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USMLE Step 1 Quick Notes > Respiratory > Flashcards

Respiratory Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the relation of the pulmonary artery to the bronchus at each lung hilus?

A

Right: Anterior
Left: Superior

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2
Q

What is the equation for pulmonary vascular resistance?

A

PVR = (Ppulm.art - Patrium)/CO

Remember P = QR

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3
Q

What happens to arterial PaO2 and PaCO2 during exercise?

A

They do not change! Your body tries to compensate for exercise by increasing perfusion through increased CO.

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4
Q

What happens to venous O2 and CO2 content during exercise?

A

CO2 increases and O2 decreases

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5
Q

What is the MCC of rhinosinusitis?

A

Viral (can cause superimposed bacterial infection)

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6
Q

What is the classic triad for fat emboli?

A

Hypoxemia, petechial rash, and neuro abnormalities

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7
Q

What happens with gas emboli?

A

Nitrogen bubbles precipitate in ascending divers

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8
Q

How do you treat gas emboli?

A

Hyperbaric Oxgen

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9
Q

What is the imaging test of choice for PE?

A

CT angiography

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10
Q

What do you get from shipbuilding, roofing, plumbing?

A

Asbestosis

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11
Q

What do you have if you see ivory white calcified pleural plaques?

A

Asbestosis but are not precancerous

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12
Q

What are golden brown fusiform rods resembling dumbells?

A

Ferruginous bodies- macrophages that have eaten asbestos fibers and coated them with ferritin. Seen with asbestosis.

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13
Q

What do you see eggshell hilar lymph node calcifications with?

A

Silicosis

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14
Q

What do you get from mines, sandblasting, foundries?

A

Silicosis

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15
Q

What do babies get supplemental O2 for ARDS?

A

Retinopathy of prematurity, bronchopulmonary dysplasia

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16
Q

What do you use Bethamethasone for?

A

Neonatal RDS

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17
Q

What do you use Beclamethasone for?

A

COPD/Asthma

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18
Q

What does persistently low O2 tension in neonatal ARDS increase risk for?

A

PDA

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19
Q

What do presence of bronchial breath sounds indicate?

A

Consolidation (lobar pneumonia, pulmonary edema)

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20
Q

What are kulchitsky cells?

A

Small dark blue cells in small cell carcinoma

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21
Q

What are the side effects of Salmeterol/Formoterol?

A

Arrhythmia, tremor

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22
Q

What is the MC morbidity problem with Theophylline?

A

Tacchyarrhythmias and seizures

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23
Q

What do you use for aspirin induced asthma?

A

Zafirlukast, Montlukast

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24
Q

What does airspace opacities in superior region of lower lobes suggest?

A

Aspiration pneumonia (especially with leukocytosis and history of dementia)

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25
Q

What is nasopharyngeal carcinoma associated with?

A

EBV

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26
Q

What would hamartoma of the lung show?

A

Hyaline cartilage

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27
Q

What cancer does asbestosis cause?

A

Bronchogenic adenocarcinoma > mesothelioma

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28
Q

What does nitroprusside do to your Hb?

A

Causes conversion to metHb

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29
Q

How do you treat Methemoglobinemia?

A

Methylene blue or ascorbic acid (converts ferric to ferrous iron)

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30
Q

What is usually the cause of unilateral pleural effusion?

A

Bacterial usually

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31
Q

What would you in pleural effusion (think exudate vs transudate)

A

LDH, protein

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32
Q

What do you calculate CO if given arteriovenous O2 content?

A

CO = O2 consumption/ arterial O2 content - venous O2 content

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33
Q

If surfactant is messed up what do you see?

A

Patchy ateclectasis

34
Q

What is the 1st line treatment for chronic asthma?

A

Fluticasone (Glucoroticoids)

35
Q

How long does bicarb compensation take?

A

3-5 days; so if you see acid-base question make sure to consider how long its been and hence if compensation is occurring

36
Q

Where do fish bones get lodged?

A

Piriform recess

37
Q

What is the diagnosis? Upper body rash, neurological symptoms, respiratory dress after long bone fracture or liposuction.

A

Fat embolus

38
Q

What causes a spontaneous pneumothorax?

A

Spontaneous sudden onset chest pain in tall think malefrom apical subpleural blets rupturing

39
Q

What happens that is important for lung devo at 26 weeks?

A

Phosphatidylcholine sharply increases and lecithin increases but very slowly

40
Q

What causes hypercalcemia in sarcoidosis?

A

Activated macrophages cause 1alpha hydroxylase mediated vitamin activation

41
Q

Why does resistance increase in medium sized compared to trachea?

A

Because of high turbulent flow

42
Q

What causes panacinar emphysema?

A

Proteases released from alveolar macrophages and neutrophils

43
Q

What does adenocarcinoma show in histology?

A

Mucin producing cells that cause copious amounts of fluid in sputum; does not invade

44
Q

What does a mutation in CFTR cause?

A

Abnormal bolding and glycosylation of CFTR

45
Q

What is the main hormone for implicated in surfactant production?

A

Cortisol

46
Q

How far up are the lung apices?

A

Above the clavicle

47
Q

What is a normal A-a gradient is?

A

10-15 mmHg

48
Q

Which of the lung cancers is inoperable?

A

Small Cell Carcinoma

49
Q

What happens with PaO2 in CO poisoning?

A

Does not change (it only lowers the saturation of Hb)

50
Q

What is a major risk factor for acute onset respiratory distress?

A

Acute pancreatitis

51
Q

What is used to treat primary pulmonary HTN (ie the heritable one)

A

Bosentan

52
Q

What does regeneration during lung damage?

A

Type II pneumocytes

53
Q

How long does it take to adjust to high altitude?

A

Two weeks

54
Q

What do you give patients that come in with acute exacerbation of asthma?

A

Leukotriene receptor inhibitors (Zafirlukast)

55
Q

What will show greater changes in PCO2, perfusion or diffusion limited?

A

Perfusion because CO2 diffuses better than O2

56
Q

What is normal alveolar and tracheal PO2?

A

Alveolar: 104
Tracheal: 150

57
Q

How does septic shock affect the lungs?

A

Causes ARDS leading to intra-alveolar edema, interstitial edema, hyaline membrane formation, inflammation

58
Q

What nerve increases bronchoconstriction?

A

Vagus by acting on M3 receptors

59
Q

How does left heart systolic failure affect the lung?

A

Decreases compliance of lung: LF systolic failure –> increased end systolic volume –> greater pressure for pulmonary artery to push against –> increased pulmonary artery pressure –> fluid leakage into parencyma –> decreased compliance of lung

60
Q

What causes dilated vessels of upper trunk and neck, facial edema and plethora, cough, dizziness?

A

SVC Syndrome

61
Q

What is Clindamycin used for?

A

Anaerobes above diaphragm and group A strep

62
Q

How do you tell a staph pneumonia apart from a strep pneumonia?

A

Staph produces cavitary lesion and strep does not (it produces necrotizing abscessing pneumonia)

63
Q

How does silicosis increase susceptibility to TB?

A

By impairing macrophage fusion with phagolysosome

64
Q

What is the diagnosis? HIV patient with lesions that on histology look like spindle shaped small vessel proliferations?

A

Kaposi sarcoma

65
Q

What else can Kaposi sarcoma cause besides red flat maculopapular lesions?

A

Diarrhea

66
Q

How does PaO2 change with CO poisoning?

A

It doesn’t. PaO2 is unaffected by CO since it is dissolved. O2 content would be changed.

67
Q

What do you see with theophylline toxicity?

A

Seizures, abdominal pain, arrhythmias, vomiting, diarrhea

68
Q

What would you see just SVC syndrome with?

A

Mediastinal mass (NOT pancoast since that would also show horner’s)

69
Q

Diagnosis? Interstitial fibrosis with paraseptal and subpleural cystic airpsace enlargmenet (honeycomb lung)

A

Idiopathic pulmonary fibrosis

70
Q

What is the shake stability test?

A

Multiple wells with ethanol and amniotic fluid are shaken and examined for ring of stable foam. Foam stability index is highest value well that contains ring of foam. It evaluates surfactant functionality/lung maturity.

71
Q

What happens to compliance in emphysema?

A

It increases!!

72
Q

What increases in obstructive lung diseases?

A

RV, FRC, TLC

73
Q

What is FRC equal to?

A

ERV + RV

74
Q

At what levels do structures perforate the diaphragm?

A

T8: IVC
T10: Esophagus, vagus
T12: aorta, thoracic duct, azygous vein

“I ate ten eggs at twelve”

75
Q

A 16-year-old boy is admitted to the emergency department because of a knife wound to the left side of his chest. An x-ray of the chest shows an air-fluid level in the left side of the chest, partial collapse of the left lung, and elevation of the stomach bubble. The mediastinum is in the midline. Which of the following is the most likely diagnosis?

A

Hemopneumothorax not under tension

Air fluid levels = hydropneumothorax. If there’s also a stab in the scenario then its blood instead of water.

No mediastinal shift means no tension

76
Q

What does altitude sickness cause?

A

High altitude pulmonary edema (a type of ARDS) that would look like bilateral fluffy infiltrates on Xray

77
Q

What would happen to numbers of type 1, type 2 pneumocytes and fibroblasts in chronic inflammatory interstitial pneumonitis?

A

Type 1 will go down (since they are destroyed)

Type 2 will go up (since they regenerate)

Fibroblasts go up (chronic inflammation causes fibrosis)

78
Q

What do you think of middle aged non smoking woman with SOB?

A

Idiopathic pulmonary fibrosis

79
Q

What is anthracosis?

A

Asymptomatic condition found in urban dwellers exposed to sooty air where carbon accumulates in macrophages

80
Q

What are the cmplications of sleep apnea?

A

Pulm/systemc HTN
Arrhythmias
Sudden cardiac death

81
Q

Why does maternal diabetes cause neonatal ARDS?

A

Insulin inhibits surfactant production

USMLE Step 1 Quick Notes (17 decks)

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