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Respiratory Flashcards

1
Q

What are symptoms of DVT?

A

Swollen foot/ankle (unilateral)

+/- pain, +/- Homan’s sign (pain with ankle dorsiflexion) +/- palpable cord

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2
Q

What causes elevated D-dimer? What is it?

A

Seen in DVT, PE

It is a fibrin degradation product that is elevated when plasmin is dissolving a clot

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3
Q

What are symptoms of PE

A 
Pleuritic chest pain
SOB
Cough
Fever
Tachypnea
Tachycardia
Altered mental status/confusion
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4
Q

What are EKG changes seen in PE?

A

S1Q3T3
Wide S in lead 1
Large Q
Inverted T in lead 3

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5
Q

What are fat emboli associated with?

A

Long bone fractures

Liposuction

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6
Q

What is the classic triad of fat emboli?

A

Hypoxemia
Neurologic abnormalities
Petechial rash

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7
Q

What can amniotic fluid emboli cause?

A

DIC

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8
Q

How do you get air embolus?

A

With Caisson disease - the bends; decompression illness when you are scuba diving and come up too quickly
Could also be introduced from IV

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9
Q

How do you get bacterial embolus?

A

From bacterial endocarditis - shoots off clots all over body

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10
Q

What is pneumothorax?

A

Abnormal collection of air in the pleural space that interferes with normal breathing.

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11
Q

What are exam findings for pneumothorax?

A

Decreased breath sounds on affected side
CXR
CT scan

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12
Q

What is most concerning type of pneumothorax?

A

Tension pneumothorax - with every breath air escapes into pleural space and gets trapped (pushes organs of mediastinum to opposite side)

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13
Q

What is treatment for pneumothorax?

A

Need to get rid of air

Need a chest tube until lung has recovered

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14
Q

What is pathology in obstructive lung conditions?

A

There is obstruction of air flow resulting in air trapping the lungs (Can’t get rid of air very well); The airways close prematurely at high lung volumes and cause increased RV and total lung volume is increased.

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15
Q

What happens on pulmonary function test in COPD?

A

The FEV1 is greatly decreased and FVC is decreased also but the ratio of FEV1/FVC is decreased. THIS IS HALLMARK OF COPD

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16
Q

What happens in restrictive lung disease?

A

There is restricted lung expansion that causes decreased lung volumes

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17
Q

What happens on pulmonary function test in restrictive lung disease?

A

Both FEV1 and FVC ratio are decreased but ratio stays close to normal; the lung volumes are lower than normal

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18
Q

What are Curschmann spirals?

A

Whorled mucus plugs formed by shed epithelium in asthma

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19
Q

What are Charcot-Leyden crystals?

A

Eosinophilic, hexagonal, double pointed needle-like crystals formed from breakdown of eosinophils in sputum

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20
Q

What is differential for Eosinophilia?

A 
Drugs
Neoplasma
Atopic disease (allergy, asthma, Churg-Strauss)
Addison disease
Acute interstitial nephritis
Collagen vascular disease
Parasites (Ascaria, Strongyloides,)
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21
Q

What is the pathophysiology of Chronic Bronchitis?

A

Hyperplasia of mucus-secreting glands in bronchi –> Reid index >50%

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22
Q

What is the Reid Index?

A

The thickness of the gland layer/total thickness of bronchial wall

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23
Q

How do you diagnose Chronic Bronchitis?

A

Productive cough for > 3 months per year for > 2 years

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24
Q

What are symptoms of Chronic Bronchitis?

A

Wheezing, crackles, cyanosis, late-onset dyspnea, CO2 retention, secondary polycythemia

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25
What are blue bloaters?
-Hypoxemia, hypercapnia | Seen in chronic bronchitis; refers to the poor oxygenation and pulmonary hypertension that can sometimes occur
26
What is pathophysiology of emphysema?
Enlargement of air spaces, decreased recoil, increased compliance, decreased diffusing capacity for CO resulting from destruction of alveolar walls
27
What are the types of emphysema?
1. Centracinar - associated with smoking - usually most prominent in upper lobes and superior segments of lower lobes 2. Panacinar - associated with alpha1-antitrypsin deficiency
28
Where is destruction in centriacinar emphysema?
In the respiratory bronchioles
29
Where is destruction in panacinar emphysema?
Entire acinus - respiratory bronchioles, acinar ducts, acinus
30
What are signs of alpha 1 antitrypsin deficiency?
Early onset emphysema (increased elastase activity, loss of elastic fibers) Early onset cirrhosis (builds up in liver)
31
What is Bronchiectasis? What is it associated with?
Destruction and dilation of bronchial walls --> causes chronic recurrent infections, purulent sputum, hemoptysis -Associated with CF and Kartagener syndrome
32
What are pink puffers?
Dyspnea, hyperventilation
33
Most common cause of pulmonary HTN
COPD
34
Inhaled treatment of choice for chronic asthma
Inhaled steroid
35
Inhaled treatment of choice for acute asthma
Albuterol or Levalbuterol - NOT Salmeterol long acting
36
Narrow therapeutic index, drug of last resort for asthma
Theophylline
37
Inhibits mast cells release of mediators, only used for prophylaxis in asthma
Cromolyn
38
Inhaled treatment that blocks muscarinic receptors
Ipratroprium, Tiotropium
39
Blocks conversion of arachidonic acid to leukotriene
Zileuton
40
Inhaled long acting Beta agonist
Salmeterol
41
What medication for nasal decongestant can cause rebound congestion?
Pseudoephedrine, phenylephrine
42
What is the pathophysiology of interstitial lung diseases? How does it affect breathing mechanics?
They decrease pulmonary diffusing capacity and increase A-a gradient
43
What is sarcoidosis characterized by?
Immune-mediated, widespread non-caveating granuloma, elevated serum ACE levels and elevated CD4/CD8 ratio
44
What does sarcoidosis look like on X-ray?
Bilateral hilar adenopathy and reticular opacities
45
Who is sarcoidosis common in?
Black females
46
Erythema nodosum and bilateral adenopathy
Sarcoidosis
47
What is the mnemonic for Sarcoidosis?
``` A GRUELING Disease ACE increase Granuloma RA Uveitis Erythema nodosum Lymphadenopathy Idiopathic Noncaseating granuloma Gammaglobulinemia Vitamin D increase ```
48
What type of reaction is hypersensitivity pneumonitis?
Mixed type II/IV reaction to environmental antigen --> dyspnea, cough, chest tightness, headache
49
What are the different types of Pneumoconiosis
``` Anthracosis Asbestosis Coal worker's lung Silicosis Berylliosis ```
50
a. What is Asbestosis associated with? b. What are characteristic lung findings? c. Affects which part of lung? d. Increased risk of cancer?
a. Associated with shipbuilding, roofing, plumbing b. Ivory white, calcified, supra diaphragmatic and pleural plaques; Asbestos (Ferruginous bodies) are golden brown fusiform rods resembling dumbbells found in alveolar septum c. Affects lower lobes d. Increased risk of bronchogenic carcinoma > mesothelioma
51
What is damage from in pneumoconiosis disease?
From the macrophages
52
a. the other name for Coal workers' pneumoconiosis b. Caused by: c. Affects which part of lung? d. Increased risk of cancer?
a. Anthracosis b. prolonged coal dust exposure --> macrophages become laden with carbon and cause inflammation/fibrosis (black lung disease) c. Affects UPPER lobes d. No risk of cancer
53
a. What is Silicosis associated with? b. Characteristic lung findings? c. Affects which part of the lung? d. Increased risk of?
a. Foundries, sandblasting, mines b. Macrophages respond to silica and release fibrogenic factors that cause fibrosis c. Affects UPPER lobes d. Increased susceptibility to TB (because silica disrupts phagolysosomes and impairs macrophages) Also increased risk of bronchogenic carcinoma
54
a. What is Berylliosis associated with? b. Lung pathology? c. Affects which part of lung? d. Increased risk of?
a. Aerospace and manufacturing industries b. Granulomas on histology c. Upper lobes d. Increased risk of carcinoma
55
Golden-brown fusiform rods resembling dumbbells
Ferruginous asbestos bodies
56
Lung findings in silicosis
Eggshell calcification of hilar lymph nodes
57
What is the pathophysiology of ARDS?
Shock, infection, toxic gas inhalation, aspiration, high [O2], pancreatitis --> inflammatory cells/mediators and oxygen free radicals --> damage to endothelial or alveolar epithelial (type I) cells --> diffuse alveolar damage and hyaline membrane disease
58
What is Hyaline membrane disease?
Seen in ARDS | Initial damage due to macrophage substances
59
What is cause of neonatal RDS?
Surfactant deficiency --> increased surface tension --> alveolar collapse
60
What is treatment of neonatal RDS?
Maternal steroids 24-48 hours before birth, artificial surfactant for infant
61
Which ratio is predictive of neonatal RDS?
Lecithin:Sphingomyelin ratio <1.5 in amniotic fluid
62
What are risk factors for neonatal RDS?
Prematurity Maternal diabetes C section
63
What is lung finding in neonatal RDS?
air space and interstitial opacities - ground glass appearance
64
Bilateral hilar adenopathy, uveitis
Sarcoidosis
65
Vasculitis and glomerulonephritis
Wegeners, Goodpastures
66
Anti-glomerular basement membrane antibodies
Goodpastures
67
Honeycomb lung on x-ray
Interstitial fibrosis
68
Tennis racket shaped cytoplasmic organelles
Birbeck granules
69
Iron-containing nodules in the alveolar septum
Ferruginous bodies - suggest Asbestosis
70
Cough, hemoptysis, bronchial obstruction, wheezing, pneumonic "coin" lesion on CXR or non-calcified nodule on CT
Lung cancer
71
Complications of lung cancer | SPHERE of complications
``` Superior vena cava syndrome Pancoast tumor Horner syndrome Endocrine (paraneoplastic) Recurrent laryngeal nerve compression Effusions (pleural or pericardial) ```
72
What does non-small cell carcinoma (oat cell) include?
Large cell Squamous cell Adenocarcinoma
73
Adenocarcinoma a. Location b. Characteristics c. Histology
MOST COMMON TYPE a. Peripheral b. Most common lung cancer in NON Smokers but also associated with smoking; CEA positive, activating mutations include KRAS, EGFR, ALK. c. Glandular pattern on histology, often stains mucin +.
74
What is Bronchioalveolar carcinoma? Characteristics?
Subtype of adenocarcinoma CXR often shows hazy infiltrates similar to pneumonia (excellent prognosis) Grows along alveolar septa --> thickens alveolar walls
75
Large cell Carcinoma a. Location b. Characteristics c. Histology
a. Peripheral b. Highly anapestic undifferentiated tumor; poor prognosis; Strongly associated with smoking c. Giant cells, secretes bHCG
76
Squamous cell Carcinoma a. location b. charactersistics c. histology
a. Central b. hilar mass arising from bronchus; Cavitation, Cigarettes, hyperCALCEMIA (PTHrP produced) c. Keratin pearls! and intracellular bridges
77
Small cell carcinoma a. location b. characteristics c. histology
a. Central b. N:C ratio is very high; produces ACTH, ADH or antibodies against presynaptic Ca channels (Lambert Eaton); amplification of myc oncogenes c. Neoplasm of neuroendocrine Kulchitsky cells --> small dark blue cells; Chromogranin A
78
S MMnemonic for lung cancer
``` Squamous cell Small cell Smoking Central Secreting ```
79
What do you seen microscopically for Mesothelioma?
Psammoma bodies
80
Most common locations of lung cancer metastasis?
Brain Bone Liver Adrenal
81
How is small cell carcinoma treated?
Chemotherapy; not amenable to surgical resection
82
What is FEV1/FVC ratio in obstructive disease? restrictive disease?
obstructive - decreased ratio; FEV1 decreases more than FVC | restrictive - greater than normal; FVC decreases more than FEV1
83
Why do you see hypercalcemia in sarcoidosis?
In the macrophages of the granuloma there is increased 1alpha hydroxyase that activates Vitamin D

Step 1 AB (29 decks)

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