pulm Flashcards

1
Q

MC location and pathogen of rhinosinusitis?

A

maxillary sinus in adults

viral URI MCC (can get superimposed bacterial infection (S pneumo, H flu, M cat))

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2
Q

MC location of epistaxis?

A

anterior segment of nostril = Kiesselbach plexus

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3
Q

location of life-threatening epistaxis?

A

posterior segment - sphenopalatine artery (branch of maxillary artery)

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4
Q

what are lines of Zahn?

A

alternating areas of pink (platelets, fibrin) and red (RBCs)

found in thrombi formed PRE-mortem only

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5
Q

Reid index?

A

thickness of gland layer / total thickness of bronchial wall

** chronic bronchitis: Reid index > 50%

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6
Q

centriacinar vs panacinar emphysema?

A

centriacinar: smoking
panacinar: alpha1 antitrypsin

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7
Q

what are Curschmann spirals?

A

shed epithelium –> whorled mucus plugs

happens in ASTHMA

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8
Q

what are Charcot Leyden crystals?

A

eosinophilic hexagonal double-pointed needle-like crystals
formed from breakdown of eos in sputum
happens in ASTHMA

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9
Q

drugs that cause restrictive lung disease?

A

bleomycin
busulfan
amiodarone
methotrexate

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10
Q

rheumatoid arthritis and pneumoconioses with intrapulmonary nodules?

A

Caplan syndrome

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11
Q

shipbuilding/roofing/plumbing, ivory white calcified supradiaphragmatic/pleural plaques?

A

asbestosis
increased incidence of lung ca (bronchogenic > mesothelioma)
LOWER lobes

** asbestos bodies = golden-brown fusiform rods that look like dumbbells

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12
Q

aerospace and manufacturing industries, granulomas?

A

berylliosis
UPPER lobes
occasionally responsive to steroids

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13
Q

prolonged coal dust exposure?

A

coal workers’ pneumoconiosis
macrophages laden with carbon –> inflammation and fibrosis
UPPER lobes

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14
Q

anthracosis?

A

asymptomatic condition found in many urban dwellers exposed to sooty air

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15
Q

foundries/sandblasting/mines, lung fibrosis?

A

silicosis
silica disrupts phagolysosomes and impairs macrophages –> increased susceptibility to TB
increased risk of bronchogenic carcinoma
UPPER lobes

** eggshell calcification

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16
Q

neonatal respiratory distress syndrome?

A

surfactant deficiency –> increased surface tension –> alveolar collapse - ground glass
lecithin:sphingomyelin < 1.5
persistently low O2 –> risk of PDA

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17
Q

risks with therapeutic supplemental O2 in NRDS?

A

retinopathy of prematurity
intraventricular hemorrhage
bronchopulmonary dysplasia

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18
Q

risk factors for NRDS?

A
prematurity
maternal diabetes (increased fetal insulin
C-section delivery (decreased fetal glucocorticoid release)
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19
Q

tx of NRDS?

A

give mom steroids before birth

artificial surfactant after birth

20
Q

ARDS histologic findings?

A

intra-alveolar hyaline membranes

21
Q

mechanism of damage in ARDS?

A

release of neutrophilic substances toxic to alveolar wall
activation of coag cascade
O2-derived free radicals

22
Q

histologic findings in pulmonary HTN?

A

arteriosclerosis
medial hypertrophy
intimal fibrosis

23
Q

heritable cause of PAH?

A

inactivating mutation in BMPR2 gene - normally inhibits vascular smooth mm proliferation

24
Q

categories of pulm HTN?

A
PAH
2/2 L heart dz
2/2 lung dz/hypoxia
2/2 chronic thromboembolism
multifactorial
25
when does trachea deviate toward lesion?
atelectasis/bronchial obstruction
26
MCC of lobar PNA?
S pneumoniae Legionella Klebsiella
27
MCC of bronchopneumonia
S pneumo S aureus H flu Klebsiella
28
MCC of atypical PNA?
viruses Mycoplasma Legionella Chlamydia
29
MCC of lung abscesses?
anaerobes (Bacteroides, Fusobacterium, Peptostreptococcus) | S aureus
30
tx of lung abscesses?
clinda
31
hemorrhagic pleural effusion, pleural thickening, psammoma bodies?
mesothelioma
32
effects of Pancoast tumor?
Horner's SVC syndrome sensorimotor deficits hoarseness
33
facial plethora, neck and upper extremity edema?
SVC syndrome causes: malignancy (Pancoast), thrombosis from indwelling catheters ** if severe, can raise ICP
34
paraneoplastic syndrome of small cell lung ca?
ACTH SIADH Lambert Eaton myelitis/encephalitis
35
gene changes in small cell?
amplification of myc
36
histology of small cell?
neuroendocrine Kulchitsky cells small dark blue cells Chromograinin A +
37
gene changes of adenocarcinoma of lung?
KRAS EGFR ALK
38
histology of adenocarcinoma of lung?
glandular pattern mucin + bronchioalveolar subtype: growth along alveolar septa - look thickened
39
paraneoplastic syndrome of squamous cell lung ca?
PTHrP --> hypercalcemia
40
findings in squamous cell lung ca?
hilar mass - arising from bronchus cavitation kertain pearls and intercellular bridges
41
large cell carcinoma of lung can secrete what?
b-HCG
42
histology of large cell carcinoma of lung?
pleomorphic giant cells
43
bronchial carcinoid tumor?
sx due to mass effect, occasional carcinoid syndrome ** histo: nests of neuroendocrine cells, chromogranin A +
44
which lung ca are central?
small cell | squamous cell
45
which lung ca is inoperable?
small cell
46
which lung ca is unresponsive to chemo?
large cell ca