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respiratory Flashcards

1
Q

Caplan syndrome

A

RA and pneumoconioes with intrapulmonary nodules

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2
Q

Asbetosis

A

Affects lower lobes; ferruginous bodies (golden-brown fusiform rods resembling dumbbells) in alveolar sputum; “ivory white” calcified pleural plaques; high risk of lung cancer (bronchogenic carcinoma > mesothelioma)

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3
Q

berylliosis

A

Beryllium in aerospace and manufacturing industry; affects upper lobes; granulomatous on histolgy and thus, on occasion, responsive to steroids

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4
Q

Coal workers’ pneumoconiosis

A

Affects upper lobes; black lung disease 2/2 prolonged coal dust exposure; perilymphatic accumulation of coast dust-laden macrophages

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5
Q

Silicosis

A

Foundaries, sandblasting, mines; upper lobes; macrophages respond to silica and release fibrogenic factors, silica also disrupt phagolysosomes and impair macrophages which increase susceptibility to TB; birefringent silica particles surrounded by fibrous tissue and “eggshell” calcification of hilar lymph nodes; increase risk of bronchogenic carcinoma

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6
Q

Neonatal respiratory distress syndrome: diagnostic test, complications, treatment complications, treatment

A

Licithin:spingomyelin ratio <1.5 in amniotic fluid; persistently low O2 tension leads to risk of PDA; other complications include metabolic acidosis, necrotizing enterocolitis;therapeutic supplemental oxygen can result in retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia; maternal steroids before birth, artificial surfactant for infant

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7
Q

Small cell carcinoma

A

Central; neoplasm of neuroendocrine Kulchitsky cells small dark blue cells; chromogranin A positive; amplification of myc oncogenes common; rx with chemo

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8
Q

Adenocarcinoma

A

Peripheral; most common lung cancer overall and most common among non-smokers; activiating mutations of KRAS, EGFR, ALK; associated with hypertrophic osteoarthropathy (and clubbing); histo: glandular pattern on histology, stains mucin positive;

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9
Q

Bronchioloalveolar subtype of adenocarcinoma

A

Grows along alveolar septa, apparent “thickening” of alveolar walls; CXR shows hazy infiltrates similar to pneumonia

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10
Q

Squamous cell carcinoma

A

Central: cavitation, cigarattes, hyperCalcemia 2/2 PTHrP; histo: keratin pearls and intracellular bridges

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11
Q

Large cell carcinoma

A

Peripheral; highly anaplastic undifferentiated tumor; poor prognosis; histo: pleomorphic giant cells, can secrete beta-hCG

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12
Q

Bronchial carcinoid tumor

A

Systems due to mass effective, occasionally carcinoid syndrome; histo: nests of neuroendocrine cells chromogranin A positive

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13
Q

TB drugs MOA: rifampin

A

inhibits bacterial DNA-dependent RNA polymerase, inhibiting transcription

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14
Q

Total airway resistance breakdown

A

UR tract (nasal passages, mouth, pharynx, larynx) account for half; in LR tract, first 10 out of 21 generations of bronchi contribute most with 2-5 being the highest; in contrast, airways <2 mm in diameters like bronchiolescontribute less to total airway frictional resistance

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15
Q

TB drugs MOA: isoniazid

A

inhibits mycolic acid (long branched-chain fatty acids in the outer peptidoglycan cell wall) and other mycobacterial virulence factors (sulfatides, wax D, cord factor)) synthesis

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16
Q

Lamellar bodies of type II pneumocytes function

A

Store and release pulmonary surfactant into fluid layer of the inner surface of alveloi and reduce surface tension; deficiency of this can lead to patchy alveolar atelectasis

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17
Q

Pathogenesis of centriacinar emphysema

A

Chronic, heavy smoking injures bronchioles, activates alveloar macrophages that attract PMN and macrophages to come and release proteases that degrade extracellular cellular matrix; the resultant protease-antiprotease imbalance leads to acinar wall destruction and irreversible airspace dilatation distal to the terminal bronchioles

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18
Q

Phrenic nerve referred pain MOA

A

Irritation of the mediastinal or diaphragmatic parietal pleura will cause sharp, inspirational pain in C3-C5 distribution (base of the neck and over shoulder)

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19
Q

Lung abscess 3 MOA

A
  1. oropharyngeal, with anaerobic oral flora, a.w. LOC, dysphagia; 2. complication of bacterial pneumonia, more common with immunosuppression, old age, chronic lung disease; 3. septicemia/infectious endocarditis, more common agents being Staph and Strep
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20
Q

Sarcoidosis pw

A

Erythema nodosum, arthrlagias, hilar LN, elevated serum ACE, liver involvement with scattered noncaseating granulomas

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21
Q

Mycobacterial resistance to isoniazid

A

Non-expression of the catalase-peroxidase enzyme or through genetic modification of the isoniazid binding site on the mycolic acid synthesis enzyme

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22
Q

TB med MOA: ethambutol

A

Inhibit synthesis of the mycobacterial cell wall; resistence develops when mycobacteria increases production of arabinosyl transferase

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23
Q

TB med MOA: streptomycin

A

Aminoglycoside antibiotic that inhbitis mycobacterial protein synthesis by disabling ribosomal 30S subunit and disrupt translation

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24
Q

TB med MOA: pyranizamide

A

Converted to active form by mycobacterial enzyme pyrazinamidase, and after lowers the environmental pH in susceptible strains

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25
Q

Allergic asthma MOA and rx

A

Leukotrienes and ACh cause bronchospasm; leukotrienes infiltrate bronchial mucosa to cause bronchial constriction and yperreactivity, mucosal edema, mucus hypersecretion

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26
Q

Isoniazid monotherapy used for:

A

Positive PPD and negative CXR with no evidence of clinical disease

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27
Q

Pulmonary fibrosis pw, CXR, PFT, biopsy

A

Progressive dyspnea; b/l reticulonodular opacities; restrictive pattern (decreased FEV1/FVC, normal ratio, decreased diffusion capacity); lung biopsy showing patchy interstitial lymphocytic inflammation and fibrosis of alveolar walls

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28
Q

Viral bronchiolitis pw

A

Prodrome of low-grade fever, rhinorrhea, followed by progressive cough, tachypnea, and agitation with exam showing b/l wheezing, prolonged expiration, scattered rales; most commonly attributed to RSV infection; normally self-limited, if serious can give humidified oxygen, IV fluids, and ribavirin (nucleoside analog that inhibits guanine nucleotides)

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29
Q

Oseltamivir

A

Sialic acid analogue inhibitor of flu A/B viral neuraminidases

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30
Q

Ganciclovir

A

guanine nucleoside analogue, similar to acyclovir but that it exhibits greater activity against CMV DNA polymerase

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31
Q

Amantadine

A

Impaires uncoating of flu A virion after host cell endocytosis

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32
Q

High altitude exposure

A

Hypoxemia with chronic respiratory alkalosis, with corresponding decrease in bicarb 2/2 renal compensation

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33
Q

Nyastatin MOA

A

Binding to ergosterol in fungal cell membrane, causing formation of poors and leakage of fungal cell contents; not absorbed in GI tract and administered as an oral agent against oropharyngeal candidiasis

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34
Q

Dust particle clearance: 10-15 um, 2.5-10 um, < 2 um

A

Trapped in URT, cleared by mucociliary transport, phagocytized by macrophages in the terminal bronchioli and alveoli, who release PDGF and IGF to induce inflammation and fibroblasts (pneumoconiosis)

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35
Q

Extrinsic allergic asthma: sputum findings

A

Eosinophils (granule-containing cells) that are recruited and activated by IL-5 secreted by TH2 helper T cells, Charcot-Leyden crystals;

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36
Q

L/S and fetal lung development

A

Phosphatidylcholine (lecithin) and phosphatidylglycerol are major componenets of lung surfactant; fetal lung lecithin production increases sharply at 30 weeks gestation and phosphatidylglycerol production increases at 36. L/S ratio of >2 indicates adequate surfactant production

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37
Q

Chloride shift

A

Within RBC, carbonic anhydrase forms bicarb which diffuse into the plasma. To maintain, electrical neutrality, chloride ions diffuse into RBC

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38
Q

Anaphylaxis markers

A

Mast cell release of histamine and tryptase

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39
Q

Degranulation of mast cells MOA

A

Aggregation of IgE-Fc receptors on the mast cell surface

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40
Q

Ethambutol SE

A

optic neuritis that results in color blindness, central scotoma, and decreased visual acuity

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41
Q

ARDS histo

A

Diffuse injury to alveolocapillary membrain results in interstitial and intraalveolar edema, acute inflammation, alveolar hyaline membranes (fibrin exudate, plasma protein-rich edema fluid mixed with cytoplasmic and lipid remnants of necrotic epithelial cells)

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42
Q

PMN elastase

A

Major protease of extracellular elastin degradation; inhibited by alpha-1-antitrypsin

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43
Q

Alpha-1-antitrypsin deficiency

A

Unopposed action of PMN elastase on alveolar walls; a.w. panacinar emphysema and liver cirrhosis; smoking dramatically increases risk of panacinar emphysema as oxidant products of smoke inactivate edogenous a1-AT, producing a “functional” a-AT deficiency as well.

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44
Q

CF MOA

A

3-base pair deletion in CFTR gene at position 508; which impaires posttranslational processing of CFTR , degradation in proteosome and complete absence in affected epithelial cells

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45
Q

Vitamin E deficiecy

A

needed to maintain orderly differentiation of specialized epithelia, including mucus-secreting columnar epithelia of the ocular conjunctiva, respiratory tracts, urinary tracts, and pancreatic exocrine ducts. Deficiency can lead to squamous metaplasia of such epithelia to keratinizing epithelium

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46
Q

Arterial PaCO2 is a direct indicator of alveolar ventilation status: Hypocapnia and hypercapnia meanings

A

Alveolar hyperventilation; hypoventilation (upper airway obstruction, reduced ventilatory drive, respiratory muscle fatigue, and decreased chest wall compliance

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47
Q

Foreign body damage to what nerve causes damage to the cough reflex?

A

Internal laryngeal nerve, located behind a thin mucosa overlying the piriform recess (where food gets caught)

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48
Q

Pulmonary artery hypertension two-hit hypothesis

A

First hit: abnormal BMPR2 gene; second hit: second insult (infection, drugs, ion channel defect results in vascular smooth proliferation in the pulmonary vasculature and elevated pulmonary pressure

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49
Q

Which parts of the respiratory tract are lined with pseudostratified, columnar mucus-secreting spithelium? Stratified squamous spithelium?

A

Nose, paranasal sinuses, nasopharynx, most of the larynx and the tracheobronchial tree; oropharynx, larygngopharynx, anterior epiglottis, upper half of the posterior epiglottis, and true vocal cords

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50
Q

Partial pressure of oxygen in alveolar air

A

150 - PaCO2/0.8

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51
Q

Thoracentesis location

A

Above 7th rib at midclavicular line, 8th rib along midaxillary line, and 11th rib along posterior scapular line; insertion of the needle below these points increases risk of penetrating abdominal structures; insertion of th eneedle on the inferior margin risks striking the subcostal neurovascular bundle

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52
Q

Adenocarcinoma in situ

A

Well-differentiated dysplastic columnar cells that line the alveolar septa without vascular or stromal invasion; can produce copius amounts of water sputum (bronchorrhea); imaging shows discrete msas or pneumonia-like consolidation

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53
Q

Cromolyn/nedocromil

A

Mast stabilizing agents that inhibit degranulation independent of stimuli present; less effective than inhaled GC, considered 2nd line.

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54
Q

COPD PFT

A

Decreased FEV1/FVC; emphysema also increases TLC/RV

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55
Q

Restrictive lung dz PFT

A

Decreased lung volume (TLC, vital capacity, FRC, RV); FEV1/FVC may be increased

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56
Q

How to minimize work of breathing in patients with increased elastic resistance (e.g. pulmonary fibrosis) and patients with increased airflow resistance (e.g. asthma, COPD)

A

Fast, shallow breaths (RR high and tidal volume low); slow, deep breaths (lower rate, higher volume)

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57
Q

Pulmonary edema effect on lung compliance

A

Decreases lung compliance to the point where normal inspiratory effort is not enough to distend the lungs; results in poor gas exchange

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58
Q

N-aetylcysteine MOA

A

Mucolytic agent used in CF, cleaves disulfide bonds within mucus glycoproteins and loosen thick sputum

59
Q

Restrictive lung dz: Expiratory flow rates increased due to?

A

Increased elastic recoild 2/2 decreased lung compliance and increased radial traction exerted on the conducting airways by the fibrotic lung

60
Q

CFTR MOA at mucus/exocrine glands and sweat glands

A

ATP-gated chloride channel that pumps against concentration gradient; at mucous membranes/exocrine glands, pumps Cl out, which creates electrical gradient that pulls Na and water with it; at eccrine sweat glands, salt is removed from the originally isotonic sweat (basis for the sweat choride test)

61
Q

Integrated exercise response

A

Increases HR, CO, RR so that arterial blood gases remain relatively constant (venous oxygen decreased and venous CO2 increased)

62
Q

MAC infection in HIV presentation, rx

A

Fever, weight loss, diarrhea, reticuloendothelial sx (marked anemia, HSM, elevated alk phos and lactate dehydrogenase); in contrast to TB, grows well at high temperatures; azithromycin

63
Q

pO2 in LA is lower than that in the pulmonary capillaries: why?

A

Deoxygenated lood from the bronchial arteries mixes with oxygenated blood from the pulmonary veins

64
Q

Cerebral circulation regulators

A

Systemic blood pressure (less important) and arterial blood gas levels, esp. CO2 (more important); Direct/linea relationship between CO2 and cerebral blood flow (O2 effect kicks in if O2 less than 50).

65
Q

Bronchiolitis obliterans

A

Chronic rejection of lung transplants; lymphocytic inflammation, necrosis, and fibrosis of the bronchiolar wall eventually leading to occlusion of the bronchiolar lumen

66
Q

Why clindamycin over metronidazole for lung abscess?

A

Because it covers aerobic organisms like s. pneumonia and s. aureus as well

67
Q

Type II pneumocyte function

A

Regeneration of alveloar lining following injury, surfactant production, and serve as progenitor for type I pneumocytes

68
Q

Azoles MOA, SE

A

Inhibit fungal cytochrome P450 enzyme synthesis of ergosterol; inhibit human P450 system and cause drug-drug interactions

69
Q

Idiopathic pulmonary fibrosis surgical biopsy

A

Extensive interstitial fibrosis with paraseptal and subpleural cystic airsplace enlargement (honeycomb lung)

70
Q

Amphtericin B MOA

A

Binds ergosterol in fungal cell membran to create pores and lyse cell

71
Q

Terbinafine MOA

A

Inhibits fungal enzyme squalene-2,3-epoxidase, decreasing synthesis of ergosterol

72
Q

Griseofulvin MOA

A

Binds microtubules, inhibits mitosis; only effective in dermatophyte fungi as it accumulates in keratin-containing tissues

73
Q

Flucytosine MOA; used with what other agent to treat what condition?

A

inhibit both DNA/RNA synthesis in fungal cells; combined with amphotericin B to treat cryptococcal meningitis

74
Q

Meconium ileus MOA

A

Abnormally dehydrated meconium (inspissated green mass) leads to distal small bowel obstruction in a neonate (bilious vomiting, abdominal distention, air fluid levels, and small bowel diltation)

75
Q

CF mortality cause

A

Persistent, treatment-resistent infectious pneumonias, bronchiectasis, bronchitic obstructive pulmonary disease and associated cor pulmonale

76
Q

ARDS characterized by:

A

Increased pulmonary capillary permeability, leaky alveolocapillary membrane; interstitial/intra-alveolar edema, inflammation, hyaline membrane formation leads to decreased lung compliance, increased WOB, and decreased oxygen difusoin capacity. More severe involvement can also cause V/Q mismatch.

77
Q

ARDS has what normal finding?

A

PCWP (indicates lack of cardiogenic cause)

78
Q

Respiratory tract changes in structure/function

A

Bronchi: psuedostratified columnar ciliated epithelium with goblet cells, submucosal mucoserous glands, and cartilage; bronchioles, terminal bronchiols, and respiratory bronchiols have ciliated simple cuboidal cells (no goblet cells, glands, cartilage); epitheliail cilia persist up to the end of the respiratory bronchioles

79
Q

Asbetosis CXR

A

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

80
Q

Emphysema

A

Decreased FEV1/FVC, increased total lung volume, and decreased diffusing capacity 2/2 destruction of alveoli and adjoining capillary beds

81
Q

Pulmonary HTN MOA

A
  1. Medial hypertrophy (increased arteriolar smooth muscle thickness); 2. Intimal fibrosis (onion skinnin); 3. Luminal narrowing; 4. Plexiform lesions (interlacing tufts of small vascular channels)
82
Q

Pulmonary arterial hypertension (PAH) mutation

A

Inactivating mutations involving pro-apoptotic BMPR2 gene

83
Q

Pulmonary arterial hypertension temporizing measure until transplant

A

Bosentin, an endothelin-receptor antagonist that blocks endothelin (potential vasoconstrictor that also stimulates endothelial proliferation)

84
Q

Pyrazinamide requires what environment?

A

Acidic environment (i.e. within macrophage phagolysosomes); other agents are more effective against extracellular mycobacteria

85
Q

Methacholine

A

Muscarinic cholinergic agonist that causes bronchoconstriction and increased airway secretoins; decrease in FEV1 by more than 20% after challenge indicates bronchial asthma

86
Q

Antifungals

A

Polyenes (binds to ergosterol, creates pores), azoles (inhibit ergosterol synthesis), echinocandins (inhibit glucan synthesis and inhibit cell wall formation), pyrimidines (interferes with fungal DNA/RNA synthesis)

87
Q

Amphotericin B SE

A

Binds to cholesterol; dose-dependent nephrotoxicity 2/2 decreased GFR; hypokalemia, hypomagnesemia; anemia

88
Q

Bronchiolitis obliterans organizing pneumonia (BOOP) MOA

A

Inflammation, granulation tissue proliferation that obstructs small bronchioles and airways and consolidate the alveoli

89
Q

S. pneumo pneumonia MOA

A

1.Congestion 2/2 fluid extravation into alveolar space, lobe is red, heavy, and boggy, first 24 hrs; 2. “red hepatization” as PMN, RBC accumulate in alveolar space, red/firm lobe, days 2-3; 3. “gray hepatization” due to deposition of fibrinous material in the alveolar space (RBCs disintegrate), gray-brown firm lobe, days 4-6; 4. elimination of S. pneumoniae

90
Q

TB caseous necrosis MOA

A

T-lymphocyte delayed type hypersensitivity reaction; T-lymphocyte stimulation of macrophages and CD8 T cells; macrophages undergo epithelioid and Langhans giant cell transformation and fibroblasts are activated

91
Q

Theophylline intoxication, rx

A

Abdominal pain, vomiting, diarrhea, cardiac arrhythmias, seizures; activated charcol, cathartics, beta-blockers

92
Q

Functional residual capacity

A

Center of the airway PV curve: the intrapleural pressure is negative (-5 cm H20)

93
Q

TB: Locations of extrapulmonary disease

A

Basal meninges (tuberculous meningitis), lumbar spine (Pott disease), psoas muscle (posas abscess), and serous membranes like pericardium and pleura; in extreme cases, miliary TB everywhere

94
Q

TB: primary infection

A

Aerosolized respiratory secretions fall into the lower lobe, creating a Ghon complex

95
Q

Isoniazid SE

A

Peripheral neruopathy as isoniazid is structurally similar to pyridoxine (B6). This arises from increased urinary excretion and defective synthesis of GABA neuroransmitters

96
Q

Cheyne-Stokes respiration

A

Cyclic breathing that periods of apnea are followed by gradually increasing tidal volumes and then gradually decreasing tidal volumes until the next apneic period; most commonly seen in CHF

97
Q

SVC syndrome presentation, most common cause

A

Dyspnea, cough, facial swelling, upper extremnities; HA, dizziness, confusoin 2/2 cerebral edema and elevated ICP, dilated collateral veins; Mediastinal mass (lung cancer, then non-Hodgkin lymphoma)

98
Q

Streptomycin MOA

A

Inactivates 30S ribosomal subunit, inhibits protein synthesis

99
Q

Elastase released from what cell?

A

PMN (inhibited by alpha-1 antitrypsin) and macrophages (inhibited by tissue inhibitors of metalloproteinases)

100
Q

Difference between arterial resistance in systemic and pulmonary circulation

A

Systemic: high; pulmonary: low

101
Q

Medullary respiratory has 3 inputs

A

Central chemoreceptors (detect hypercapnia), peripheral chemoreceptors at carotid and aortic bodies (detect hypoxemia), and pulmonary stretch receptors (regulate inspiration during lung distention)

102
Q

Alpha-1-antitrypsin deficiency

A

Chronic panacinar emphysema, prferentially localized to lower pulmonary lobes

103
Q

Small cell carcinoma

A

Tumor arises from primitive cells in the basal layer of the bronchial epithelium; round/oval cells with scant cytoplasm and large hyperchromatic nuclei, may resemble lymphocytes but smaller in size; IHC stains show neuroendocrine markers like neuron specific enolase, chromogranin, synaptophysin; strongly associated with smoking, centrally located

104
Q

Abscess formation

A

PMN and macrophage srelease lysosomal enzymes taht damage tissue

105
Q

Reid index

A

Measures mucous gland enlargement; thickness of mucous gland layer in the bronchial wall submucosa divided by thickness of the bronchial wall between the respiratory epithelium and bronchial cartilage (excluding cartilage); >40 percent indicates diseases, reflects severity as well

106
Q

Difference between minute ventilation and alveolar ventilation?

A

Alveolar ventilation does not take into account dead space

107
Q

Ethambutol MOA, SE

A

Inhibits carbohydrate polymerization and prevents peptidoglycan cell wall synthesis; optic neuritis, decreased visual acuity, central scotoma, color blindness

108
Q

Differentiate between absolute and relative (plasma contraction) erythrocytosis with

A

RCB mass (increased mass means absolute, normal means relative)

109
Q

Differentiate between primary and secondary erythrocytosis with

A

Serum epo levels (low means primary, high means secondary)

110
Q

Differentiate between hypoxic and other causes of secondary erythrocytosis with

A

SaO2 < 92, PaO2 < 65

111
Q

Most common benigh lung tumor

A

Hamartomas, pw asymptomatic peripherally located “coin lesion” in patients 50-60 years old, composed of disorganized cartilage, fibrous, and adipose tissue

112
Q

Supine pts aspirate into:

A

Posterior segments of the upper lobes and the superior segment of the lower lobs; R>L

113
Q

Basophil

A

Dark blue granules, irregular size, obscured nucleus; granules contain heparin, histamine, SRS-A

114
Q

Eosinophil

A

bilobed nuclei with large eosinophilic granules; release major basic protein, a potent anti-helminth toxin capable of causing dmg to epithelial and endothelial cells (moa of atopic/extrinsic allergic asthma)

115
Q

Chronic rejection of lung transplant MOA

A

Bronchiolitis obliterans syndrome: inflammation and fibrosis of the small bronchioles leads to obstruction, presenting with dyspnea, nonproductive cough, and wheezing

116
Q

Retinopathy of prematurity or retrolental fibroplasia MOA

A

Temporary local hyperoxia in the retina causes upregulation of proangiogenic factors like VEGF upon return to room air ventilation; this neovascularization may lead to retinal detachment and blindness

117
Q

Fat emboli stains black with

A

Osmium tetroxide

118
Q

chronic bronchitis histology

A

Thickened bronchial walls, PMN infiltratoin, mucous gland enlargement, patchy squamous metaplasia

119
Q

Verenicline MOA

A

partial agonist of nicotinic acetylcholine receptors; reduces withdrawal cravings and attenuates reward of nicotine

120
Q

Caspofungin MOA

A

Block polysaccharide glucan synthesis, suppress synthesis of cell wall

121
Q

Physiologic dead space refers to:

A

Regions of alveolar ventilation that do not engage in gas exchange due to relatively low alveolar perfusion and or alveolar hyperareation

122
Q

Nonselective BB SE

A

Bronchoconstriction, peripheral vasospasm, predispose DM pt to hypoglycemia

123
Q

Pancoast tumor presentation

A

Ipsi Horner’s, rib destruction, atrophy of hand muscles, and C8-T1 pain

124
Q

LaPlace law and the relationsihp between sphere radius and distending pressure

A

P = 2T/r; As radius with constant surface tension decreases, the distending pressure increases: thus, smaller spheres collapse before larger ones; surfactant counteracts alveolar collapse by decreasing surface tension as the alveolar radius decreases and surfactant concentration increases

125
Q

Pulmonary vascular resistance components, point of minimum resistance

A

Alveolar vessels, where increased lung volumes increases resistance by increasing length and reducing diameter; and extra-alveolar, where decreased lung volumes increase resistance by decrease radial traction and compression by positive intrathoracic pressure; FRC

126
Q

Vagal stimulation of lung leads to:

A

Bronchoconstriction and increased bronchial mucus secretion, which lead to increased airway resistance and WOB

127
Q

Trachael deviation in an opacified lung

A

Toward lung opacified lung with atelectasis; away from opacificied lung with large pleural effusion

128
Q

Obstructive lesion of mainstem bronchus

A

Unilateral pulmonary opacification and deviation of trachea toward the opacified lung

129
Q

Vitamin D toxocity can occur with:

A

Sarcoidosis or other granulomatous dz (TB, Hodgkin’s, non-Hodgkin’s)

130
Q

Smoking causes hypoxia via what mechanisms?

A
  1. chronic bronchitis decreases diameter of conducting airways; 2. emphysema dilates alveolar air spaces and reduce contact between airspaces and deoxygenated blood; 3. increasing concentration of carboxyhemoglobin
131
Q

Inflammatory cytokines and effect

A

IL-1, IL-6, TNF-alpha; stimulate hepatic production of acute phase reactants to bind on microbes and fix complement

132
Q

PGD2, PGE2, PGF2

A

Vasodilation, edema

133
Q

PGI2

A

Vasodilation, inhibition of platelet aggregation

134
Q

TxA2

A

Vasoconstriction, promotion of platelet aggregation

135
Q

Leukotriene B4

A

Chemotaxis

136
Q

Leukotriene C4, D4, E4

A

Vasoconstriction, bronchospasm, increased vascular permeability; important role in bronchial asthma

137
Q

Lipoxin A4, B4

A

Vasodilation, inhibition of PMN chemotaxis, monocyte adhesion

138
Q

Bradykinin

A

Vasodilation, increased vascular permeability, stimulates SMC contraction

139
Q

Interferon gamma

A

Produced by activated T cells, recruits leukocytes and activates phagocytosis

140
Q

IL-4

A

Produced by Th2 cells, stimulates growth of B cells and increases number of Th2 cells at inflammation site

141
Q

Asbestos exposure clinical manifestations

A

Pleural plaques, asbetosis (progressive, diffuse pulmonary fibrosis and asbestoes bodies (golden-brown beaded rodes), bronchogenic carcinoma, malignant mesothelioma

142
Q

CF GU manifestations

A

Bilateral absence of vas deferns and azoospermia

143
Q

Malignant mesothelioma

A

Hemorrhagic pleural effusions and pleural thickening; electron microscopy shows tumor cells with numerous long sleder microvilli and abundant tonofilaments

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