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DIT > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

structures pass through diaphragm

A

T8: IVC
T10: esophagus and vagus n
T12: aorta, thoracic duct, azygos vein

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2
Q

chronic sinusitis, infertility, and situs inversus

A

Kartagener syndrome

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3
Q

embryology of diaphragm

A

septum transversum fuses with pleuroperitoneal fold and pericardioperitoneal fold
common defect is pleuroperitoneal folds

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4
Q

formulas for calculating TLC

A

FRC+IC

IRV+TV+FRC

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5
Q

in lung collapse, what happens to volumes

A

lung volume decreases

intrathoracic volume increases

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6
Q

what gene mutation causes primary pulmonary HTN

A

BMPR2

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7
Q

secondary causes of pulmonary HTN

A

COPD, mitral stenosis, recurrent thromboemboli, autoimmune disease, L->R shunts, sleep apnea, high altitude

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8
Q

treatments for pulmonary HTN

A

Bosentan/Ambrisentan
PG analogs
sildenafil
nifedipine (dihydropyridine CCBs)

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9
Q

physiologic dead space formula

A

VD=VT * (PaCO2-PeCO2)/PaCO2

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10
Q

pulmonary pressure

A

P=Q/R = Ppulmonary-PL atria/CO

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11
Q

form of Hg A has high affinity and low affinity for O2

A

R form - high affinity
T form - low affinity (Taut)
Fe2+ high affinity
Fe3+ low affinity

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12
Q

substances shift oxygen-binding Hg curve to right

A

increased CO2, acid, temperature, 2,3-BPG, and exercise

increased Cl also

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13
Q

treatment for methemoglobinemia

A

methylene blue, vit C

cimetidine if giving drug that induces methemogobinemia

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14
Q

treat cyanide poisoning

A

nitrates to oxidize hemoglobin to methemoglobin that binds cyanide. thiosulfate to convert to thiocyanate for renal excretion

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15
Q

what is normal A-a gradient

A

10-15 mmHg

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16
Q

what might elevate A-a gradient

A

hypoxemia: shunting, V/Q mismatch, fibrosis, increased FiO2, advanced age

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17
Q

women with fibroids is tired all the time. What is the diagnosis

A

anemia due to fibroid bleeding.
PaO2 and saturation are normal
total O2 content is low

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18
Q

alveolar gas equation

A 
PAO2= PIO2 - PaCO2/R
PAO2= 150-PaCO2/0.8
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19
Q

ways to check for hypoxemia

A

increased A-a gradient

PaO2/FiO2 gradient (<200 severe hypoxia (ARDS)

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20
Q

oxygen deprivation can be caused by

A

hypoxemia (decreased PaO2)
Hypoxia (decreased O2 delivery to tissue)
Ischemia (decreased blood to tissue)

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21
Q

V/Q at base, apex, airway obstruction and blood obstruction

A

base 1
airway obstruction -> 0 (no ventilation, so blood is “shunted” without being oxygenated)
blood obstruction -> infinity (physiologic dead space) 100% O2 improves

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22
Q

ways CO2 is transported in blood

A

bicarb
carbaminohemoglobin (bound to n-terminus of globin not heme)
freely dissolved

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23
Q

what G-force causes blackouts

A

4-6

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24
Q

hypoxic environment acclimatization results in

A

increased hematocrit (up to 65) and hemoglobin (up to 20)

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25
what is the cause of acute cerebral and pulmonary edema in mountain sickness
cerebral: hypoxia vasodilation pulmonary: hypoxic vasoconstriction increases capillary pressure so that edema results
26
pt suffers a recent tibia fracture and no history of COPD or asthma is shown to have hypoxia. CXR is normal. What is the cause of the hypoxia and what disease process does it mimic?
DVT from stasis causing PE | mimics MI
27
multiple long bone fractures
fat embolism
28
elevated D-dimers
PE, DVT
29
Virchow's triad
hypercoagulability, endothelial damage, stasis of blood
30
ECG changes in PE
S1Q3T3 wide S wave in lead I large Q and inverted T wave in lead III
31
treatment of DVT
heparin for prevention and acute management | warfarin for long-term prevention
32
blue bloater
Chronic bronchitis | hypoxemia and hypercapnia
33
pink puffer
emphysema | dyspnea, hyperventilation
34
Cuschmann's spirals
asthma | shed epithelium form mucus plugs
35
most common cause of pulmonary HTN
COPD
36
hallmark of COPD and restrictive lung disease
COPD: decreased FEV1/FVC ratio restrctive: dereased total capacity with normal or increased FEV1/FVC
37
pt has an extended expiratory phase. what is the disease process?
obstructive lung disease
38
differential for eosinophilia
DNAAACP Drugs, Neoplasm, Atopic diseases (asthma, allergy), Addison disease, Acute interstitial nephritis, collagen vascular disease, parasites
39
triggers for asthma
viral URI, allergens, stress | test with methacholine challenge
40
asthma
reversible bronchoconstriction | smooth muscle hypertrophy, Curschmann's spirals and Charcot-Leyden crystals
41
inhaled treatment of choice for chronic asthma
corticosteroids
42
inhaled treatment of choice for acute exacerbations
B2 (albuterol)
43
narrow therapeutic index, drug of last resort for asthma/COPD
theophylline
44
blocks conversion of arachidonic acid to leukotriene
zileuton
45
inhibits mast cell release of mediators, prophylaxis
cromolyn
46
inhaled treatment that blocks muscarinic receptors
ipratropium and tiotropium
47
inhaled long acting B2 agonist
salmeterol
48
blocks leukotriene receptors
montelukast, zofirlukast
49
cause rebound nasal congestion if taken long-term
pseudophedrine and phenylephrine
50
sarcoidosis symptoms
``` A GRUELING Disease ACE increase Granulomas Rheumatoid Uveitis Erythema nodosum (tibial) Lymphadenopathy (hilar bilateral) Idiopathic Noncaseating granuloma Gammaglobulinemia vit D increase ```
51
H&E of lung biopsy from plumber shows elongated structures with clubbed ends in tissues
asebestosis | increased risk of mesothelioma and bronchogenic carcinoma
52
silicosis pts need to worry about
TB and cancer
53
bilateral hilar adenopathy, uveitis
Sarcoidosis
54
vasculitis and glomerulonephritis
Goodpasture's and Wegener's
55
anti-glomerular basement membrane antibodies
Goodpasture's
56
Honeycomb lung on x-ray
interstitial fibrosis
57
tennis-racket shaped cytoplasmic organelles
Birbeck granules (eosinophilic granuloma)
58
iron-containing nodules in the alveolar septum
Ferruginous bodies (suggests asbestosis)
59
k-ras mutation and CEA positive lung cancer
adenocarcinoma
60
keratin pearls seen on biopsy of hilar mass in smoker
squamous cell carcinoma
61
Kulchitsky cells seen in cancer with myc oncogenes
small cell (oat cell) carcinoma
62
associated with Lambert Eaton syndrome
small cell carcinoma
63
pleomorphic giant cells in a smoker
large cell carcinoma
64
nests of neuroendocrine cells with brochospasm, flushing and diarrhea
bronchial carcinoid tumor B-FDR bronchospasm and wheezing, flushing, diarrhea, right sided heart lesions
65
Psammoma bodies and not associated with smoking
Mesothelioma
66
apex of lung and causes Horner's syndrome
Pancoast tumor
67
pt develops bronchogenic lung cancer but has never smoked. He is a coal miner. Exposure to what caused cancer
radon gas and silica
68
location of lung metastasis
brain, bone, liver (jaundice, hepatomegaly), adrenals
69
lung cancer associated with SIADH
small cell lung
70
common cause of pneumonia in immunocompromised
pneumocystis jirovecci
71
most common cause of atypical/walking pneumonia
Mycoplasma pneumoniae
72
common causative agent for pneumonia in alcoholics
Klebsiella pneumoniae
73
can cause in interstital pneumonia in bird handlers
Chlamydia psittaci
74
cause of pneumonia in a pt with a history of exposure to bats and bat droppings
histoplasma
75
cause of pneumonia in pt who recently visited southwest US
coccidioides
76
pneumonia associated with "currant jelly" sputum
klebsiella
77
Q fever
coxiella burnetti
78
pneumonia from air conditioners
Legionella pneumophilla
79
pneumonia in children 1 or younger
RSV
80
common cause of pneumonia in neonate
Group B strep (G+) E. coli (G-)
81
common cause of pneumonia in children and young adults (college, military)
mycoplasma
82
viral pneumonia
RSV
83
wool-sorter's desiase
bacillus anthracis
84
pneumonia in ventilator patients and those with cystic fibrosis
Pseudomonas aeruginosa
85
pontiac fever
legionella pneumophilla
86
30 year old comatose man on ventilator develops infection and dies. pus-filled cavity in lung. what is it
lung abscess due to aspiration
87
milky-appearing fluid in pleural space
lymphatic effusion
88
causes of a transudative pleural effusion
``` CHF Cirrhosis nephrotic syndrome PE fluid overload ```
89
causes of exudative pleural effusion
``` pneumonia infection TB cancer uremia connective tissue disorder ```

DIT (28 decks)

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