Pulmonary and Critical Care Flashcards
pleuritic chest pain arising from the mediastinal or diaphragmatic pleura will be carried by the _____ nerve
phrenic
amniotic fluid lecithin (phosphatidylcholine) to sphinomyelin ration (L/S) is measured to assess ______
considered mature when ration is greater than
fetal lung maturity
2
probability of a child from two parent populations with different mutant allele carrier frequencies will inherit and AR disease is =
25% multiplied by the carrier frequencies
_______ pneumocytes regenerate alveolar lining following injury and produce surfactant
Type II
COPD encompasses _______ and _______. _________ causes destruction of interalveolar walls and decreased ____________, leading to increased ________, ___________, _______________
patients present with hyperinflated lungs, flattened diaphragm, barrel shaped chest
chronic bronchitis and emphysema
emphysema
lung elastic recoil
residual volume, functional reserve capacity, total lung capacity
smaller spheres w/o surfactant will ______ compared to larger ones due to laplace’s law and the difference in _____
collapse
surface tension
ill school children spread to older adult, abrupt onset fever, HA, myalgia, and malaise, symptoms gradually improve =
predisposes to secondary infection bacterial pneumonia from (3)
influenza A
streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae
cromoglycates such as ______ block mast cell degranulation independent of the triggering stimulus
cromolyn and nedocromil
the F508 mutation in the _____ protein is the most common mutation in patients with ____. These patients produce eccrine sweat with higher than normal concentrations of sodium and chloride, thus exposure to high temperatures and exercise can lead to ______
CFTR
CF
hyponatremia
early onset, no smoking history of emphysema is likely due to ______ and shows as lower lobe predominant
due to breakdown of _____
properties of this protein are due to extensive crosslinking between monomers, facilitated by
alpha 1 antitrypsin deficiency
elastin
lysyl oxidase
_________ and aceetylcholine have pharmacologic receptor antagonists that offer clear therapeutic benefit in allergic asthma, while _______ plays a minor role
Leukotrienes (LTC4, D4, E4)
Histamine
anaphylactic shock is due to _____ hypersensitivity which occurs when cell surface bound ____ bridge by ______. This is mediated by basophils, mast cells and ____
Type I
Antibody
Antigen
IgE
pulmonary vascular resistance is lowest at the _____
functional residual capacity
Each MHC class I molecule consists of a heavy chain and a _______. These molecules interact with
Beta 2 microglobulin
CD8 CTL
minute ventilation includes _______ while alveolar ventilation does not
dead space volume
antiretroviral therapy prenattaly will decrease
HIV transmission to infant
F508 mutation in CF leads to protein _____ and failure of ______ followed by proteasome mediated degradation of CFTR proteins
misfolding and failure of glycosylation
the most highly oxygenated blood in the fetus is carried by the _______ which empties directly into the _____ via the ________
umbilical vein
inferior vena cava
ductus venosus
alveolar fluid contains natural proteases like elastase that are derived from infiltrating ________ and alveolar _______
neutrophils
macrophages
hyperinflated lungs, airway mucus plugging, cellular infiltrate of the bronchial wall =
cellular infiltrate due to =
controlled most strongly by
chronic bronchial asthma
leukotrienes
glucocorticoids like fluticasone (inhaled)
HIV pneumonia with CD4+ count 400-1400 =
less than 200 =
Strep pneumo
P jiroveci
the most common cause of lung abscesses in alcoholics is a __________ infection of ________ that should be treated with _________
another common cause of aspiration pneumonia in alcoholics is ______ that should be treated with _______
polymicrobial
anaerobes
clindamycin
Klebsiella
cephalosporins
recurrent respiratory infections, dextrocardia, infertility = which is a form of primary ciliary dyskinesia. This disorder is characterized by situs inversus, chronic sinusitis, and bronchiectasis and is due to the failure of _________ to develop normally
Kartagener syndrome
dynein arms
immunosuppressed, lung infection with infiltrates, unresponsive to antibiotics, stains red on ________ is indicative of ______________ infection. The polysaccharide capsule appears clear and unstained on india ink
mucicarmine
Cryptococus neoformans
immunosuppressed, fever, weight loss, HSM, painful oral ulcers, cough, bone marrow aspirate shows intracellular ovoid bodies in macrophages =
Histoplasma capsulatum
________ is the most aggressive type of lung cancer and can present with paraneoplastic SIADH and hyponatremia. These have neuroendocrine origin and will stain for markers such as _______ or CD56, enolase, chromogranin, and synaptophysin
Small cell carcinoma of the lung
Neural cell adhesion molecule (NCAM)
chest tube placement for pleural effusion is placed into the 4th or 5th intercostal space in the anterior axillary or midaxillary line and traverses through ________, _________, and the parietal pleura
serratus anterior
intercostals
IL-12 stimulates the differentiation of naive Thelper cells into the ______ cell. Patients with IL 12-R deficiency suffer from severe mycobacterial infections due to the inability to mount a strong cell mediated ______immune response. They are treated with ______
IL2, IFNy, lymphotoxin B secreted by
IL4, 5, 10, 13 secreted by
Th1
granulomatous
IFN-y
Th1
Th2
obstructive lung disease due to _______ or _______ shows as a left shift and shrinkage on a volume flow loop, where as restrictive lung disease due to _______ will show as a right shift and shrinkage on a volume flow loop
chronic bronchitis or emphysematous destruction of interalveolar walls
pulmonary fibrosis
________ is a fast acting, depolarizing neuromuscular blocking agent used for rapid sequence intubation that has two phases of blockade
Succinylcholine
sudden onset dyspnea in a setting of calf swelling is strongly suggestive of _____. This leads to the development of a ______ mismatch, hypoxemia, hyperventilation, and ________
pulmonary embolism
V/Q
respiratory alkalosis
________ has an inactivating mutation affecting _____ that results in recurrent infections with catalase positive bacteria and fungi affecting the lungs, skkin, lymph nodes and shows diffuse granuloma formation. These patients lack neutrophil superoxide production.
inheritance =
chronic granulomatous disease
NADPH oxidase
X linked
sensitized ___ cells secrete ____ and _____ which promote B lymphocyte classing switching for IgE synthesis
Th2
IL4
IL13
_________, _________, _________ are able to disrupt the peptidoglycan cell wall of G+ and G- organisms: after treatment, these organisms lose their ability to tolerate ______ stress
penicillins
cephalosporins
vancomycin
osmotic
worsening shortness of breath, normal PaO2, normal SaO2, low oxygen content =
chronic blood loss
daytime somnolence, non restorative sleep with frequent awakenings, morning headaches, obese, systemic HTN =
obstructive sleep apnea
during aerobic exericse, increased skeletal muscle ______ production increases the ______ of ______
CO2
PCO2
Mixed venous blood
patient with chronic fatigue, dyspnea, difficulty concentrating, and increased PaCO2 in the setting of obesity likely has _________, which is an important causes of hypoxemia with a normal alveolar to arterial oxygen gradient
obesity hypoventilation syndrome
aging is associated with steady decreases in chest wall compliance, but increases in lung compliance due to loss of ______ recoil. THis causes an _______ in residual volume, a _________ in forced vital capacity, and an unchanged total lung capacity
elastic
increase
decrease
older adult with incidental pleural thickening with calcification of the posterolateral midlung zones and diaphragm likley has
full blow _______ presents with slowly progressive diffuse pulmonary fibrosis
asbestos related pleural disease
asbestosis
pulmonary _______ resembles sarcoidosis with nodular infiltrates, enlarged lymph nodes, noncaseating granulomas
berylliosis
nodular densities and eggshell calcifcations of the hilar nodes are seen in
pulmonary silicosis
radiographic multiple discrete nodules most prominent in the upper lung zones
coal workers pneumoconiosis
in left ventricular failure, fluid accumulation in the lung interstitium leads to
decreased compliance
polyribosylribitol phosphate, or PRP is a capsule component and major virulence factor for ______. This is the most common cause of _____, and presents with fever, stridor, and dyspnea in unvaccinated children
Haemophilus influenzae type b
epiglottitis
most inhaled particles that lodge in the bronchial tree are removed via proximal transport by ________ epithelial cell
ciliated
adult with long lasting cough, with bursts of coughing so severe that they vomit, that is around kids often =
this a _______ coccobacillus
pertussis (whooping cough)
Gram -
acute respiratory distress syndrome develops results in formation of interstitial and alveolar edema and exudate resulting from increased _______. This leads to _____ lung compliance, _______ work of breathing, ________ V/Q mismatching, and a _________ pulmonary capillary wedge pressure
pulmonary capillary permeability
decrease
increase
worsening
normal
immunosuppressed due to lung tranplant, pneumonitis, enlarged cells with intranuclear and intracytoplasmic inclusions (owls eyes) =
type of virus
CMV
enveloped, dsDNA virus
candida albicans is a normal inhabitant of the _______ including ______, thus it is a common contaminant of sputum culture
looks like
GI tract
oral cavity
budding yeast
sepsis is one of the most common risk factors for ______. As cytokines circulate in response to infection, they activate the pulmonary epithelium and provoke and neutrophil inflammatory response that leads to capillary damage and the leakage of protein and fluid into the alveolar space
acute respiratory distress syndrome
FEV1 <80% =
FEV1/FVC <70%? >70%?
FVC normal? or decreased? less than 80%?
obstructive or restrictive
obstructive, restrictive
obstructive, obstructive, restrictive
emphysema will cause an ______ in total lung capacity, a _______ in diffusing capacity for carbon monoxide, and a _______ in FEV1/FVC ratio
increase
decrease
decrease
cruise travel or hotel visit, headache, confusion, watery diarrhea, fever, bradycardia =
lab findings =
culture on
Legionella pneumonia
hyponatremia
BCYE
COPD can cause hypoxia suffiicient enough to stimulate _____ production
EPO
the ____________ mediates the afferent limb of the cough reflex above the vocal cords. Foreign bodies lodged in the piriform recess can cause damaged to this nerve
internal laryngeal nerve
progressive exertional dyspnea and dry cough, restrictive profile on PFT, and interstitial fibrosis with cystic air space enlargement are characteristic of _______, with honeycomb changes and fibroblastic foci more prominent in the subpleural and paraseptal spaces. This is in the absence of any other indicating symptoms
idiopathic pulmonary fibrosis
_______ infection by M tuberculosis occurs after inhaling the organism. This infection is characterized by a Ghon complex, which consists of lower lobe lung lesion (Ghon focus) and ipsilateral hilar adenopathy with calcification
Primary
________ commonly contaminates hospital _______. The culture is performed on BCYE with L cysteine and iron, and the organism is best visualized with silver stains
Legionella
water systems
young adult african american women with progressive dyspnea on exertion, nonproductive cough, and fatigue with a family history of RA. Non caseating granulomas with aggregates of epitheloid macrophages and multinucleated giant cells
Sarcoidosis
the inflammatory cells that mediate COPD are _____, _____, and ____
neutrophils
macrophages
CD8+ CTL
chronic cough and progressive weight loss with positive acid fast bacilli =
samples of granulomas will yield ______ giant cells with multiple nuclei on the periphery in a horsehoe pattern. The macrophages that form these giant cells are activated by _______
pulmonary tuberculosis
Langerhans
CD4+ Th1 lymphocytes
F508 mutation in CF impairs ____ of CFTR
post translational processing
the intercostal vein, artery, and nerve lie in the subcostal groove on the ______ of the rib.
Thoracentesis should be performed above the 8th rib at the midclavicular line, the 10th rib along the mixaxillary line, and the 12th rib along the posterior scapular and paravertebral line. At the 10th rib, you risk injuring the ____
inferior border
right hepatic lobe
stab wound above the clavicle between the mid clavicular line and the lateral sternal line risks injuring the ______
lung pleura
thickened bronchial walls, lymphocytic infiltrate, mucous gland enlargement, and patchy squamous metaplasia of the bronchial mucosa indicates =
_______ is the leading cause of chronic bronchitis
chronic bronchitis
cigarette smoking
drug that reduces nicotine cravings while decreasing pleasurable effects of cigarettes and other tobacco products =
MOA?
varenicline
parital agonist of NAChR
_______ is the antifungal of choice for oropharyngeal candidiasis in patients without advanced immunodeficiency
Nystatin
Arterial PaCO2 is a direct indicator of ________ status. Hypocapnia implies alveolar _______.
hypercapnia implies ________
upper airway obstruction, reduced ventilatory drive, respiratory muscle fatigue, and decreased chest wall compliance are possible causes of _______
alveolar ventilation status
hyperventilation
hypoventilation
hypoventilation
Th1 cells, IL2, IFN-y, and macrophages contribute to the noncaseating granulomas seen in
african american female with pulmonary infiltrates and hilar adenopathy
sarcoidosis
the work of breathing is minimized in patients with _______ when their respiratory rate is high and tidal volume is low (fast shallow breaths). in contrast, patients with ______ breathe at a lower rate/higher tidal volume (slow deep breaths) in order to minimize work of breathing
pulmonary fibrosis
asthma/COPD
_______ is an anticholinergic agent and derivative of atropine that blocks the action of ACh at MAChR, preventing ________ and reducing parasympathetic stimulation of tracheobronchial submucosal glands in the lungs
Ipratropium
bronchoconstriction
most common site for MRSA colonization is the
anterior nares
in patients with alpha-1 antitrypsin deficiency, _______ dramatically increases the risk of developing panacinar emphysema
smoking