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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
Q

what is the cause of acute cerebral and pulmonary edema in mountain sickness

A

cerebral: hypoxia vasodilation
pulmonary: hypoxic vasoconstriction increases capillary pressure so that edema results

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26
Q

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?

A

DVT from stasis causing PE

mimics MI

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27
Q

multiple long bone fractures

A

fat embolism

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28
Q

elevated D-dimers

A

PE, DVT

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29
Q

Virchow’s triad

A

hypercoagulability, endothelial damage, stasis of blood

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30
Q

ECG changes in PE

A

S1Q3T3
wide S wave in lead I
large Q and inverted T wave in lead III

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31
Q

treatment of DVT

A

heparin for prevention and acute management

warfarin for long-term prevention

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32
Q

blue bloater

A

Chronic bronchitis

hypoxemia and hypercapnia

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33
Q

pink puffer

A

emphysema

dyspnea, hyperventilation

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34
Q

Cuschmann’s spirals

A

asthma

shed epithelium form mucus plugs

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35
Q

most common cause of pulmonary HTN

A

COPD

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36
Q

hallmark of COPD and restrictive lung disease

A

COPD: decreased FEV1/FVC ratio
restrctive: dereased total capacity with normal or increased FEV1/FVC

37
Q

pt has an extended expiratory phase. what is the disease process?

A

obstructive lung disease

38
Q

differential for eosinophilia

A

DNAAACP
Drugs, Neoplasm, Atopic diseases (asthma, allergy), Addison disease, Acute interstitial nephritis, collagen vascular disease, parasites

39
Q

triggers for asthma

A

viral URI, allergens, stress

test with methacholine challenge

40
Q

asthma

A

reversible bronchoconstriction

smooth muscle hypertrophy, Curschmann’s spirals and Charcot-Leyden crystals

41
Q

inhaled treatment of choice for chronic asthma

A

corticosteroids

42
Q

inhaled treatment of choice for acute exacerbations

A

B2 (albuterol)

43
Q

narrow therapeutic index, drug of last resort for asthma/COPD

A

theophylline

44
Q

blocks conversion of arachidonic acid to leukotriene

45
Q

inhibits mast cell release of mediators, prophylaxis

46
Q

inhaled treatment that blocks muscarinic receptors

A

ipratropium and tiotropium

47
Q

inhaled long acting B2 agonist

A

salmeterol

48
Q

blocks leukotriene receptors

A

montelukast, zofirlukast

49
Q

cause rebound nasal congestion if taken long-term

A

pseudophedrine and phenylephrine

50
Q

sarcoidosis symptoms

A 
A GRUELING Disease
ACE increase
Granulomas
Rheumatoid
Uveitis
Erythema nodosum (tibial)
Lymphadenopathy (hilar bilateral)
Idiopathic
Noncaseating granuloma
Gammaglobulinemia
vit D increase
51
Q

H&E of lung biopsy from plumber shows elongated structures with clubbed ends in tissues

A

asebestosis

increased risk of mesothelioma and bronchogenic carcinoma

52
Q

silicosis pts need to worry about

A

TB and cancer

53
Q

bilateral hilar adenopathy, uveitis

A

Sarcoidosis

54
Q

vasculitis and glomerulonephritis

A

Goodpasture’s and Wegener’s

55
Q

anti-glomerular basement membrane antibodies

A

Goodpasture’s

56
Q

Honeycomb lung on x-ray

A

interstitial fibrosis

57
Q

tennis-racket shaped cytoplasmic organelles

A

Birbeck granules (eosinophilic granuloma)

58
Q

iron-containing nodules in the alveolar septum

A

Ferruginous bodies (suggests asbestosis)

59
Q

k-ras mutation and CEA positive lung cancer

A

adenocarcinoma

60
Q

keratin pearls seen on biopsy of hilar mass in smoker

A

squamous cell carcinoma

61
Q

Kulchitsky cells seen in cancer with myc oncogenes

A

small cell (oat cell) carcinoma

62
Q

associated with Lambert Eaton syndrome

A

small cell carcinoma

63
Q

pleomorphic giant cells in a smoker

A

large cell carcinoma

64
Q

nests of neuroendocrine cells with brochospasm, flushing and diarrhea

A

bronchial carcinoid tumor
B-FDR
bronchospasm and wheezing, flushing, diarrhea, right sided heart lesions

65
Q

Psammoma bodies and not associated with smoking

A

Mesothelioma

66
Q

apex of lung and causes Horner’s syndrome

A

Pancoast tumor

67
Q

pt develops bronchogenic lung cancer but has never smoked. He is a coal miner. Exposure to what caused cancer

A

radon gas and silica

68
Q

location of lung metastasis

A

brain, bone, liver (jaundice, hepatomegaly), adrenals

69
Q

lung cancer associated with SIADH

A

small cell lung

70
Q

common cause of pneumonia in immunocompromised

A

pneumocystis jirovecci

71
Q

most common cause of atypical/walking pneumonia

A

Mycoplasma pneumoniae

72
Q

common causative agent for pneumonia in alcoholics

A

Klebsiella pneumoniae

73
Q

can cause in interstital pneumonia in bird handlers

A

Chlamydia psittaci

74
Q

cause of pneumonia in a pt with a history of exposure to bats and bat droppings

A

histoplasma

75
Q

cause of pneumonia in pt who recently visited southwest US

A

coccidioides

76
Q

pneumonia associated with “currant jelly” sputum

A

klebsiella

77
Q

Q fever

A

coxiella burnetti

78
Q

pneumonia from air conditioners

A

Legionella pneumophilla

79
Q

pneumonia in children 1 or younger

80
Q

common cause of pneumonia in neonate

A

Group B strep (G+) E. coli (G-)

81
Q

common cause of pneumonia in children and young adults (college, military)

A

mycoplasma

82
Q

viral pneumonia

83
Q

wool-sorter’s desiase

A

bacillus anthracis

84
Q

pneumonia in ventilator patients and those with cystic fibrosis

A

Pseudomonas aeruginosa

85
Q

pontiac fever

A

legionella pneumophilla

86
Q

30 year old comatose man on ventilator develops infection and dies. pus-filled cavity in lung. what is it

A

lung abscess due to aspiration

87
Q

milky-appearing fluid in pleural space

A

lymphatic effusion

88
Q

causes of a transudative pleural effusion

A 
CHF
Cirrhosis
nephrotic syndrome
PE
fluid overload
89
Q

causes of exudative pleural effusion

A 
pneumonia
infection
TB
cancer
uremia
connective tissue disorder

DIT (28 decks)

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