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USLME Kiss my ass and pray > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Alveolar Gas equation

PAO2=

A

PIO2 - (PaCO2/R)

Can be approximated PAO2= 150 - PaCO2/0.8***

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2
Q

A-a gradient

A

PAO2-PaO2 = 10-15 mmHG

increased indicates underlying lung pathology

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3
Q

Air in the stomach on CXR in an infant be concerned w/

Early warning in the mother?

A

Trachealoesophageal fistula and esphageal atresa

Polyhydrominos

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4
Q

Most common type of tracheal esophageal fistula

A

C type w/ esophageal atresia and distal fistula

Type E (or H type) is the just a fistula

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5
Q

Diaphragm is made by the joining of what 4 structures?

Failure leads to?

A 
septum transversum (from the cranial aspect)
fuses w/ pueroperitonela folds, abdominal walls, and esophageal mesentery

Failure congenitally leads to herniation and lung hypoplasia (usually the L) polyhydraminos associated

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6
Q

Presentation of congenital diaphragm heniation

A

polyhydraminos in utero
hypoplastic lung -> cyanosis and inability to breath

flattened stomach

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7
Q

5 structures perforating the diaphragm and at what level?

A

T8 - IVC
T10 - esophagus
T12 - aorta, azygos vein, thoracic duct

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8
Q

innervation of the diaphragm

A

Phrenic C3-5

leads to referred pain to the shoulder (spleen and cholecysitis)

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9
Q

Aspiration pneumonia is more likely going to be found in what lobe?

A

R lobe due to wider and more vertical

Peanut inspiration the same but if lying down will be in the superior portion od the right inferior lobe while standing up it will be inferior portion of R inferior lobe

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10
Q

Importance of bronchopulmonary segments? Contains?

A

separated by connective tissue - has a bronchus, and 2 arteries per segment, veins are in the periphery

Spepaerates out the right 3 lobes and the L 2 lobes further

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11
Q

Smokers will see what transformation in their trachea

A

columnar ciliated cells -> stratified squamous through metaplasia

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12
Q

Chronic sinusitis, infertility and situs inversis?

Cause?

A

Kartagener syndrome

Due to dyenin not functioning leading to cilia defects all over

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13
Q

Important measure of fetal lung maturity

A

lecithen:Springomyelin ratio being greater than 2.0

See if enough dipalmitolphasphatidylcholine is being made

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14
Q

Product of type II pneumocytes?

A

dipalmitolphasphatidylcholine

other type II and I pneumocytes during injury

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15
Q

Role of type I pneumocytes?

A

gas diffusion - very thin

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16
Q

muscles of inspiration

  • quiet
  • exercise(3)
A

diaphragm

Sternocleidomastoid, scalenes, external intercostals

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17
Q

muscles of expiration

  • quiet
  • exercise
A

quiet is passive

exercise - internal intercostals, transverse abdominus, rectus abdominus, internal and external obliques

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18
Q

TLC is the combination of?

A

Functional Residual capacity and Inspiratory capacity or

Inspiratory reserve volume and Tidal volume and experatory reserve volume and residual volume

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19
Q

Inspiratory capacity is a combination of?

A

Tidal volume and inspiratory reserve volume

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20
Q

Vital capacity is a comination of

A

expiratory reserve capacity, tidal volume and inspiratory reserve capacity

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21
Q

Functional reserve capacity

A

residual volume and expiratory reserve volume

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22
Q

Determining the physiologic dead space formula

A

Dead space
= Tidal volume x [(PaCO2 - PeCO2)]/PaCO2

a= arterial
e expired air

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23
Q

Functional residual capacity (FRC) what is the relationship between chest wall and lungs

how does it change in emphysema?

How does it change in fibrosis?

A

they are balanced in their pull - airway and alveolar pressure are 0 and the intrapleural pressure is negative

in emphasymia there is increased compliance so the FRC is increased. More volume at given pressure

in fibrosis there is decreased compliance so less volume at a given pressure

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24
Q

Diffusion limited gases are?(2)

what does that mean?

A

CO and O2 (in diseased state: emphysema/fibrosis)

means that the partial pressure of the arterial will not be saturated upon leaving the lung - amount of gas carried limited by the diffusion

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25
Q

Perfusion limited gases(3)

what does that mean?

A

CO2, O2, N20

it means that the amount of gas that leaves the lung, the amount of gas carried is limited by the perfusion of the lung, equilibrates very quickly

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26
Q

How does COPD lead to Cor pulmonale

A

Cor pulmonale is heart failure due to lung disease. In COPD there is less oxygen perfusing the pulmonary vasculature leading to vasoconstriction and increased pressure. This increased pressure feeds back on the R heart leading to failure

-normally vessels expand w/ decreased O2, lungs shunt away

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27
Q

Pulmonary hypertension is defined as?

A

> 25mmHg in rest
35 mmHg exercising

Normally 10-15 mmHg

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28
Q

Pressure is equal to?

How does radius affect the system?

A

∆P = Q x R

R = (8 x length x viscosity)/(pi x r^4)

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29
Q

IN pulmonary resistance, what can change? What can’t generally?

A

radius of the tube
viscosity of the fluid

can’t really change the length
R = (8 x length x viscosity)/(pi x r^4)

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30
Q

Adding He to Oxygen does what

A

decreases the viscosity of the air and thus leads to less pressure

R = (8 x length x viscosity)/(pi x r^4)
∆P = Q x R
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31
Q

Primary pulmonary hypertension is due to

A

BMPR2 mutation -> increased smooth muscle proliferation

Loss of function mutation where normally BMPR2 regulates growth and lose radius

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32
Q

Causes of secondary pulmonary hypertension (6)

A 
COPD/fibrosis (vasoconstriction w/ low alveolar oxygen)
Mitral stenosis(feeds back)

Autoimmune (infammation -> intimal fibrosis)

sleep apnea/ high altitude

thromboembolic events

Left to right shunt (increased circulation)

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33
Q

Rx for pulmonary hypertension (4)

A

bosentan/ambriasentan
prostaglandin analogs
Sildenafil - phosphodiesterase inhibitors
Dihydropyradine CCB - nifedipine

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34
Q

Adult Hemoglobin is normally made out of?

How does it compare to fetal hemoglobin?

A

4 globin molecules (2 alpha 2 beta)
w/ 4 heme molecules

Fetal hemaglobin(2 alpha 2 gamma) has a higher preference for oxygen by being less affinity high 2,3 BPG, allows acquiring of oxygen from

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35
Q

2 types of states hemoglobin can be in and what favors each state

A

Taut - favors tissue and unloading
- in the presence of high: H, temp, 2,3 BPG, CO2

relaxed form favors O2 binding
-in the presence of low CO2, how H concentration and temp and 2,3 BPG

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36
Q

Hard working muscles leads to what type of hemoglobin state?

A

taught form and unloading of oxygen

lactic acidosis, low CO2, increased temp and metabolites of oxidation (2,3 BPG)

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37
Q

Methoglobin is what?

A

Ferric form (Fe 3+), oxidized iron in the hemoglobin instead of ferrous (Fe+2) form

Toxic for it favors cyanide more readily and does not favor O2 as much

Nitrates indue this and is Useful Rx cyanide poisoning w/ thiosulfate to excrete the thiocyante

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38
Q

Rx for methomoglobinemia (2)

A

methylene blue and Vitamin C

Also can give cimetidine over longer time

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39
Q

Agents known to cause methoglobin(6)

A

Methelglobin is the oxidized form of hemoglobin (Fe +3)

Nitrates/nitrities
Antimalarials - chloroquine/primaquine
Dapsone
sulfonamide
local anesthetics - lidocaine
metoclopramide
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40
Q

Carboxyhemaglobin is?

Complications associated w?

A

hemoglobin bound to CO, see cherry red lips
- have decreased oxygen unloading in the tissues as a result

Causes a L shift in the graph due to readily binding of CO to the hemoglobin and thus not able to carry as much oxygen

(thus why pulse ox still shows high % sat because cannot differentiate what the hemoglobin is saturated w)

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41
Q

CO causes what kind of shift in the oxygen hemoglobin curve

A

Left shift
Causes a L shift in the graph due to readily binding of CO to the hemoglobin and thus not able to carry as much oxygen

(thus why pulse ox still shows high % sat because cannot differentiate what the hemoglobin is saturated w)

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42
Q

that causes a right shift in the hemoglobin oxygen curve and what does that mean from a oxygen unloading stanpoint

A

increased: CO2, [H] (low pH), temp and 2,3 BPG causes a right shift. Meaning there is left hemoglobin saturation at a given partial pressure of oxygen favoring unloading into the tissue(taut form)

The opposite is true for low CO2, [H], temp and 2,3 BPG and CO-> fairs Hg saturation at lower arterial pressure

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43
Q

Anemia leads to what changes in the the following lab results:

PaO2
Total oxygen content
O2 saturation

A

PaO2 normal
total oxygen content decreased
O2 saturation normal

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44
Q

COPD leads to what changes in the the following lab results:

PaO2
Total oxygen content
O2 saturation

A

PaO2 decreased
Total oxygen content down
O2 Saturation decreased

Physiologic shunt moves oxygen away from healthy tissue

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45
Q

Exercise leads to what changes in the the following labs

PaO2
venous O2

A

PaO2 normal

venous O2 is lower
-due to increased metabolites -> right shift on the hemoglobin oxygenation curve

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46
Q

Normal A-a gradient?
- what does it mean

what may raise A-a gradient

A

15-10 mmHg
means the difference in the O2 content in the alveoli - the O2 content in the arterial

elevated gradient may mean hypoxemia

  • V-Q mismatch
  • older age
  • elevated FiO2 (giving O2)
  • fibrosis
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47
Q

If PaCO2 increases and all else is the the same, what happens to PAO2?

A

It decreases

PAO2 =150 - (PaCO2/0.8)

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48
Q

What may change the PI02 in the alveolar gas equation

A

normally PAO2 = PIO2 (PaO2/R)
-> PAO2= 150 - (PaCO2/0.8)

PI O2 varries w/ atmospheric pressure and FiO2( the % oxygen content)

high altitude lowers PAO2

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49
Q

A-a ratio

A

PaO2/FiO2

normally equals 300mmHg
<200 = severe hypoxemia

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50
Q

What may cause normal A-a gradient hypoxeima?(2)

Elevated ?(4)

A

normal ( low O2 in alveoli -> low O2 in blood)

  • elevated altitude
  • hypoventilation

Elevated (not transfering)

  • fibrosis
  • VQ mismatch
  • R to L Shunt
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51
Q

What is ischemia and what are some causes?(2)

A

lack of blood FLOW

Obstruction - MI/stroke
Venous blockage - traffick jam

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52
Q

What is hypoxia and some causes? (4)

A

hypoxia is lack of O2 in the tissue

heart failure, low CO output
anemia
hypoxemia
CO poisoning

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53
Q

V/Q ratio at the base of the lungs?

A

is < 1

due to gravity there is excess perfusion to the amount of ventillation

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54
Q

V/Q ratio at the apex of the lungs

A

> 1

due to blood falling down, there is excess ventilation ( why TB loves it here)

With exercise the ratio approaches 1 w/ capillary recruitment of the apex

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55
Q

V/Q in pulmonary edmea

A

approaches 0 and is known as a shunt

airway obstruction limits the ventilation no mater how much blood flows through

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56
Q

Which of the following circumstances benefits from O2 High V/Q or low V/Q

A

Higher ventilation to perfusion would benefit more because of capillary recruitment

low V/Q or ~ 0 would be a shunt and no mater how much O2 you give it will not make it

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57
Q

V/Q ratio in a PE

A

Blood obstruction leads to V/Q ratio approaching infinity

The small flow can be increased w/ other capillaries being recruited with the ventilation
-assuming less than 100% deadspace

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58
Q

CO2 is carried in the blood how (3)

A
  • dissolve in blood
  • Bicarb
  • carried on the N terminal of the glob in (NOT heme group) as carbaminohemoglobin
  • -binding encourages taut form (O2 release)
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59
Q

Exercise has what effect on the following?

V/Q ratio
pulmonary blood flow
pH
PaO2
PaCo2
Venous O2
Venous Co2
A 
V/Q-> 1
pulmonary blood flow increases w/ CO
pH drops w/ lactic acidosis
Pa O2 - No∆
Pa Co2 - no ∆
Venous O2 - decreases
Venous CO2 - increases
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60
Q

How does hematocrit and Hemoglobin change in high altitude

A

Increases

40%-> 60% hematocrit
15 g/dL -> 20 g/dL

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61
Q

Responses of the bode to high altitude(5)

A

Increase in ventilation
Increase in EPO -> (increased Hct and Hbg)
Increased bicarb excretion (renal comp for Resp alkalosis)
Increase in 2,3 BPG -> right curve shift
Increase in mitcochondria

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62
Q

How does acetazolamide help with acute mountain sickness

A

acetazolimide augments the loss of bicarb already being losses to help with respiratory alkalosis due less alveolar oxygen pressure -> hypoxemia

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63
Q

How many Gs needed to pass out

why do you pass out

A

4-6 Gs

Due to blood pooling in the legs and abdomen -> lack of return to the heart and lack of brain perfusion

64
Q

Clinical derangements seen in acute MTN sickness(4)

A

HA
Fatigue
Acute cerebral edema (hypoxia induced vasodialtion)
Acute pulmonary edema (hypoxia induced vasoconstriction -> local HTN and permeability)

65
Q

Chronic MTN sickness see? (6)

A 
increase in RBC mass and hematocrit
increased blood viscosity -> decreased flow
elevated pulmonary artery pressure 
-> right sided heart enlargement
-> peripheral artery pressure falls
-> CHF
66
Q

How is the following affected by zero gravity?

blood volume
RBC mass
muscle strength
Cardiac Output
bone mass
A

all is decreased

Bone mass lost due to loss of Ca and phosphate

67
Q

What is nitrogen necrosis and pathophys

A

nitrogen necrosis is when N in the air is dissolved into the neural membrane causing reduced neuronal excitability in high pressure environments

Diver -> jovial and carless (drunk)
- loss of strength and coordination

68
Q

Hyperbaric treatment is useful for what 4 conditions

A

CO poisoning
Decompression sickness
Gas gangrene - clostridium
Osteomyolitis

69
Q

Symptoms of decompression sickness(3)

A 
Pain 
->in the joints, and muscles of arms/legs
Neurologic symptoms
 -> dizziness, paralysis, syncope
Chokes
-> SOB, pulmonary edema and death
70
Q

Virchows triad -> risk of DVT

A

hypercoagability
-post partum, sickle cell, polycythemia, CHF, estrogen

Stasis
-post op, long trips, pregnancy

Endothelial damage
- fracture, infection, post op

71
Q

Symptoms of DVT

A

swollen foot or ankle +/-:

  • pain
  • homan’s sign - pain with calf dorsiflexion
  • palable cord
72
Q

Diagnosis of DVT?(2)

A
  • D dimer if low probability

- compression US if high

73
Q

Rx for DVT

A

heparin or enoxaparin until the Warfarin is therapeutic

74
Q

PE symptoms(5)

can mimic?

A 
Pleuritic chest pain*
SOB*
cough
hemptysis - rare
fever

tachypenia*
tachycardia*
acute mental status ∆*

MI

75
Q

Studies that can help diagnosis a PE (6)

A 
elevated D dimer
large A-a gradient
EKG
CT
VQ scan
pulmonary angiogram
76
Q

What is seen in 20% of PE EKGs

A

S1Q3T3
-acute pressure an R ventricle overload

wide S on lead 1

Lead 3:
large Q and inverted T wave

77
Q

Causes of emboli and respective sources(6)

A

Fat emboli - long bone fractures and liposuction

Bacteria - endocarditis

amniotic fluid - post partum

Thrombi - vichows triad

tumor

air- IV(rarely); the bends

78
Q

A negative D dimer tells you what?

A

rules out clotting and PE for lack of fibrin degeneration products, plasmin is not dissolving things

Positive does not tell you much

79
Q

Primary pneumothorax is due to?

A

tall younger thin males that have blebs that rupture

no lung disease prior

80
Q

obstructive lung disease:

FEV1
FVC
FEV1/FVC
TLC

A

FEV1 decreased a lot
FVC decreased
Ratio is decreased - less than 80%

TLC is increased

81
Q

Restrictive lung disease

FEV1
FVC
FEV1/FVC
TLC

A

FEV1 decreases the same amount as FVC. FVC may a little more ->

Normal to slightly increased ratio

TLC is decreased

82
Q

blue bloater

A

chronic bronchitis

hypoxemia, hypercapneia

83
Q

pink puffer

A

emphysemia

hyperventilation, dypsnea

84
Q

Most common cause of pulmonary hypertension?

A

COPD

85
Q

chronic bronchitus is defined clinically as

A

Productive cough > 3months over 2 years

86
Q

Reid2 ty index

A

Measure of chronic bronchitis where goblet cells hypertrophied to greater than 50% the distance of the bronchial wall

87
Q

chronic bronchitis pathophysiology

A

a form a COPD (blue bloater), the patin has constant exposure to som irritant leading to mucal hyperplasia and narrowing of bronchial wall

-> hypoxemia, wheezes, crackles, cyanosis, and late onset dypsnea

88
Q

Emphysema pathophysiology

A

destruction of lung parenchyma either through increased elastase activity w/ lack of alpha1 antitrypsin deficiency or due to smoking leads to increased lung compliance and enlargement of air spaces

NOT cyanotic

89
Q

2 types of emphysema and etiologies

A

Panacinar in the lower lung fields is associated w/ alpha 1 antitrypsin deficiency

Centriacinar is in the upper lung fields and associated w/ smoking

90
Q

Have a patient w/ history of emphysema that presents with acute exacerbated SOB be worried of?

A

pneumothorax

91
Q

Key feature of asthma as an obstructive lung disease

A

it is reversible

92
Q

Curschmanns spirals

A

sloughed off epithelium that forms mural plugs in asthma

93
Q

Charcot leyden crystals

A

breakdown of eosinophils from inflammation associated w/ asthma

94
Q

Findings in asthma

A

cough, wheeze, tachypnea, dypsnea, hypoxemia, low I/E ratio, pulsus paradoxis

95
Q

Pulsus paradoxis is?

Associated w?

A

smaller pals pressure associated with decrease L ventricular filling due to overfilling of the R ventricle upon inspiration

asthma

96
Q

Bronchiectasis is associated w/ what pathology(4)

A

kartageners syndrome
CF
Smoking
allergic bronchopulmonary aspergillosis

97
Q

Bronchiectasis pathophysiology

A

chronic necrotizing infection of bronchi -> permanently dilated airways w/ purulent sputum discharge

abcesses

98
Q

Concern w/ beta 2 agonists?

A

there is some spillover to beta 1, levabuterol has less

see tachycardia and arrhythmia at higher doses

99
Q

adenosine may not work in emergency cardio situations due to the presence of what other drug>

A

Theophylline

100
Q

If a patient is having to use their albuterol inhaler more than 2x/week consider adding on a

A

inhaled steroid

  • fluticasone
  • beclomethasone
  • budesonide
101
Q

antihistamine used in N/V

A

promethazine

102
Q

antihistamine used in vertago

A

meclizine

103
Q

antihistamine used in appetite stimulation

A

cyproheptadine

104
Q

Expectorants (2)

A

Guaifenesin

N acytelcysteine

105
Q

Types of restrictive lung disease

(3 general categories)

A

Poor breathing mechanics
-poor muscular effort(Guillian barrie, myasthenia gravis, polio)

-poor structural apparatus (scoliosis, kyphosis, obesity)

Interstitial lung disease

  • ARDS
  • Neonatal RDS
  • Pneumoconioses
  • Sarcoidosis
  • idiopathic pulmonary fibrosis
  • Goodpastures syndrome
  • Granulamatosis w/ polangiitis - wegeners
  • Langerhans histiocytosis/eosinophilic granuloma
  • Hypersensitivity pneumonitis
  • drug toxicity
106
Q

Interstitial Lung disease causes (10)

A
  • ARDS
  • Neonatal RDS
  • Pneumoconioses
  • Sarcoidosis
  • idiopathic pulmonary fibrosis
  • Goodpastures syndrome
  • Granulamatosis w/ polangiitis - wegeners
  • Langerhans histiocytosis/eosinophilic granuloma
  • Hypersensitivity pneumonitis
  • drug toxicity
107
Q

Sarcoidosis associations/presentation

A

A GREULING Disease

ACE increase
Granulomas - noncaseating
RA - sometimes
Erythema nodosum
Uveitis
LAD (hilar, bilateral)
Idiopathic
Not TB
Gamma globulinema
D- Vit D increase -> hypercalcemia
108
Q

honeycombing of the lungs

A

idiopathic pulmonary fibrosis

109
Q

tennis racket shape cytoplasmic organelles

A

Beirbeck granules in langerhans histiocytosis, eosinophilic granuloma

110
Q

Hypersensitivity pneumonitis examples?

A

Restrictive lung cause

- organic dust leading to farmers lung or pidgins lung

111
Q

Pneumoconioses (4) and brief cause

A

Anthracosis - Coal miners lung

Silacosis - sand balding and the mines

Asbestosis - pumbers/shipyards/roofers

Berylliosis - aerospace manufacturing

112
Q

Anthracosis is and associations?

A

Coal miners lung

  • > restrictive lung disease in the upper lobes
  • damage due to macrophage response

No risk of CA

113
Q

Silacosis

hisology?
associations?(2)

A

Eggshell calcification of hilar lymph nodes
-> macrophages respond to silica and release fibrogenic factors -> restrictive lung disease in the upper lung

Associated w/ increase risk of TB and bronchogenic carcinoma

114
Q

Asbestosis

histology (3)

Associations?

A

see ivory white calcified pleural plaques in the lower lobes

Asbestos bodies - golden brown fusiform rods (dumbbells) w/in

ferruginous bodies - hemosiderin (Fe) laden bode asbestos fibers

Higher risk of
-bronchogenic carcinoma*
mesothelioma

115
Q

golden brown fusiform rods resembling dumbbells found on histology

A

asbestos bodies

116
Q

Beryllliosis

2 associations

A

aerospace manufacturing

  • > noncaseasting granulomas
  • > increased lung cancer risk
117
Q

Therapeutic oxygen in neonatal respiratory distress carries what risk?(2)

A

retinopathy of prematurity( white reflex due to vascular prolix in the inner retina)

and bronchopulmonary dysplasia

118
Q

Maternal steroids should be given how soon before a premature mother gives birth

A

24-48 hrs

119
Q

Causes of ARDS

A 
truama
sepsis
shock
gastric aspitation
pancreatitis
toxic gas inhalation
high O2
uremia
infection
heroin overdose
120
Q

the pathophysiology of ARDS

A

Injury due to (shock, sepsis, High O2, Heroin OD…. ) -> inflammatory cells and mediators and oxygen free radicals

  • > alveolar damage to the Type I pneumocytes or endothelial cells
  • > increase alveolar capillary permeability
  • > Diffuse Alveolar Damage and Hylaine Membrane Disease

Which feeds back and causes more damage w/ recruited cell mediators

Immune system causes more damage after the initial insult

121
Q

Complication Risks of ARDS?

A

DIC and coagulation cascade activation

122
Q

Sleep apnea is defined as

A

repeatesd cessation of Breathing >10s during sleep -> disrupted sleep -> disrupted daytime

123
Q

Pulmonary HTN w/ Sleep Apnea?

A

due to hypoxemia and responding vasoconstriction of the lungs can lead to systemic?

124
Q

4 common METS of lung cancer

A

BLAB

Bone
Liver
Adrenal
Brain

125
Q

Presentation of lung Ca? (variety)

A 
Cough and hoarseness - Recurrent laryngeal
Horners syndrome
Weight loss
coin lesion
wheezing
Dysphagia
paraneoplastic syndromes
-Hypercalcemia w/ squamous cell
-SIADH,  Lambert Eaton, and Cushings in Small cell
126
Q

4 traditional tumors and their respective locations

A

Non small cell

  • Adrenocarcinoma - periphery
  • Large cell carcinoma - periphery
  • Squamous cell - central

Small cell - central

127
Q

Lung Cancers associated w/ Smoking(4)

A

Large cell
Bronchioalveolar subtype of adrenocarcinoma
squamous cell
small cell/ Oat cell

128
Q

Lung cancers not associated w/ Smoking(3)

A

Adrenocarcinoma
mesothelioma
Bronchial Carcinoid tumor

129
Q

Most common cancer in nonsmokers and associated mutation

A

Adrenocarcinoma

  • k RAS
    CEA +

Subtype bronchioalveolar is associated w/ smoking and presents as hazy infiltrates ~ pneumonia

130
Q

Cancer that may first appear as pneumonia or hazy infiltrate

A

bronchioloalveolar subtype of adenocarcinoma

131
Q

Highly anapestic, undifferentiated tumor made of pleomorphic giant cells in the periphery of the lung?

A

Large cell carcinoma

poor prognosis

132
Q

Squamous cell carcinoma of the lung presents as (4)

A

hilar mass in the bronchus
Keratin pearls
Cavitations on CXR or CT
Hypercalcemia w/ paraneoplastic PTHrP

133
Q

Small cell carcinoma presents as (5)

A

Paraneoplastic

  • SIADH
  • Cushings w/ ACTH produced
  • Lambert Eaton (weakness due to Ab against presynaptic Ca channels)

Central and undifferentiated
Kylchitsky cells - small dark blue cells

myc associated

134
Q

Kulchitsky cells

A

small dark blue cells in small cell carcinoma

myc oncogene associated

135
Q

Lung tumor associated with right sided heart lesions and murmurs. What also may be seen (3)

A

Bronchial carcinoid tumor
-neuroendocrine cells secreting serotonin
BFDR

Bronchospasm
Flushing
Diarrhea
R Sided Heart symptoms and murmurs

136
Q

Pancoast tumor may present as(2)

A

Horner syndrome

  • ptosis
  • myosis
  • anhydrosis

hoarsness (recurrent laryngeal nerve compression)

137
Q

Radon exposure leads to an increase risk of?

A

Lung cancer - seen in mines and basements

138
Q

Mesothelioma is found where and presents as? (3)

A

associated w/ apsestosis and found in the pleural lining

hemorrhagic pleural effusions
pleural thickening
psammoma bodies

139
Q

Most common cause of pneumonia in immunecompromised

A

pneumocystis jirovecii

140
Q

most common cause of atypical pneumonia

A

mycoplasma pneumonia

141
Q

common pneumonia in alcoholics

A

Klebsiella

142
Q

common cause of pneumonia in bird handlers

A

chlamydophilia psittaci

143
Q

often causes pneumonia in a patient w/ a history of exposure to bat or bird droppings

A

histoplasma

144
Q

Often cause pneumonia w/ a history of traveling to S Cali, New mexico, W Texas

A

Coccidiodes

145
Q

current jelly sputum pneumonia

A

klebsiellia

146
Q

q fever pneumonia

A

Coxiella burnetti

147
Q

Most common cause of pneumonia in children 1 yr old or younger

A

RSV

148
Q

Most common cause of pneumonia in neonate (birth -28days)

A

Group B

E coli

149
Q

Most common cause on pneumonia in children and young people

A

mycoplasma pneumonia

150
Q

Most common cause of viral pneumonia

A

RSV

151
Q

Wool sorter’s disease pneumonia due to

A

Bacillus anthacis

152
Q

Common cause of pneumonia in ventilator patients and those w/ CF

A

Pseudomonas

153
Q

lung abcesses are often due to

A

aspiration of oropharyngeal contents

  • anaerobes (bacteriodes, fusobacterium, peptostreptococcus)
  • S aureus
  • Klebsiella
154
Q

Chylothorax

A

lymphatic tissue from the thoracic duct that has been damaged leaking into the pleural space causing an effusion

milky white appearance

155
Q

Transudate causes of pleural effusion

A

Volume overload - CHF, cirrosis

Lack of protein - nephrotic syndrome

156
Q

Exudate causes of pleural effusion

A

malignancy, pneumonia, callogen vascular disease, trauma

all due to increase vascular permeability w/ inflammation

USLME Kiss my ass and pray (33 decks)

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