Pulm Flashcards
1
Q
Histo present of nasopharyngeal carcinoma?
A
- Pleomorphic keratin cells in background of lymphocytes
2
Q
What is kiesselbach’s plexus?
A
- Animostesis of four arteries anterior septum
3
Q
What does IL10 do?
A
- Inhibit TH1
2. Stimulates TH2
4
Q
To which side does trachea deviate in collapsed lung?
A
Towards the collapse
5
Q
What does A-a gradient > 15 mean (3 possibilities)?
A
- Diffusion limitation
- Right to left shunt
- V/Q mismatch
* Blood is flowing through pulmonary vasculature but is not being oxygenated
6
Q
Cardiac changes in pulm embolism?
A
- Right axis deviation
2. Right heart strain
7
Q
Volumes in restrictive lung disease?
A
Almost all are decreased
8
Q
Take of HPV that can lead to head/neck cancer?
A
HPV 16
9
Q
Normal A-a gradient?
A
10 - 15
10
Q
Presentation of tension pneumothorax?
A
Trachea pushed to other side
11
Q
Composition of fetal HgB?
A
2 alpha
2 gamma
12
Q
What causes edema at high alt?
A
- Can be both pulmonary and cerebral
- Increased capillary pressure and permeability
13
Q
What is alveolar dead space?
A
Alveolar ventilation but not perfusion = no gas exchange
14
Q
How to treat acquired methemoglobin?
A
IV methylene blue
15
Q
What is normal FEV1?
A
75 - 80% total lung volume
16
Q
What are bronchogenic cysts?
A
- Abnormal foregut budding leading to dilation of terminal / large bronchi and chronic infections
- **Dilation of large airways also seen in bronchiectasis
17
Q
2-3 bpg impact on hemoglobin? When is it produced?
A
- Stabilizes taut form
- Produced at high altitude to allow more O2 delivery to peripheral tissues
18
Q
2 key mediators of pain?
A
- Bradykinin
2. Prostaglandin E2
19
Q
Does Co2 bind to heme? Does Co?
A
Co2: No
CO: Yes, competitively binds forming carboxy HgB
20
Q
Most common CF mutation?
A
- F508 in CFTR
- Leads to abnormal folding and failure of glycosylation
21
Q
Diseases in which bronchiectasis is seen?
A
- CF
- Kartagener
- Aspergillosis
* Caused by decreased ciliary motility
22
Q
Primary cause of pulmonary embolism?
A
DVT
23
Q
What is problem in bronchiectasis?
A
Abnormal dilation of airway leading to loss of tone and trapping
- Think of how much air you can feel being blown when you switch from a straw to a pipe
24
Q
Initial presentation of pulmonary hypertension?
A
Exertional dyspnea
25
What is laplace law?
Collapsing pressure = [2 x surface tension] / radius
- As tension goes up, so will collapsing pressure
- Surfactant reduces tension so this does not happen
- Decrease tension increases compliance decreasing work of breathing
26
What is the Bohr effect?
Increased H in peripheral tissues shifts curve right favoring oxygen delivery
27
What is hypersensitivity pneumonitis? Cause?
"Farm/bird workers lung"
- Type III/IV hypersensitivity
- Usually from actinomyces or aspergillus
- Also occurs with bird droppings
28
Type of vaccine for strep pneumo?
Polysaccharide
29
What is a unique target for lung metastasis?
Adrenal
30
Burkhold catalse positive for negative?
Positive
31
What is methemoglobin?
- Oxidized form for hemoglobin containing ferric Fe3+
- Not good at binding O2 leading to functional anemia
- Has high affinity for cyanide ion: CN -
32
What is the alveolar gas equation?
PAo2 = 150 - [PaCo2 / .8 ]
33
What is responsible for the green color of puss?
Neut MPO
34
Disease processes associated with spontaneous pneumothorax?
1. Marfan's
2. Ehlers-danlos
3. Homocystinuria
35
2 pathologies when hyaline membranes are seen?
ARDS
| NRDS
36
What are JVD, lower extremity edema and hepatomegaly indicative of?
Right ventricular failure (cor pulmonale) which is often caused by pulmonary hypertension
37
What is often associated with squamous cell carcinoma?
Production of PTHrP increase Ca
38
How to differentiate OSA from obesity hypoventilation syndrome?
OHS: Daytime HYPERcapnia with PaCo2 > 45
OSA: normal
39
Presentation of lambart eaton?
Proximal muscle weakness
40
What are the features of selective Iga deficiency?
1. Shock with transfusion
2. Recurrent infx
3. Autoimmune disease
41
What is a pathologic cause of R - L shunt?
Pulmonary edema: edema is blocking exchange so blood returns to left side without being oxygenated
42
What does H flue require to grow?
1. Factor X: hematin
2. Factor V: NAD
- would also be able to grow on chocolate agar as these are found in blood
43
Which lung cancers linked to smoking?
1. Squamous cell carcinoma: males
2. Small cell: Males
3. Adenocarcinoma: females
4. Large cell
44
How does A1AT deficiency present in liver?
- Cirrhosis with pink, PAS + granules
| - Misfolded protein is accumulating in the ER
45
Main component of surfactant?
- Dipalmitoylphosphatidylcholine: a phospholipid
| AKA: lecithin
46
Appearance of asbestosis?
- Calcified, ivory white pleuro plaques in lower lobes
47
At what week are fetal lungs usually mature?
Week 35 with L:S > 2
48
Most common cancer with asbestosis?
Bronchogenic carcinoma
49
Next step if coin lesion found on CXR?
Compare to previous Xray, next them then would be biopsy which is necessary for diagnosis
50
Triad of aspirin asthma?
1. Asthma
2. ASA induce bronchospasm
3. Nasal polyps
51
How do parameters changes in COPD?
1. Increased RV
2. Decreased FEV1: drops at greatest rate
3. Decreased FVC
52
How to treat NRDS?
RX: maternal steroids prior to birth
| - Insufficient surfactant at birth = alveolar collapse from decreased compliance
53
Cell type mediating delayed hypersensitivity?
T cells
54
Where does histamine induced dilation occur?
Arterioles
55
Presentation of fat emboli?
Petechial rash in addition to standard presentation
56
TB caseating or no caseating?
Caseating
57
Where does cillia span in respiratory tract?
Trachea to respiratory bronchioles
58
What is blood oozing from all IV sites indicative of?
DIC
59
How does silica impact the macs?
Impairs formation of the phagolysosomes
60
Where to veins and arteries run in lungs?
Arteries: center
| Veins / lymphatics: along the edges
61
What is ischemia?
Decreased blood flow to tissues
62
What does bronchoalveolar carcinoma arise from?
Clara cell
63
Causes of high A-a gradient Hypoxemia?
1. Diffusion limitation
2. Right to left shunt
3. V/Q mismatch
64
Which pleura carries pain fibers?
Parietal - P for Pain
65
Difference in cell type between respiratory bronchiole and alveoli?
Bronchiolar: cuboidal
Alveolar: squamous
66
What is defective in kartagener?
Dynein arm of cylia
| - Can no longer clear mucus leading inflammation and bronchiectasis
67
Associations with congenital pulmonary hypoplasia?
1. Congenital diaphragmatic hernia
2. Bilateral renal agenesis: oligohydramnios
3. Ureteral obstruction on utero
4. Multicystic kidney disease
68
What L:S ration indicates lung maturity?
> 2
69
Ddx for berylliosis?
Sarcoidosis as it has non caseating granulomas in lungs but also all over the rest of body
70
Where do apices of lungs end?
2 - 4 cm above clavicles
71
What is FVC?
Max air you can blow out in one large breath
72
What disease cause diffusion limitation and how?
1. Emphysema: Decreased surface area
| 2. CF: Increased thickness of membrane
73
Ventilation higher in apex or base?
Base, both perfusion and ventilation increase here but increase in Perfusion is greater due to gravity
74
What are lamellar bodies?
- Produce surfactant in type II pneumos
75
2 pleuras and what are they attached to?
1. Parietal - chest wall
| 2. Visceral - Lung
76
Signs of CO poisoning?
- Cherry red skin: will not appear cyanotic
* Cyanosis seen in carboxy hemoglobin
- New onset headache
77
Diagnosis of methemoglobin?
- Clinical cyanosis with pulse ox 85-90%
- However, blood gas is normal
- Blood is chocolate brown in color
78
Causes of exudative effusion?
1. Malignancy
2. Pneumonia
3. Trauma
* need to drain due to increased risk of infx
79
What is increased fremitus indicative of?
Pneumonia or other consolidating process
80
Sequelae of pancoast?
- Non small cell bronchogenic carcinoma
1. Horner's: compression of cervical plexus
2. Weakness in hand/arm: brachial plexus compression
3. Hoarseness: recurrent laryngeal nerve compression
4. SVC syndrome
81
Most common site of sinus inflammation?
Maxillary sinus
82
Where are aspirations and tubes more likely to go?
Right main stem bronchi as it is more vertical
83
Leading cause of cancer death?
Lung in both mean and woman
84
Associated diseases with silicosis?
1. TB
| 2. Bronchogenic carcinoma
85
When does fetal respiration become viable?
- Week 25: canalicular phase
| - Respiratory bronch, alveolar ducts, and prominant capillaries develop
86
Genetic cause of methemoglobin?
- Cytochrome b5 reductase deficiency
87
What happens to chest in emphysema?
Lung tissue destroyed leading to no counter force to chests outward pull leading to expanded chest
88
What is atelectasis?
Alveolar collapse
89
Sarcoid caseating or non caseating?
Non
90
When is hyperresonance seen?
Collapsed lung
91
Cells in terminal bronchioles?
1. Smooth muscle and
| 2. Ciliated, pseudostratified columnar cells
92
What is the respiratory zone?
Everything distal to terminal bronchioles:
1. Respiratory bronchioles
2. Alveolar ducts
3. Alveolar sacs
93
What travels with esophagus through diaphragm?
Vagus nerve at T10
94
What does small cell carcinoma arise from?
Neuroendocrine kulchitsky cells
95
Cell involved in sarcoid granuloma and what is it secreting?
TH1 CD4+ secreting IL2 and INF-gamma
| - Gamma is responsible for activating macs
96
Risk of new born oxygen admin?
1. Retinopathy
| 2. Bronchopulmonary dysplasia
97
How to visualize legionella?
Silver stain
98
FEV1/FVC in restrictive disease?
FEV1 / FVC > 80 %
| - Both quantities drop, however
99
What are charcot leyden crystals and creola bodies seen in?
Asthma
100
What does low alveolar Po2 do?
- Constriction of vessels shunting to more oxygenated areas
| - Can cause pulm htn.
101
What lung cancer is neurogranin positive?
Carcinoid
102
Characteristics of Type I pneumocytes?
- Thin, flat squamous cells
- Make up majority of alveolar surface
- Conduct gas exchange
103
What do lines of zahn mean?
A clot was formed prior to death
104
What type of virus are inactivated by ether?
Enveloped
105
What type of allergy is asthma?
Type I
| -
106
Where does posterior epistaxis come from?
Sphenopalatine artery: branch of maxillary that can cause life threatening hemorrhage
107
Signs of pulmonary emboli?
1. Dyspnea
2. Chest pain
3. SOB
4. Tachy
108
Where is diaphragmatic irritation referred to?
- Pain in shoulder and trapezius ridge
| - Referred visceral pain
109
Presentation of carcinoid syndrome? Cause? Location
Excess serotonin - usually only presents if in liver otherwise the liver would metabolize serotonin
1. Flushing
2. Diarrhea
3. Wheezing
4. Fibrosis of heart valves
110
What cancer most common in non smokers?
Adenocarcinoma - more often in females
111
Where does TB usually infect?
Love oxygen so infect apex
112
Equation for alveolar ventilation?
[tidal volume - dead space] x RR
113
More O2 bound to Hg or in serum?
Bound to hemoglobin
114
Most common cause of hypoxia with normal arterial sat?
Anemia
115
What does IL4 do?
Plasma cell class switching to IgE
116
Is V/Q higher at base or apex?
Apex
117
What causes right shifts?
```
ACE BATs right handed:
Acid
CO2
Exercise
BPG
Altitude
Temp
***All of these increase taut form allowing better delivery to tissues
```
118
Mutations in adenocarcinoma of lung?
Adenocarcinoma makes you "AKE"
1. ALK
2. KRAS
3. EGFR
119
Lung volume smaller or greater in smokers?
Greater: RV increases as more leftover air stuck in lungs after expiration
120
Body's response to High altitude?
1. Hypoxia induced increase in EPO
2. Increased BPG increasing delivery
3. Increased mitochondria to increase oxidation
4. Respiratory alkalosis due to hyperventilation and CO2 blow off
5. Kidneys respond by wasting bicarb
6. Pulm vasocinstrcition
121
Eosinophil role in asthma?
Release MBP causing epithelial damage and spasm
122
3 scenarios for increased BPG?
1. Altitude
2. Hypoxia
3. CHF
123
What does high compliance mean?
Same pressure creates higher change in volume
124
Lung cancer associated with osteoarthropathy?
Adenocarcinoma
125
When is silicosis seen?
- Sandblasting in foundries and mining
- Silica leads to H2O2 causing macs to release cytokines
- Leads to egg shell calcifications in hyilar nodes
126
What is a congenital diaphragmatic hernia?
Congenital hole in diaphragm allowing bowels to protrude into thorax compressing lungs
- Leads to pulmonary hypoplasia
127
Cause of tension pneumothorax?
Penetrating chest wall injury
128
3 forms of CO2 transport?
1. Converted to carbonic acid by carbonic anhydrase
- H dissociates and left with bicarb
- This is majority
2. Dissolved CO2
3. Bound to Hg as carbaminohemoglobin
129
Cause of bronchiectasis?
Necrotizing inflammation with damage to airway walls
130
Another name for phosphatidylcholine?
Lecithin
131
How do you get methemoglobinemia?
1. Nitrites
2. Dapsone: leprosy Rx
3. Benzocaine
132
What is normal pressure in pulmonary artery?
10 - 14 mmhh
133
What does Co do to binding curve?
Left shift = less unloading in tissues
134
Volumes on lung graph from top to bottom?
```
"L.I.T.E.R"
Lung volumes:
IRV
TV
ERV
RV
```
135
What mediates ARDS damage?
Neuts induce protease and free radical damage of Type I and II pneumocytes
136
Ddx for caseating granuloma?
1. Fungi
| 2. TB - AFB showing red acid fast
137
V/Q in zone 1 vs 3?
Decreased in zone 3 due to gravity increased perfusion
138
Most common bugs in rhinosinusitis?
1. Strep Pneumo
2. H. Flu
3. Moraxella
* **Same for otitis media
139
What are absent breath sounds, hyperresonance and decreased fremitus indicative of?
Pneumothorax
140
What stimulates central chemoreceptors? Peripheral?
Central: Change in PH from PaCO2
Peripheral: O2
141
What travels through diaphragm with aorta?
Azygos vein
142
What is Calplan syndrome?
Pneumoconiosis + Rheumatoid arthritis
143
What is V/Q of infinity? Causes?
Ventilation but limited perfusion:
1. Pulmonary embolism
100% oxygen impoves
144
What is V/Q of zero? Causes?
Complete shunt: perfusion but no ventilation
1. Airway blockade:
a. Status asthmaticus
b. CF mucus plug
* **100% O2 does NOT Improve as it will never reach capillaries
145
What is the following indicative of:
- Decreased breath sounds
- Dullness to percussion
- Decreased fremitus
Pleural effusion
| *If tracheal deviation: bronchial obstruction as deviation is from collapse of lung
146
Where is the horizontal fissure found?
- Right lung separating superior and middle lobes
| - Anteriorly found above fourth rib
147
What can repeated rhinitis lead to?
Nasal polyps
148
Total O2 content in CO, anemia and polycythemia?
Anemia: Decreased
CO: Decreased
Poly: Increased
149
What do restrictive lung diseases do to TLC?
Decreases
150
% O2 sat Hg in CO, anemia and polycythemia?
Anemia: normal
CO: decreased
Poly: normal
151
What makes up the anatomic dead space?
Conducting zone as does not participate in gas exchage
152
How does exercise impact PaO2/Co2?
No change due to efficient gas exchange
153
Which is the only pneumoconiosis increasing TB risk?
Silicosis because it impairs formation of the phagolysosomes which would fight the TB
154
What is thought to drive the interstitial fibrosis?
TGF-B being released by injured pneumocytes in an attempt to heal
155
What makes up inspiratory capacity?
TV + IRV
156
Fetal or adult have higher O2 affinity? Why?
Fetal: shifts left meaning at same PPO2, more % O2 bound
| - Decreased affinity for 2-3 bpg gives higher 02 affinity
157
What is the hallmark of COPDS?
Decrease FEV1/FVC
158
What is A-a Grandient
- PAo2 - PaO2
| Normally: 10 - 15mmhg
159
Causes of lobar pneumonia?
1. S. pneumo
| 2. Klebsiella
160
What type of fluid is seen in ARDS?
Protein rich
161
Impact of smoking on lungs?
- Centriacinar emphysema
- Increases compliance
- Decreases recoild
162
What happens to diffusion capactiy of CO in emphysema?
Decreases as alveoli are being destroyed making it harder for O2 to diffuse
163
What nerve can be stimulated to treat OSA?
Hypoglossal pulling the tongue forward
164
Which TH2 cytokines drive asthmatic allergic inflammation?
TH2 secretion of: IL 4, 5, 10, 13
165
What can mimic sjogren syndrome?
Sarcoidosis impacting salivary and lacrimal glands
166
Causes of interstitial pneumonia?
1. Virus
2. Mycoplasma
3. Legionella
4. Chlamydia - parrot fever
167
Main carcinogen in cigarettes?
Polycyclic Hydrocarbons
168
What lowers venous PO2 with normal arterial?
Exercise
169
What is marker of fetal lung maturity?
"Lecithin:sphingomyelin"
| 2 = low risk of NRDS
170
What is homans sign?
- Tender calf with dorsiflexion of foot
| - Side of DVT
171
Where does histamine induced increased permeability occur?
Post capillary venules
172
What are cold agglutinins seen in?
Mycoplasma pnuemo
173
Difference between OSA and central sleep apnea?
- Central has no respiratory effort - CNS issue
| - Whereas OSA has resp effort against closed breathing apparatus
174
4 phases of pneumonia?
1. Congestion - edema and infiltrates
2. Red hepatization - Exudate with neuts and blood
- Lung becomes liver ike
3. Grey hepatization - Breakdown of RBCs
4. Resolution
175
Causes of transudative effusion?
1. Increased capillary pressure
| 2. Decreased serum protein
176
What do sarcoid granulomas consist of?
1. Epithelioid macrophages
| 2. Multinucleated giant cells
177
What has gone wrong in chronic granulomatous disease? type of infections seen?
- Impaired NADPH oxidase activity leading to impaired respiratory burst and intracellular phagocytic killing
- Catalase positive allows org to destroy own hydrogen peroxide so host cant use it
178
What does MHC I consist of?
- Single heavy chain and a B2 microglobulin
| - Found on surface of all nucleated cells
179
What is increased reid index indicative of?
Chronic bronchitis: hypertrophy of mucus glands to deal with insults from smoke or other toxins
180
What is rhinitis often associated with?
Asthma
| Excema
181
Most common cancers in US?
```
Breast / prostate
#2 lung: but lung is #1 cause of cancer death
```
182
What are lamellar bodies?
Surfactant is stored and transported to cell surface in them
183
What is deposited in primary amyloidosis? Secondary?
1: Amyloid light chain
2: AA
184
What are curschmann spirals?
- Seen in asthma
| - Caused by shed epithelium in mucus plugging
185
Posterior extent of lungs?
T 1 - T10 (exp) T12 (insp)
186
What is the haldane effect?
Describes how CO2 is released from RBC:
- In lungs O2 binding causes H+ dissociation combining with bicarb to form carbonic acid
- Carbonic anhydrase splits this into CO2 and H2O
- Co2 is then exhaled
187
What does the dotted line convey on lung chest wall graph?
Compliance: the steeper it is, the greater the compliance
| - Same pressure creates higher change in volume
188
What does a BMPR2 mutation result in?
Smooth muscle proliferation leading to primary pulmonary hypertension
189
3 types of pneumonia? Appearance?
1. Lobar - intra alveolar exudate
2. Broncho - acute inflammation and patchy infiltrate in more than one lobe
- Red currant jelly sputum
3. Interstitial "walking pneumonia" - diffuses patchy infiltration on xray
190
Which effusion has high protein?
Exudate
191
Mucus of cilia end first?
Mucus, need cillia to pump it up
192
Blood from umbilical vein use SVC or IVC?
IVC
193
What is interstitial fibrosis with cystic spaces indicative of?
Idiopathic pulmonary fibrosis
194
Who is primary pulm htn seen in and what causes it?
- 20 - 40 yo women
| - BMPR2 mutation causing smooth muscle proliferation
195
Sequelae of sleep apnea?
Alveolar hyoventilation and hypoxia leading to:
1. Polycythemia - increased EPO release
2. Pulmonary hypertension
196
Cause of laryngeal papilloma?
HPV 6 / 11
197
How to treat cyanide?
1. Give Nitrites converting hemoglobin to methemoglobin
2. Met then binds cyanide removing from circulation
3. Give thiosulfate to form thiocyanate which is renally excreted
198
What are the T and R forms for HgB?
T - Taught, tissues, low affinity to drop off
- Only in this state when no oxygen bound
R - Relaxed, respiratory, high affinity
199
What is hypoxia?
Decreased oxygen delivery to tissues
| - Usually from anemia
200
What keeps airways open at FRC?
Negative intrapleural pressure
201
Mutation in A1AT deficiency?
Normal allele: PIM
| Mutated allele: Piz
202
Large cell association?
Gynecomastia
203
What is the obstruction in emphysema?
- Alveoli, which normally provide elastic recoil that expels air are destroyed
- Without this recoil hard to expel air and this is the "obstruction"
- Also, it is the alveoli that keep bronchioles open as air accelerates across it so if they are destroyed the air pulls bronchioles shut leading to trapping
204
Which was does trachea deviate in tension pneumothorax?
Away from pneumothorax
205
Equation for minute ventilation?
Tidal volume x respiratory rate
206
Dissolved O2 in CO, anemia and polycythemia?
Anemia: norm
Poly: norm
CO: norm
207
Equation for dead space?
"Taco PaCo, PeCo, PaCo"
| Vt x [PaCo2 - PeCo2] / PaCo2
208
What is an apneic event?
- Cessation of breathing > 10s during sleep
- Disrupts sleep leading to daytime somnolence
- In OSA, respiratory effort still continues against obstruction
209
Characteristics of small cell carcinoma of lung?
1. Aggressive
2. Centrally located
3. Excess ADH / ACTH
4. Lambert eaton
5. Kulchitsky cells on Histo
6. Early metastasis
* *NOT resectable, so small you can't see it!
210
Risk factors for NRDS?
1. Maternal diabetes
2. C section - not enough stress cortisol
3. Prematurity
211
Lab values in sarcoidosis? Why?
1. Elevated ACE
| 2. HYPERcalcemia: granulomas have 1 a-hydroxylase activity activating vitamin D
212
What is physiologic dead space?
Alveolar dead space + Anatomic dead space from conducting zone
213
What happens to compliance in ARDS?
- Pulmonary edema leading to stiff non compliant lungs
- Greater ventilation pressure will be needed
- Dotted line on graph will be flatter - less change in volume for same change in pressure
214
Most important contributing factor to pulmonary vascular resistance?
Radius - is to the 4th power in the equation
215
2 Main categories of lung cancer? And difference in treatment?
1. Small cell: not resectable, need chemo
| 2. Non small cell: resectable
216
Who are angiofibromas seen in?
Only in adolescent males present with severe epistaxis
217
What is chronic bronchitis?
- Hypertrophy of mucus glands with reid index > 50%
218
What are plexiform lesions indicative of?
Pulmonary hypertension
219
Which lung cancers are central?
1. Small cell
| 2. Squamous cell
220
When is a TE fistula most likely to form?
4 - 7 weeks
221
Most common cause of restrictive lung disease?
Interstitial fibrosis
222
Most common site of embolization to lung?
Deep femoral veins
| - Even though the most common site of DVT is in calf
223
Most common primary lung cancer?
Adenocarcinoma
224
How soon must rejection occur for it to be acute?
225
What is SVC syndrome?
- Congestion of blood returning to hear from head / neck
1. Facial swelling
2. JVD
3. Headache / dizziness
4. SOB
5. Cerebral hemorrhage
226
Which cancer can be confused with pneumonia on CXR?
- Bronchoalveolar subtype of adenocarcinoma
| - Grows along alveolar septa leading to thickening of alveolar walls
227
What is milky white effusion high in TGs?
Chylothorax usually from damage to thoracic duct during surgery
228
What is found in asthmatic mucus?
Curschmann spirals
| Charcot leyden crystals
229
What is the pierre robbins sequence?
Mandibular hypoplasia is trigger:
1. Cleft palate
2. Retrognathia: abnormal positioning of jaw
3. Glossoptosis: airway obstruction frombackwards displacement of the tongue base
230
How does clindamycin work?
- Binds 50s ribosomal decreasing protein synthesis
231
What can drop arterial PO2?
Pulmonary fibrosis and empheses limit diffusion of O2 dropping this
232
What causes panacinar emphysema?
- A1-antitrypsin deficiency
- A1 normally inhibits neut elastase from breaking down elastin
- W/o A1, elastase destroys elastin
- A1 is misfolding in liver leading to hepatic damage
233
Most common cause of epiglottis?
H. Flu
234
Industries associated with asbestosis?
Ship building
Roofing
Plumbing
235
Cell types in bronchi/trachea?
1. Cartilage
2. Goblet cells
* *Are absent in terminal bronchioles
236
What doe mast cells dump in asthma?
- Allergen cross linking of surface IgE leads to dump of preformed histamine granules leading to dilation and increased permeability
237
What occurs to TLC in obstructive disease?
Air is trapped in RV increasing TLC
238
When do pneumocytes develop?
Saccular phase: 26th week - birth
239
Virchow triad?
1. Stasis
2. Hypercoag
3. Endothelial damage
240
Presentation of squamous cell of lung?
1. Keratin pearls and intercellular bridges
2. Hypercalcemia
3. Central hilar mass
241
Mutation in small cell carcinoma?
Amplification of myc
242
What does trachea branch into?
Left and right mainstem bronchi
243
Treatment of ARDS?
Mechanical ventilation w/ low tidal volume and high end positive expiratory pressure
*Have be careful of damage from O2 admin
244
What to think if child with nasal polyps?
CF
245
What is smooth muscle hypertrophy, inflammation and mucus plugging indicative of?
Asthma
246
Pressures at FRC?
- System pressure is same as atmospheric
- Inward pull of lung = outward pull of chest wall
- No net air movement
- Both airway and alveolar pressure = zero
- Intrapleural pressure is negative to keep airway open
247
What is considered pulmonary hypertension?
> 25 mmhg in pulmonary artery
248
Diagnostic characteristic for chronic bronchitis?
> 3 months cough for at least 3 years
249
What makes up conducting zone?
- Nose to terminal bronchiole
- Trachea, bronchus, bronchiole
- Warms, humidifies, and filters air
250
What is DIC?
- Activation of coag cascade
- Oozing at IV sites
- Schistocites
1. Bleeding
2. Bruising
3. Kidney failure
251
What is hypoxemia? Causes?
- Decreased PP arterial O2
| Can be normal A-a or increased A - gradient
252
Which pneumoconiosis increased risk for cancer?
1. Berylliosis
| 2. Asbestosis
253
What happens in late phase of asthmatic inflammation?
Eosinophils dump major basic protein leading to further constriction
254
Cause of aspiration pneumo?
1. Bacteroides
2. Fusobacterium
3. Peptococcus
255
Histology in mesothelioma?
- Psammoma bodies
| * *Also seen in papillary thyroid carcinoma
256
What does increased positive pressure due to blood flow in zone 1?
Compresses alveoli compressing capillaries with low flow further decreasing it
257
What is bronchiectasis?
- Permanent dilation of bronchi
| - Prevents with purulent sputum, infections, hemoptysis
258
Pulse ox on CO poison vs. methemoglobin?
CO: 100%
Methem: 85%
259
Why is maternal diabetes risk for NRDS?
Maternal glucose crosses placenta increasing fetal insulin which inhibits surfactant
260
Pathogenesis of ARDS?
1. Neuts and T cells release cytokines toxic to walls
| 2. Increased permeability leading to proteinaceous edema, inflammation, and hyaline membranes
261
Two common benign lung lesions?
1. Granuloma
2. Hamartoma: disorganized tissue that belongs in area
- lung tissue + cartilage
262
Common association of berry aneurism?
Autosomal dominant polycystic kidney disease
263
Who is cheyne stokes breathing often seen in and what is it?
- CHF patients
- Apnea followed by gradually increasing then decreasing tidal volumes
- Chronic hyperventilation leads to hypocapnia which causes apnea during sleep
264
What part of lung do coal workers and anthracosis impact?
Upper
265
Which pneumoconiosis shows eggshell calcification and birefringence?
Silicosis
266
Most common cause of walking pneumo? Association?
Mycoplasma - IgM hemolytic anemia
| - No cell wall so not seen on stain
267
Characteristics of Type II pneumocytes?
- Secrete surfactant from lamelar bodies
| - Stem cells that proliferate in damage
268
What do MHC I and II present?
I: virus
II: Bacteria
269
What happens to FRC in emphysema?
- Reset and increased
- This is point where tension of wall and lung normally meet
- Resetting leads to the barrel chest commonly seen in emphysema
270
Normal limiting factor in gas exchange?
Perfusion: O2 equilibrates early along capillary so you can only get more in blood by increasing flow
- True for O2, Co2, and N
* **CO in diffusion limited as release from blood is slow
271
Where are pseudo stratified ciliated columnar cells located?
Conducting zone extending to beginning of terminal bronchioles
272
What do right and left shit mean?
Right: Decreased affinity for O2 and increased unloading in tissue
Left: Increased
273
What is mediating fibrosis in pneumoconiosis?
Macs being set off by the small particles that have entered the alveoli
274
What causes OSA?
Relaxation of pharyngeal muscle tone
275
Pathogenesis ARDS?
- Damage to capillary alveolar interface
- Exudate leaks into air sac
- Protein reorganized into hyaline membrane preventing gas exchange
- Also increases alveolar surface tension leading to collapse
276
Causes of normal A-a gradient Hypoxemia?
1. High altitude
| 2. Alveolar hypoventilation
277
Where are asteroid bodies seen?
Granulomas of sarcoidosis
278
Who is kelbssiella pneumo seen in?
Patients at risk for aspiration - presents as currant jelly
279
What is empyema?
Pus in pleural space
280
Most common lung cancer?
Metastasis: multiple lesions in vascular pattern
281
What makes up functional residual capacity?
Volume of lungs after normal expiration:
| ERV + RV
282
Where do small cell cancers arise?
Small cell is central
283
What makes up vital capacity?
Amount of air youd breathe in in you exhaled maximally then inhaled maximally:
IRV + TV + ERV
284
Breakdown of airway resistance?
- Upper tract 1/2
- Highest in medium sized bronchi from turbulent flow
- Very low in terminal bronch
285
What does IL 5 do?
Call in eosinophils
286
NRDS complications?
1. Persistence of PDA due to decreased O2 tension
2. Necrotizing enterocolitis
3. Free radical injury in retina or lung from supplemental O2
287
What do mast cells dump in second phase?
Leukotrienes C4, D4, E4
| - Lead to constriction of the vessels
288
What type of cell lines pleura?
Mesothelial
289
Diagnostic tests for CGD??
1. Negative NBT test
| 2. Decreased fluorescence on DHR cytometry
290
What is an acinus?
The terminal bronchiole and the avioli
291
Drugs that can cause interstitial fibrosis?
1. Bleomycin
2. Amiodarone
3. Radiation
292
What type of lung disease are pneumoconiosis?
Restrictive
293
What are clara cells?
- Non ciliated secretory cells of bronchioles
- Degrade toxins via cyp450
- Secrete protective surfactant like solution
* ***Clara starts with C, clara cells are found in the Conducting zone
294
Disorder hirschsprung seen in?
Downs
295
When is meconium ileus seen in infants?
CF?
296
What does obstruction of bronchus lead to?
Collapse of lung with tracheal deviation towards side of collapse
297
Pneumonia associated with cruise ships?
Legionella
298
Characteristics of legionella?
1. Very high fever
2. Watery diarrhea
3. Brady
4. Headache and confusion
5. Salt wasting
299
Gram stain of legionella?
- Faintly gram negative with many neutrophils with few or no orgs
300
Normal PP O2 in alveoli?
104
301
Causes of hypoxemia with normal A-a gradient?
1. Altitude
| 2. Hypoventilation
302
How does inactivated flu vaccine work?
Induce neutralizing Ig against hemagglutinin preventing future viral entry upon infx
303
What does mac release of IL12 caues?
TH1 differentiation
304
What does TNF-a do?
Released by macs to recruit more macs
305
Normal resp/gastric and sweat gland function of CFTR?
GI/resp: Cl secretion which inhibits Na reabsorption: if non functional, Na resorption increases and Cl excretion decreases
Sweat: Increase Cl/Na resorption, if broken Na/Cl content in sweat increases
306
What is responsible for pulmonary abscess?
Lysosomal content release by macs
307
What do normal and increased RBC mass indicate?
Normal: relative erythrocytosis
Increased: Absolute erythrocytosis
308
What type of receptor of CFTR?
ATP binding transmembrane protein: pumps chloride out using ATP for energy
309
Initial asthma treatment?
Inhaled steroids and long acting beta agonistis
310
How does hypocapnia impact cerebral blood flow?
Decreases it: this is why patients with increased ICP are hyperventilated
311
What is the virulence factor of MTB?
Cord factor: observed as it growing in parallel cords/serpentine chains
312
What type of hypersensitivity is anaphylaxis?
Type I
313
Where is thoracentesis safe?
Anterior: between 6 - 8
Axially: 8 - 10
Posterior: 10 - 12
****Need to perform above rib to avoid hitting nerve or vein
