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USMLE > Pulmonary > Flashcards

Pulmonary Flashcards

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USMLE® Step 1 flashcards
1
Q

Pulmonary Hypertension

A

Normal PAP = 10-14
PAH = >25

Idiopathic or Primary PAH

  • heritable
  • often due to an inactivating mutation in BMPR2 (this gene normally inhibits vascular smooth muscle)
  • a mutation in BMPR2 allows for excessive VSM proliferation leading to increased resistance
  • associated with HIV and Kaposi sarcoma
Pg 614 
Treatments 
Bosentan and Androsentan 
- competitively antagonize the endothelin receptor to decrease PVR 
Prostaglandins 
Sildenafil 
Dihydropyridine CCB (nifedipine)

When a lung collapses the intrathoracic volume increases due to chest wall expansion

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2
Q

FRC

A
  • at FRC airway and alveolar pressures are at 0
  • and intra pleural pressure is negative (prevents pneumothorax)
  • PVR is at minimum
  • Compliance = change in lung volume for a given change in pressure, decrease in pulmonary fibrosis, pneumonia, pulmonary edema, increase in emphysema, normal aging.
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3
Q

Cyanide Poisoning

A

Give patient nitrites

  • converts hemoglobin to methemoglobin and allows for increased removal of cyanide by methemoglobin
  • methemoglobin has an increased affinity for cyanide
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4
Q

Methemoglobinemia

A
  • nitrites and nitrates
  • anti malarial drugs
  • dapsone
  • sulfonamides
  • local anesthetic
  • metoclopramide

Treatments

  • methylene blue
  • vitamin C
  • Cimetidine gradually lowers methemoglobin levels

Clinical presentation

  • cyanosis
  • chocolate colored blood
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5
Q

Carboxyhemoglobin

A

Hemoglobin bound to CO in place of O2
- causes a decrease in oxygen binding capacity with a left shit in the oxygen dissociation curve which decreases O2 unloading in tissues

Treatment = hyperbaric O2 and 100% O2

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6
Q

Oxygen Content of Blood

A

Pg 605

COPD

  • decreased arterial PO2
  • physiologic shunt –> decreased O2 extraction ratio
  • decreased blood O2 content

Excercise/activity

  • No change in arterial O2 content
  • decreased venous PO2 due to increased O2 demand and increased oxygen extraction by tissues
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7
Q

Alveolar Gas Equation

A

606

Normal A-a gradient = 10-15mmHg
PAO2 - PaO2

Anemia can occur due to uterine fibroids = causes excessive uterine bleeding

Cyanosis occurs when deoxygenated Hb is >5g/dL

See Picture

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8
Q

High Altitude

A
  • Barometric pressure is decreased
  • decreased PaO2 and PAO2

Compensation
- acute increase in ventilation ==> causes you to blow off more CO2 ==> increased bicarbonate excretion
- respiratory alkalosis with metabolic acidosis compensation
- increase Erythropoietin => Increase Hb and hematocrit (RBC)
- increased 2,3-BPG ==> to allow unloading of oxygen to tissues
- increased mitochondria, increased O2 efficiency
- Treatment = Acetozolamide to help with altitude sickness
Pg 607

Acute mountain sickness symptoms

  • headache
  • fatigue
  • acute cerebral edema due to hypoxia induced vasodilation
  • acute pulmonary edema = hypoxia induced local vasoconstriction which increases capillary pressure which forces fluid out the vasculature and into the lungs

Chronic mountain sickness

  • Increased RBC mass and hematocrit
  • increased blood viscosity and decreased tissue blood flow
  • elevated PAP
  • Right heart enlargement
  • Peripheral artery pressure
  • Congestive Heart failure
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9
Q

Aviation and Space Flight

A

The effect of gravitational force on the body on a flight
- G-force moves blood
- Positive G (pushes you into chair) = Head–> Feet
Visual blackouts occur at about 4-6Gs because there insufficient blood return to the heart and insufficient pumping go blood to brain
- Negative G = Feet –> Head

Space G-force
- G-force that is achieved during a spacecraft liftoff = 8-9Gs

How is the body affected at 0 gravity?

  • decreased blood volume
  • decreased RBC mass
  • decreased muscle strength/work capacity
  • decreased maximum cardiac output
  • loss of calcium and phosphate resulting in loss of bone mass
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10
Q

Deep Sea and Hyperbaric Medicine

A

Nitrogen Narcosis

  • Nitrogen dissolves into neural membranes which causes reduced neuronal excitability
  • diver becomes jovial/careless and become drowsy and lose strength coordination

Decompression sickness = the bends = caisson disease

  • when you are underwater nitrogen disolves in the blood
  • when you come up to sea level to quickly the gases begin to escape the dissolve state and form actual bubbles that can occlude the blood vessels
  • symptoms = pain in joints and muscles of arms and legs, neurological problems (dizziness, paralysis, syncope) , chokes (air bubbles occlude lung capillaries resulting shortness of breath, pulmonary edema, death)
  • Treatment = hyperbaric therapy

Hyperbaric oxygen uses

  • decompression sickness
  • arterial gas emboli
  • carbon monoxide poisoning
  • Gas gangrene
  • osteomyelitis
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11
Q

Asthma

A

Curshmanns Spiral = shed epithelium forms whirled mucus plugs

Charcot Leyden crystals = eosinophilic, hexagonal, double pointed, needle like crystals formed from breakdown of eosinophils in sputum

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12
Q

Lines of Zahn

A
  • interdigiting areas of pink
  • platelets, fibrin and red RBCs found only in thrombi formed before death
  • help distinguish pre and postmortem thrombi
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13
Q

READ STEP BOOK

A

611-613

And DRUGS of Respiratory

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14
Q

Sarcoidosis

A
  • bilateral hilar lymphadenopathy
  • noncaseating granulomatous
  • increased ACE and Vitamin D due to increased 1-alpha hydroxylase
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15
Q

Drugs that can cause Restrictive Lung Disease

A

Bleomycin
Busulfan
Amiodarone
Methotrexate

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16
Q

Lung Cancer

A

Small Cell (oat cell) lung carcinoma

Non-Small cell carcinoma

  • adenocarcinoma - most common type of lung cancer. Usually found on pre-existing lesions. Most common lung cancer found in non smokers and females. CEA positive
  • squamous cell carcinoma
  • large cell lung cancer

617-619

17
Q

Pneumonia

A

Pg 616

Common cause of pneumonia in immunocompromised = Pneumocystis jiroveci

Most common cause of atypical/walking pneumonia = Mycoplasma pneumonia

Common cause in alcoholics = Klebsiella pneumoniae = aspirational

Interstitial pneumonia in bird handlers = Chlamydia psittaci

See Pictures

18
Q

Lung Abscess

A

Pg 617

  • always treat with clindamycin
19
Q

Pleural Effusion

A

Pg 615

- Exudative effusions must be drained as soon as possible for risk of infection

20
Q

Restrictive Lung Diseases

A

Sarcoidosis

  • 10x more common in blacks in US
  • non-caseating granuloma = epithelioid histiocytes
  • can see asteroid body = giant cell configuration
  • peripheral adenopathy
  • cutaneous rash = pretrial
  • hypercalcemia = due to increased Vit D. (increased 1-alph hydroxylase enzyme)
  • BILATERAL HILAR ADENOPATHY

Hypersensitivity Pneumonitis
- noncaseating granulomas in upper portions of lungs

Silicosis

  • glass maker, sand blasting
  • impairs the phagolysosome formation which causes increased TB risk
  • eggshell calcification of hilar lymph nodes
  • increased incidence of TB
  • nodules coalesce and pull lungs inwards

Berylliosis

  • non-caseating granulomas in lungs, hilar lymph nodes (looks like sarcoidosis)
  • increased risk for lung cancer
  • systemic disease with granulomas in all organs possible

Coal Workers Pneumoconiosis

  • with Rheumatoid Arthritis = Caplan syndrome
  • build up of carbon inside macrophages = anthracosis

Idiopathic Pulmonary Fibrosis

  • TGF-beta from injured pneumocytes induces fibrosis
  • must exclude radiation therapy
  • lung transplant is only treatment

ANY NONCASEATING GRANULOMA CAN CAUSE HYPERCALCEMIA

21
Q

ARDS

A

There is decreased lung compliance due to loss of surfactant and damaged alveoli

  • deflating lung is easier than inflating
  • lung damage allows neutrophils to get into alveoli and produce cytokines that damage type 1 pneumocytes
  • hyaline membranes are formed due to protein exudation
  • Type 2 pneumocytes proliferate to fix damaged type 1

Be careful with Ventilator
- high tidal volume ventilation may lead to acute lung injury

22
Q

Pots Puffy Tumor

A
  • Sinusitis in which there is pus collection under periosteum of frontal bone ==> can cause meningitis
23
Q

Influenza Virus

A
  • Single Stranded RNA virus
  • has nucleocapsid surrounded by matrix
    Matrix
  • Hemagglutinin = required for attachment to cells (decreased infectivity with antibody to this)
  • Neuraminidase = required for release of virus from infected cells (antibody correlates with viral shedding and illness severity) => Zanamivir and Oseltamivir

Antigenic drift

  • point mutations
  • cause epidemics
  • occurs in influenza A and B
  • reason we get flu shots every year

Antigenic Shift

  • major change due to exchange of gene segments
  • genetic reassortment
  • occurs in A subtypes only
  • can cause a pandemic

very bad BODY ACHES

24
Q

Cyanosis

A

Patients with normal Hgb manifest cyanosis at higher SaO2 values than patients with anemia

25
Q

Cilia in Respiratory Tract

A

Line all the way up to the terminal bronchioles

26
Q

Obesity Hypoventilation Syndrome

A

Pickwickian Syndrome
- caused by restricted expansion of the chest wall due to severe obesity. This leads to Hypoventilation with a chronically elevated PCO2 and reduced PO2

27
Q

Ether

A

Ether and other organic solvents can inactivate the enveloped viruses which by definition have an outer lipid bilateral coat acquired from the host cell plasma or nuclear membranes

  • Non enveloped viruses are resistant to ether
28
Q

Beta Blocker Overdose

A

Treated by glucagon

29
Q

Diastolic heart Failure

A
  • the ejection fraction is normal and left ventricular end diastolic volume is normal
  • the left ventricular end diastolic pressure is increased
  • due to a stiffened left ventricle
  • increased compliance

Systolic Heart Failure

  • progressive chamber dilation with increased LV volume and elevated LVEDP
  • reduced ejection fraction occurs
  • there is a decrease in contractility
  • decreased compliance
30
Q

Coin Lesion

A
  • 1st check previous X-Ray
  • 2nd = biopsy lesion

Benign lesions

  • GRANULOMA
  • bronchial hamartoma = often calcified = has lung tissue plus cartilage
31
Q

Lung Cancer

A

Likes to metastasize to the adrenal glands

Pleural involvement occurs with adenocarcinoma

32
Q

Inhaled Corticosterids

A
  • fluticasone and budesonide
  • inhibit the synthesis of virtually all cytokines
  • inactivate NF-Kappabeta the transcription factor that induces production of TNF-alpha (inflammatory agent)
  • 1st line therapy in chronic asthma in order to be able to reduce inflammation

USMLE (14 decks)

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