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Quick Notes for Step 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

ABPA

A

Hypersensitivity to Aspergillus in patients w/ asthma

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2
Q

Equation for Alveolar-arterial oxygen Gradient

A

PAO2 = 150-(PaCO2/.8)

- Can be used to determine the cause of hypoxemia/if there is a significant difference

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3
Q

Acinar wall destruction

A

Elastase is in neutrophils

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4
Q

Alveolar Ventilation includes:

A

The tidal volume and dead space volume

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5
Q

Bronchial smooth muscle relaxation by:

A

Increased intracellular cAMP (via B agonists)

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6
Q

Reid Index in Chronic Bronchitis

A

> 40%

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7
Q

Silicosis Increases Susceptibility to TB because:

A

It may disrupt Macrophage Phagolysosomes preventing killing of intracellular mycobacteria

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8
Q

ARDS

A

Caused by injury to endothelial cells lining pulmonary capillaries adjacent to alveoli
Tx: Positive Pressure ventilation

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9
Q

Pulmonary Embolism Gas Changes

A

Hypoxemia and respiratory alkalosis:

  • increased pH
  • decreased PaCO2
  • low PaO2
  • normal HCO3 because no renal compensation for Acute PE (Renal compensation takes 3-5 days)
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10
Q

Tx for Pneumothorax

A

Chest tube placement or needle aspiration

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11
Q

PTHrp

A

Squamous cell lung cancer → makes PTHrp (related peptide) which acts like PTh → hypercalcemia

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12
Q

Normal Tracheal pO2 and Alveaolar pO2

A
  • Normal tracheal pO2 is 150 and normal alveolar pO2 is 104
  • At rest: the equilibrium is perfusion limited
  • Diffusion limited during exercise, emphysema, or pulmonary fibrosis
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13
Q

Silicosis Appearance

A

Egg shell calcification w/ birefringent silica particles

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14
Q

Cheyne Stokes

A
  • Cyclic breathing in which apnea is followed by increasing then gradually decreasing tidal volumes until the next apneic period
  • Seen w/ advanced congestive heart failure
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15
Q

Secondary Pulmonary HTN: COPD vs CHF

A
  • COPD: due to hypoxia induced vasoconstriction and obliteration of the vasculature
  • CHF: pulmonary venous congestion due to backup that causes impaired secretion of NO (and increased endothelin → vasoconstriction) resulting in increased vascular tone
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16
Q

Increased Resistance in Medium-size Bronchi due to:

A

More turbulence

- Otherwise everything else decreases in resistance w/ more branching

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17
Q

If Radius Decreases by 50%, Flow will:

A

Decrease by a factor of 14

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18
Q

Intrapleural Pressure at Rest (FRC)

A

Slightly negative (-5)

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19
Q

Filters to Prevent DVTs from becoming PEs placed in:

A

IVC

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20
Q

Effect of Vagus on Airway

A

Bronchoconstricts which increases the work of breathing by increasing airway resistance

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21
Q

Metabolic Disturbances w/ PE

A

Respiratory alkalosis (due to compensatory hyperventilation) and hypoxemia

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22
Q

Bleomycin: Side effect

A

Pulmonary fibrosis as a side effect (diffuse ground glass opacity)

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23
Q

Obstructive Lung Disease

A

Emphysema (pink puffer), Chronic bronchitis (blue bloater), asthma, bronchiectasis
- Decreased FEV1/FVC ratio; very decreased FEV1

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24
Q

Restrictive Lung Disease

A

Interstitial lung diseases

- Decreased FVC and TLC; mostly preserved FEV1/FVC

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25
Methacholine
Challenge to test for asthma
26
Ried Index
Increased thickness of mucus layer in Chronic Bronchitis
27
Curschmann spirals
In asthmatic patients (mucus casts of small airways)
28
Lung Abscess & Aspiration Pneumonia
- will see an air-fluid level and cavitary lesion - Release of enzymes from lysosomes of macrophages and neutrophils - Commonly caused by oropharyngeal anaerobic bacteria - Aspiration pneumonia: peptostreptococcus, bacteroides, fusobacterium
29
Atypical Pneumonia in AIDS
pneumocystis jirovecci
30
Prophylaxis for MAC in AIDS patients
Azithromycin
31
Aspiration
(into right lobe; shorter/vertical) - Supine: posterior upper lobe or superior lower lobe - Upright: lower inferior lobe
32
Arterial Alveolar Gradient
does not normally exceed 10-15
33
Bosentan
treat pulmonary arterial HTN (antagonizes endothelin 1 receptors)
34
Pneumonia + Diarrhea
Legionella (not visible w/ gram stain) | - Will have hyponatremia
35
Pneumonia + mild transient anemia
Mycoplasma (cold agglutinins)
36
Squamous cell lung cancer --> Hypercalcemia
Due to PTHrP release
37
Major basic protein
causes bronchial damage in atopic asthma (also used to kill helminths)
38
Hypocapnia
- indicates alveolar hyperventilation | - Arterial PaCO2 is the best indicator of alveolar ventilation
39
Thoracocentesis
- should be performed about the 7th rib in midclavicular line, 9th rib along the midaxillary line, and the 1th rib along posterior scapular line
40
ARDS
- Normal wedge pressure - Requires absence of cardiogenic pulmonary edema for diagnosis - Leaky alveolar capillary membrane - Intra-alveolar edema, inflammation, and hyaline formation
41
TB Infection
- one week → intracellular replication | - 2-4 weeks → cytokine release due to T cell stimulation
42
Transudate in alveoli lumen w/:
Cardiogenic pulmonary edema
43
Sarcoidosis: Bronchioalveolar Lavage Findings
high CD4/CD8 ratio
44
Omalizumab
anti IgE antibody used for resistant allergic asthma
45
Effects of CO Poisoning
No change in PaO2 (dissolved oxygen), decreased O2 content, increased carboxyhemoglobin, does not increase methemoglobin
46
Goodpasture's
Antibodies to Type IV collagen (alpha3chain) in basement membrane
47
Pulmonary vascular resistance is lowest at ______
FRC - Increased lung volumes AND decreased lung volumes increase resistance (Increased causes stretching of alveolar capillaries) & (Decreased causes decreased radial traction on the large extra alveolar vessels)
48
Recurrent laryngeal nerve can be compressed or injured by:
Left atrium enlargment or injured by ligation of the inferior thyroid artery
49
Tx of Small Cell Lung Cancer
Surgery not indicated, it is very sensitive to chemo - Some express neurofilaments - Neuroendocrine markers: chromogranin, synpatophysin
50
Drugs that can cause Pulmonary Edema
Aggressive Osmotic Diuretics
51
Reduce work of Breathing with higher elastic resistance (pulmonary fibrosis) by:
Breathing fast and shallow breaths
52
Reduce work of Breathing with increased airflow resistance (asthma, COPD) by:
Breathing slower and deeper minimizes work
53
Chest C ray looks much worse than it is
Mycoplasma Pneumoniae (can culture on cholesterol)
54
Radial Traction
outside fibrotic tissue opens up airways so lower airflow resistance, air flows out faster with restrictive lung diseases
55
Cromylin Sodium and Nedocromil
Mast cell stabilizers (prevent degranulation) | - Tx for allergic rhinitis and bronchial asthma
56
Must be careful with giving _____________ to COPD patients
Supplementary O2 | - their respiratory drive depends on O2
57
Lung Cancer in Non-smoking woman
Adenocarcinoma (MC lung cancer)
58
Obstructive Lesion in Mainstem Bronchus: X ray findings
Opacified/white lung (only on side of lesion) due to atelectasis Tracheal deviation towards lesioned side
59
Tumor w/ numerous long slender microvilli and abundant tonofilaments
Mesothelioma | adenocarcinoma has small plump microvilli
60
Neonatal Oxygen Supplementation for RDS
May cause retinopathy of prematurity and bronchopulmonary dysplasia
61
Foam Stability Index
Evaluates surfactant functionality | (mix ethanol and amniotic fluid) --> ring of stable foam
62
Smoking cessation at any age will:
prolong life expectancy, decrease risk of MI, lung cancer, and cerebrovascular accident, and slow the rate of pulmonary function loss
63
Development of Respiratory acidosis and hypoxemia in setting of Fixed ventilation suggests:
Pulmonary pathology that increases both dead space and right to left shunt
64
Hydropneumothorax
Air and fluid = hydropneumothorax If fluid is blood (eg. w/ stabbing), it’s a hemopneumothorax Lack of mediastinal shift indicates that it’s not under tension
65
Altitude sickness
- high-altitude pulmonary edema (a type of ARDS) | - x-ray demonstrates diffuse bilateral fluffy infiltrates
66
Amiodarone: Side Effect
Interstitial Lung Disease
67
Heart Sound Aw/ Pulmonary Hypertension
P2 louder than A2
68
Chronic Inflammatory Pneumonitis
- Damage to lung parenchyma (composed primarily of type I pneumocytes) - Type II pneumocytes, in addition to making surfactant, can replicate in order to replace type I pneumocytes, so they will be increased - Chronic interstitial inflammation results in fibrosis, hence an increase in fibroblasts
69
Lung Transplant Chronic Rejection
Bronchiolitis Obliterans syndrome - immune reaction affecting small airways - dyspnea and wheezing - inflammation and fibrosis of bronchiolar walls
70
Charcot Leyden Crystals
Found in Asthma | - formed from the breakdown of eosinophils in sputum
71
Increased Radial Traction w/
Interstitial lung disease | - leads to increased expiratory flow
72
Kulchitsky cells (dark blue cells)
Small Cell Lung Cancer | - neuroendocrine neoplasm
73
Keratin pearls and intracellular bridges
Squamous cell lung cancer
74
Theophylline
PDE antagonist used for asthma

Quick Notes for Step 1 (18 decks)

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