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Pulmonary > Midterm > Flashcards

Midterm Flashcards

1
Q

What is the pathological hallmark of sarcoidosis?

A

Noncaseating granuloma

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2
Q

What chest xray findings are highly suggestive of sarcoidosis?

A

Combination of diffuse interstitial infiltrates in the lung fields and hilar lymphadenopathy

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3
Q

What looks like sarcoid?

A

Beryllium disease

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4
Q

Asbestosis classic lesion

A

calcified parietal pleural plaque

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5
Q

Zileuton

A

Asthma med
5-lipoxygenase pathway inhibitor
(leukotriene modifying)

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6
Q

Omalizumab

A

Asthma med

anti IgE antibody

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7
Q

Cromolyn sodium

A

Asthma med
stabilizes mast cells (inhibits degranulation), interferes with chloride channel function
nebulizer only, no MDI
very safe, but not sure how effective it actually is

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8
Q

Theophylline

A

Asthma med
class of xanthine derivatives
Phosphodiesterase inhibitor

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9
Q

What drug decreases clearance of theophylline?

A

Ciprofloxacin!

inhibits the cytochrome p450 enzyme

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10
Q

Which disease causes the lung to grossly resemble cirrhosis?

A

UIP

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11
Q

With what type of lung cancer could you see a cushings syndrome?

A

Small cell carcinoma

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12
Q

What type of cancer might you see eaton-lambert syndrome in?

A

small cell carcinoma

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13
Q

Brush cells

A

1 of the 5 cell types of respiratory epithelium
Has microvilli
Neurons seen in relation to them, suggesting they may have a sensory function

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14
Q

Basal (short) cells

A

1 of the 5 cell types of respiratory epithelium

= progenitor cells of other cell types in the respiratory epithelium

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15
Q

Small granule cell

A

1 of the 5 cell types of the respiratory epithelium
Secretes polypeptide hormones
May function to control serous & mucous secretion in the respiratory system
related to enteroendocrine cells of the GI system

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16
Q

What are the 3 cell types of the olfactory epithelium?

A

olfactory cell
sustentacular cell
basal cell

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17
Q

Sustentacular cell

A

1 of 3 cell types that make up the olfactory epithelium
a columnar cell with many microvilli
provides support, nourishment, and electrical insulation for the olfactory cells

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18
Q

Bowman’s glands

A

mucoserous glands within the lamina propria underlying the olfactory epithelium
keep the olfactory surface moist

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19
Q

BOOP

A

granulation tissue plugs project into lumen of distal bronchioles & air sacs
prognosis generally excellent

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20
Q

Stellate shaped nodules (w/ area of central cavitation)

A

pulmonary eosinophilic granuloma

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21
Q

The one with langerhans cells (histiocytes)

A

pulmonary eosinophilic granuloma

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22
Q

“crazy-paving”

A

Pulmonary alveolar proteinosis

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23
Q

Montelukast (singulair)

A

Asthma med

leukotriene receptor antagonist

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24
Q

zafirlukast (accolade)

A

Asthma med

leukotriene receptor antagonist

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25
Q

What do you see an increased Reid index in?

A

chronic bronchitis

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26
Q

acetazolamide

A

carbonic anhydrase inhibitor

for acute mountain sickness

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27
Q

Molecular defects in lung cancer

A

K-ras (adenocarcinoma)
p53 & Rb (50-60% NSCLC, and > 90% SCLC)
chr 3p deletion all types

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28
Q

SCLC staging

A

limited - extensive disease

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29
Q

NSCLC staging

A

stage I - small tumor, 65-85% 5yr
stage II - extension to chest wall/pleura, 40%
stage III - LN, 20%
stage IV - metastatic, 0%

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30
Q

Most common lung cancer in women & nonsmokers

A

adenocarcinoma

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31
Q

keratin pearls

A

Squamous cell lung cancer

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32
Q

treatment of SCLC

A

NO surgery

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33
Q

“oat cell” lung cancer

A

SCLC

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34
Q

nests of uniform cells

A

carcinoid tumor of lung

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35
Q

Lung cancers related to & not related to smoking

A

smoking:
SCLC, squamous cell lung cancer, large cell lung cancer
non-smoking:
adenocarcinoma, carcinoid tumor

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36
Q

popcorn lesion on xray

A

pulmonary hamartoma

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37
Q

most common tumors that metastasize to lung

A

solid tumors –> breast, colon, sarcomas

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38
Q

ferruginous bodies

A

asbestos

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39
Q

apneustic breathing

A

problem switching from inspiration to expiration, so pause at end of inspiration

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40
Q

Biot’s breathing

A

apnea in the middle of normal breathing

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41
Q

Kussmaul breathing

A

deep & fast

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42
Q

indoor cooking with fossil fuels in underdeveloped countries is a risk factor for what?

A

Obstructive lung disease

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43
Q

paraseptal emphysema associated with what?

A

spontaneous pneumothorax of young men

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44
Q

strongest predisposing factor for asthma

A

atopy

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45
Q

Factors for predicted normal PFTs

A

height, age, sex

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46
Q

central to the management of COPD

A

inhaled bronchodilators

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47
Q

what determines risk assessment in asthma

A

of exacerbations

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48
Q

head & neck cancer risk factors

A

tobacco & alcohol (betel nut w/ chewing tobacco in india), genetic factors (nasopharyneal in southern china), mate (tea from south america), asbestos, hardwood dust (nasal & sinus tumors), HPV (oropharyngeal)

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49
Q

erythroplasia

A

premalignant lesion

high incidence of carcinoma in situ

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50
Q

leukoplasia

A

premalignant lesion

more common & less likely to become malignant than erythroplasia

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51
Q

Head & Neck cancer - molecular progression

A

heterozygosity, p53, p16

52
Q

Isoretinoin

A

reduces incidence of 2nd primaries in H&N cancer

53
Q

EGFR inhibitors

A

given in conjunction with XRT to treat H&N cancers

EGFR is overexpressed in these cancers

54
Q

Cetuximab (erbitux)

A

IgG monoclonal antibody against the binding domain in EGFR

an EGFR drug to be used in H & N cancer

55
Q

Which type of cancer is associated with HPV?

A

oropharyngeal

56
Q

Which type of cancer has high incidence in southern China?

A

nasopharyngeal

57
Q

Which type of cancer is associated with epstein barr virus?

A

nasopharyngeal

58
Q

nasopharyngeal tumor presentation

A

blockage of eustachian tube (hearing loss, sensation of fluid in ears), headache, nose bleeds, double vision, proptosis & other cranial nerve symptoms
metastatic spread to posterior cervical chain

59
Q

what is the most common head & neck tumor?

A

laryngeal

60
Q

Treatment of early laryngeal tumors

A

radiation, vocal cord stripping, laser therapy, partial laryngectomy (not chemo)

61
Q

prophylactic cranial radiation

A

used for both limited & extensive SCLC stages as long as there’s response to tumor
NOT of any benefit for NSCLC

62
Q

SCLC treatment

A

limited: chemo + chest radiation
Extensive: chemo
PCI for both stages
NO surgery

63
Q

NSCLC treatment

A

Stage I/II = surgery (adjuvent chemo for stage II & radiation for high risk pts)
Stage III = chemoradiation
Stage IV = palliative chemo (sx curative if isolated brain or adrenal mets with stage I in lung)
no benefit of PCI

64
Q

Bevucizumab

A

intravenous mAb against VEGF
used in combo with chemotherapy for NSCLC
associated w/ hypertension, GI perforation/wound healing problems
contraindicated in squamous type

65
Q

EGFR tyrosine kinase mutations in NSCLC

A

prognostic of better survival outcomes in general
exon 19 deletion or L858R mutation predictive biomarker of tretment response to EGFR TKIs such as erlotinib
found in adenocarcinomas, with higher prevalence among non-smokers

66
Q

Erlotinib

A

Oral EGFR tyrosine kinase inhibitor (TKI)
used alone (no proven benefit in combo with chemo)
common toxicities: skin rash & diarrhea

67
Q

EML4-ALK translocation

A

3-5% of adenocarcinomas

younger, never smokers

68
Q

Crizotinib

A

oral inhibitor of ALK

effective against adenocarnimomas with ALK transformation

69
Q

Oncogenic drive mutations in squamous cell lung cancer

A

FGFR1 amplification

DDR2 mutation

70
Q

where does repiratory epithelium become columnar?

A

respiratory bronchiole

71
Q

swell bodies

A

venous plexuses in the lamina propria of the concha

direct the flow of ambient air to the opposite side

72
Q

what muscle is the vocalis muscle a part of?

A

thyroarytenoid muscle

73
Q

neuroepithelial bodies

A

in the bronchioles

groups of 80-100 cells containing secretory granules which receive cholinergic nerve endings

74
Q

clara/bronchiolar cell

A

lack cilia
secrete a surfactant like material
produce a clara cell secretory protein the decreases lung injury
divide to regenerate the bronchiolar epithelium

75
Q

structures in the hilum

A

artery is superior
bronchus in middle
vein is inverior

76
Q

secondary lobules of miller

A

contain terminal bronchioles, & respiratory bronchioles, alveolar ducts & alveoli

77
Q

knob

A

a single smooth muscle cell that guards the opening to each alveolus as it branches from an alveolar duct

78
Q

type II pneumocytes are aka

A

greater alveolar cells

septal cells

79
Q

Gold stages of COPD

A

1 mild >80
2 moderate 50-80
3 severe 30-50
4 very severe >30

80
Q

noncaseating v. caseating granuloma

A

non caseating has center with intact viable cells

caseating has necrosis in center

81
Q

What infection in CF is pathognomonic?

A

culture positive presence of pseudomonas, esp the mucoid strain, in the lung of a child with chronic pulmonary disease

82
Q

intercellular bridges

A

desmosome attachments

in squamous cell carcinoma

83
Q

when would you see a central softening or cavitation in a tumor due to necrosis?

A

squamous cell carcinoma

84
Q

which is the most aggressive lung tumor?

A

small cell carcinoma

85
Q

BOOP xray

A

patchy air spaces

86
Q

UIP aka

A

UIP = usual interstitial pneumonia
IPF = idiopathic pulmonary fibrosis
Cryptogenic fibrosing alveolitis

87
Q

simple nodular silicosis

A

2-4mm lesions w/ microscopic whorled appearance
needle shaped silica crystals in nodules
hilar lymph nodes enlarged w/ egg shell calcification
xray diagnosis, no respiratory dysfunction or symptoms

88
Q

what do asbestos bodies look like?

A

central colorless fiber core & beaded protein coat

“dumbbell in macrophage”

89
Q

asbestosis

A

asbestos bodies & diffuse interstitial fibrosis

inc risk of lung cancer & mesothelioma

90
Q

hypersensitivity pneumonitis aka

A

extrinsic allergic alveolitis

91
Q

UIP

A

peripheral SUBPLEURAL areas of honeycombing
**variation in age of lesions
fibroblast foci
poor prog

92
Q

DIP v. RBILD micro

A

DIP has widespread alveolar macrophage infiltrate

RBILD macrophage infiltrate is predominantly peribronchiolar

93
Q

pulmonary eosinophilic granuloma aka

A

histiocytosis X

langerhans cell granulomatosis

94
Q

idiopathic pulmonary hemosiderosis (IPH)

A

similar to goodpastures but no renal failure or cytotoxic Abs
intraalveolar hemorrhage and hemosiderin filled macrophages
hyperplasia of type II pneumocytes and variable interstitial septal fibrosis

95
Q

4 things that stimulate contraction pathway:

A

M3 muscarinic
Cysteinyl leukotriene 1
histamine H1
endothelin A/B

96
Q

Contraction pathway

A

Gq receptors –> phospholipase C –> IP3 –> Ca release from SR –> Contraction

97
Q

Methacholine

A

nonspecific M2-M3 agonist

98
Q

Methacholine challenge test

A

dose at which FEV1 falls by 20% or more

measure of airway hyperresponsiveness

99
Q

Ipratroprium

A

nonspecific M2-M3 antagonist
contraction at low doses, relaxation at high doses
More M2 in central airways so helps with tracheomalacia

100
Q

Tiotroprum

A

M3 specific antagonist

101
Q

C fiber endings

A

release substance P & neurokinin A

cause contraction

102
Q

Relaxation pathway

A

Gs coupled receptors –> adenylate cyclase –> cAMP –> protein kinase A –> phosphorylates 4 things –> causing dec Ca release (among other things) –> Relaxation

103
Q

Things that stimulate the relaxation pathway:

A 
Epi
inhaled B2 agonists
prostacyclin
PGE2
VIP
adenosine
NO
104
Q

Factors favoring Th1 phenotype

A 
= protective immunity
presence of older sibling
early exposure to day care
tuberculosis, measles, or hep A infection
rural environment
105
Q

Factors favoring Th2 phenotype

A 
= allergic diseases including asthma
widespread use of antibiotics
western lifestyle
urban environment
diet
sensitization to house-dust mites & cockroaches
106
Q

work exacerbated asthma

A

preexisting asthma made worse by employment

107
Q

occupational asthma

A

precipitated by a particular occupational enviroment and not by stimuli outside the workplace

108
Q

irritant induced asthma

A

follows exposure to workplace irritants

109
Q

reactive airways dysfunction syndrome

A

suden inhalation of a large dose of highly irritating substance causing asthma symptoms

110
Q

Asthma - impairment v. risk

A 
impairment = immediate manifestations of the disease
risk = potential for exacerbations or decreased lung function
111
Q

Salmeterol v. formoterol

A

salmeterol 10-20 min onset of action
formoterol 1-3 min onset of action
lower lipophilicity of formoterol

112
Q

theophylline/aminophylline adverse effects

A

N/V, headache, insomnia, palpitations, tachycardia, convulsions, arrhythmias
metabolized in liver, so inc half life in liver disease

113
Q

Candidates for omalizumab therapy

A 
adolescent (12 and up) & adult pts
moderate to severe persistent asthma
perennial allergy
IgE bw 30-700 IU/mL
symptoms not well controlled with ICS or ICS + LABA
pts not elligible for immunotherapy
114
Q

Infections in CF

A

staph aureus when young
pseudomonas when older
Also MRSA, cepacia complex, stenotrophomonas, atypical myocbacteria, fungi

115
Q

What was the causative agent with popcorn workers lung?

A

diacetyl - a butter flavored ketone

116
Q

Well controlled asthma - action

A

maintain current step

consider step down if well controlled at least 3 months

117
Q

Not well controlled asthma - action:

A

step up 1 step

re-evaluate in 2-6 weeks

118
Q

Very poorly controlled asthma - action:

A

consider oral steroids

step up 1-2 steps & re-evaluate in 2 weeks

119
Q

normal anion gap

A

12 +/- 4

120
Q

Numbers for calculating compensation in acid base cases

A

met acid: 1.5 & 8
met alk: 0.9 and 16
resp acid: 1 and 3.5
resp alk 2 and 4

121
Q

PFT used to determine severity in obstructive disease

A

FEV1 (% pred)

122
Q

PFT used to determine severity in restrictive disease

A

TLC

123
Q

Decreased DLCO

A

obstructive lung disease
parenchyma disease
pulmonary vascular disease
anemia

124
Q

Increased DLCO

A

pulmonary hemorrhage
polycythemia
L –> R shunt

125
Q

tree in bud sign

A

bronchiolitis

Pulmonary (6 decks)

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