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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
Q

Methacholine

A

Challenge to test for asthma

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26
Q

Ried Index

A

Increased thickness of mucus layer in Chronic Bronchitis

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27
Q

Curschmann spirals

A

In asthmatic patients (mucus casts of small airways)

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28
Q

Lung Abscess & Aspiration Pneumonia

A
  • 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
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29
Q

Atypical Pneumonia in AIDS

A

pneumocystis jirovecci

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30
Q

Prophylaxis for MAC in AIDS patients

A

Azithromycin

31
Q

Aspiration

A

(into right lobe; shorter/vertical)

  • Supine: posterior upper lobe or superior lower lobe
  • Upright: lower inferior lobe
32
Q

Arterial Alveolar Gradient

A

does not normally exceed 10-15

33
Q

Bosentan

A

treat pulmonary arterial HTN (antagonizes endothelin 1 receptors)

34
Q

Pneumonia + Diarrhea

A

Legionella (not visible w/ gram stain)

- Will have hyponatremia

35
Q

Pneumonia + mild transient anemia

A

Mycoplasma (cold agglutinins)

36
Q

Squamous cell lung cancer –> Hypercalcemia

A

Due to PTHrP release

37
Q

Major basic protein

A

causes bronchial damage in atopic asthma (also used to kill helminths)

38
Q

Hypocapnia

A
  • indicates alveolar hyperventilation

- Arterial PaCO2 is the best indicator of alveolar ventilation

39
Q

Thoracocentesis

A
  • 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
Q

ARDS

A
  • Normal wedge pressure
  • Requires absence of cardiogenic pulmonary edema for diagnosis
  • Leaky alveolar capillary membrane
  • Intra-alveolar edema, inflammation, and hyaline formation
41
Q

TB Infection

A
  • one week → intracellular replication

- 2-4 weeks → cytokine release due to T cell stimulation

42
Q

Transudate in alveoli lumen w/:

A

Cardiogenic pulmonary edema

43
Q

Sarcoidosis: Bronchioalveolar Lavage Findings

A

high CD4/CD8 ratio

44
Q

Omalizumab

A

anti IgE antibody used for resistant allergic asthma

45
Q

Effects of CO Poisoning

A

No change in PaO2 (dissolved oxygen), decreased O2 content, increased carboxyhemoglobin, does not increase methemoglobin

46
Q

Goodpasture’s

A

Antibodies to Type IV collagen (alpha3chain) in basement membrane

47
Q

Pulmonary vascular resistance is lowest at ______

A

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
Q

Recurrent laryngeal nerve can be compressed or injured by:

A

Left atrium enlargment or injured by ligation of the inferior thyroid artery

49
Q

Tx of Small Cell Lung Cancer

A

Surgery not indicated, it is very sensitive to chemo

  • Some express neurofilaments
  • Neuroendocrine markers: chromogranin, synpatophysin
50
Q

Drugs that can cause Pulmonary Edema

A

Aggressive Osmotic Diuretics

51
Q

Reduce work of Breathing with higher elastic resistance (pulmonary fibrosis) by:

A

Breathing fast and shallow breaths

52
Q

Reduce work of Breathing with increased airflow resistance (asthma, COPD) by:

A

Breathing slower and deeper minimizes work

53
Q

Chest C ray looks much worse than it is

A

Mycoplasma Pneumoniae (can culture on cholesterol)

54
Q

Radial Traction

A

outside fibrotic tissue opens up airways so lower airflow resistance, air flows out faster with restrictive lung diseases

55
Q

Cromylin Sodium and Nedocromil

A

Mast cell stabilizers (prevent degranulation)

- Tx for allergic rhinitis and bronchial asthma

56
Q

Must be careful with giving _____________ to COPD patients

A

Supplementary O2

- their respiratory drive depends on O2

57
Q

Lung Cancer in Non-smoking woman

A

Adenocarcinoma (MC lung cancer)

58
Q

Obstructive Lesion in Mainstem Bronchus: X ray findings

A

Opacified/white lung (only on side of lesion) due to atelectasis
Tracheal deviation towards lesioned side

59
Q

Tumor w/ numerous long slender microvilli and abundant tonofilaments

A

Mesothelioma

adenocarcinoma has small plump microvilli

60
Q

Neonatal Oxygen Supplementation for RDS

A

May cause retinopathy of prematurity and bronchopulmonary dysplasia

61
Q

Foam Stability Index

A

Evaluates surfactant functionality

(mix ethanol and amniotic fluid) –> ring of stable foam

62
Q

Smoking cessation at any age will:

A

prolong life expectancy, decrease risk of MI, lung cancer, and cerebrovascular accident, and slow the rate of pulmonary function loss

63
Q

Development of Respiratory acidosis and hypoxemia in setting of Fixed ventilation suggests:

A

Pulmonary pathology that increases both dead space and right to left shunt

64
Q

Hydropneumothorax

A

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
Q

Altitude sickness

A
  • high-altitude pulmonary edema (a type of ARDS)

- x-ray demonstrates diffuse bilateral fluffy infiltrates

66
Q

Amiodarone: Side Effect

A

Interstitial Lung Disease

67
Q

Heart Sound Aw/ Pulmonary Hypertension

A

P2 louder than A2

68
Q

Chronic Inflammatory Pneumonitis

A
  • 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
Q

Lung Transplant Chronic Rejection

A

Bronchiolitis Obliterans syndrome

  • immune reaction affecting small airways
  • dyspnea and wheezing
  • inflammation and fibrosis of bronchiolar walls
70
Q

Charcot Leyden Crystals

A

Found in Asthma

- formed from the breakdown of eosinophils in sputum

71
Q

Increased Radial Traction w/

A

Interstitial lung disease

- leads to increased expiratory flow

72
Q

Kulchitsky cells (dark blue cells)

A

Small Cell Lung Cancer

- neuroendocrine neoplasm

73
Q

Keratin pearls and intracellular bridges

A

Squamous cell lung cancer

74
Q

Theophylline

A

PDE antagonist used for asthma

Quick Notes for Step 1 (18 decks)

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