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Step 1 AB > Respiratory > Flashcards

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
Q

What are blue bloaters?

A

-Hypoxemia, hypercapnia

Seen in chronic bronchitis; refers to the poor oxygenation and pulmonary hypertension that can sometimes occur

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26
Q

What is pathophysiology of emphysema?

A

Enlargement of air spaces, decreased recoil, increased compliance, decreased diffusing capacity for CO resulting from destruction of alveolar walls

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27
Q

What are the types of emphysema?

A
  1. Centracinar - associated with smoking - usually most prominent in upper lobes and superior segments of lower lobes
  2. Panacinar - associated with alpha1-antitrypsin deficiency
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28
Q

Where is destruction in centriacinar emphysema?

A

In the respiratory bronchioles

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29
Q

Where is destruction in panacinar emphysema?

A

Entire acinus - respiratory bronchioles, acinar ducts, acinus

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30
Q

What are signs of alpha 1 antitrypsin deficiency?

A

Early onset emphysema (increased elastase activity, loss of elastic fibers)
Early onset cirrhosis (builds up in liver)

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31
Q

What is Bronchiectasis? What is it associated with?

A

Destruction and dilation of bronchial walls –> causes chronic recurrent infections, purulent sputum, hemoptysis
-Associated with CF and Kartagener syndrome

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32
Q

What are pink puffers?

A

Dyspnea, hyperventilation

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33
Q

Most common cause of pulmonary HTN

A

COPD

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34
Q

Inhaled treatment of choice for chronic asthma

A

Inhaled steroid

35
Q

Inhaled treatment of choice for acute asthma

A

Albuterol or Levalbuterol - NOT Salmeterol long acting

36
Q

Narrow therapeutic index, drug of last resort for asthma

A

Theophylline

37
Q

Inhibits mast cells release of mediators, only used for prophylaxis in asthma

A

Cromolyn

38
Q

Inhaled treatment that blocks muscarinic receptors

A

Ipratroprium, Tiotropium

39
Q

Blocks conversion of arachidonic acid to leukotriene

A

Zileuton

40
Q

Inhaled long acting Beta agonist

A

Salmeterol

41
Q

What medication for nasal decongestant can cause rebound congestion?

A

Pseudoephedrine, phenylephrine

42
Q

What is the pathophysiology of interstitial lung diseases? How does it affect breathing mechanics?

A

They decrease pulmonary diffusing capacity and increase A-a gradient

43
Q

What is sarcoidosis characterized by?

A

Immune-mediated, widespread non-caveating granuloma, elevated serum ACE levels and elevated CD4/CD8 ratio

44
Q

What does sarcoidosis look like on X-ray?

A

Bilateral hilar adenopathy and reticular opacities

45
Q

Who is sarcoidosis common in?

A

Black females

46
Q

Erythema nodosum and bilateral adenopathy

A

Sarcoidosis

47
Q

What is the mnemonic for Sarcoidosis?

A 
A GRUELING Disease
ACE increase
Granuloma
RA
Uveitis
Erythema nodosum 
Lymphadenopathy
Idiopathic
Noncaseating granuloma
Gammaglobulinemia
Vitamin D increase
48
Q

What type of reaction is hypersensitivity pneumonitis?

A

Mixed type II/IV reaction to environmental antigen –> dyspnea, cough, chest tightness, headache

49
Q

What are the different types of Pneumoconiosis

A 
Anthracosis
Asbestosis
Coal worker's lung
Silicosis
Berylliosis
50
Q

a. What is Asbestosis associated with?
b. What are characteristic lung findings?
c. Affects which part of lung?
d. Increased risk of cancer?

A

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
Q

What is damage from in pneumoconiosis disease?

A

From the macrophages

52
Q

a. the other name for Coal workers’ pneumoconiosis
b. Caused by:
c. Affects which part of lung?
d. Increased risk of cancer?

A

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
Q

a. What is Silicosis associated with?
b. Characteristic lung findings?
c. Affects which part of the lung?
d. Increased risk of?

A

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
Q

a. What is Berylliosis associated with?
b. Lung pathology?
c. Affects which part of lung?
d. Increased risk of?

A

a. Aerospace and manufacturing industries
b. Granulomas on histology
c. Upper lobes
d. Increased risk of carcinoma

55
Q

Golden-brown fusiform rods resembling dumbbells

A

Ferruginous asbestos bodies

56
Q

Lung findings in silicosis

A

Eggshell calcification of hilar lymph nodes

57
Q

What is the pathophysiology of ARDS?

A

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
Q

What is Hyaline membrane disease?

A

Seen in ARDS

Initial damage due to macrophage substances

59
Q

What is cause of neonatal RDS?

A

Surfactant deficiency –> increased surface tension –> alveolar collapse

60
Q

What is treatment of neonatal RDS?

A

Maternal steroids 24-48 hours before birth, artificial surfactant for infant

61
Q

Which ratio is predictive of neonatal RDS?

A

Lecithin:Sphingomyelin ratio <1.5 in amniotic fluid

62
Q

What are risk factors for neonatal RDS?

A

Prematurity
Maternal diabetes
C section

63
Q

What is lung finding in neonatal RDS?

A

air space and interstitial opacities - ground glass appearance

64
Q

Bilateral hilar adenopathy, uveitis

A

Sarcoidosis

65
Q

Vasculitis and glomerulonephritis

A

Wegeners, Goodpastures

66
Q

Anti-glomerular basement membrane antibodies

A

Goodpastures

67
Q

Honeycomb lung on x-ray

A

Interstitial fibrosis

68
Q

Tennis racket shaped cytoplasmic organelles

A

Birbeck granules

69
Q

Iron-containing nodules in the alveolar septum

A

Ferruginous bodies - suggest Asbestosis

70
Q

Cough, hemoptysis, bronchial obstruction, wheezing, pneumonic “coin” lesion on CXR or non-calcified nodule on CT

A

Lung cancer

71
Q

Complications of lung cancer

SPHERE of complications

A 
Superior vena cava syndrome
Pancoast tumor
Horner syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal nerve compression
Effusions (pleural or pericardial)
72
Q

What does non-small cell carcinoma (oat cell) include?

A

Large cell
Squamous cell
Adenocarcinoma

73
Q

Adenocarcinoma

a. Location
b. Characteristics
c. Histology

A

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
Q

What is Bronchioalveolar carcinoma? Characteristics?

A

Subtype of adenocarcinoma
CXR often shows hazy infiltrates similar to pneumonia (excellent prognosis)
Grows along alveolar septa –> thickens alveolar walls

75
Q

Large cell Carcinoma

a. Location
b. Characteristics
c. Histology

A

a. Peripheral
b. Highly anapestic undifferentiated tumor; poor prognosis; Strongly associated with smoking
c. Giant cells, secretes bHCG

76
Q

Squamous cell Carcinoma

a. location
b. charactersistics
c. histology

A

a. Central
b. hilar mass arising from bronchus; Cavitation, Cigarettes, hyperCALCEMIA (PTHrP produced)
c. Keratin pearls! and intracellular bridges

77
Q

Small cell carcinoma

a. location
b. characteristics
c. histology

A

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
Q

S MMnemonic for lung cancer

A 
Squamous cell
 Small cell
Smoking
Central
Secreting
79
Q

What do you seen microscopically for Mesothelioma?

A

Psammoma bodies

80
Q

Most common locations of lung cancer metastasis?

A

Brain
Bone
Liver
Adrenal

81
Q

How is small cell carcinoma treated?

A

Chemotherapy; not amenable to surgical resection

82
Q

What is FEV1/FVC ratio in obstructive disease? restrictive disease?

A

obstructive - decreased ratio; FEV1 decreases more than FVC

restrictive - greater than normal; FVC decreases more than FEV1

83
Q

Why do you see hypercalcemia in sarcoidosis?

A

In the macrophages of the granuloma there is increased 1alpha hydroxyase that activates Vitamin D

Step 1 AB (29 decks)

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