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Uworld > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

COPD can cause hypoxia which can lead the cortical cells of the kidney to produce

A

EPO

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2
Q

How is the FRC in obstructive and restrictive disease

A

obstructive: increased, restrictive: decreased

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3
Q

When the vagus nerve is stimulated, what neurotransmitter is released and how does this affect the lungs

A

ACh, bronchoconstriction

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4
Q

With thoracentesis, insertion of the needle on the inferior margin of the risks striking the subcostal ________

A

neurovascular bundle

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5
Q

_________ is at risk when doing thoracentesis at the upper border of 10th rib at mid axillary line

A

right hepatic lobe

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6
Q

________ is inversely related to and considered to be the main indicator of total alveolar ventilation

A

Arterial PaCO2

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7
Q

Hypocapnia implies alveolar ________

A

hyperventilation

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8
Q

Hypercapnia implies alveolar ________

A

hypoventilation (upper airway obstruction, dec ventilatory drive, respiratory muscle fatigue, decreased chest wall compliance)

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9
Q

The rubber like properties of elastin are due to extensive _________ between elastin monomers which is facilitated by _________

A

cross-linking, lysyl oxidase

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10
Q

________ is a slowly progressive disease caused by Gram positive anaerobic bacteria. They typically lead to _________ abscesses. Typically develops from ________ and alcoholics are at increased risk

A

actinomycosis, cervicofacial, aspiration

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11
Q

ventilation/perfusion ratio _____ in lung from apex to base

A

decreases

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12
Q

What are the pressures in Zone 1 of the lung and how is the blood flow

A

alveolar>arterial>venous

so because arterial pressure is less than alveolar=no blood flow

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13
Q

What are pressures in zone 2 of the lung and how is the blood flow

A

arterial>alveolar>venous

so because alveolar pressure is greater than venous, blood flow is halted at venous end of capillary bed, so blood flows in pulsatile fashion

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14
Q

What are pressures in zone 3 of the lung and how is the blood flow

A

arterial>venous>alveolar

so continuous blood flow

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15
Q

A normal A-a gradient is from?

A

5-15mmHg

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16
Q

Hypoxemia with a normal A-a gradient can be caused by?

A

Obesity hypoventilation, high altitude

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17
Q

Hypoxemia with an elevated A-a gradient can be caused by?

A
  • R to L shunt (septal defects, pulmonary edema)
  • V/Q mismatch (pulmonary embolism, COPD)
  • impaired diffusion (interstital lung disease)
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18
Q

PE is associated with hypoxemia and what acid base status

A

respiratory alkalosis

because hyperventilation can’t significantly improve blood oxygenation–> increases in breathing lead to hypocapnia because more CO2 is excreted

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19
Q

The pO2 in the left atrium and ventricle is lower than that in the pulmonary capillaries due to mixing _________ blood from the pulmonary veins with _________ blood from the bronchial circulation and thebesian veins

A

oxygenated, deoxygenated

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20
Q

Although ________ is the definite treatment of pulmonary hypertension. You can give __________ in the waiting period because it blocks _________ and leads to vasodilation

A

lung transplant, bosentan, the endothelin receptor

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21
Q

The ________ extend above the level of the first clavicle and first rib and can be damaged in a ________

A

lung apices, pneumothorax

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22
Q

In CF, their sweat high high levels of which two molecules? How is their serum levels

A

Na and Cl, hyponatremia and hypochloremia

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23
Q

CTFR channel functioning is ______ in sweat ducts compared to respiratory and intestinal glands

A

reversed

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24
Q

In CF, the nasal mucosa will have ______ sodium absorption

A

increased

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25
Q

small, ovoid, and budding yeast cells in macrophages

A

histoplasmosis

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26
Q

tissue damage and resultant abscess formation is primarily caused by ________

A

lysosomal enzyme release from neutrophils and macrophages

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27
Q

IL-12 stimulates the differentiation of “naive” helper T cells into the _____ subpopulation. How do you treat a deficiency in IL-12?

A

Th1, IFN gamma which helps activate macrophages

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28
Q

CD8 cells recognize foreign antigens presented with MHC _____. Each of these has what else in its molecule. Which cells have this class?

A

Class 1, heavy chain and beta2 microglobulin, all nucleated cells

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29
Q

CD4 cells recognize presentation from MHC _____ and each of these has what on its molecule. Which cells have this class?

A

class 2, alpha and beta polypeptide chains, antigen presenting cells ( B cells, dendritic cells, langerhans cells)

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30
Q

CF can lead to pancreatic insufficiency and lead to malabsorption of _______ vitamins. Deficiency of which of these contributes to pancreatic ducts with squamous metaplasia?

A

fat soluble, vitamin A

normal levels of vitamin A are required to maintain orderly differentiation of specialized epithelia, including mucus secreting columnar epithelium

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31
Q

What is the most common liver pathology finding in sarcoidosis

A

scattered granulomas

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32
Q

During aerobic exercise, increased skeletal muscle CO2 production increases the PCO2 of _________ blood

A

mixed venous

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33
Q

primary cell lines increased in stable COPD are

A

neutrophils, CD8 T cells, macrophages

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34
Q

The pulmonary vasculature is unique in that hypoxia leads to _________

A

vasoconstriction, so that blood flow is diverted from underventilated areas

-this is the opposite in the systemic circuit so hypoxic tissues receive blood flow

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35
Q

The lung is supplied by ________ from the pulmonary and bronchial systems. As a result lung ________ rarely develops as a complication of pulmonary embolism

A

dual, infarction

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36
Q

Small cell lung cancer paraneoplastic syndromes

A

SIADH, Lambert Eaton, ACTH (cushing syndrome), cerebellar ataxia

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37
Q

Squamous cell lung cancer syndrome

A

Inc PTHrP–> hypercalcemia

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38
Q

adenocarcinoma of lung syndrome

A

hypertrophic ostearthopathy, dermatomyositis, migratory thrombophlebitis

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39
Q

The Ghon complex occurs with _____ infection with TB

A

primary

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40
Q

Physiologic iron loss through ______ and ______ slows the progression of hemachromatosis in women

A

menstruation, pregnancy

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41
Q

Supplemental oxygen in patients with COPD can lead to inc CO2 retention—> ________. A major cause is inc in _______

A

confusion and depressed consciousness, physiologic dead space

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42
Q

What is the clinical triad of fat embolism syndrome

A

acute onset neurological abnormalities, petechial rash, and severe long bone or pelvic fracture

-see fat globules depositing in pulmonary microvessels, CNS, and dermal capillaries

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43
Q

Sepsis is a commom cause of ARDS. These symptoms are most likely from what?

A

fluid accumulation in the alveolar space

-neutrophils provoke an inflammatory response that leads to capillary damage and leakage of protein and fluid into the alveolar space

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44
Q

The diagnostic finding on V/Q for a PE is

A

a perfusion defect without a ventilation defect

-The embolus prevents adequate blood flow to certain parts of lung

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45
Q

Classic sputum findings in asthma

A

granule containing cells with crystalloid masses

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46
Q

The CFTR protein is a trans membrane _____ gated channel

A

ATP

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47
Q

Touch and hearing depend on _______ gated channels

A

mechanically

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48
Q

Photoreceptor and olfactory neurons depend on ________ ion channels

A

cyclic nucleated gated

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49
Q

Changes in electrical membrane potential rely on ____ gated channels

A

voltage

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50
Q

Etanercept and infliximab block what?

A

TNF alpha

-be careful in initiating and check for latent TB

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51
Q

Interstitial lung disease is associated with ______ elastic recoil which leads to ____ radial traction

A

increased, increased

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52
Q

_____________ breathing describes cyclic breathing in which apnea is followed by gradually increasing and then decreasing tidal volumes until the next apneic period

A

Cheyene Stokes

53
Q

At the FRC, the intrapleural pressure is ____

A
  • 5cm H2O

- when get a stab wound, intrapleural pressure equilibriates with air and lets air in and lung collapses=pneumothorax

54
Q

Abnormal BMPR2 gene predisposes to excessive _______ and _______

A

endothelial and smooth muscle cell proliferation

55
Q

Drug induced lupus is commonly caused by which 3 drugs? How are these three drugs metabolized

A

Hydralazine, Isoniazid, Procainamide, phase 2 acetylation in the liver (slow acetylators at greatest risk)

56
Q

Pancoast syndrome is caused by a tumor at the ______ (which is also known as). What are the 4 signs of this?

A

lung apex (superior sulcus)

  • shoulder pain (involve lower brachial plexus)
  • Horner syndrome
  • upper extremity edema
  • spinal cord compression

-also hemoptysis, atrophy of hand muscles, pain C8-T2

57
Q

superior vena cava syndrome presents with a __________ and you see what sx?

A

mediastinal mass, facial flushing, dilated neck vessels, dyspnea

58
Q

How are the PaO2, SaO2, oxygen content in anemia

A

normal and oxygen content dec

59
Q

Laplaces law is and what does it say about smaller spheres?

A

P=2T/r

smaller spheres tend to collapse before larger ones and surfactant prevents this

60
Q

Reid index is the ratio of the thickness of the _______. It is a sensitive measure of _______ enlargement

A

muscoal gland layer in the bronchial wall submucosa to the thickness of the bronchial wall between the respiratory epithelium and bronchial cartilage, mucus gland

61
Q

How is airway resistance along the bronchial tree?

A

It inc from trachea to medium sized bronchi (b/c of turbulent flow) and then dec all the way down to the terminal bronchioles

62
Q

Small cell carcinoma of the lung is thought to be from cells of _______ origin

A

neuroendocrine

-see neuro adhesion molecule, chromogranin, enolase, neurofilaments

63
Q

Lactic acidosis in septic shock results from tissue _______, which impairs ________

A

hypoxia, oxidative phosphorylation and causes shunting of pyruvate to lactate following glycolysis

64
Q

Elderly patients with dementia, history of stroke (paresthesias), and soft and breathy voice may have ______ which is a risk for ______ pneumonia

A

dysphagia, aspiration

-if see facial nerve palsy (consider other neuro deficits liek with swallowing)

65
Q

Obesity typically causes _____ lung disease pattern. How are FEV,FVC,ERV,RV,TLC

A

restrictive, everything is dec except RV is normal

66
Q

apical sub pleural ______ can lead to pneumothorax

A

blebs

67
Q

pt. with dyspnea and chest tightness and triad of prostate cancer, smoker history, and older age lead to inc risk of ________

A

venous thromboembolism, so PE from hypercoagulability

68
Q

Normal bronchi are lined by ______________ epithelium that works to propel things up the ororpharynx. Chronic irritation such as smoking can change this to _________. This change is similar to what process in the esophagus?

A

Pseudostratified ciliated columnar epithelium, stratified squamous epithelium, Barrett’s (where esophageal squamous is replaced by intestinal columnar epithelium from chronic acid exposure

Squamous is more adapted for irritation however this leads to less effective mucociliary clearance—-> inc risk of infections

69
Q

High altitude exposure results in respiratory ________. After 24-48 hrs, chronic respiratory ______ sets in and leads to a dec in serum ________ reflecting renal compensation

A

Alkalosis, alkalosis,bicarbonate

70
Q

In left ventricular failure, fluid in the interstitium signifies dec ___________

A

Lung compliance

71
Q

Pancoast tumor is seen in ______ of the lung and what are the 3 major symptoms

A

Adenocarcinoma, shoulder pain, ptosis, hoarseness because the tumor compressed the cervical sympathetic plexus

72
Q

In obstructive lung disease, how is the ratio with RV and TLC

A

both are inc so get an inc RV/TLC ratio b/c TLC inc through an inc residual volume for more air trapping

73
Q

prolonged sleep apnea can lead to

A

pulmonary HTN, RH failure

74
Q

_______ can be given in theophylline intoxication to dec GI absorption

A

charcoal

75
Q

Pulmonary vascular resistance is lowest at the ___________. Increased lung volumes ___ PVR due to expanding alveoli and decreased lung volumes ____ PVR due to dec radial traction

A

functional residual capacity, inc, inc

76
Q

Cromolyn and nedocromil block _______ degranulation in asthma

A

mast cell

77
Q

_________ have the strongest effects on the inflammatory component of asthma

A

corticosteroids

78
Q

_______ chemoreceptors are responsible for sensing arterial PaO2 and can be suppressed with oxygen administration.

A

peripheral

79
Q

_____ is the major stimulator of respiration in healthy individuals. However, in COPD, response to this is blunted and _______ becomes more important for respiratory drive

A

CO2, O2 (hypoxemia)

80
Q

Pulmonary berylliosis closes resembles which disease (noncaseating granulomas, enlarged lymph nodes)

A

sarcoidosis

81
Q

__________ from inhalation of organic dusts tends to result in diffuse nodular interstitial infiltrates

A

hypersensitivity pneumonitis

82
Q

________ presents with nodular densities and eggshell calcifications

A

pulmonary silicosis

83
Q

Two functions of type 2 pneumocytes

A

produce surfactant and regeneration of alveolar lining

84
Q

Pulmonary emoboli appear as _________ wedge shaped lesions in the periphery of the lung. IV drug users are at risk of developing what in the heart that can lead to this

A

hemorrhagic, tricuspid valve endocarditis

85
Q

Aspirated material is more likely to travel down the ______ lung. When supine, aspiration goes to the ________ segment of the upper lobes and _______ of the lower lobes. Pt.’s who are upright tend to aspirate in the ________ segments of the lower lobes

A

right, posterior, superior, basilar

86
Q

If just suffered an MI, how are lungs going to look

A

transudate in alveolar lumen from pulmonary edema because of left heart failure

87
Q

neutrophils in alveolar fluid signals with what kind of fluid

A

aspiration pneumonia, exudate

88
Q

focal necrosis of alveolar walls and intra alveolar hemorrahge

A

goodpastures,

89
Q

lung harmartomas often have islands of mature __________ , fat, smooth muscle and clefts lined by respiratory epithelium

A

hyaline cartilage

90
Q

neuroendocrine markers are seen in which lung cancer

A

small cell lung cancer and also carcinoid syndrome

91
Q

Presence of hemosiderin laden macrophages in pulmonary alveoli indicates ______ of pulmonary capillary hydrostatic pressures, most commonly from ________

A

chronic elevation, left heart failure

92
Q

Man with right sided calf pain and has a thrombus, thrombus is extracted and has high levels of CK leak out, why?

A

cell membrane damage (repurfusion injury from oxygen free radical damage)

93
Q

The work of breathing is minimized in patients with elastic resistance when their RR is ____ and tidal volume is _______

A

high RR, low TV

94
Q

The work of breathing in patients with obstructive disease (increased airflow resistance) breathe at _____ rate and ____ TV

A

lower RR, higher TV

95
Q

Use of oxygen supplementation for premies can lead to what problem

A

neovascularization (VEGF mediated) into the retina

96
Q

An accentuated second heart sound signals __________

A

pulmonary HTN

97
Q

An obstructive lung lesion in a mainstem ________ can prevent ventilation of entire lung leading to atelectasis and complete lung collapse. See unilateral pulmonary opacification on X ray and a trachea deviated ________ affected side

A

bronchus, affected, see a hemothorax in one lung

98
Q

Silicosis impairs which immune cells and can lead to reactivation of TB

A

macrophages

99
Q

_________ is the most common malignancy associated with asbetos and ______ is the one caused only by asvestos

A

bronchogenic carcinoma, mesothelioma

100
Q

meconium ileum is a very strong finding for _______ and the most likely cause of death is_________. What do you see?

A

cystic fibrosis, pneumonia

-inspissated mass in distal ileum, abnormally viscous mucus in small bowel

101
Q

elastase in the lung is produced in _________

A

alveolar macrophages and granules of neutrophils

102
Q

In ARDS, the _______ is typically normal. You see ___lung compliance, ____work of breathing, ____ventilation perfusion matching

A

pulmonary capillary wedge pressure

-dec, inc, worsened

103
Q

in the fetus the umbilical _____ has the highest oxygen content and then this goes and bypasses the liver and enters the _________

A

vein, IVC

104
Q

Acute pulmonary rejection affects the _______ and chronic affects ______

A

acute: pulmonary and bronchial vessels
chronic: small airways=bronchiolitis obliterans

105
Q

columnar mucin secreting cells that line alveolar spaces without invading stroma or vessels

A

adenocarcioma=malignant neoplasm

106
Q

_______ cancer has the highest mortality amongst men and women

A

LUNG

107
Q

Exposure to carbon monoxide shifts hemoglobin to carboxygemoglobin which leads to a _______ shift

A

Left, so that hgb is less likely to load off the tissues

108
Q

cheyenne stokes breathing is common in

A

heart failure

109
Q

alpha antirypsin is an _________ inhibitor

A

elastase

-so when deficient, have overactive elastase

110
Q

a ______ pneumothorax patients develop tachypnea, dyspnea, tachycardia, and mediastinum, heart, and trachea all shift ______ from the affected side. Compression of the SVC—>________. How do you tx?

A

tension, away, inc venous pressures and jugular venous distention
-place a needle in second intercostal space midclavicular line

111
Q

in pneumothorax, intrapleural pressure _____ with inspiration and this make sit harder to breathe

A

inc
-normally intrapleural pressure is lower than atmospheric pressure during inspiration, allowing the lungs to expand and fill with air

112
Q

What does guanifesin do?

A

expectorant–>thins respiratory secretions, doesn’t suppress cough reflex

113
Q

what does N-acytelcysteine do?

A

liquifies mucus in COPD, CF by disrupting disulfide bonds

114
Q

TOF with pulmonary atresia, give _______ to keep open

A

prostaglandins (alprostadil)

115
Q

In the lungs, there’s and HCO3/Cl exchanger that does what

A

allow HCO3 to enter and Cl to leave

116
Q

in polycythemia vera, you have ____ total blood O2 content and hemoglobin concentration and _____ PaO2 and percent saturation

A

inc, normal

117
Q

3 neuron pathway for Horner’s syndrome

A

first order neuron: descends from posterolateral hypothalamus to level of C8-T2
2nd order neuron: exits spinal cord at T1 and then heads to sympathetic trunk–>superior cervical ganglion
3rd order neuron: ascends along internal carotid and joins ophthalmic division of trigeminal nerve

118
Q

foam stability index measures ________ ratio (mix ethanol and amniotic fluid

A

surfactant

119
Q

How does pulmonary embolism affect CVP, CO, SVR?

A

inc CVP, dec CO, inc SVR

120
Q

For COPD, pulm function tests show inc in what 2 variables

A

RV, TLC

121
Q

In cough syncope you have _______ intrathroacic pressure—> ______ venous return to the heart–>____ CO and cerebral perfusion

A

increased, dec–>dec

122
Q

In ARDS, alveolar filling with proteinaceous material and cellular debris causes _________ gas exchange and _____ shunting—>hypoxemia. Also see ______ dead space and hypercapnia

A

ineffective, right to left, increased

123
Q

As we age how are residual volume, FVC, TLC, chest wall compliance, and lung compliance?

A

dec chest wall compliance and inc in lung compliance from loss of elastic recoil–>in RV, dec FVC, unchanged TLC

124
Q

Central sleep apnea secondary to heart failure is for increased sensitivity to _____

A

CO2 and stimulation of vagal receptors, is a protective measure from hypercapnia

125
Q

During a sever asthma attack, hyperventilation leads to _____ CO2–> respiratory _______

A

inc, respiratory

126
Q

errors in the embryonic lung stage lead to

A

tracheoesophageal fistula

127
Q

Stages of lung development

A 
Every Pulmonologist Can See Alveoli 
Embryonic (mainstream bronchi)
Pseudoglandular (terminal bronchioles)
Canalicular (respiratory bronchioles)
Saccular (alveolar ducts--> terminal sacs)
Alveolar (alveoli up to 8 years)
128
Q

Chronic dyspnea after lung transplantation thing

A

bronchiolitis obliterans

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