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USMLE: step 1 > Pulm > Flashcards

Pulm Flashcards

1
Q

Histo present of nasopharyngeal carcinoma?

A
  • Pleomorphic keratin cells in background of lymphocytes
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2
Q

What is kiesselbach’s plexus?

A
  • Animostesis of four arteries anterior septum
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3
Q

What does IL10 do?

A
  1. Inhibit TH1

2. Stimulates TH2

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4
Q

To which side does trachea deviate in collapsed lung?

A

Towards the collapse

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5
Q

What does A-a gradient > 15 mean (3 possibilities)?

A
  1. Diffusion limitation
  2. Right to left shunt
  3. V/Q mismatch
    * Blood is flowing through pulmonary vasculature but is not being oxygenated
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6
Q

Cardiac changes in pulm embolism?

A
  1. Right axis deviation

2. Right heart strain

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7
Q

Volumes in restrictive lung disease?

A

Almost all are decreased

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8
Q

Take of HPV that can lead to head/neck cancer?

A

HPV 16

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9
Q

Normal A-a gradient?

A

10 - 15

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10
Q

Presentation of tension pneumothorax?

A

Trachea pushed to other side

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11
Q

Composition of fetal HgB?

A

2 alpha

2 gamma

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12
Q

What causes edema at high alt?

A
  • Can be both pulmonary and cerebral

- Increased capillary pressure and permeability

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13
Q

What is alveolar dead space?

A

Alveolar ventilation but not perfusion = no gas exchange

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14
Q

How to treat acquired methemoglobin?

A

IV methylene blue

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15
Q

What is normal FEV1?

A

75 - 80% total lung volume

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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
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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

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18
Q

2 key mediators of pain?

A
  1. Bradykinin

2. Prostaglandin E2

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19
Q

Does Co2 bind to heme? Does Co?

A

Co2: No
CO: Yes, competitively binds forming carboxy HgB

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20
Q

Most common CF mutation?

A
  • F508 in CFTR

- Leads to abnormal folding and failure of glycosylation

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21
Q

Diseases in which bronchiectasis is seen?

A
  1. CF
  2. Kartagener
  3. Aspergillosis
    * Caused by decreased ciliary motility
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22
Q

Primary cause of pulmonary embolism?

A

DVT

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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

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24
Q

Initial presentation of pulmonary hypertension?

A

Exertional dyspnea

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25
Q

What is laplace law?

A

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
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26
Q

What is the Bohr effect?

A

Increased H in peripheral tissues shifts curve right favoring oxygen delivery

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27
Q

What is hypersensitivity pneumonitis? Cause?

A

“Farm/bird workers lung”

  • Type III/IV hypersensitivity
  • Usually from actinomyces or aspergillus
  • Also occurs with bird droppings
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28
Q

Type of vaccine for strep pneumo?

A

Polysaccharide

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29
Q

What is a unique target for lung metastasis?

A

Adrenal

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30
Q

Burkhold catalse positive for negative?

A

Positive

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31
Q

What is methemoglobin?

A
  • Oxidized form for hemoglobin containing ferric Fe3+
  • Not good at binding O2 leading to functional anemia
  • Has high affinity for cyanide ion: CN -
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32
Q

What is the alveolar gas equation?

A

PAo2 = 150 - [PaCo2 / .8 ]

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33
Q

What is responsible for the green color of puss?

A

Neut MPO

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34
Q

Disease processes associated with spontaneous pneumothorax?

A
  1. Marfan’s
  2. Ehlers-danlos
  3. Homocystinuria
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35
Q

2 pathologies when hyaline membranes are seen?

A

ARDS

NRDS

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36
Q

What are JVD, lower extremity edema and hepatomegaly indicative of?

A

Right ventricular failure (cor pulmonale) which is often caused by pulmonary hypertension

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37
Q

What is often associated with squamous cell carcinoma?

A

Production of PTHrP increase Ca

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38
Q

How to differentiate OSA from obesity hypoventilation syndrome?

A

OHS: Daytime HYPERcapnia with PaCo2 > 45
OSA: normal

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39
Q

Presentation of lambart eaton?

A

Proximal muscle weakness

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40
Q

What are the features of selective Iga deficiency?

A
  1. Shock with transfusion
  2. Recurrent infx
  3. Autoimmune disease
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41
Q

What is a pathologic cause of R - L shunt?

A

Pulmonary edema: edema is blocking exchange so blood returns to left side without being oxygenated

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42
Q

What does H flue require to grow?

A
  1. Factor X: hematin
  2. Factor V: NAD
    - would also be able to grow on chocolate agar as these are found in blood
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43
Q

Which lung cancers linked to smoking?

A
  1. Squamous cell carcinoma: males
  2. Small cell: Males
  3. Adenocarcinoma: females
  4. Large cell
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44
Q

How does A1AT deficiency present in liver?

A
  • Cirrhosis with pink, PAS + granules

- Misfolded protein is accumulating in the ER

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45
Q

Main component of surfactant?

A
  • Dipalmitoylphosphatidylcholine: a phospholipid

AKA: lecithin

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46
Q

Appearance of asbestosis?

A
  • Calcified, ivory white pleuro plaques in lower lobes
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47
Q

At what week are fetal lungs usually mature?

A

Week 35 with L:S > 2

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48
Q

Most common cancer with asbestosis?

A

Bronchogenic carcinoma

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49
Q

Next step if coin lesion found on CXR?

A

Compare to previous Xray, next them then would be biopsy which is necessary for diagnosis

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50
Q

Triad of aspirin asthma?

A
  1. Asthma
  2. ASA induce bronchospasm
  3. Nasal polyps
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51
Q

How do parameters changes in COPD?

A
  1. Increased RV
  2. Decreased FEV1: drops at greatest rate
  3. Decreased FVC
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52
Q

How to treat NRDS?

A

RX: maternal steroids prior to birth

- Insufficient surfactant at birth = alveolar collapse from decreased compliance

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53
Q

Cell type mediating delayed hypersensitivity?

A

T cells

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54
Q

Where does histamine induced dilation occur?

A

Arterioles

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55
Q

Presentation of fat emboli?

A

Petechial rash in addition to standard presentation

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56
Q

TB caseating or no caseating?

A

Caseating

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57
Q

Where does cillia span in respiratory tract?

A

Trachea to respiratory bronchioles

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58
Q

What is blood oozing from all IV sites indicative of?

A

DIC

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59
Q

How does silica impact the macs?

A

Impairs formation of the phagolysosomes

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60
Q

Where to veins and arteries run in lungs?

A

Arteries: center

Veins / lymphatics: along the edges

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61
Q

What is ischemia?

A

Decreased blood flow to tissues

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62
Q

What does bronchoalveolar carcinoma arise from?

A

Clara cell

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63
Q

Causes of high A-a gradient Hypoxemia?

A
  1. Diffusion limitation
  2. Right to left shunt
  3. V/Q mismatch
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64
Q

Which pleura carries pain fibers?

A

Parietal - P for Pain

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65
Q

Difference in cell type between respiratory bronchiole and alveoli?

A

Bronchiolar: cuboidal
Alveolar: squamous

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66
Q

What is defective in kartagener?

A

Dynein arm of cylia

- Can no longer clear mucus leading inflammation and bronchiectasis

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67
Q

Associations with congenital pulmonary hypoplasia?

A
  1. Congenital diaphragmatic hernia
  2. Bilateral renal agenesis: oligohydramnios
  3. Ureteral obstruction on utero
  4. Multicystic kidney disease
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68
Q

What L:S ration indicates lung maturity?

A

> 2

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69
Q

Ddx for berylliosis?

A

Sarcoidosis as it has non caseating granulomas in lungs but also all over the rest of body

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70
Q

Where do apices of lungs end?

A

2 - 4 cm above clavicles

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71
Q

What is FVC?

A

Max air you can blow out in one large breath

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72
Q

What disease cause diffusion limitation and how?

A
  1. Emphysema: Decreased surface area

2. CF: Increased thickness of membrane

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73
Q

Ventilation higher in apex or base?

A

Base, both perfusion and ventilation increase here but increase in Perfusion is greater due to gravity

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74
Q

What are lamellar bodies?

A
  • Produce surfactant in type II pneumos
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75
Q

2 pleuras and what are they attached to?

A
  1. Parietal - chest wall

2. Visceral - Lung

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76
Q

Signs of CO poisoning?

A
  • Cherry red skin: will not appear cyanotic
  • Cyanosis seen in carboxy hemoglobin
  • New onset headache
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77
Q

Diagnosis of methemoglobin?

A
  • Clinical cyanosis with pulse ox 85-90%
  • However, blood gas is normal
  • Blood is chocolate brown in color
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78
Q

Causes of exudative effusion?

A
  1. Malignancy
  2. Pneumonia
  3. Trauma
    * need to drain due to increased risk of infx
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79
Q

What is increased fremitus indicative of?

A

Pneumonia or other consolidating process

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80
Q

Sequelae of pancoast?

A
  • 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
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81
Q

Most common site of sinus inflammation?

A

Maxillary sinus

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82
Q

Where are aspirations and tubes more likely to go?

A

Right main stem bronchi as it is more vertical

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83
Q

Leading cause of cancer death?

A

Lung in both mean and woman

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84
Q

Associated diseases with silicosis?

A
  1. TB

2. Bronchogenic carcinoma

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85
Q

When does fetal respiration become viable?

A
  • Week 25: canalicular phase

- Respiratory bronch, alveolar ducts, and prominant capillaries develop

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86
Q

Genetic cause of methemoglobin?

A
  • Cytochrome b5 reductase deficiency
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87
Q

What happens to chest in emphysema?

A

Lung tissue destroyed leading to no counter force to chests outward pull leading to expanded chest

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88
Q

What is atelectasis?

A

Alveolar collapse

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89
Q

Sarcoid caseating or non caseating?

A

Non

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90
Q

When is hyperresonance seen?

A

Collapsed lung

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91
Q

Cells in terminal bronchioles?

A
  1. Smooth muscle and

2. Ciliated, pseudostratified columnar cells

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92
Q

What is the respiratory zone?

A

Everything distal to terminal bronchioles:

  1. Respiratory bronchioles
  2. Alveolar ducts
  3. Alveolar sacs
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93
Q

What travels with esophagus through diaphragm?

A

Vagus nerve at T10

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94
Q

What does small cell carcinoma arise from?

A

Neuroendocrine kulchitsky cells

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95
Q

Cell involved in sarcoid granuloma and what is it secreting?

A

TH1 CD4+ secreting IL2 and INF-gamma

- Gamma is responsible for activating macs

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96
Q

Risk of new born oxygen admin?

A
  1. Retinopathy

2. Bronchopulmonary dysplasia

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97
Q

How to visualize legionella?

A

Silver stain

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98
Q

FEV1/FVC in restrictive disease?

A

FEV1 / FVC > 80 %

- Both quantities drop, however

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99
Q

What are charcot leyden crystals and creola bodies seen in?

A

Asthma

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100
Q

What does low alveolar Po2 do?

A
  • Constriction of vessels shunting to more oxygenated areas

- Can cause pulm htn.

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101
Q

What lung cancer is neurogranin positive?

A

Carcinoid

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102
Q

Characteristics of Type I pneumocytes?

A
  • Thin, flat squamous cells
  • Make up majority of alveolar surface
  • Conduct gas exchange
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103
Q

What do lines of zahn mean?

A

A clot was formed prior to death

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104
Q

What type of virus are inactivated by ether?

A

Enveloped

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105
Q

What type of allergy is asthma?

A

Type I

-

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106
Q

Where does posterior epistaxis come from?

A

Sphenopalatine artery: branch of maxillary that can cause life threatening hemorrhage

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107
Q

Signs of pulmonary emboli?

A
  1. Dyspnea
  2. Chest pain
  3. SOB
  4. Tachy
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108
Q

Where is diaphragmatic irritation referred to?

A
  • Pain in shoulder and trapezius ridge

- Referred visceral pain

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109
Q

Presentation of carcinoid syndrome? Cause? Location

A

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
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110
Q

What cancer most common in non smokers?

A

Adenocarcinoma - more often in females

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111
Q

Where does TB usually infect?

A

Love oxygen so infect apex

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112
Q

Equation for alveolar ventilation?

A

[tidal volume - dead space] x RR

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113
Q

More O2 bound to Hg or in serum?

A

Bound to hemoglobin

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114
Q

Most common cause of hypoxia with normal arterial sat?

A

Anemia

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115
Q

What does IL4 do?

A

Plasma cell class switching to IgE

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116
Q

Is V/Q higher at base or apex?

A

Apex

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117
Q

What causes right shifts?

A 
ACE BATs right handed:
Acid
CO2
Exercise
BPG
Altitude 
Temp
***All of these increase taut form allowing better delivery to tissues
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118
Q

Mutations in adenocarcinoma of lung?

A

Adenocarcinoma makes you “AKE”

  1. ALK
  2. KRAS
  3. EGFR
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119
Q

Lung volume smaller or greater in smokers?

A

Greater: RV increases as more leftover air stuck in lungs after expiration

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120
Q

Body’s response to High altitude?

A
  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
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121
Q

Eosinophil role in asthma?

A

Release MBP causing epithelial damage and spasm

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122
Q

3 scenarios for increased BPG?

A
  1. Altitude
  2. Hypoxia
  3. CHF
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123
Q

What does high compliance mean?

A

Same pressure creates higher change in volume

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124
Q

Lung cancer associated with osteoarthropathy?

A

Adenocarcinoma

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125
Q

When is silicosis seen?

A
  • Sandblasting in foundries and mining
  • Silica leads to H2O2 causing macs to release cytokines
  • Leads to egg shell calcifications in hyilar nodes
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126
Q

What is a congenital diaphragmatic hernia?

A

Congenital hole in diaphragm allowing bowels to protrude into thorax compressing lungs
- Leads to pulmonary hypoplasia

127
Q

Cause of tension pneumothorax?

A

Penetrating chest wall injury

128
Q

3 forms of CO2 transport?

A
  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
Q

Cause of bronchiectasis?

A

Necrotizing inflammation with damage to airway walls

130
Q

Another name for phosphatidylcholine?

131
Q

How do you get methemoglobinemia?

A
  1. Nitrites
  2. Dapsone: leprosy Rx
  3. Benzocaine
132
Q

What is normal pressure in pulmonary artery?

A

10 - 14 mmhh

133
Q

What does Co do to binding curve?

A

Left shift = less unloading in tissues

134
Q

Volumes on lung graph from top to bottom?

A 
"L.I.T.E.R"
Lung volumes:
IRV
TV
ERV
RV
135
Q

What mediates ARDS damage?

A

Neuts induce protease and free radical damage of Type I and II pneumocytes

136
Q

Ddx for caseating granuloma?

A
  1. Fungi

2. TB - AFB showing red acid fast

137
Q

V/Q in zone 1 vs 3?

A

Decreased in zone 3 due to gravity increased perfusion

138
Q

Most common bugs in rhinosinusitis?

A
  1. Strep Pneumo
  2. H. Flu
  3. Moraxella
    * **Same for otitis media
139
Q

What are absent breath sounds, hyperresonance and decreased fremitus indicative of?

A

Pneumothorax

140
Q

What stimulates central chemoreceptors? Peripheral?

A

Central: Change in PH from PaCO2
Peripheral: O2

141
Q

What travels through diaphragm with aorta?

A

Azygos vein

142
Q

What is Calplan syndrome?

A

Pneumoconiosis + Rheumatoid arthritis

143
Q

What is V/Q of infinity? Causes?

A

Ventilation but limited perfusion:
1. Pulmonary embolism
100% oxygen impoves

144
Q

What is V/Q of zero? Causes?

A

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
Q

What is the following indicative of:

  • Decreased breath sounds
  • Dullness to percussion
  • Decreased fremitus
A

Pleural effusion

*If tracheal deviation: bronchial obstruction as deviation is from collapse of lung

146
Q

Where is the horizontal fissure found?

A
  • Right lung separating superior and middle lobes

- Anteriorly found above fourth rib

147
Q

What can repeated rhinitis lead to?

A

Nasal polyps

148
Q

Total O2 content in CO, anemia and polycythemia?

A

Anemia: Decreased
CO: Decreased
Poly: Increased

149
Q

What do restrictive lung diseases do to TLC?

150
Q

% O2 sat Hg in CO, anemia and polycythemia?

A

Anemia: normal
CO: decreased
Poly: normal

151
Q

What makes up the anatomic dead space?

A

Conducting zone as does not participate in gas exchage

152
Q

How does exercise impact PaO2/Co2?

A

No change due to efficient gas exchange

153
Q

Which is the only pneumoconiosis increasing TB risk?

A

Silicosis because it impairs formation of the phagolysosomes which would fight the TB

154
Q

What is thought to drive the interstitial fibrosis?

A

TGF-B being released by injured pneumocytes in an attempt to heal

155
Q

What makes up inspiratory capacity?

156
Q

Fetal or adult have higher O2 affinity? Why?

A

Fetal: shifts left meaning at same PPO2, more % O2 bound

- Decreased affinity for 2-3 bpg gives higher 02 affinity

157
Q

What is the hallmark of COPDS?

A

Decrease FEV1/FVC

158
Q

What is A-a Grandient

A
  • PAo2 - PaO2

Normally: 10 - 15mmhg

159
Q

Causes of lobar pneumonia?

A
  1. S. pneumo

2. Klebsiella

160
Q

What type of fluid is seen in ARDS?

A

Protein rich

161
Q

Impact of smoking on lungs?

A
  • Centriacinar emphysema
  • Increases compliance
  • Decreases recoild
162
Q

What happens to diffusion capactiy of CO in emphysema?

A

Decreases as alveoli are being destroyed making it harder for O2 to diffuse

163
Q

What nerve can be stimulated to treat OSA?

A

Hypoglossal pulling the tongue forward

164
Q

Which TH2 cytokines drive asthmatic allergic inflammation?

A

TH2 secretion of: IL 4, 5, 10, 13

165
Q

What can mimic sjogren syndrome?

A

Sarcoidosis impacting salivary and lacrimal glands

166
Q

Causes of interstitial pneumonia?

A
  1. Virus
  2. Mycoplasma
  3. Legionella
  4. Chlamydia - parrot fever
167
Q

Main carcinogen in cigarettes?

A

Polycyclic Hydrocarbons

168
Q

What lowers venous PO2 with normal arterial?

169
Q

What is marker of fetal lung maturity?

A

“Lecithin:sphingomyelin”

2 = low risk of NRDS

170
Q

What is homans sign?

A
  • Tender calf with dorsiflexion of foot

- Side of DVT

171
Q

Where does histamine induced increased permeability occur?

A

Post capillary venules

172
Q

What are cold agglutinins seen in?

A

Mycoplasma pnuemo

173
Q

Difference between OSA and central sleep apnea?

A
  • Central has no respiratory effort - CNS issue

- Whereas OSA has resp effort against closed breathing apparatus

174
Q

4 phases of pneumonia?

A
  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
Q

Causes of transudative effusion?

A
  1. Increased capillary pressure

2. Decreased serum protein

176
Q

What do sarcoid granulomas consist of?

A
  1. Epithelioid macrophages

2. Multinucleated giant cells

177
Q

What has gone wrong in chronic granulomatous disease? type of infections seen?

A
  • 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
Q

What does MHC I consist of?

A
  • Single heavy chain and a B2 microglobulin

- Found on surface of all nucleated cells

179
Q

What is increased reid index indicative of?

A

Chronic bronchitis: hypertrophy of mucus glands to deal with insults from smoke or other toxins

180
Q

What is rhinitis often associated with?

A

Asthma

Excema

181
Q

Most common cancers in US?

A 
Breast / prostate
#2 lung: but lung is #1 cause of cancer death
182
Q

What are lamellar bodies?

A

Surfactant is stored and transported to cell surface in them

183
Q

What is deposited in primary amyloidosis? Secondary?

A

1: Amyloid light chain
2: AA

184
Q

What are curschmann spirals?

A
  • Seen in asthma

- Caused by shed epithelium in mucus plugging

185
Q

Posterior extent of lungs?

A

T 1 - T10 (exp) T12 (insp)

186
Q

What is the haldane effect?

A

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
Q

What does the dotted line convey on lung chest wall graph?

A

Compliance: the steeper it is, the greater the compliance

- Same pressure creates higher change in volume

188
Q

What does a BMPR2 mutation result in?

A

Smooth muscle proliferation leading to primary pulmonary hypertension

189
Q

3 types of pneumonia? Appearance?

A
  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
Q

Which effusion has high protein?

191
Q

Mucus of cilia end first?

A

Mucus, need cillia to pump it up

192
Q

Blood from umbilical vein use SVC or IVC?

193
Q

What is interstitial fibrosis with cystic spaces indicative of?

A

Idiopathic pulmonary fibrosis

194
Q

Who is primary pulm htn seen in and what causes it?

A
  • 20 - 40 yo women

- BMPR2 mutation causing smooth muscle proliferation

195
Q

Sequelae of sleep apnea?

A

Alveolar hyoventilation and hypoxia leading to:

  1. Polycythemia - increased EPO release
  2. Pulmonary hypertension
196
Q

Cause of laryngeal papilloma?

A

HPV 6 / 11

197
Q

How to treat cyanide?

A
  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
Q

What are the T and R forms for HgB?

A

T - Taught, tissues, low affinity to drop off
- Only in this state when no oxygen bound
R - Relaxed, respiratory, high affinity

199
Q

What is hypoxia?

A

Decreased oxygen delivery to tissues

- Usually from anemia

200
Q

What keeps airways open at FRC?

A

Negative intrapleural pressure

201
Q

Mutation in A1AT deficiency?

A

Normal allele: PIM

Mutated allele: Piz

202
Q

Large cell association?

A

Gynecomastia

203
Q

What is the obstruction in emphysema?

A
  • 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
Q

Which was does trachea deviate in tension pneumothorax?

A

Away from pneumothorax

205
Q

Equation for minute ventilation?

A

Tidal volume x respiratory rate

206
Q

Dissolved O2 in CO, anemia and polycythemia?

A

Anemia: norm
Poly: norm
CO: norm

207
Q

Equation for dead space?

A

“Taco PaCo, PeCo, PaCo”

Vt x [PaCo2 - PeCo2] / PaCo2

208
Q

What is an apneic event?

A
  • Cessation of breathing > 10s during sleep
  • Disrupts sleep leading to daytime somnolence
  • In OSA, respiratory effort still continues against obstruction
209
Q

Characteristics of small cell carcinoma of lung?

A
  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
Q

Risk factors for NRDS?

A
  1. Maternal diabetes
  2. C section - not enough stress cortisol
  3. Prematurity
211
Q

Lab values in sarcoidosis? Why?

A
  1. Elevated ACE

2. HYPERcalcemia: granulomas have 1 a-hydroxylase activity activating vitamin D

212
Q

What is physiologic dead space?

A

Alveolar dead space + Anatomic dead space from conducting zone

213
Q

What happens to compliance in ARDS?

A
  • 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
Q

Most important contributing factor to pulmonary vascular resistance?

A

Radius - is to the 4th power in the equation

215
Q

2 Main categories of lung cancer? And difference in treatment?

A
  1. Small cell: not resectable, need chemo

2. Non small cell: resectable

216
Q

Who are angiofibromas seen in?

A

Only in adolescent males present with severe epistaxis

217
Q

What is chronic bronchitis?

A
  • Hypertrophy of mucus glands with reid index > 50%
218
Q

What are plexiform lesions indicative of?

A

Pulmonary hypertension

219
Q

Which lung cancers are central?

A
  1. Small cell

2. Squamous cell

220
Q

When is a TE fistula most likely to form?

A

4 - 7 weeks

221
Q

Most common cause of restrictive lung disease?

A

Interstitial fibrosis

222
Q

Most common site of embolization to lung?

A

Deep femoral veins

- Even though the most common site of DVT is in calf

223
Q

Most common primary lung cancer?

A

Adenocarcinoma

224
Q

How soon must rejection occur for it to be acute?

225
Q

What is SVC syndrome?

A
  • Congestion of blood returning to hear from head / neck
    1. Facial swelling
    2. JVD
    3. Headache / dizziness
    4. SOB
    5. Cerebral hemorrhage
226
Q

Which cancer can be confused with pneumonia on CXR?

A
  • Bronchoalveolar subtype of adenocarcinoma

- Grows along alveolar septa leading to thickening of alveolar walls

227
Q

What is milky white effusion high in TGs?

A

Chylothorax usually from damage to thoracic duct during surgery

228
Q

What is found in asthmatic mucus?

A

Curschmann spirals

Charcot leyden crystals

229
Q

What is the pierre robbins sequence?

A

Mandibular hypoplasia is trigger:

  1. Cleft palate
  2. Retrognathia: abnormal positioning of jaw
  3. Glossoptosis: airway obstruction frombackwards displacement of the tongue base
230
Q

How does clindamycin work?

A
  • Binds 50s ribosomal decreasing protein synthesis
231
Q

What can drop arterial PO2?

A

Pulmonary fibrosis and empheses limit diffusion of O2 dropping this

232
Q

What causes panacinar emphysema?

A
  • 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
Q

Most common cause of epiglottis?

234
Q

Industries associated with asbestosis?

A

Ship building
Roofing
Plumbing

235
Q

Cell types in bronchi/trachea?

A
  1. Cartilage
  2. Goblet cells
    * *Are absent in terminal bronchioles
236
Q

What doe mast cells dump in asthma?

A
  • Allergen cross linking of surface IgE leads to dump of preformed histamine granules leading to dilation and increased permeability
237
Q

What occurs to TLC in obstructive disease?

A

Air is trapped in RV increasing TLC

238
Q

When do pneumocytes develop?

A

Saccular phase: 26th week - birth

239
Q

Virchow triad?

A
  1. Stasis
  2. Hypercoag
  3. Endothelial damage
240
Q

Presentation of squamous cell of lung?

A
  1. Keratin pearls and intercellular bridges
  2. Hypercalcemia
  3. Central hilar mass
241
Q

Mutation in small cell carcinoma?

A

Amplification of myc

242
Q

What does trachea branch into?

A

Left and right mainstem bronchi

243
Q

Treatment of ARDS?

A

Mechanical ventilation w/ low tidal volume and high end positive expiratory pressure
*Have be careful of damage from O2 admin

244
Q

What to think if child with nasal polyps?

245
Q

What is smooth muscle hypertrophy, inflammation and mucus plugging indicative of?

246
Q

Pressures at FRC?

A
  • 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
Q

What is considered pulmonary hypertension?

A

> 25 mmhg in pulmonary artery

248
Q

Diagnostic characteristic for chronic bronchitis?

A

> 3 months cough for at least 3 years

249
Q

What makes up conducting zone?

A
  • Nose to terminal bronchiole
  • Trachea, bronchus, bronchiole
  • Warms, humidifies, and filters air
250
Q

What is DIC?

A
  • Activation of coag cascade
  • Oozing at IV sites
  • Schistocites
    1. Bleeding
    2. Bruising
    3. Kidney failure
251
Q

What is hypoxemia? Causes?

A
  • Decreased PP arterial O2

Can be normal A-a or increased A - gradient

252
Q

Which pneumoconiosis increased risk for cancer?

A
  1. Berylliosis

2. Asbestosis

253
Q

What happens in late phase of asthmatic inflammation?

A

Eosinophils dump major basic protein leading to further constriction

254
Q

Cause of aspiration pneumo?

A
  1. Bacteroides
  2. Fusobacterium
  3. Peptococcus
255
Q

Histology in mesothelioma?

A
  • Psammoma bodies

* *Also seen in papillary thyroid carcinoma

256
Q

What does increased positive pressure due to blood flow in zone 1?

A

Compresses alveoli compressing capillaries with low flow further decreasing it

257
Q

What is bronchiectasis?

A
  • Permanent dilation of bronchi

- Prevents with purulent sputum, infections, hemoptysis

258
Q

Pulse ox on CO poison vs. methemoglobin?

A

CO: 100%
Methem: 85%

259
Q

Why is maternal diabetes risk for NRDS?

A

Maternal glucose crosses placenta increasing fetal insulin which inhibits surfactant

260
Q

Pathogenesis of ARDS?

A
  1. Neuts and T cells release cytokines toxic to walls

2. Increased permeability leading to proteinaceous edema, inflammation, and hyaline membranes

261
Q

Two common benign lung lesions?

A
  1. Granuloma
  2. Hamartoma: disorganized tissue that belongs in area
    - lung tissue + cartilage
262
Q

Common association of berry aneurism?

A

Autosomal dominant polycystic kidney disease

263
Q

Who is cheyne stokes breathing often seen in and what is it?

A
  • CHF patients
  • Apnea followed by gradually increasing then decreasing tidal volumes
  • Chronic hyperventilation leads to hypocapnia which causes apnea during sleep
264
Q

What part of lung do coal workers and anthracosis impact?

265
Q

Which pneumoconiosis shows eggshell calcification and birefringence?

266
Q

Most common cause of walking pneumo? Association?

A

Mycoplasma - IgM hemolytic anemia

- No cell wall so not seen on stain

267
Q

Characteristics of Type II pneumocytes?

A
  • Secrete surfactant from lamelar bodies

- Stem cells that proliferate in damage

268
Q

What do MHC I and II present?

A

I: virus
II: Bacteria

269
Q

What happens to FRC in emphysema?

A
  • 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
Q

Normal limiting factor in gas exchange?

A

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
Q

Where are pseudo stratified ciliated columnar cells located?

A

Conducting zone extending to beginning of terminal bronchioles

272
Q

What do right and left shit mean?

A

Right: Decreased affinity for O2 and increased unloading in tissue
Left: Increased

273
Q

What is mediating fibrosis in pneumoconiosis?

A

Macs being set off by the small particles that have entered the alveoli

274
Q

What causes OSA?

A

Relaxation of pharyngeal muscle tone

275
Q

Pathogenesis ARDS?

A
  • 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
Q

Causes of normal A-a gradient Hypoxemia?

A
  1. High altitude

2. Alveolar hypoventilation

277
Q

Where are asteroid bodies seen?

A

Granulomas of sarcoidosis

278
Q

Who is kelbssiella pneumo seen in?

A

Patients at risk for aspiration - presents as currant jelly

279
Q

What is empyema?

A

Pus in pleural space

280
Q

Most common lung cancer?

A

Metastasis: multiple lesions in vascular pattern

281
Q

What makes up functional residual capacity?

A

Volume of lungs after normal expiration:

ERV + RV

282
Q

Where do small cell cancers arise?

A

Small cell is central

283
Q

What makes up vital capacity?

A

Amount of air youd breathe in in you exhaled maximally then inhaled maximally:
IRV + TV + ERV

284
Q

Breakdown of airway resistance?

A
  • Upper tract 1/2
  • Highest in medium sized bronchi from turbulent flow
  • Very low in terminal bronch
285
Q

What does IL 5 do?

A

Call in eosinophils

286
Q

NRDS complications?

A
  1. Persistence of PDA due to decreased O2 tension
  2. Necrotizing enterocolitis
  3. Free radical injury in retina or lung from supplemental O2
287
Q

What do mast cells dump in second phase?

A

Leukotrienes C4, D4, E4

- Lead to constriction of the vessels

288
Q

What type of cell lines pleura?

A

Mesothelial

289
Q

Diagnostic tests for CGD??

A
  1. Negative NBT test

2. Decreased fluorescence on DHR cytometry

290
Q

What is an acinus?

A

The terminal bronchiole and the avioli

291
Q

Drugs that can cause interstitial fibrosis?

A
  1. Bleomycin
  2. Amiodarone
  3. Radiation
292
Q

What type of lung disease are pneumoconiosis?

A

Restrictive

293
Q

What are clara cells?

A
  • 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
Q

Disorder hirschsprung seen in?

295
Q

When is meconium ileus seen in infants?

296
Q

What does obstruction of bronchus lead to?

A

Collapse of lung with tracheal deviation towards side of collapse

297
Q

Pneumonia associated with cruise ships?

A

Legionella

298
Q

Characteristics of legionella?

A
  1. Very high fever
  2. Watery diarrhea
  3. Brady
  4. Headache and confusion
  5. Salt wasting
299
Q

Gram stain of legionella?

A
  • Faintly gram negative with many neutrophils with few or no orgs
300
Q

Normal PP O2 in alveoli?

301
Q

Causes of hypoxemia with normal A-a gradient?

A
  1. Altitude

2. Hypoventilation

302
Q

How does inactivated flu vaccine work?

A

Induce neutralizing Ig against hemagglutinin preventing future viral entry upon infx

303
Q

What does mac release of IL12 caues?

A

TH1 differentiation

304
Q

What does TNF-a do?

A

Released by macs to recruit more macs

305
Q

Normal resp/gastric and sweat gland function of CFTR?

A

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
Q

What is responsible for pulmonary abscess?

A

Lysosomal content release by macs

307
Q

What do normal and increased RBC mass indicate?

A

Normal: relative erythrocytosis
Increased: Absolute erythrocytosis

308
Q

What type of receptor of CFTR?

A

ATP binding transmembrane protein: pumps chloride out using ATP for energy

309
Q

Initial asthma treatment?

A

Inhaled steroids and long acting beta agonistis

310
Q

How does hypocapnia impact cerebral blood flow?

A

Decreases it: this is why patients with increased ICP are hyperventilated

311
Q

What is the virulence factor of MTB?

A

Cord factor: observed as it growing in parallel cords/serpentine chains

312
Q

What type of hypersensitivity is anaphylaxis?

313
Q

Where is thoracentesis safe?

A

Anterior: between 6 - 8
Axially: 8 - 10
Posterior: 10 - 12
**Need to perform above rib to avoid hitting nerve or vein

USMLE: step 1 (15 decks)

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