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LCK STEP > CHAPTER: Resp > Flashcards

CHAPTER: Resp Flashcards

1
Q

Another name for phosphatidylcholine

A

Lecithin

L/sphingomyelin ratio > 2 = healthy

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2
Q

Where in the airways is:

  1. Highest R
  2. End cartilage // goblet cells
  3. End SM
A

Med size airways = ↑est R
End cart + GC @ bronchi
End SM @ terminal bronchioles

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3
Q

What goes through at T10 vs 12?

A

10: esophagus + CN 10
12: red - white - blue
Aorta - thoracic duct - azygous vein

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4
Q

Level at which these bifurcate:
Common carotid
Trachea
AA

A

CC: C4
T: T4
AA: L4

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5
Q

What value isn’t measured on spirometry and thus messes up a lot of lung vol calcs

A

RV

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6
Q

Where is Hgb taut vs relaxed

A

Taut @ tissues = low O2 affinity for unloading
Relaxed @ resp to pick up O2
↑O2 affinity b/c ↓BPG affinity

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7
Q

4 causes of a R shift in the Hgb binding curve

A

R shift = ↓affinity

  1. Acidosis: (exercise) ↑H+ to bind Hb = HbH
  2. ↑BPG
  3. ↑Temp
  4. ↑Pco2: think will make O2 unload more to correct this
  5. Altitude
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8
Q

How does CO poisoning change the Hgb binding curve

A

L shift - ↑affinity for CO

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9
Q

Describe how methemoglobin is generated + 2 symptoms + antidote

A 
Hgb (Fe 2+) + nitrates or benzocaine (local anesthetic)
Convert to Hgb (Fe 3+) = mHg
Symptoms:
1. Cyanosis
2. Chocolate blood 
Antidote = methylene blue
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10
Q

How does the O2 binding curve change with CO?

A
  1. Comes down = ↓O2 bound to Hb

2. Faster slope = ↑affinity for CO > O2

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11
Q

Why does myoglobin not show positive cooperativity (aka more linear slope of binding curve)?

A

B/c monomeric

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12
Q

What is hypoxemia vs hypoxia?

A

Xemia = ↓PaO2 = dissolved O2
Hypoxia = ↓O2 delivery to tissues
Xemia can lead to hypoxia

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13
Q

Describe V/Q of the lobes of the lung

A

Top lobe = ↓V/↓↓Q = ↑ratio = wasted vent b/c preferentially vasocontrict away from a low airflow area
Middle w/e
Bottom lobe = highest V + Q but ↑V/↑↑Q = ↓ratio, aka the perfusion is so much greater than vent

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14
Q

Describe change to high altitude:

A

↓O2 atm = ↓PAO2 = ↓PaO2
↑vent to compensate = ↓PaCO2 = resp alkalosis (time causes comp metabolic acidosis aka excreting HCO3)
↑EPO + BPG to comp
↓PAO2 -> hypoxic vasoconstriction -> pulm HTN + RHF

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15
Q

2 BVs you need to know for nose bleeds

A

Ant = Kiesselbach plexus

Post/potentially life threatening = sphenopalatine art (branch maxillary art)

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16
Q

What does a negative D dimer tell you about suspected PE?

A

Not a PE

+ d dimer rules in it, - rules it out

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17
Q

What is Homan sign?

A

If you dorsiflex pts foot -> calf pain

Sign of PE

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18
Q

3 causes of nasal polyps

A
  1. Repeated rhinitis
  2. CF (kid)
  3. ASA intol asthma (adult)
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19
Q

What might you biopsy for suspected nasopharyngeal carcinoma//aka what might present?

A

Cervical LNs

See keratin + (epi) cells w/ lymphocyte background (makes sense since EBV tumor)

20
Q

Describe etiology of vocal cord nodules that are:

  1. Bilateral
  2. 1 unilat
  3. Multiple unilat
A
  1. Overuse - made of myxoid CT
    2 // 3 - adults // kids - laryngeal carcinoma = SCC
    Smoking, alc, or HPV 6/11 (weird low grade!!)
21
Q

3 non-lung presentations of TB granulomas

A

Base meninges
Kidney -> sterile pyuria (pus in urine)
Pott’s… duh you know that

22
Q

Shape of TB granuloma + cytokine that maintains it

A

Horseshoe - necrotic granuolma

IFNg

23
Q

Hemm or ischemic infarct for PE

A

Unlikely to infarct at all b/c lots co-lat circulation

If anything, hemm

24
Q

What type of gas causes problems with the bends? What is this disease called if it goes chronic and causes bone necrosis?

A

Nitrogen bubbles precipitating

Caisson disease

25
Q

What are Lines of Zahn

A

Pink + red interdig of a PE

Tells you pre-mortem PE

26
Q

Describe chronic bronchitis

  1. Symptoms
  2. FEV1/FVC ratio
  3. Measure of severity
  4. Pathophys
A

Productive cough on/off > 2yrs
Hypertrophy of mucous glands: Reid index (B/A+B+C)
Mucous plugs trap CO2
Air trapping = obstructive = ↓FEV1/FVC

27
Q

Histo findings asthma

A

Mucous plugs w/ Curschmann spirals

Charcot Leyden crystals = eos

28
Q

PE + CXR finding for asthma

A 
Pulsus paradoxus (↓10 on insp) among others
Peribronchial cuffing
29
Q

Dseases that are causes of bronchiectasis

A

Damage cilia: smoking, Kartagener
CF
ABPA

30
Q

How do misfolded A1AT proteins stain?

A

PAS + @ ER hepatocytes

31
Q

Describe imaging of pulm fibrosis

A

TGF beta mediated

  1. Subpleural patches “honeycombing”
  2. Lower&raquo_space; upper lobe
32
Q

What is Caplan syndrome?

A

Pneumoconioses + RA

33
Q

Histo berylliosis

A

Granulomas

34
Q

Patho + histo + imaging for silicosis

A

Silica X macrophage phagolysosome (↑risk TB)
Macro are able to cause fibrosis
Histo: birefringent particles
Imaging: eggshell calcification hilar LNs

35
Q

Patho ARDS

A

Endo damage -> protein rich fluid leaks into alveoli

Pulm edema that isn’t due to heart = normal PCWP

36
Q

Describe acute vs chronic lung transplant rejection

A 
Acute = BVs lymph infiltrate 
Chronic = bronchiolitis obliterans = X small airways
37
Q

Gene for heritable pulm art HTN

A

BMPR 2 - excess SM prolig

Think young woman with resp distress and possible RHF

38
Q

Percussion of atelectasis

A

Dull

39
Q

Breath sounds for consolidation

A

Pna, pulm edema

Bronchial BS // insp crackles

40
Q

What would milky pleural effusion fluid suggest?

A

↑TGs = lymphatic

“Chylothorax”

41
Q

4 stages of lobar pna

A
  1. Red + soft = congestion
  2. Red + firm = exudate in alveolar space
  3. Gray + firm = RBCs in exudate get degrade
  4. T2P resolve to normal tissue
42
Q

What cells cause lung abscess (not bugs)

A

Neutrophils + macro responding to infection kill bugs and surrounding tissue

43
Q

2 histo + markers and features for mesothelioma

A

Cytokeratin
Calretinin
Long slender microvilli + tonofilaments

44
Q

Histo + paraneo of small cell carcinoma

A

Poorly diff neuroendocrine - + NCAM (neural cell adhesion molecules)
ACTH (Cushing presentation)
SIADH (hypoNa b/c dilute)
Lambert Eaton

45
Q

Histo + paraneo of squamous cell carcinoma

A

Keratin pearls w/ intercell bridges

PTHrP

46
Q

Histo + paraneo of large cell carcinoma

A

Pleomorphic giant cells

BhCG

LCK STEP (27 decks)

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