pulm

Question 1

mechanism of action of cromolyn

Answer 1

inhibits mast cell degranulation

Question 2

most common bacteria causing PNA

Answer 2

strep pneumo

Question 3

rifampin monotherapy

Answer 3

N meningitis prophylaxis for those know to be exposed

used with other meds in pulm infxn because high occurrence of resistance

Question 4

tx for idopathic pulmonary arterial hypertension while awaiting transplant

Answer 4

Bosentan
competitive antagonist of endothelin receptors

endothelin= vasconstrictor that stim endothelial proliferation
tx decreases pulmonary arterial pressure and lessens progression of vascular and R ventricular hypertrophy

Question 5

rifampin mechanism of action

Answer 5

inhibits DNA dependent RNA synthesis–> no transcription

Question 6

What does the acid fast stain bind

Answer 6

mycolic acid

Question 7

effect of COPD on cerebral vasculature

Answer 7

COPD–> increased CO2 and decreased O2
brain needs more O2 so it decreases cerebral vascular resistance.
Cannot increase O2 by increasing flow because brain will swell–> bad

Question 8

Where on the lung capacity curve is the Pulm Vasc Resistance the lowest

Answer 8

at the Function residual capacity

Question 9

stim of vagus nerve to the lung

Answer 9

parasympathetic stim with ACh acting on M3 receptors–> bronchoconstriction and increased mucous secretion–> increases work of breathing

Question 10

what things can cause decreased pulmonary compliance

Answer 10

lung cannot stretch well

pulmonary fibrosis
pulmonary edema (like from heart failure)
insufficient surfactant

Question 11

mucicarmine stain

Answer 11

Cryptococcus neoformans

detects polysaccaride capsule (stains red)

Question 12

what enzyme is functioning in the nuclelous?

Answer 12

RNA polymerase I making rRNA

Question 13

treatment for RSV Viral bronchiolitis

Answer 13

use ribavarin for this with immunodeficiency, prematurity, or cardiopulm disease

Question 14

cystic fibrosis is what kind of transmembrane receptor?

Answer 14

ATP gated chloride channel

Question 15

Why is clindamycin a good Abx for drunk with aspiration PNA?

Answer 15

covers anaerobic oral flora and aerobic bacteria

Question 16

Varenicline mechanism of action

Answer 16

aka chantix

partial agonist of nicotinic ACh receptors
decreases withdrawal cravings and rewarding effects of nicotine

Question 17

pleasure and addiction center of the brain

Answer 17

nucleus accumbens

Question 18

obstructive sleep apnea likely to develop?

Answer 18

pulmonary HTN

Question 19

where is the pulmonary lesion in secondary TB?

Answer 19

apical lesion

Question 20

lower lobe lung lesion with calcified lymphnode on the same side

Answer 20

primary TB

Question 21

vitamin deficiency cause of squamous metaplasia of epithelium to keratinizing epithelia

Answer 21

Vit A deficiency

Vit A required for normal differentiation of epithelial cells

Question 22

cause of the color in green sputum or pus

Answer 22

myeloperoxidase is released from neutrophil granules

it contains heme pigmentation and is blue green

Question 23

stabbed in the L fifth intercostal space, mid clavicular line

Answer 23

will hit L lung and possibly L ventricle if deep enough

Question 24

mechanism of action of N-acetylcysteine in CF

Answer 24

breaks disufide bonds within mucous–> loosens mucous

Question 25

mechanism of tissue damage in M tuburculosis

Answer 25

type 4 hypersensitivity

Question 26

what is the molecular abnormality of CF?

Answer 26

abnormal post translational processing of CFTR--> sents protein to proteosome instead of membrane

Question 27

mechanism of action of streptomycin

Answer 27

inhibits initiation of protein synthesis by bind and distorting prokaryotic ribsome 30s

Question 28

What factors involved in asthma have symptoms relieved when treated with antagonists

Answer 28

leukotrienes C4, D4, E4, and Ach

Question 29

acid fast bacteria in HIV pos with CD4 count of 40

Answer 29

MAC

Question 30

treatment and prophylaxis of MAC

Answer 30

prophylaxis: Azithromycin treatment: clarythromycin or azithromycin with rifabutin or ethambutol

Question 31

What is the measure of pathological index for chronic bronchitis?

Answer 31

Reid Index: thickness of mucus gland layer / total bronchial wall thickness normal is 0.4

Question 32

mechanism of action of ethambutol

Answer 32

inhibits carbohydrate polymerization of peptidyglycan cell wall

Question 33

major causes of hypoxemia (low PaO2)

Answer 33

alveolar hypoventilation ventilation/perfusion mismatch diffusion impairment R to L shunting

Question 34

hypoxemia with normal A-a gradient

Answer 34

alveolar hypoventilation

Question 35

what nerve is located in the piriform recess?

Answer 35

internal laryngeal nerve, branch of vagus cough reflex

Question 36

selective beta blockers

Answer 36

metoprolol, atenolol, esmolol, acebutolol

Question 37

``` at high elevation pH PaO2 PaCO2 HCO3 ```

Answer 37

``` pH elevated (blowing off most CO2) PaO2 decreases (approx 60)--> increased drive for ventilation PaCO2 decrease (blowing off CO2 because of increased resp drive) HCO3 decreased (losing HCO3 to compensate for resp alk) ```

Question 38

What is the mechanism of Amphotericin B toxicity?

Answer 38

binds to cholesterol prefers fungal ergosterol, but still binds cholesterol to some degree

Question 39

``` what are the PFTs in COPD FVC FEV1 Residual vol TLC residual vol/TLC increased ```

Answer 39

``` FVC decreased FEV1 decreased residual vol increases (lots of air trapped in there) TLC idncreased Residual vol/TLC increase ```

Question 40

cytokines that mediate systemic inflammatory response

Answer 40

TNF alpha IL 1 IL 6

Question 41

mechanism behind increased ESR in inflammatory response

Answer 41

TNF alpha, IL 1, IL6 stimulate release of acute phase proteins (fibrinogen). increased fibrinogen--> increased ESR

Question 42

what is the last trait of bronchiole epithelium that disappears as the airways branch

Answer 42

cilia

Question 43

what is the mechanism of pulmonary abscess?

Answer 43

lysosomal enzymes released from neutrophils and macrophages

Question 44

Mechanism of action of Ipratroprium

Answer 44

ACh blocker | inhibits vagus mediate bronchoconstriction

Question 45

s/p lung transplant fibrotic obstruction of the terminal bronchioles necrosis lymphcytic inflammation

Answer 45

chronic rejection