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RESPIRATORY EXAM 2 > MISC > Flashcards

MISC Flashcards

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1
Q

Where does mesothelioma often metastasize to?

A

Hilar lymph nodes and liver

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1
Q

Define massive hemothorax, what can happen to the neck veins?

A

greater than 1500 cc blood into thorax? Neck veins can distend from compression or be flat from hypovolemia

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2
Q

T/F: pulse oximeter assures adequate ventilation

A

FALSE but it can tell you for sure if there is inadequate ventilation, may give false pos in CO poisoning

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2
Q

How is a solitary fibrous tumor attached to the pleura?

A

By a pedicle, this is not a malignant tumor–usually, if it is it will be pleiomorphic

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2
Q

Which genes are involved in both small cell and non-small cell carcinomas?

A

p53

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3
Q

Where are common sites for mets in adenocarcinoma of the lung?

A

peribronchial and hilar lymph nodes

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3
Q

What is the Tx for a pulmonary contusion? What are the Sx similar to?

A

PEEP ventilation; similar to ARDS

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3
Q

Where does most diaphragmatic injury as a result of BLUNT trauma occur? What about ones that are asymptomatic?

A

blunt left and asymptomatic right

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4
Q

How to evaluate pleural effusion?

A

first do CXR then thoracentesis

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5
Q

What is the function of methionine 358 in the A1AT molecule?

A

It acts as bait and elastase cleaves (bites) a peptide bond on the carboxyl side of the methionine which allows A1AT to create jaws that trap the elastase binding site

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5
Q

What is the triad of laryngeal injury?

A

Subcutaneous emphysema, palpable fracture, and hoarseness

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5
Q

Where are 3 areas empyema may come from?

A

blood, lung parenchyma, or subdiaphragmatic/liver abscesses

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5
Q

What is the most common type of tumor to find in pleura?

A

Metastatic especially from lung, breast, and ovaries

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5
Q

Most diseases involve pleural fluid glucose below what in an effusion?

A

60

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6
Q

What’s the deal with the Pittsburgh variant of A1AT deficiency?

A

They are A1AT deficient but also have a bleeding disorder bc rather than act on elastase A1AT acts on THROMBIN

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6
Q

In which patient with PEA would a thoracotomy not be indicated in?

A

one who has blunt trauma

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7
Q

if the protein is in the 7-8 range in a pleural effusion what should you think?

A

Multiple myeloma and Waldenstroms macroglobulinemia

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9
Q

Levels around what value are concerning for LDH pleural fluid levels? i.e. malignancy, pargonismiasis, empyema, and rheumatoid pleurisy

A

1000 IU

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9
Q

What kind of needle and where does it go for pericardiocentesis?

A

16 or 18 gauge needle at left xiphisternal jxn

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10
Q

What are 3 functions of pleural mesothelial cells?

A

Balance coagulation and fibrinolysis, act as phagocytes, and produce CT

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10
Q

What 4 things can cause increased pleural fluid production?

A

Increase in permeability, increase in microvascular pressure, decrease in oncotic pressure, and decreased pleural pressure

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11
Q

What is the most common microscopic finding with mesothelioma?

A

Epithelioid

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12
Q

What are lights diagnostic criteria to define pleural fluid as an exudate?

A

If LDH in pleural fluid to serum fluid ratio is greater than .6, if pleural protein and serum protein ratio is greater than .5, or if pleural fluids LDH is greater than 2/3 the upper limits of the normal serum LDH at that lab

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13
Q

Which lung cancer is associated with pleural retractions?

A

Adenocarcinoma, but pleural plaques would be mesothelioma which is not a lung cancer per se

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14
What is the major WBC present in pleural fluid?
mostly macrophages and then some lymphocytes
15
How does bronchoalveolar carcinoma grow? What is the distribution in the sexes?
lepidically or along the alveolar septa, this is a slower growing subtype of adenocarcinoma and it affects the sexes equally
17
Which 3 organisms are found in recurrent infections with cystic fibrosis?
Pseudomonas, staph, and aspergillus
18
What is really being affected in cystic fibrosis?
Epithelial glands
18
If the aorta is disrupted where will the following displace: trachea, right mainstem, left mainstem, and esophagus
trachea right, right mainstem elevated and right, left mainstem depressed and esophagus, right
19
ZZ individuals with A1AT are at risk for what other organ dysfunction aside from panacinar emphysema?
Non-alcoholic liver cirrhosis
20
What is the function of ASO hybridization?
This is Allele Specific Oligonucleotide hybridization and can be used to detect single, specific genotypes
22
How do you insert the laryngoscope and move the tongue when doing orotracheal intubation?
Hold laryngoscope in left hand put on right side of tongue and sweep to left
24
What is the Tx for open pneumothorax?
Airtight dressing on 3 sides and chest tube placed remotely from the wound
24
What is the Tx of a small tracheobronchial tear? Large?
Small is to manage airway, large is surgery (greater than 1/3 the lumen of trachea)
26
Why do CF patients have foul smelling stools?
Because the inability to secrete bile and pancreatic enzymes from their blocked hepatobiliary ducts leads to malabsorption and fatty stools usually smell
27
What do agitation and being obtunded indicate regarding airway obstruction?
Agitation is hypoxia, Obtunded is hypercarbia
28
What is the Tx of diaphragmatic trauma and why?
surgery because of risk for intraperitoneal injury
29
What is the real, physiological function of alpha-1 antitrypsin?
To inhibit ELASTASE, though the name implies it is trypsin, that was really only in vitro
30
What occurs at the 508 mutation in CF? What is functionally lost?
There was a 3 bp deletion which deletes a single phenylalanine at position 508, this messes up one of the nucleotide binding folds (NBF) that binds ATP
30
What is the morphology of chronic rejection in lung transplantation?
bronchiolitis obliterans with IRREVERSIBLE decrease in PFT's
31
What are the protein concentrations in a pleural effusion from TB? What if it is a transudate?
4 in TB, around 3 in transudates
33
Why is adenocarcinoma both less serious and potentially more serious than SCC?
It is peripherally located and more likely resectable and it grows slower, but potentially more dangerous because it mets earlier
34
In the ER how should you VIEW labored breathing?
As impending respiratory failure
35
What are 3 clinical conditions in which airway mgmt is difficult based on mech of injury?
maxillofacial trauma, laryngeal trauma, and neck trauma
36
What is the normal A1AT genotype? What are the mutant alleles?
MM is the normal, S and Z are the mutant alleles with Z being the worst
37
Which genes are exclusively involved in non-small cell carcinomas?
p16 and RAS
37
What makes a typical carcinoid vs an atypical carcinoid?
Typical is 2 or fewer mitoses per 10 hpfs/ atypical is 2-10 mitoses in 10 hpfs
39
Which genes are exclusively involved in small cell carcinoma?
c-myc and RB
40
What is the first priority in ANY trauma situation?
AIRWAY and ventilation
42
In which patients should you use an oropharyngeal airway?
Unconscious patients
44
Where do small cell carcinoma cells come from?
The basal cells (stem) of the bronchial epithelium, so they are centrally located and partially differentiate into neuroendocrine cells
45
Which tumor may form a coin lesion on CXR? Which infection?
hamartoma (most often cartilage) hisoplasma capsulatum
46
What is the most common cause of a simple pneumothorax? Tx?
Lung laceration with leakage of air into pleural space; chest tube
47
How would you Tx esophageal disruption?
Needs surgery (they will have bloody NG drainage or hematemesis)
48
What are the 3 types of definitive airways? Below which GCS scale is it indicated? What are some other indications?
Orotracheal, nasotracheal, and surgical. Below 8? Others: couldn?t maintain airway, apneic, possible impending compromise of airway
49
What is measured in the newborn screening for cystic fibrosis?
Immunoreactive trypsinogen (IRT)
50
In which patients should you use a nasopharyngeal airway? What is the correct measurement?
Conscious patients; measured from nostril to patient's ear lobe
50
What is required for flail chest?
2 or more ribs that are fractured in 2 or more places
52
Most common cause of hydrothorax:
CHF
53
What is the minimum age for surgical airway?
12
54
Which pleura is most important for fluid turnover? What arteries supply it?
Parietal pleura, intercostals
56
Which lung cancer is centrally located and may have cavitations? What are the histological findings?
Squamous cell carcinoma, keratin pearls and intercellular bridging
58
Benign tumorlets in the lung are seen in what condition?
Pulmonary neuroendocrine cell hyperplasia
59
What is the most accurate way to determine correct placement of a tube in the lungs?
End tidal CO2 detection
60
What are the correct endotracheal tube sizes for males, females, and kids? How do you determine the correct length?
males: 7.5-8 mm. Females: 7-7.5 mm, kids 4 mm, length--multiply size by 3 cm
62
Where do you put a chest tube?
4th or 5th IC space (nipple) anterior to midaxillary line
63
What is the algorithm for Tx of massive hemothorax?
1) fluid resuscitation then 2) chest tube to drain blood and 3) THORACOTOMY if more than 1500 cc blood comes out of chest tube, or lose 200 cc blood for 2-4 hours OR if you continuously need transfusions
64
W/respect to oncogenesis in lung cancer what are promoters and initiators?
Polycyclic aromatic hydrocarbons are initiators; phenol derivatives are promoters
65
Where do carcinoid tumors tend to be located? What do they look like?
Centrally, they are regular sized with uniform round nucleus
66
The most common CF mutation involves deletion of which amino acid?
Phenylalanine at postion 508
67
Can you do lung transplants in cancer?
NO it would preclude lifelong immunosuppressive treatment
68
5 signs of cardiac tamponade?
Kussmauls, increased pulsus paradoxus, hypotension, pulsatile JVD, and muffled heart sounds
69
Why are SCC patients hypercalcemic? Differentiate SCC demographics from adenocarcinoma
B/c the tumor releases a PTH-like protein, SCC is men who smoke and adeno is predominately women who do not smoke
70
What histologically determines prognosis in squamous cell carcinoma?
amount of keratin
71
Most common cause of hemothorax
Ruptured aneurysm
72
How would you differentiate hamartoma of the lung from inflammatory myofibroblastic tumor?
Hamartoma occurs in adults whereas inflammatory myofibroblastic tumor is in children and it produces the ALK gene (anaplastic lymphoma kinase)
74
Which GI surgery is often needed in CF patients?
Surgery for small intestinal blockage
75
What is rapid sequence induction? Who is used in and why?
Putting the tube in. First you do lidocaine then succynlcholine and versed and etomidate if HYPOTENSIVE? used in awake pts or ones with intact gag reflex as this can lead to aspiration pneumonia
76
Why does smoking exacerbate A1AT?
because the smoke oxidizes a METHIONINE at position 358 in a crucial position at which it binds to elastase
78
The cancer that mostly affects men and has peripherally clumped chromatin and prominent nucleoli behaves most like what? Why? What does it produce?
Acts most like adenocarcinoma it is large cell carcinoma which is undifferentiated so could be early squamous or adeno based on appearance, it releases colony stimulating factor
80
4 indications for lung transplant
CF, idiopathic pulmonary fibrosis, PHTN, and endstage emphysema
81
What is the median age for non-smoking and smoking A1AT deficient persons?
Non-smoking live to 62, smoking to 40
83
What is the correct size to use when making oropharyngeal airway?
From center of mouth to angle of mandible
84
In gene therapy, which virus was used to introduce new CFTR genes into humans via transfection?
Vaccinia virus
85
What is the most likely cause of death in a MVA or fall?
Aortic disruption
86
What is a definitive Tx in treating advanced A1AT deficiency (i.e. ZZ genotype)?
Lung and liver transplantation
87
What are the most common infections in lung transplants in first few perioperative weeks vs. months after?
at first, bacteria then fungi
88
Which A1AT genotype is most likely to get cirrhosis and why?
The ZZ genotype since MM is normal, SZ is bad but ZZ is the worst, since there is almost no normal protein, it accumulates in hepatocytes, damaging them and leading to possible cirrhosis
89
Cystic fibrosis is most common in which population?
Caucasian
90
Which cancer produces colony stimulating factor
large cell carcinoma
91
How do you perform needle decompression? How do you know it was successful?
14 guage IV needle 2nd IC space. Sudden rush of air
92
Most common cause of chylothorax
trauma to thoracic duct
93
Which chromosome is the gene for A1AT? What point mutation occurs for S and Z? What substitution?
14 in the Z genotype GAG--\>AAG and lysine for glutamate, in S it is GAA to GTA at a different position leading to valine to glutamate? In Z the mutation causes the protein to stay in the rER of hepatocytes
94
When using PCR to detect CF, which area of the genome is amplified?
The F508 region
95
What is the Tx for tension pneumothorax?
Needle decompression

RESPIRATORY EXAM 2 (8 decks)

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