Boards and Beyond Flashcards
Result on pancreatic insufficiency seen in CF
- Chronic pancreatitis
- CF-related diabetes
- Fat malabsorption
- Steatorrhea:
- Frequent stools
- Foul-smelling stools
- Oily or greasy
- Stools may float
How do you treat exudative effusion?
Drainage
In preterm delivery, ___________ is used to stimulae surfactant production in lungs
Bethamethasone
Only condition with increased fremitus is ___________.
Lobar pneumonia
How is complicated community acquired pneumonia?
- Fluoroquinolone (levoloxacin)
- Amoxicillin pluss azithromycin
Special COPD drugs
- Theophylline
- Roflumilast
Treatment for moderate COPD
- As needed short acting bronchodilator
- Long-acting bronchodilator
How do you diagnose a PE?
- CT angiogram- can’t be used with CKD
- VQ scan
______________ effusion is due to high vascular permeability.
Exudative
Conditons that are hyperresonant on percussion
Pneumothorax
Emphysema
Which TB drug competes with uric acid for excretion in kidneys?
Pyrazinamide
Prevention of RSV
- Palivizumab
- Monoclonal antibody against F protein
- Uses in pre-term infants
______________ blocks synthesis of mycolic acids.
Isoniazid
List one condition in which physiological shunting occurs?
Atelectasis (collasped airway)
Which TB drug inhibits bacterial DNA-dependent RNA polymerase?
Rifampin- inhibits RNA synthesis
Role of club cells
Surfactant
Detoxification
*Also known as clara cells
Distingush between inhaled, oral, and IV steroids.
- Inhaled: Beclomethasone, fluticasone, budesonide
- Oral: Prednisone
- IV: Methylprenisolone (Solumedrol)
Sarcodosis pathology
- Accumulation of TH1 CD4 helper cels
- Secrete IL-2 and IFN-y
- Ultimately leads to granuloma formation
High altitude stimulates the production of _________.
2,3 BPG
Most frequent non-cardiac causes of pulsus paradoxus
Asthma and COPD
Oligohyramnios is caused by fetal _________ abnormalities.
Kidney
Why are inspired O2 and alveolar O2 not equal?
Due to mixing of alveolar oxygen with CO2
Which antibotics are given in COPD? And when?
- Fluroquinolones
- Amoxicillin/clavulanate
- Moderate to severe COPD
- Increased dysnea
- Increased sputum
- Increased sputum purelence
Restriction with normal DLCO
Extra-pulmonary cause
Classic lab values for PE
low PaO2 and low PCO2
Classical causes of rales
Pulmonary edema (bases)
Pneumonia
Intersitial fibrosis
How shoud nosocomia pneumonia be treated?
- Cefepime or Ceftazidime
- Imipenem or Meropenem
- Piperacillin-tazobactum (Zosyn)
In patients with COPD, ______ is the only therapy shown to improve mortality.
Oxygen
Lymphatic effusions have very high _________ counts.
Triglycerides
Result of thick mucus in GI tract due to CF
- Impaired low of bile and pancreatic secretions
- Malapsorption especially fats
- Loss of fat soluble vitamins
- Steatorrhea
Why is neonatal respiratory distress syndrome difficult to treat?
Due to intrapulmonary shunting, O2 goes to ealthy alveoli and the collasped alveoli remain unventilated
Baby needs to swollow ________ in areas that have developed to stimulate development.
Amniotic fluid
Classic causes of stridor
Laryngotracheitis (croup)
Epiglottitis
Retropharyngeal abscess
Diphtheria
Which form of restrictive disease has a normal A-a gradient?
Poor breathing mechanics
- Neuromuscular
- Structural
Treatment or RSV
- Ribavirin
- Inhibits synthesis of guanine nucleotides
Conditions that are dull on percussion
Pleural effusion
Consolidation (pneumonia)
Treatments for primary pulmonary hypertension
- Epoprostenol: Prostacyclin (IV)
- Bosentan: Endothelin-1 receptor antagonist (PO)
- Sildenafil: Inhibits PDE-5 in smooth muscle of lungs (PO)
Most common consquence of CFTR mutations
- Abnormal processing
- Abnormal protein folding
- Prevents protein trafficking to correct cellular location
Low DLCO conditions
- Interstitial lung disease
- Emphysema
- Abnormal vasculature
- Prior lung resection
- Anemia
Rhochi
Secretions in large airways
- Fever, malaise, chills, fatigue, and headache
- No respiratory complaints
- Chest radiograph normal
Pontiac fever
Treatment for Mild COPD
As needed short acting bronchodilator
Classic skin lesion in sarcordosis
Erythema nodosum
- Inflammation of fat cells under skin
- Tender red nodules
- Usually on both shins
Stridor
Wheeze that is almost entirely inspiratory
Usually loudest over neck
Theophylline overdose scenario
Nausea, vomiting, seizures
Condtions caused by RSV
Bronchiolitis
Pneumonia
Acute respiratory failure
Conditions in which nail clubbing seen
Bronchiectasis
CF
Lung tumors
Pulmonary fibrosis
Cyanotic congenital heart disease
Isoniazid is co-administed with _______ to limit neurotoxicity.
B6
Insterstitial lung disease has a ____________ lung appearance.
Reticulonodular “honeycomb”
What drug is used to stimulate sweat to test for CF?
Pilocarpine
Causes of cheyne-stokes breathing
- Delayed detection/ response to changes in PaCO2
Most common CFTR mutation
Delta F508
- Deletion of 3 DNA bases (nonframeshift delection)
- Codes for 508th AA: Phenylalanine
Mechanism of lobar pneumonia
- Bacteria acquired in nasopharynx
- Aerosolized to alveolus
- Enter alveolar type II cells
- Pneumococci multiply in alveolus
- Invade alveolar epithelium
- Pass from one alveolus to next
- Inflammation/ consolidation of lobes
Immunosuppresants used to treat sarcoidosis
Methotrexate
Azathioprine
Mycophenolate
FEV1 levels for different levels of COPD
- Mild: >80%
- Moderate:50-70%
- Severe: 30-49%
- Very severe: <30%
DLCO seen in severe disease
<40%
How can pulmonary edema be distinguished from ARDS?
Pulmonary capillary wedge pressure (PCPW) is normal in ARDS
Do bronchioles typically have cartilage?
No
Restriction with low DLCO
Interstitial lung disease
Able to bind more CO2 to hemoglobin in a _____ (low/high) O2 environment.
Low
Theophylline inhibits __________.
Phosphodiesterase, which prevents the breakdown of cAMP and leads to increased cAMP
- Farmer or bird handler
- Cough, dyspnea, chest tightness
- Diffuse crackles
Hypersensitivity pneumonitis
Abnormal septation of the lung bud from the foregut
Tracheoesophageal fistula
Mutaion of _________ leads to isoniazid resistance.
katG- encoded to catalase-peroxidase, which converts INH to its active form
Rales
Small airways “pop” open after collapse
Early insiratory. late inspiratory or expiratory
Stages of lun maturation
- Pseudoglandular (5-16wk)
- Canalicular (16-26 wk)
- Saccular (26wk-birth)
- Alveolar (after birth)
Why is hypercapnia seen in pulmonary fibrosis and not other diffusion limited conditions?
Due to destruction of alveolar capillaries, result in a dead space
*Not due to diffusion limitation
Why will CO2 remain normal in shunting?
Due to hyperventilation
Hypoxemia with normal A-a gradient
Hypoventialtion
High altitude
*In these cases alveoli are working
Treatment for Very severe COPD
- Short acting bronchodilator
- Long-acting bronchodilator
- Inhaled corticosteroids
- Oxygen/Surgery
O2 content, PaO2 and % sat in presence of CO
O2 content: Decreased
PaO2 : Normal
% sat: Decreased
Causes of central sleep apnea
- Central nervous system disease (encephalitis)
- Neuromuscular diseases (polio, ALS)
- Severe kyphoscolosis
- Narcotics
O2 contenc, PaO2 and % sat in hypoxemia
All decreased
How does an RSV infection present?
- Runny nose (URI)
- Wheezing (Lower tract)
Example of condition in with V/Q is less than 1
Pulmonary edema
Peak Expiratory flow (PEF) falls when _______ gets worse.
Obstruction
IC
TV + IRV
Cheyne-stokes breathing is common in _________ and __________ patients.
HF and stroke
Sytoms of High CO2
Lethargy
Confusion
Agitation
At what stage to respiratory bronchioles develop?
Canalicular Period (16-26 wks)
How do you test for CF in patients with a negative sweat test?
Test nasal transepithelial potential difference
- Measure nasal voltage
- CF patients: More negative voltage
- Due to abnormal sodium processing
Calcified ghon complex is a _______.
Ranke complex
Blue Bloater
Chronic Bronchitis
- Cyanosis from shunting
- Air trapping
In bronchopulmonary dysplasia _______ does not progress normally.
Alveolarization
NOTE: Babies that develop bronchopulmonary dysplasia have poor gas exhange due to abnormal secondary septation. These babies have fewer and larger alveoli compared to normal children
How is uncomplicated community acquired pneumonia treated?
Azithromycin
Clarithromycin
Doxycycline
Congenital diaphragmatic hernia
- Defective formation of pleuroperitoneal membrane
- Hole in diaphragm
- Reduced chest circumference
__________ is a phosphodiesterase-4 inhibitor that may relax airway smooth muscle.
Roflumilast
*Used in COPD
Cause of aspirin exacerbated respiratory disease
- Dysregulation of arachidonic acid metabolism
- Overproduction of leukotrienes
Bronchioalveolar carcinoma looks like ________ on X-Ray.
Pneumonia
O2 contenc, PaO2 and % sat in HF
All normal
Infertily in CF due to absent ________.
Vas deferens
- Problem is sperm transport not spermatogenesis
Systemic diseases with interstitial lung feautures
- Scleroderma
- RA
- Goodpasture’s
- Wgener’s
- Sarcoidosis
Wheezes
Air lows through narrowed bronchi
Usually expiratory
Why is patent ductus arteriousus a complication of neonatal respiratory distress syndrome?
Hypoxia keeps shut open
FRC
RV + ERV
Omalizumab
- IgG monoclonal antibody
- Inhibits IgE binding to IgE receptor on mast cells and basophils
Exacerbations of CF are treated with ___________.
Antibiotics
Side effects of isoniazid
- Neurotoxicity
- Haptotoxicity
- Drug-induced lupus
What drug increases chloride influx? When is it used?
Ivacaftor (tablets); only for patients with G551D mutation
Where does an aspired foreign body go, if a person is supine?
- Right inferior lobe- superior portion (apical)
- Right upper lobe- posterior segment
Mechanism of Theophylline cardiotoxicity
Blocks adenosine receptors, increases heart rate
How should a lung abscess be treated?
Clindamycin
*If big enough, it has to be surgically drained
Long acting bronchodilators
Salmeterol
Formoterol
Tiotropium
__________ won’t correct with 100 % oxygen/
Shunting
What happens to partial pressures of O2 and CO2 in arteries and veins during exercise?
Veins: O2 falls, CO2 rises
Arteries: O2 and CO2 normal
Three basic mechanism that create a high A-a gradient
Fibrosis
Shunt
V/Q mismatch
PVR is lowest when the lungs are at the ______.
FRC
*This occurs after expiration of a normal tidal volume
Causes of pumonary hypoplasia
- Oligohydramnios
- Congenital diaphragmatic hernia
O2 content, PaO2 and % sat in anemia
O2 content: Decreased
PaO2 : Normal
% sat: Normal
_____________ is a potent cerebral vasodilator.
CO2
*increases in CO2, increase in cerebral blood flow
Side effect of steroids
Oral candidiasis
VC
TV + IRV + ERV
Short acting bronchodilators
Albuterol
Ipratropium
Characterisrtic of Mycobacterium tuberculosis
- Obligate aerobes
- Facultative intracellular
- AFB stain
Drugs used for both COPD and asthma
- Short acting bronchodilators
- Long acting bronchodilators
- Steroids
Side of effect of ehtambutol
Optic neuropathy
What abnormality can result in a stroke from a DVT?
Patent foramen ovale can allow venous clot to react arterial systems
Classica cause of Rhonchi
COPD
Light’s Criteria
Exudate if:
- Pleural protein/serum protein > 0.5
- Pleural LDH/ serum LDH >0.6
- Pleural LDH > 2/3 upper limits normal LDH
Treatment for Aspirin exacerbated respiratory disease
Montelukast
Zafirlukast
TLC
RV + ERV + IRV +TV
Mechanisms of silicosis
Macrophages react to silica, resulting in inflammation, activation of fibroblasts and collagen
Treatment for Severe COPD
- Short acting bronchodilator
- Long acting bronchodilator
- Inhaled corticosteriod
Normal DLCO
75-140%
What drugs promote the clearance of airway secretions in CF patients?
- Inhaled DNase (doornase alfa)
- Inhaled saline
- N-acetylcysteine
What is used to measure %O2 saturation of blood?
Pulse Oximetry
*Uses light and photodetector
Systemic side efects of B2 agonists
Hypertension, arrhyythmia
Components of upper respiratory tract
Nasal cavity
Pharynx
Larynx
How is small pneumothorax treated?
- 100% O2
- Displaces nitrogen from capillary blood
- Increases gradient for nitrogen reabsorption from pleural space
Classical causes of wheezes
HF (cardiac asthma)
Asthma
Chronic bronchitis
Obstruction (tumor; localized wheeze)
How is a DVT diagnosed?
Lower extremity ultrasound
How is allergic bronchopulmonary aspergillosis diagnosed? Treated?
Skin testing aspergillosis
Steroids
What type of pneumonia is a serious complication for ARDS?
Ventilator acquired pneumonia
First line treatment for aspiration pneumonia
Clindamycin
Which values are not meausred by spirometry?
RV
FRC
Long acting B2 agonist are not used as monotherapy and are always used with ______.
Inhaled corticosteroids
How are newborns tested for CF?
- Increased blood levels of immunoreactive trypsinogen
- Follow up with sweat test if positive
Side of effects of rifampin
Liver, GI
Blunting of costophrenic angle
Pleural effusion
Classic causes o bronchial breath sounds
Seen in pneuomonia with consolidation
Common causes of hypoxia
Hypoxemia
HF
Anemia
CO
Sleep apnea treatments
- Weight loss
- CPAP
- Upper airway surgery
How is hypersensitivity pneumonitits diagnoses? Treated?
Diagnosis
- Bronchoalveolar lavage
- Inhalation challenge
- Lung biopsy
Treatment
- Avoid exposure
- Steroids
Which interleukins are suppresed by steroids?
IN-Y, TNF-a, GM-CSF
How do you treat transudative effusion?
Usually treat for underlying cause (no drainage)
- Dyspnea, hpoxemia
- ARDS
- Confusion
- Focal deficits
- Petechiae
Fat embolism
Treatment for pneumocystis jiroveci
- TMP-SMX (first line)
- Dapsone
- Pentamidine
Prophylasis: TMP-SMX when CD4 <200
Lung buds form as outgrowth from ___________.
Foregut
CF presentation
- Usually diagnosed <2yo
- Respiratory disease
- Failure to thrive
- Meconium ileus
Where does the pulmonary artery pass relative to bronchi?
Right- Anterior to bronchi
Left- Superior to bronchi
Present of pectoriloquy indicate what?
Fluid in lungs: Effusion, consolidation
Treatment for acute exacerbations of COPD
- Oxygen
- Nebulized albuterol +/- ipratropium
- IV or oral corticosteroids
- Antibiotics
_________ inhibts arabinosyl transferase.
Ethambutol. polymerizs arabinose or mycobacteria cell walls
CF lung disease
- Productive cough
- Hyperinflation of lungs on X ray
- Obstructive pattern
Inheritence patten of cystic fibrosis
Autosomal recessive
At what stage do type II pneumocytes form?
Canalicular (16-26 wks)
__________ does not cause hypoxemia unless accompanied by a V/Q mismarch.
Dead space
Virulence factors of TB. How do they work?
- Trehalose dimycolare (cord factor)
- Heps evade immune response
- Causes granuloma formation
- Triggers cytokine release
- Sulfatides
- Inhibits fusion of pagosomes/lysosomes
- Catalase-peroxidase
- Resists host cell oxidation
Bronchial breath sound
High pitched lung sounds
Longer expiratory phase than normal
A cut phrenic nerve cause the diaphragm to _______.
Elevate
*Can be seen on fluoroscopy (“sniff test”)
