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Step 1 > Pulm Random Facts > Flashcards

Pulm Random Facts Flashcards

1
Q

Relationship of the pulmonary artery to the bronchus at each lung hilm

A

RALS= Right anterior; left superior

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2
Q

What goes through the diaphragm at T12?

A

Aorta, thoracic duct, and azygos vein

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3
Q

What is the functional residual capacity?

A

Volume of gas in lungs after normal expiration (residual volume plus expiratory reserve volume)

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4
Q

How to calculate physiologic dead space?

A

Tidal volume * (Paco2-Peco2)/Paco2; Paco2= arterial Pco2; Peco2=expired air Pco2

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5
Q

What decreases pulmonary compliance?

A

Pulmonary fibrosis, pneumonia, pulmonary edema

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6
Q

What increases pulmonary compliance?

A

Emphysema, normal aging

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7
Q

What shifts the hemoglobin dissociation curve to the right?

A

Increased Cl, H+, CO2, 2,3-BPG, and temperature

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8
Q

What is familial erythrocytosis?

A

A beta-globulin mutation that results in reduced binding of 2,3-BPG

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9
Q

How to remember which is ferrous and which is ferric?

A

Just the two of us: ferroUS is Fe2+

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10
Q

How much oxygen can 1 g of hemoglobin bind?

A

1.34 mL

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11
Q

Which gases are perfusion limited?

A

O2 (normal health), CO2, N20

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12
Q

Which gases are diffusion limited?

A

O2 (emphysema, fibrosis), CO.

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13
Q

How do you calculate the pulmonary vascular resistance?

A

[P(pulm artery)-P(L atrium)]/cardiac output

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14
Q

What is the alveolar gas equation?

A

PAo2=PIo2-(PaCO2/R); R is the respiratory quotient=CO2 produced/O2 consumed

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15
Q

What can cause an A-a gradient?

A

V/Q mismatch, diffusion limitation (eg. fibrosis), right to left shunt

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16
Q

What is the normal V/Q ratio at the apex and base of the lungs?

A

V/Q at apex=3 (wasted ventilation); V/Q=0.6 (wasted perfusion); BUT both ventilation and perfusion are greater at the base of the lung than at the apex

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17
Q

Pressures in the apex of the lung

A

PA> Pa > Pv

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18
Q

Pressures in zone 2 of the lung

A

Pa >PA> Pv

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19
Q

Pressures in zone 3 (base) of the lung

A

Pa >Pv > PA

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20
Q

What is the Bohr effect?

A

Increased Pco2 causes increased H+, which causes decreased hemoglobin affinity for O2 causing oxygen unloading

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21
Q

What is the Haldane effect?

A

Increasing Po2 causes increased binding of O2 o Hb causing release of H+ and CO2

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22
Q

Where does CO2 bind to hemoglobin

A

At the N-terminus of globin (NOT to heme)

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23
Q

What happens in the kidney in response to high altitude?

A

Increased renal excretion of HCO3- to compensate for respiratory alkalosis (can augment with acetazolamide)

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24
Q

Which bacteria may be superimposed on viral rhino sinusitis?

A

S. pneumo, H. flu, M. catarrhalis

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25
Q

Where do life-threatening nose bleeds occur?

A

Posterior segment (sphenopalatine artery, a branch of maxillary artery)

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26
Q

Classic triad of fat emboli?

A

Hypoxemia, neurologic abnormalities, petechial rash

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27
Q

Multifocal ischemic necrosis of bone

A

Caisson disease, chronic form of air emboli.

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28
Q

What are Charcot-Leyden crystals?

A

Eosinophilic, hexagonal, double-pointed, need-like crystals form from breakdown of eosinophils in sputum, associated with asthma

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29
Q

What are Curschmann spirals?

A

Shed epithelium forms whorled mucus plugs (associated with asthma)

30
Q

What is bronchiectasis?

A

Chronic necrotizing infection of bronchi causes permanently dilated airways, purulent sputum, recurrent infections, hemoptysis

31
Q

Which drugs can cause interstitial lung diseases?

A

Bleomycin, amiodarone, methotrexate, busulfan

32
Q

What do you see in hypersensitivity pneumonitis

A

Mixed type III/IV hypersensitivity, predominance of CD8+ cells, often seen in farmers and those exposed to birds

33
Q

What is Caplan syndrome?

A

Rheumatoid arthritis and pneumoconioses with intrapulmonary nodules

34
Q

What is anthracosis

A

Asymptomatic condition found in many urban dwellers exposed to sooty air

35
Q

“Eggshell” calcification of hillier lymph nodes

A

Silicosis

36
Q

What do you see on histology in silicosis

A

Birefringent silica particles surrounded by fibrous tissue

37
Q

What is silicosis associated with?

A

Foundries, sandlasting, mine

38
Q

What is the relationship between silicosis and TB

A

Silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB

39
Q

What does therapeutic O2 in neonates predispose to?

A

Retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia

40
Q

What is idiopathic PAH often due to?

A

An inactivating mutation in BMPR2 gene (which normally inhibits vascular smooth muscle proliferation)

41
Q

What are Light’s criteria:

A

Exudate if 2 of 3: Effusion protein/serum protein ratio >0.5, effusion LDH/serum LDH >0.6; Effusion LDH > 2/3 the upper limit of the reference range

42
Q

What are lung abscesses often caused by?

A

Anaerobes (eg. Bacteroides, Fusoacterium, Peptostreptococcus) or S. pneumo

43
Q

“Cough productive of foul-smelling sputum”

A

Abscess

44
Q

Tumor cells with long, slender microvilli and abundant tonofilaments

A

Mesothelioma

45
Q

What is the immunohistochemical marker for mesothelioma

A

Pancytokeratin

46
Q

Where does lung cancer metastasize to?

A

Adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly)

47
Q

Tx of small cell lung cancer

A

Chemotherapy (Inoperable!!)

48
Q

Lung cancer that’s chromogranin A +

A

Small cell or bronchial carcinoid tumor

49
Q

What does small cell carcinoma stain positive for?

A

Chromogranin A, neural cell adhesion molecule (NCAM), neuron-specific enolase, and synpatophysis

50
Q

What does CXR show in bronchioloalverolar subtype of adenocarcinoma of the lung?

A

Hazy infiltrates similar to pneumonia because it grows along alveolar septa causing apparent “thickening” of the walls. This type has an excellent prognosis.

51
Q

Which type of lung tumor can secrete beta-HCG?

A

Large cell carcinoma. Also has pleomorphic giant cells and a poor prognosis.

52
Q

What is chlorpheniramine

A

First generation H1 blocker

53
Q

What is hydroxyzine

A

First generation H1 blocker

54
Q

What is loratadine

A

Second generation H1 blocker

55
Q

What is fexofenadine

A

2nd gen H1 blocker

56
Q

What is desloratadina

A

2nd gen H1 blocker

57
Q

What is dimenhydrinate

A

1st gen H1 blocker

58
Q

MOA of N-acetylcysteine for expectoration

A

Loosens mucus plugs by disrupting disulfide bonds

59
Q

MOA of dextromethorphan

A

Antagonizes NMDA glutamate receptors. Synthetic codeine analog

60
Q

MOA of bosentan

A

Endothelia receptor antagonist to decrease pulmonary vascular resistance. Hepatotoxic (monitor LFTs)

61
Q

What can PDE5 inhibitors be used for other than erectile dysfunction

A

Pulmonary HTN

62
Q

MOA of epoprostenol, iloprost

A

Prostacyclin (PGI2) analogs with direct vasodilatory effects on pulmonary and systemic arterial vascular beds. Inhibit platelet aggregation

63
Q

MOA of ipratropium

A

Muscarinic antagonist, competitively blocks muscarinic receptors, preventing bronchoconstriction

64
Q

MOA of montelukast and zafirlukast

A

Block leukotriene receptors (CysLT1).

65
Q

What are montelukast and zafirlukast especially good for?

A

Aspirin-induced asthma

66
Q

MOA of zileuton

A

5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes. Hepatotoxic

67
Q

What is omalizumab?

A

Monoclonal anti-IgE antibody. Binds mostly unbound serum IgE and blocks binding to Fc-epsilon-RI. Used in allergic asthma resistant to inhaled steroids and long-acting beta2-agonists

68
Q

What type of drug is theophylline?

A

Methylxanthine

69
Q

MOA of theophylline

A

Likely causes bronchodilation by inhibiting phosphodiesterase causing increased cAMP levels due to decreased cAMP hydrolysis. Also blocks actions of adenosine (which cause bronchoconstriction)

70
Q

Toxicity of theophylline

A

Seizures and tachyarrhythmias

71
Q

MOA of methacholine

A

Muscarinic receptor (M3) agonist.

72
Q

MOA of magnesium in an acute asthma flare-up

A

Inhibits Ca influx into airway smooth muscle

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