Respiratory Flashcards
Which type of pneunomycte proliferates during lung damage?
Type II
What is the most important lecithin?
Dipalmitoylphosphatidylcholine
What week does surfactant production begin? End?
begin = 26
end = 35
What does RALS mean?
relation of pulmonary artery to bronchus at right and left side
What are the five cause of an O2-Hb right shift?
Cl-
H+
temperature
CO2
23BPG
What is the function of nitrites in treating Cyanide poisoning? Purpose of thiosulfate?
nitrites = Hb into Methemoglobin (Fe3+) which binds cyanide
thiosulfate = thiosulfate = water soluble
How many mL’s of O2 can be bound in one dL?
20.1
What does PA mean?
partial pressure of gas in alveolar air
What does Pa mean?
partial pressure of gas in pulmonary blood
Name an organism that thrives in high O2 of the lung? Where would this organism be found?
TB
apex of lung
What is the triad of a fat emboli?
hypoxemia
petechiae
neurological abnormalities
What is the test of choice for a PE?
CT pulmonary angiography
What is the unique location where lung cancer likes to metastisize?
adrenal glands
What is Stewart-Treves Syndrome?
lymphatic malignancy associated with persistent lymphedema
What is the hallmark of bronchitis?
hyperplasia of mucus secreting glands in the lung
What is the Reid Index? What does the Reid Index have to be to diagnose chronic bronchitis?
thickness of lung glands/total thickness
greater than 50%
What type of emphysema is associated with smoking? What lobes?
centriacinar
upper
What type of emphysema is associated with α1 anti-Trypsin activity? What lobes?
panacinar
lower
What is the hallmark of asthma?
hypertrophy of lung smooth muscle
What are the two histological findings of Asthma?
Curschmann spirals
Charcot-Leyden Crystals
What are Curshmann Spirals composed of?
mucus plugs with whorls of shed epithelium
What are Charcot-Leyden Crystals composed of?
major basic protein from eosinophils
What is pulsus paradoxus?
drop in systolic pressure upon inhalation
What is Bronchiectasis?
necrotizing infection of bronchi that leads to permanent dilation
Name two diseases that cause Bronchiectasis?
Kartagener
Cystic Fibrosis
Name an infective disease that causes Bronchiectasis?
Aspergillosis
Is sarcoidosis a caseating or noncaseating granuloma?
noncaseating
What two lab values would be increased during Sarcoidosis?
ACE and Ca2+
What are the three pneumoconioses?
anthracosis
silicosis
asbestosis
What four drugs are known to cause lung fibrosis?
busulfan
bleomycin
amiodarone
methotrexate
Would ARDS be a restrictive or obstructive disease?
restrictive
Would pulmonary Langgerhans Cell Histiocytosis be a restrictive or obstructive lung disease?
Obstructive
Hypersensitivity Pneumonitis may occur as a result to exposure to what two allergens?
Farmers
birds
How does sarcoidosis present in the eye?
anterior uveitis
What is Caplan Syndrome?
rheumatoid arthritis and pneumoconiosis
What part of the lung does asbestos effect?
base
What part of the lung does asbestos effect?
lower
What part of the lung do silica and coal effect?
upper
Which pneumoconioses increases risk to TB?
Silicosis
Which pneumoconioses increases risk of bronchogenic carcinoma?
silicosis
Below what ratio of lecithin:sphingomyelin is predictive or NRDS?
1.5
Other than drugs, what keeps a PDA open?
Hypoxemia
What are the two consequences of supplemental O2 during NRDS?
Bronchogenic dysplasia
retinopathy
What increases the risk of NRDS?
insulin
What decreases the risk of NRDS?
glucocorticoids
What mm of Hg would signal pulmonary HTN?
> 25 mm Hg
What gene is Primary Pulmonary HTN associated with?
BMPR2
What is the normal function of BMPR2?
inhibit smooth muscle function
What is a Pancoast tumor?
tumor in apex of lung
Which four cancers commonly metastisize to the lung?
bladder, colon, breast, prostate
What are four sites lung cancer commonly metastisizes to?
Adrenal, Brain, Bone, liver
Are adenocarcinomas central or peripheral?
peripheral
What type of lung cancer most often appears in non-smokers?
adenocarcinoma
What three oncegenes is lung adenocarcinoma associate with?
KRAS/EGFR/ALK
Which lung cancer is associated with clubbing?
Adenocarcinoma
Which type of lung cancer grows along the alveolar septa?
Bronchioloalveolar subtype
Is squamous cell carcinoma central or peripheral?
central
Which lung cancer subtype produces a cavitation?
squamous
Cigarette smoking most often causes what type of lung cancer?
squamous
Which type of lung cancer is associated with hypercalcemia? Why?
squamous
releases PTHrp
What are the two histological findings of squamous cell lung cancer?
keratin pearls/whorls
intercellular bridges
Which type of lung cancer often arises from the bronchi?
squamous
Is small cell lung cancer central or peripheral?
central
What are the three PNP products released by small cell lung cancer?
ADH
ACTH
Antibodies to L-type Ca2+ channels (EL)
L-myc is implicated during the pathogenesis of what type of lung cancer?
small cell
What cell type is small cell lung cancer derived from?
Kulchitsky
Is a Large Cell Lung Carcinoma central or peripheral?
peripheral
What is the prognosis of Large Cell Lung Carcinoma?
poor
What does Large Cell Lung Carcinoma look like on histology?
pleomorphic giant cells
Which lung cancer would stain positive for Chromogranin A?
Carcinoid
Pancoast tumor can cause what two syndrome?
SVC Syndrome
Horner Syndrome
Which bacteria is the most common to superimpose itself on a viral lung infection?
Staph. aureus
Lobar pneumonia. Name three bacteria on differential.
S. pneumoniae
Legionella
Klebsiella
Legionella pneumonia would be associated with what common source?
aerosolized water
What four bacteria are known to cause bronchopneumonia?
S. pneumoniae
S. aureus
H. influenzae
Klebsiella
Does interstitial pneumoniae present quickly or indolently?
indoldent
Which three bacteria are known to cause Interstitial Pneumoniae?
Mycoplasma
Legionella
Chlamydia
What type of pneumoniae do viruses cause?
interstitial
What three viruses are known to cause interstitial pneumoniae?
RSV
Influenza
Adenovirus
Which three bacteria are implicated in aspiration pneumonia?
Bacteroides
Fusobacterium
Peptococcus
Is transudate protein rich or protein poor?
protein poor
Would a pleural effusion with transudate or exudate be at an increased risk of infection?
exudate
What person does a spontaneous pneumothorax arise in?
tall, thin young man
What is the common name for 2nd generation histamine blockers?
“-adine”
Why are 2nd generation histamine blockers less sedating?
less penetration into CNS
What are the two expectorants?
Guaifensein
N-acetylcysteine
What is the antidote for dextromethorphan?
naloxone
What receptor does dextromethorphan antagonize?
NMDA
What drug functions similarly to salmeterol?
formoterol
Does theophylline produce bronchoconstriction or bronchodilation?
dilation
What is the MOA of theophylline?
inhibits phosphodiesterase
Which receptors does ipratropium antagonize in the lung?
muscarinic
What is the transcriptional product of NFKB?
TNFα
What are the two steroids used for lung inflammation?
Beclomethasone
fluticasone
What are the two leukotriene receptor antagonists?
Montelukast
Zafirlukast
What drug blocks the conversion of arachidonic acid to leukotrienes?
Zileuton
What is the endothelin receptor antagonist?
Bosentan
What is Omalizumab an antibody against? Free or receptor bound?
IgE
free
Which Fc receptor does IgE bind?
Fc-gamma-R1
What is the relationship of the pulmonary artery to the bronchus on the right and the left side?
Right = anterior
left = posterior
What is fungal sinusitis a complication of?
diabetes
What happens to the lung surface area during emphysema?
decreases
What is the Haldane Effect?
oxygenation of Hb promotes dissociation of H+
What is the Bohr Effect?
H+ dissociates O2 from Hb in peripheral tissues
How does the majority of CO2 get back to the lungs?
as bicarb in RBCs
What is the Chloride Shift?
exchage of HCO3 and chloride
Would ACD cause a left shift or right shift of O2-Hb dissociation curve?
right
What cells in the kidney is 1α-Hydroxylase located?
PCT
What is the Homan test? What is the Homan test indicative of?
pain on dorsiflexion of foot
DVT
What is Stewart-Treves Sydnrome? What causes it?
lymphangiosarcoma
long standing lymphadenitis
Is Lofgren Syndrome an acute or chronic sarcoidosis?
acute
What are the four symptoms of Lofgren Syndrome?
Hilar lymphadenopathy
fever
arthralgia
erythema nodosum
What is almost always the cause of Langerhans Cell Histiocytosis of the lung?
smoking
What are the two common presentations of Langerhans Cell Histiocytosis of the lung?
Pulmonary HTN
recurrent pneumothorax
Which pneumocytes are destroyed during ARDS?
Type I and Type II
What causes the k-Ras mutations in lung adenocarcinoma?
smoking
What patient population is the EGFR mutation seen during lung adenocarcinoma?
asians
In what populations are ALK mutations seen that lead to lung adenocarcinoma?
nonsmokers and young
Which cells give rise to Bronchioalveolar Carcinoma?
club cells
What three mutations are seen during Small cell carcinoma
Rb
p53
EGFR
What are the three stains of small cell lung cancer?
chromogranin
synaptophysin
CD56
WHat is the main virulence factor of H. influenzae?
IgA protease
Kiesselbachs plexus is located at the anterior or posterior nasal septum?
anterior
What is the mode of inheritance of A1AT?
co-dominant
Is sleep apnea a problem of the pharynx or larynx?
pharynx
Are lobular arteries in the center or periphery?
center
Are lobular veins in the center or periphery?
periphery
Pseudostratified ciliated columar epithelium extends all the way to what structure?
respiratory bronchiole
Smooth Muscle extends all the way to what structure?
terminal bronchiole
What type of epithelium is found in the respiratory bronchioles?
cuboidal
Does sarcoidosis have lymphocytes in them?
yes
Particles smaller than what size can make their way to the respiratory bronchiole?
Alveolar macrophages relase cytokines that that to what during their phagocytic activity?
fibrosis
Which part of the lung is the greatest contributor to anatomic dead space?
apex
Does hemoglobin have positive or negative allostery?
negative
What is bound to Hb during Carboxyhemoglobin?
CO
What is a normal A-a gradient?
10-15
Is the venous amount of O2 increased or decreased during cyanide poisoning?
increased
Do only peripheral or central chemoreceptors respond to O2?
peripheral
In which two situations does O2 become diffusion limited?
exercise
alveolar damage
What are the three perfusion limited gases?
N2O/CO2/O2
What is the diffusion limited gas?
CO
What is the equation for Pulmonary Vascular Resistance?
Pressure in pulm. artery = left atria pressure/CO
Is ventilation higher at the base of the lung or apex?
base
Is perfusion higher at the base of the lung or apex?
base
What is the phrase for pulmonary fibrosis on Xray?
“bilateral reticulonodular opacities”
Is Pulmonary FIbrosis greater in apex or base of lungs?
base
What percent of CO2 is transported as HCO3?
90%
Do restrictive lung diseases breath at a high or low rate?
high
Do obstructive lung diseases breath at a high or low rate?
low
Which nerve mediates the cough reflex?
internal laryngeal nerve
Would a PE more likely go to base or apex of lung?
base
Which two drugs can cause Pulmonary HTN?
cocaine and amphetamines
Which heart structure can be visible during Pulmonary HTN?
coronary sinus
Which tumor marker may be released by Large Cell Carcinoma of lung?
B-HCG
A bacterial lung abscess is caused by which two types of bacteria?
S. aureus or anaerobes
Does panacinar emphysema affect the upper or lower lobes?
upper
Does centriacinar emphysema affect the upper or lower lobes?
lower
What is the Hering-Bruer reflex?
stretch receptors in the lungs inhibit further inspiration
What does J Receptor stand for?
Juxtacapillary
Does obstructive atelectasis cause the trachea to deviate to or from the obstruction?
towards
How does obstructive atelectasis look on CXR?
unilateral opacification
Can aspiration pneumonia have giant cells?
yes
What type of atelectasis would present post-operatively within one hour with a fever?
resorption
What are the three first generation H1 blockers?
Diphenhydramine
Dimenhydrinate
Chlorpheniramine
Does Guaifenesin thin secretions or break up mucus plugs?
this
Does N-acetylcysteine thin secretions or break up mucus plugs?
break up plugs
What is the toxicity of Bosentan?
hepato
What are the two toxicities of Iliprost and epoprostenol?
jaw pain and flushing
Which artery in the posteriior nasal septum can cause life threatening bleeding?
sphenopalatine
What is the toxicity of Ziluteon?
hepato
What are the three toxicities of NRDS regarding oxygen administration?
Retinopathy
Intra-ventricular hemorrhage
Bronchopulmonary dysplasia
Would Retinopathy of Prematurity have increased or decreased vasculation? Why?
increased
hypoxia induces VEGF
What does thyroxine do to surfactant production?
increase
What are the two new tests for surfactant production in kids?
FOAM stability
surfactant/albumin
Which cell mediates the fibrosis of asbestosis?
macrophages
What type of calcifications for pneumoconioses?
eggshell
What type of pneumoconioses can present with Birefringment Crystals?
Silicosis
What type of pneumoconioses can increase the risk of bronchogenic carcinoma?
silicosis
Which procedure can cause a loss of peripheral chemoreceptors?
bilateral carotid endarterectomy
Does silicosis affect the upper or lower lungs?
upper
Are lines of Zahn found in a stasis clot or an embolus?
embolus
What is the time frame for bronchitis?
greater than three months for longer than two years
Would DLCO be increased or decreased during Emphysema?
decreased
Would Hypersensitivity Pneumonitis be a restrictive or obstructive pattern?
restrictive
What type of hypersensitivity is Hypersensitivity Pneumonitis?
three and four
What occurs in G1 of the cell cycle? What three drugs act here?
duplication of cellular content
carmustine/cisplatin/lomustine
