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Step 1 > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

What is surfactant (chemically)?

A

Dipalmitoyl phosphatidylcholine

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2
Q

What is the shape of Type 1 and Type 2 pneumocytes respectively

A

Type 1 - squamous, Type 2 - cuboidal and clustered

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3
Q

What do clara cells do and what is their morphology?

A

Nonciliated columnar. Secrete component of surfactant, degrade toxins, act as reserve cells

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4
Q

What ratio in amniotic fluid is used to evaluate fetal lung maturity and what is the cutoff?

A

Licithin to spingomyelin ratio. If greater than 2 it indicates lung maturity

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5
Q

When does the lung epithelium become cuboidal ciliated?

A

After the terminal bronchiole

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6
Q

At what vertebral level does each of the three major structures pass through the diaphragm?

A

IVC - T8, Esophagus - T10, Aorta - T12

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7
Q

Formula for dead space

A

Vt * (PaCO2 - PeCO2) / (PaCO2)

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8
Q

What is responsible for the higher affinity for O2 of fetal hemoglobin?

A

A lower affinity for 2,3-BPG

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9
Q

Treatment for cyanide poisoning and what is the reasoning?

A

Nitrites. Oxidizes hemoglobin to methemoglobin (high affinity for cyanide). This keeps CN- away from cytochrome oxidase. Then give thiosulfate to bind cyanide

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10
Q

What does heme do regarding O2 and H+ in the lungs and tissue respectively?

A

Lungs - bind O2 and give up H+, Tissue - release O2 and pick up H+

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11
Q

Cause of primary pulmonary hypertension

A

Inactivation mutation of BMPR2 gene (normally inhibits vascular SM proliferation)

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12
Q

What type of cell mediates intimal fibrosis?

A

Smooth muscle cells

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13
Q

What is the pO2 in the LA relative to the end of the pulmonary capillaries and why?

A

Slightly lower in the LA because deoxygenated blood from bronchial veins mixes with oxygenated blood in the pulmonary veins

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14
Q

Formula for O2 content

A

(1.34 x Saturation) + pO2

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15
Q

Alveolar gas equation

A

PAO2 = PIO2 - PaCO2/R. Normally: PAO2 = 150 - PaCO2/0.8

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16
Q

Normal A-a gradient

A

10-15 mmHg

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17
Q

Causes of increased A-a gradient

A

Shunting, V/Q mismatch, fibrosis

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18
Q

Where in the lung are ventilation, perfussion, compliance, and pO2 respectively the highest?

A

Ventilation - highest at top lowest at bottom, Perfussion - highest at bottom, lowest at top. Compliance - highest at bottom, lowest at top. pO2 - highest at top, lowest at bottom

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19
Q

Give the relationship of PA, Pa, and Pv for each zone of the lung (Zone 1 is most superior, Zone 3 is most inferior)

A

Zone 1 - PA > Pa > Pv. Zone 2 - Pa > PA > Pv. Zone 3 - Pa > Pv > PA

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20
Q

What change is seen in renal excretion of bicarb at high altitude and what can you give to augment this?

A

Increased bicarb excretion, give acetazolamide to augment

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21
Q

What heart abnormality may be seen after living at high altitude for long time?

A

RVH due to pulmonary vasoconstriction

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22
Q

Imaging test of choice for pulmonary embolus

A

Helical CT

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23
Q

Virchows triad

A

Stasis, hypercoagulability, endothelial damage

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24
Q

Homans sign

A

Dorsiflexion of the foot leading to tender calf muscles, check in suspected DVT

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25
Q

Changes seen in RV, FVC and FEV1/FVC in obstructive lung disease

A

RV up, FVC down, FEV1/FVC down (characteristic)

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26
Q

Reid index

A

Measure of gland depth/total thickness of bronchial wall. Above 50 percent in COPD

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27
Q

Which is the blue bloater and which is the pink puffer?

A

Pink puffer is emphysema, blue bloater is chronic bronchitis

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28
Q

4 main obstructive lung diseases

A

Emphysema, Chronic Bronchitis, Asthma, Bronchiectasis

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29
Q

Is exercise-induced asthma immune? Is it more or less common than regular asthma?

A

Less common, it is non-immune

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30
Q

Change in FVC, TLC, and FEV1/FVC in restrictive lung disease

A

FVC and TLC down, FEV1/FVC normal or up (greater than 80 percent)

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31
Q

Interstitial restrictive lung diseases (9)

A

ARDS, neonatal RDS, Pneumoconioses, Sarcoid, Idiopathic pulmonary fibrosis, Goodpasture, Wegener, Eosinophilic granuloma (histiocytosis X), Drug toxicity (bleomycin, busulfan, amiodarone)

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32
Q

Which pneumoconiosis is associated with eggshell calcifications of hilar lymph nodes?

A

Silicosis

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33
Q

Caplans syndrome

A

RA in pt with coal miners pneumoconiosis

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34
Q

What part of the lung is primarily affected by each of the three major pneumoconioses?

A

Coal miners - upper lobes, Silicosis - upper lobes, Asbestosis - lower lobes

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35
Q

What cells are messed up by silicosis and what is the implication of this?

A

Macrophages. May increase susceptibility to Tb

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36
Q

Sites of exposure to silicon and asbestos respectively

A

Silicon - foundries, sandblasting, mines. Asbestos - shipbuilding, roofing, plumbing

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37
Q

Which pneumoconiosis is associated with ivory white calcified pleural plaques?

A

Asbestosis

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38
Q

What cancers are increased in asbestosis?

A

Bronchogenic carcinoma and mesothelioma

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39
Q

Which pneumoconiosis is associated with dumbell shaped rods in in macrophages?

A

Asbestosis

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40
Q

Fibrocalcific parietal pleural plaques in posterolateral mid-lung zones over the diaphragm

A

Asbestosis

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41
Q

At what point in gestation is surfactant made most abundantly?

A

35th week

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42
Q

Risk factors for neonatal RDS

A

Prematurity, maternal diabetes, cesarean delivery (decreased release of fetal glucocorticoids)

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43
Q

Treatment for neonatal RDS

A

Maternal steroids before birth, artifical surfactant, thyroxine

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44
Q

Major causes of ARDS (7)

A

Trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, amniotic fluid embolism

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45
Q

What causes the damage in ARDS?

A

Neurophils destroy alveolar wall, coagulation cascade is activated, oxygen free radicals go to town

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46
Q

What changes are seen in each of the following parameters during ARDS: capillary permeability, compliance, work of breathing, V/Q matching, and PCWP?

A

Capillary permeability down, compliance down, WoB up, V/Q matching down, PCWP normal

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47
Q

Why is it that FEV1/FVC may actually be increased in restrictive lung disease

A

Fibrosis is holding airway open (increased radial traction)

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48
Q

What CBC finding occurs in chronic sleep apnea?

A

Erythrocytosis (increased epo release secondary to hypoxia)

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49
Q

Which way does the trachea deviate in tension and spontaneous pneumothorax respectively?

A

Towards lesion in spontaneous and away in tension

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50
Q

What leads to SVC syndrome?

A

Mediastinal spread of a bronchogenic tumor

51
Q

Give the location (central or peripheral) of the following lung cancers: small cell, adenocarcinoma, squamous cell, large cell

A

Small cell - central, adenocarcinoma - peripheral, scc - central, large cell - peripheral

52
Q

In right heart failure what works to decrease pulmonary edema and what tends to increase it?

A

Lymphatic drainage can increase to compensate for it, however, aldosterone levels are usually high due to low CO, which makes it worse

53
Q

Most common causes of lobar, broncho, atypical pneumonia respectively

A

Lobar - pneumococcus, klebsiella. Broncho - s aureus, h flu, klebsiella, s pneumoniae. Atypical - RSV, adenovirus, mycoplasma, legionella, chlamydia

54
Q

Lung abscess - risk factors, most common organisms, and characteristic finding

A

Risk factors - alcoholism, seizure d/o, CVA, dementia. Organisms - S auerus, anerobes (bacteroides, fusobacterium, peptostreptococcus). Find air-fluid levels on CXR

55
Q

What type of hypersensitivity is hypersensitivity pneumonitis and whom is it most commonly seen in?

A

Seen in farmers and people exposed to bird. Mixed type 3/4

56
Q

What usually causes a spontaneous pneumothorax?

A

Rupture of apical blebs. Seen in tall, thin, young, males

57
Q

Phases of lobar pneumonia and the time frames of each

A

Congestion (first 24 hrs), Red hepatization (days 2-3), Grey hepatization (days 4-6), Resolution

58
Q

What are the typical endings for 1st and second generation H1 blockers respectively?

A

1st gen is -en/-ine or -en/-ate. Second gen is -adine

59
Q

List the first generation H1 blockers (3)

A

Diphenhydramine, dimenhydrinate, chlorpheniramine

60
Q

What are the main differences between first and second generation H1 blockers?

A

1st gen used for motion sickness and sleep aid in addition to allergy. Second gen less sedation due to decreased CNS penetration

61
Q

List the second generation H1 blockers (4)

A

Loratadine, fexofenadine, desloratadine, cetirizine

62
Q

Toxicities of 1st generation H1 blockers

A

Sedation, antimuscarinic, anti alpha adrenergic

63
Q

Isoproterenol

A

Non specific B-agonist which relaxes bronchial smooth muscle but also causes tachycardia

64
Q

Albuterol

A

B2 agonist, use in acute exacerbation

65
Q

Salmeterol

A

Long acting b2 agonist. Use for prophylaxis. AEs are tremor and arrhythmia

66
Q

Theophylline

A

Inhibits PDE, leading to bronchodilation. Narrow therapeutic window. Metabolized by P450. Blocks adenosine

67
Q

Ipratropium

A

Blocks muscarinic receptors (prevents bronchoconstriction). Use in asthma and COPD

68
Q

What corticosteroids are useful in asthma and how do they work?

A

Beclomethasone and prednisone. Inhibit NF-KB which induces TNF-a and other inflammatory agents. 1st line for chronic asthma

69
Q

Zileuton

A

Lipoxygenase pathway inhibitor. Use in asthma

70
Q

Zafirlukast and montelukast

A

Block leukotriene receptors. Use in asthma (esp aspirin induced)

71
Q

What should you tell patients that are on chronic corticosteroids to do?

A

Wash mouth out recently to prevent oral candidiasis

72
Q

Guaifenesin

A

Expectorant. Does not suppress cough reflex

73
Q

N-acetylcysteine

A

Mucolytic. Use in CF. Antidote for acetaminophen overdose

74
Q

Bosentan

A

Used in pulmonary HTN. Antagonizes endothelin-1 receptors.

75
Q

Dextromethorphan

A

Antitussive. Antagonizes NMDA glutamate receptors. Synthetic analog of codeine. Mild opioid. Abuse potential

76
Q

Pseudoephedrine and phenylephrine

A

Sympathomimetic alpha agonists for nasal decongestion.

77
Q

Methacholine

A

Muscarinic receptor agonist. Use in asthma challenge testing

78
Q

Asthma in patient with chronic pain syndrome

A

Likely to be NSAID asthma

79
Q

Type of hypersensitivity in NSAID asthma

A

TRICK QUESTION. It is not hypersensitivity, it is because block of COX overactivates LOX pathway

80
Q

Liver cell adenoma in body builder

A

Assume its anabolic steroids

81
Q

What direction will the diaphgram move on the side of the lesion in spontaneous and tension pneumothorax respectively?

A

Spontaneous - up on side of lesion, tension - down on side of lesion

82
Q

Give the most common cause of 3 types of pneumonia - community typical, community atypical, and nosocomial infections

A

Community typical - strep pneumo, comunity atypical - mycoplasma pneumo, nosocomial - e coli, pseudomonas, staph aureus. Do not get strep pneumo in hospital

83
Q

Decreased percussion, increased tactile fremitus, egophony, pectoriloquy

A

Consolidation (eg lobar pneumonia)

84
Q

What is the most common cause of bronchiolitis?

A

RSV

85
Q

What is the target of the influenza vaccine?

A

A antigen

86
Q

Staccato cough

A

Chlamydia trachomatis in newborn

87
Q

Most common cause of conjuctivitis in second week of life

A

Chlamydia trachomatis

88
Q

Typical source of legionella

A

Water coolers (is a water loving bug like pseudomonas)

89
Q

When you have an atypical pneumonia, what finding should make you suspect legionella?

A

Hyponatremia

90
Q

Extrapulmonary effects of legionella

A

Interstitial nephritis (kills JG cells, lowering renin levels which is how you get hyponatremia)

91
Q

Treatment for legionella

A

Erythromycin

92
Q

Fungal infections in indwelling catheters

A

Candida

93
Q

Fungus carried by starlings and bats

A

Histoplasmosis

94
Q

Narrow based buds

A

Cryptococcus

95
Q

Pigeons

A

Cryptococcus

96
Q

Where does cryptococcus hide out?

A

Air conditioners

97
Q

Treatment for cryptococcus

A

Amphotericin B

98
Q

Broad based bud

A

Blastomyces

99
Q

Fungus associated with earthquakes

A

Coccidioides

100
Q

Most common complication of aspergilloma

A

Massive hemoptysis

101
Q

Most common cause of space occupying lesion in the brain of an AIDS patient

A

Toxoplasmosis

102
Q

Most common AIDS defining lesion

A

PCP

103
Q

Name a systemic fungus, a cancer, and a bacterium that can cavitate like Tb

A

Histoplasmosis, SCC of the lung, Klebsiella

104
Q

What do acid fast stain actually stain?

A

Mycolic acids

105
Q

Where will a foreign body go if you are sitting or standing up?

A

Posterobasal segment of right lower lobe

106
Q

Where will a foreign body go if you are lying down

A

Superior segment of right lower lobe

107
Q

Where will a foreign body go if you are lying on your right side

A

1) Middle lobe or 2) Posterior segment of right upper lobe

108
Q

Where will a foreign body go if you are lying on your left?

A

Lingula

109
Q

What is the most common site for embolization?

A

Femoral vein (as opposed to thrombosis, where most common site is deep veins of leg)

110
Q

What do you have increased risk of with coal workers pneumonconiosis?

A

Tb but not cancer

111
Q

Treatment and main extrapulmonary symptom in sarcoidosis

A

Uviitis. Steroids

112
Q

Cause of silo fillers disease

A

Fermation of gas leads to nitrogen dioxide, which gets inhaled. Wheezing, dyspnea

113
Q

Cause of farmers lung

A

Thermophilic actinomyces (a mold) causes a hypersensitivity reaction and restrictive lung disease

114
Q

Bysinosis

A

Textile industry worker with dyspnea, feel better on weekend. Hypersensitivity and restrictive lung disease

115
Q

Is the lung disease in Goodpasture obstructive or restrictive?

A

Restrictive

116
Q

What is the site of disease in chronic bronchitis, asthma, and bronchiolitis?

A

Terminal bronchioles

117
Q

Histologic findings in chronic bronchitis

A

Goblet cell metaplasia, mucus gland hyperplasia, mucous plugs

118
Q

Type of gas exchange defect in chronic bronchitis

A

Ventilation perfusion mismatch

119
Q

What is the gas exchange defect in emphysema?

A

Even loss of ventilation and perfusion (will not have retention of CO2)

120
Q

Centrilobular emphysema

A

Most associated with smoking. Primarily upper lobes. Destruction of respiratory bronchiole.

121
Q

Panacinar emphysema

A

Entire respiratory unit destroyed, associated with total lack of a1 antitrypsin. Mostly affects lower lobes

122
Q

Pathogenesis of bronchiectasis

A

Infection, destruction of elastic tissue support, dilation of airways. Segmental bronchi, filling with pus

123
Q

Patient coughing up huge amounts of pus

A

Likely to be bronchiectasis. Most common cause is CF

124
Q

Most common primary lung cancer

A

Adenocarcinoma, followed by squamous and then small cell

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