on CXR, hyponatremia
what is it
why the hyponatremia
small cell
hyponatremia because the tumor can produce ADH (causing SIADH)
what drug can you use to obliterate the pleural space
what is the science name for obliterating the pleural space
Talc slurry
Tetracycline
Bleomycin
Called a pleurodesis
patient has diarrhea, flushing, and bronchospasm
what are you thinking
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
Nedocromil and cromolyn
prevent bronchoconstriction by decreasing the release of mediators of mast cells
pertussis toxin
mech of what it does
effects on the body
AB toxin
ADP ribosylates Gi leading to increased levels of cAMP:
increased insulin production -> hypoglycemia
increased histamine sensitivity
a kid with a crazy bad cough and gram negative encapsulated organisms
pertussis
heart changes with borrelia burgdorferi
first degree heart block (increased PR interval)
premature infant with respiratory distress and a biopsy showing surfactant-rich exudate and silver-staining cysts
what disease
Pneumocystis jiroveci
vasculitis assc with hep b
polyarteritis nodosa
most common pneumonia in CF patients
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
angiotensin converting enzyme elevated
patient has noncaseating granulomas in the lungs
what are you thinking
sarcoid - 60% of patients have elevated ACE
provided the granulomas are negative for fungi or bacteria
another name for diffuse alveolar damage
what causes it
what is characteristcally seen on histo
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)
red, thick, dark bloody sputum in someone with lobar pneumonia
organism is gram _____
oxidase _____
coccus or bacillius
Gram negative, oxidase negative bacillus
klebsiella
what type of bacteria most likely cause a lung abcess (and a pneumonia that progresses slowely)
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
lecithin:sphingomyelin ratio
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
what is deficient in the lungs of a newborn with respiratory distress, specifically
mostly dipalmitoylphosphatidylcholine (DPPC)
most common opportunistic lung infection in AIDS patients and how to treat
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
what are the types of cells that define a granuloma
epithelioid histiocytes (aka macrophages)
zileuton
5-lipoxygenase pathway inhibitor. blocks conversion of arachidonic acid to leukotrienes. hepatotoxic. used in asthma
pentamidine
used to treat pneumocystis j. in people who cannot tolerate TMP-SMX because of sulfa allergy
montelukast
leukotriene receptor antagonist
