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Step 1 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

In the respiratory tree, cartilage and goblet cells extend until where?

A

Until the end of the bronchi

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2
Q

In the respiratory tree, pseudostratified ciliated columnar cells extend until where then become what?

A

Extend to beginning of terminal bronchioles then transition to cuboidal cells

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3
Q

The alveoli consist of what kind of cells?

A

Simple squamous

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4
Q

Elastase is secreted by which pulmonary cells?

A

Alveolar macrophages

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5
Q

What do Type II pneumocytes do?

A

Secrete surfactant, cuboidal and clustered, precursors to Type I pneumocytes and other Type II cells. Proliferate during lung damage.

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6
Q

What do Type I pneumocytes do?

A

97% of alveolar surfaces, line alveoli, squamous, thin for optimal gas exchange

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7
Q

What do Club (Clara) cells do?

A

Nonciliated low-columnar/cuboidal cells with secretory granules. Secrete a component of surfactant, degrade toxins, and act as reserve cells.

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8
Q

What indicates fetal lung maturity?

A

Lecithin-to-sphingomyelin ration > 2 in amniotic fluid

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9
Q

What penetrates the diaphragm at level T8?

A

Vena cava (8 letters)

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10
Q

What penetrates the diaphragm at level T10?

A

“oesophagus” (10 letters), CN X,

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11
Q

What penetrates the diaphragm at level T12?

A

Aortic hiatus (12 letters), thoracic duct, azygos vein

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12
Q

What structures is the diaphragm derived from? (lots of things)

A

Septum transversum, pleuroperitoneal folds (large portion), dorsal mesentary of esophagus, and muscular outgrowth of lateral body wall

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13
Q

What is a normal total lung capacity?

A

7 L

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14
Q

What is a normal tidal volume?

A

500 mL

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15
Q

How do you calculate physiologic dead space?

A

VD = VT x (PaCO2-PECO2)/PaCO2 “Taco Paco PEco Paco”

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16
Q

How do you calculate minute ventilation? (VE)

A

VE = VT x RR

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17
Q

How do you calculate alveolar ventilation? (VA)

A

VA = (VT-TD) x RR

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18
Q

Does the T (taut) form of hemoglobin have low or high affinity for O2?

A

Low - Taut in Tissues

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19
Q

Does the R (relaxed) form of hemoglobin have low or high affinity for O2?

A

High - Relaxed in Respiratory tract

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20
Q

Describe methemoglobin, how does it present?

A

Oxidized form of Hb (ferric, Fe3+) that does not bind O2 as readily, but has higher affinity for cyanide. May present as cyanosis and chocolate-colored blood.

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21
Q

How do you treat methemoglobin?

A

Methylene blue

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22
Q

What is the clinical presentation of cyanide poisoning?

A

Almond breath, confusion, headache; Cyanide poisons cytochrome C

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23
Q

How do you treat cyanide poisoning?

A

Use nitrites to oxidize Hb to methemoglobin, which binds cyanide, forming thiocyanate which is renally excreted.

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24
Q

Describe carboxyhemoglobin

A

Form of Hb bound to CO instead of O2. Causes less O2 binding capacity with a left shift in dissociation curve. Less O2 unloading in tissues. CO poisoning.

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25
Q

Does a curve shift to the right in the oxygen-Hb dissociation curve indicate higher or lower O2 affinity?

A

Lower

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26
Q

Does a curve shift to the left in the oxygen-Hb dissociation curve indicate higher or lower O2 affinity?

A

Higher

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27
Q

What are the factors that affect Hb’s affinity for O2?

A

H+, 2,3-BPG, altitude, temperature, CO2, and exercise

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28
Q

Does an increase in all factors shift the curve right or left?

A

Right

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29
Q

What are the consequences of a falling level of Hb?

A

A decrease of O2 content of arterial blood, but no decrease in O2 saturation or arterial PO2

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30
Q

Describe cor pulmonale

A

Pulmonary HTN causing RV failure (jugular venous distention, edema, hepatomegaly)

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31
Q

What is a normal A-a gradient?

A

10-15 mmHg

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32
Q

What is the difference between hypoxemia and hypoxia?

A

Hypoxemia is low arterial O2, whereas hypoxia is low oxygen delivery to tissues

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33
Q

What are the three forms in which CO2 is transported from tissues to the lungs?

A

HCO3- (90%), Carbaminohemoglobin/HbCO2 (5%), and Dissolved CO2 (5%)

34
Q

What is the purpose of carbonic anhydrase?

A

CO2 from tissues enters RBC and carbonic anhydrase catalyzes following reaction: CO2 + H2O –> H2CO3

35
Q

Where should thoracentesis be performed?

A

Between 6-8th ribs along midclavicular line, or between 8-10th ribs along midaxillary line, or between 10-12th ribs along paravertebral line

36
Q

Nasal polyps in children may indicate what disease?

A

CF

37
Q

Nasal polyps in asthmatic adults may indicate what?

A

ASA(Aspirin)-intolerant asthma - 10% of asthmatic adults

38
Q

Angiofibromas (benign tumors of nasal mucosa) occur in what patient population?

A

Adolescent males

39
Q

A PE, specifically fat embolus, presents how?

A

Hypoxemia, neuro abnormalities, and petechial rash

40
Q

Why can an amniotic fluid pulmonary embolus lead to DIC?

A

Amniotic fluid is loaded with tissue thromboplastin which activates the coagulation cascade

41
Q

What is the imaging test of choice for PEs?

A

Spiral CT (CT pulm angiography)

42
Q

Which type of PE usually leads to sudden death?

A

Saddle embolus

43
Q

What are lines of Zahn?

A

Interdigitating areas of pink (platelets, fibrin), and red (RBCs) found only in thrombi formed before death. Helps distinguish pre- and postmortem thrombi.

44
Q

What are the 2 most common causes of lobar pneumonia?

A

S pneumo (95%) and Klebsiella (5%)

45
Q

What is the most common cause of secondary pneumonia?

A

S aureus

46
Q

CF patients classically develop pneumonia due to which bug?

A

Pseudomonas

47
Q

What are the most common causes of atypical pneumonia?

A

Mycoplasma (#1), chlamydia, legionella, RSV (infants), CMV (post-transplant), influenza (elderly), coxiella (farmers and vets; Q fever)

48
Q

Aspiration pneumonia is typically caused by what?

A

Anaerobic bacteria

49
Q

On spirometry, what is the hallmark of obstructive lung disease?

A

Reduced FEV1/FVC ratio

50
Q

Which two organs does alpha-1 antitrypsin deficiency affect?

A

Lung- Emphysema
Liver- Misfolded protein accumulates in liver leading to cirrhosis. PiM is normal allele, PiZ is most common mutation. Protein accumulates in ER of hepatocytes and stains PAS-positive.

51
Q

What is the pathogenesis of chronic bronchitis?

A

Hyperplasia of mucus-secreting glands in the bronchi –> Reid index (thickness of gland layer/total thickness of bronchial wall) > 50% (normal is

52
Q

Who gets centriacinar emphysema?

A

Smokers

53
Q

Who gets panacinar emphysema?

A

alpha-1 antitrypsin deficiency

54
Q

Describe the pathogenesis of asthma

A

A genetic predisposition plus an allergen induces Th2 phenotype of CD4 T cells. These Th2 cells secrete IL-4 (which converts IgG–>IgE), IL-5 (which attracts eosinophils), and IL-10 (which induces Th2 phenotype proliferation)

55
Q

Curschmann spirals and Charcot-Leyden crystals are seen in the sputum of which patients?

A

Asthmatic patients

56
Q

What are Curschmann spirals and Charcot-Leyden crystals?

A

Curschmann spirals - shed epithelium forms mucus plugs

Charcot-Leyden crystals - formed from breakdown of eosinophils in sputum

57
Q

The most severe form of an asthma exacerbation is called what?

A

Status asthmaticus

58
Q

What is bronchiectasis?

A

Chronic necrotizing infection of bronchi leading to permanently dilated airways

59
Q

Why do patients with sarcoidosis have hypercalcemia?

A

The non-caseating granulomas contain an enzyme which activates VitD (any disease with many many non-caseating granulomas will present with hypercalcemia)

60
Q

Familial forms of primary pulm hypertension are associated with inactivating mutations of what gene?

A

BMPR2

61
Q

What are plexiform lesions?

A

Characteristic vascular change of pulm arteries in pulm HTN

62
Q

In Acute Respiratory Distress Syndrome, what happens to the lung?

A

Damage to lung-capillary interface results in leakage of proteins into alveoli which reorganize to form hyaline membranes. Hypoxemia and cyanosis develop as a result of thickened membrane.

63
Q

Which lung cancer may produce PTHrP?

A

Squamous cell carcinoma

64
Q

What is the most common lung cancer in non-smokers?

A

Adenocarcinoma

65
Q

What is the most common lung cancer in female smokers?

A

Adenocarcinoma

66
Q

Bronchioloalveolar carcinoma arises from which cell type?

A

Clara cells

67
Q

Carcinoid tumor arises from which cell type?

A

Neuroendocrine cells

68
Q

Which lung cancer is chromogranin positive?

A

Carcinoid tumor (neuroendocrine cells)

69
Q

How does carcinoid tumor classically present?

A

Polyp-like mass in the bronchus

70
Q

What kind of staging is used for primary tumors of the lung?

A

TNM staging

71
Q

What is a unique site of metastasis of lung cancer?

A

Adrenal gland

72
Q

How does sarcoidosis usually present?

A

Bilateral hilar lymphadenopathy, noncaseating granulomas, and increased Ca and ACE

73
Q

Hypersensitivity pneumonitis is which type of hypersensitivity reaction?

A

Mixed III/IV reaction

74
Q

What is Caplan syndrome?

A

Rheumatoid arthritis and pneumoconionses with intrapulmonary nodules

75
Q

“Ivory white” calcified pleural plaques are indicative of what?

A

Asbestosis (these are not precancerous)

76
Q

Ferruginous bodies are associated with what?

A

Asbestosis

77
Q

What is anthracosis?

A

Asymptomatic condition where carbon is trapped in macrophages and hilar lymph nodes

78
Q

What is the pathogenesis of silicosis?

A

Macrophages respond to silica and release fibrogenic factors, leading to fibrosis. Silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB. Increased risk of bronchogenic carcinoma.

79
Q

What is vasomotor rhinitis?

A

Chronic nasal discharge that worsens with sudden changes in temperature, humidity, or with exposure to odors or alcohol. Headaches, anosmia, and sinusitis are often reported.

80
Q

What is nasal vestibulitis?

A

Staphy infection of the internal nares and associated hair follicles. Can cause mucosal edema and nasal congestion.

81
Q

Which drugs can classically cause interstitial lung disease?

A

Bleomycin, busulfan, amiodarone, methotrexate)

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