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USMLE REVIEW > Respiratory > Flashcards

Respiratory Flashcards

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USMLE® Step 1 flashcards
1
Q

A 2 year old swallows a coin… where is it most likely to lodge?

A

Right mainstem bronchus

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2
Q

When sampling amniotic fluid, what indicates fetal lung maturity?

A

Lecithin-to-sphingomyelin ration > 2

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3
Q

How do you determine physiological dead space?

A

Vd= tidal volume x (PCO2 in arterial blood - PCO2 in expired air)/ PCO2 in arterial blood

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4
Q

V/Q during airway obstruction

A

V/Q approaches 0

100% O2 does not improve PaO2

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5
Q

V/Q during blood flow obstruction

A

V/Q approaches infinity

100% O2 improves PaO2

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6
Q

V/Q at apex of lung

A

Greater than 1 (wasted ventilation)

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7
Q

V/Q at base of lung

A

Less than 1 (wasted perfusion)

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8
Q

3 ways CO2 is transported from tissues to the lungs

A

HCO3
Carbaminohemaglobin
DIssolved in blood

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9
Q

Respiratory response to high altitude

A 
Increased ventilation
Increased epo (increased hematocrit)
Increased 2,3 BPG (increases O2 release from Hgb)
Increased mitochondria
Increased renal excretion of HCO3
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10
Q

Drug used for altitude sickness?

A

Acetazolamide

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11
Q

Tx for carbon monoxide poisoning?

A

Hyperbaric O2

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12
Q

At what positive G force does visual “black out” occur? why?

A

4-6 Gs

Force of pooling blood in abdomen and legs, insufficient pumping of blood to brain

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13
Q

S1Q3T3

Deep S in lead 1
Large Q and inverted T in lead 3

A

Pulmonary Embolism

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14
Q

Stroke after multiple long bone fractures… what caused the infarct?

A

Fat emboli

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15
Q

FEV1/FVC in normal lung

A

80%

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16
Q

FEV1/FVC in obstructive disease

A
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17
Q

FEV1/FVC in restrictive lung disease

A

> or = 80%
lung volumes are decreased (can’t fill up)

FEV1 and FVC are both decreased, but ratio remains the same

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18
Q

Eosinophilic
hexagnal
Double pointed- needle like crystals
Formed from breakdown of eosinophils in sputum

A

Charcot-Leyden crystals

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19
Q

Charcot-leyden cyrstals

Curschmann spirals

A

Asthma

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20
Q

Hyperplasia of mucus-secreting glands in brochi

Reid index > 50%

A

Chronic Bronchitis

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21
Q

Thickness of gland layer/ thickness of bronchial wall

A

Reid Index

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22
Q

Daily productive cough > 3 months for at least 2 consecutive years

A

Chronic Bronchitis

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23
Q

Blue Bloaters

A

Chronic bronchitis

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24
Q

Centriacinar emphysema

A

Associated with smoking

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25
Q

Panacinar Emphysema

A

Associated with alpha1-antitrypsin deficiency

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26
Q

Barrel-shaped chest

Exhalation through pursed lips

A

Emphysema = pink puffer

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27
Q 
Increased ACE enzyme
NONcaseating granulomas
Hilar Lymphadenopathy
Uveitis
Hypercalcemia
A

Sarcoidosis

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28
Q

Honey comb lung

A

Idiopathic pulmonary fibrosis

*prolonged will increase EPO release from kidney to better perfuse tissues, increasing hematocrit

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29
Q

“Tennis rack” shaped cytoplasmic organelles

A

Birbeck Granules

Langerhang cell histiocytosis

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30
Q

Iron-containing nodules in the alveolar septum

A

Ferriginous Bodies = Asbestosis

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31
Q

4 complications of lung cancer

A
  • Superior vena cava syndrome
  • Horner syndrome
  • Paraneoplastic Syndromes
  • Hoarsness
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32
Q

4 common places for lung cancer mets?

A

Brain
Bone
Liver
Adrenal Glands

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33
Q

Lung cancer associated with SIADH

A

Small cell carcinoma

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34
Q

Tumor associated with Horner syndrome

A

Pancoast

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35
Q

Lung Cancer associated with hypercalcemia

A

Squamous cell carcinoma

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36
Q

Lung cancer associated with Cushing Syndrome

A

Small cell carcinoma

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37
Q

Lung cancer associated with weakness

A

Small cell - produces Ab to Ca+ channels (Lambort-Eaton Syndrome)

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38
Q

Substances associated with lung cancer

A

Smoke
Radon
Silica
Asbestos

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39
Q

Atypical Pneumonia bugs

A

Mycoplasma Pneumoniae

Legionella

Chlamydophila pneumoniae

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40
Q

Situs Inversus
Chronic sinusitis
Bronchiectasis

A

Kartagener
Dynein defect

*Bronchiectasis due to a nonfunctional mucociliary elevator

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41
Q

Cancer associated with a shipyard worker?

A

Asbestos –> mesothelioma

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42
Q

Curshmann Spirals
Charcot-Leyden crystals
Eosinophils in sputum

A

Bronchial asthma

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43
Q

Pneumonia in immunocompromised

A

Pneumocystis jirovecii

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44
Q

Most common atypical/walking pneumonia

A

Mycoplasma Pneumonia

45
Q

Pneumonia in alcoholics

A

Klebsiella pneumoniae

46
Q

Pneumonia in bird handlers

A

Chlamydophila psittaci

47
Q

Pneumonia w/ exposure to bats or bat droppings

A

Histoplasma

48
Q

Pneumonia w/ recent travel to Cali, New mexico or west texas

A

Coccidioies

49
Q

Pneumonia with “currant jelly” sputum

A

Klebsiella

50
Q

q fever

A

Coxiella burnetti

51
Q

Pneumonia acquired from air conditioners

A

Legionella pneumophlia

52
Q

Most common cause of pneumonia in children 1 year or younger

A

RSV

53
Q

Pneumonia in a neonate

A

Group B strep

E. Coli

54
Q

Most common cause of pneumonia in children and young adults (college students, military, prison)

A

Mycoplasma

55
Q

Pneumonia in ventilator patients

A

Pseudomonas, MRSA

56
Q

Pneumonia in cystic fibrosis

A

Pseudomonas

57
Q

Pontiac Fever

A

Legionella

58
Q

What is the relationship of the arteries to the airway in a bronchopulmonary segment?

A

Arteries run with the airways in the center of the segments

59
Q

Mucoid exudate forming a cast of the airways

A

Curschmann spirals found in viscous mucus of asthma patients

60
Q

Collections of crystalloid made up eosinophil membrane protein

A

Charcot-Leyden crystals found in viscous mucus of asthma patients

61
Q

Neutropenic Patient

“Air-crescent sign”

A

Asperigillus fumigatus

**45 degree branching septae hyphae

62
Q

Absent breath sounds and positive peristaltic bowel sounds in chest

A

Congenital diaphragmatic hernia = failure of pleuroperitoneal canal to close completely

63
Q

Most common cause of death in congenital diaphragmatic hernia

A

Pulmonary hypoplasia, secondary to lack of space for the lung to grow

64
Q

What molecules are diffusion limited?

A

O2 in emphysema or fibrosis

CO

*gas does not equilibrate by the time blood reaches the end of the capillary

65
Q

Bronchiolitis

A

RSV

ssRNA non-segmented genome

66
Q

Initial phase: malaise, dry cough, chest pressure

Second phase: ARDS, hemorrhagic mediastinitis, bloody pleural effusion, mediastinal widening

A

Bacillus anthracis

“Wool-sorter’s disease”

Death in 24 hours if not treated due to septic shock from exotoxin.

**protein capsule

67
Q

Detection of mycoplasma pneumoniae

A

Cold agglutinin testing

68
Q

Symptomatic difference between cystic fibrosis and kartagners syndrome?

A

Kartagner’s will NOT have steatohrea

69
Q

Clinical difference between granulomatosis with polyangiitis and goodpastures?

A

Granulomatosis w/ polyangitis will have mucosal ulcers and a + c-ANCA

70
Q

Two lung cancers commonly associated with pancoast tumors?

A

Adenocarcinomas

Squamous Cell carcinomas

71
Q

Infectious complication arising from pulmonary silicosis?

A

Silica may disrupt phagolysosomes & impair macrophages

**increased susceptibility to TB

72
Q

Substances causing methemoglobinemia

A

Nitrates/Nitrites

Anti-malarial drugs

73
Q

Methemoglobinemia

A

Oxidized form of Hb (ferric, Fe3+) that does not bind O2 as readily, but has increased affinity for cyanide

74
Q

Carboxyhemoglobin

A

Form of Hb bound to CO in place of O2

Causes decreased oxygen binding capacity with left shift in hbg curve

Less oxygen unloading to tissues

Tx: 100 O2

75
Q

Decreased breath sounds
Decreased percussion
Decreased tactile fremitus

A

Pleural effusion

**pneuomnia has INCREASED tactile fremitus

76
Q

Child with nasal polyp

A

CYSTIC FIBROSIS!

77
Q

Adults with nasal polyp

A

Allergic polyp (allergic rhinitis)

78
Q

Adults with:
Asthma
Aspirin induced bronchospams
Nasal Poly

A

Aspirin Intolerant Asthma

79
Q

Nasopharyngeal carcinoma is associated with what infection?

A

Ebstein Barr Virus

80
Q

Life threatening nose bleed

A 
Posterior segment
Sphenopalantine artery (branch of maxillary)
81
Q

Atypical pneumonia in infant

A

RSV

82
Q

Most common bug in atypical pneumonia

A

Mycoplasma Pneumoniae

83
Q

Complication of mycoplasma Pneumoniae

A

Hemolytic anemia (IgM = cold)

84
Q

Atypical pneumonia with post transplant immunosuppressive therapy

A

CMV

85
Q

Post viral secondary infection

A

Staph Aureus

86
Q

Atypical Pneumonia
High Fever
Farmer or Vet

A

Coxiella Burnetii = Q fever

Found in tick poo or cow placenta

87
Q

Chronic necrotizing infection of bronchi

Permanently dilated airways
Purulent, foul selling sputum
Recurrent Infections
Hemoptysis

A

Bronchiectasis

Smoking
Kartagener
Cystic Fibrosis
Allergic bronchopulmonary aspergillosis

88
Q

What induces fibrosis in intestial pulmonary fibrosis?

A

TGF-B from injured pneumocytes induces fibrosis

89
Q

anthrocosis

A

Carbon-laden macrophages - found in urban dwellers exposed to sooty air

90
Q

Caplan Syndrome

A

Coal worker’s pneumoconiosis associated with Rheumatoid arthritis

91
Q

Sanblaster

A

Silicosis

92
Q

How does silica affect macrophages

A

Silica impairs phagolysosome formation by macrophages

Increased risk for TB

93
Q

Only pneumoconoiosis with increased risk for TB?

A

Silicosis

Also increased risk for lung cancer

94
Q

Miners and aerospace industry

A

Berylliosis

95
Q

Noncaseating granulomas in lung and hilar lymph nodes and systemic organs in aerospace worker

A

Berylliosis!

Sounds like sarcoid, don’t get confused!

96
Q

Construction workers
Plumbers
Shipyard Workers

A

Asbestosis

97
Q

Furrigonous body

A

Asbestos body, Iron deposits

Dumbbell shaped

98
Q

Dyspnea/ Cough
Elevated serum ACE
Hypercalcemia

A

Sarcoid

99
Q

Why is there hypercalcemia in Sarcoid?

A

Non caseating granulomas have an increased 1 alpha hydroxylase activity that activates Vit. D

100
Q

Inactivating mutation of BMPR2

A

Leads to proliferation of vascular smooth muscle and primary pulmonary HTN

> 25 mmHg

101
Q

Treatment for ARDS

A

Ventilation with positive end-expiratory pressure

**recovery may be complicated by interstial fibrosis (Type 2 pneumocytes are injured and can’t regenerate so get fibrosis)

102
Q

Main component of surfactant

A

Lecithin = phosphatidylcholine

103
Q

How does Maternal diabetes increase risk for NRDS?

A

Increased blood sugar
Baby produces more insulin

Insulin INHIBITS surfactant production

104
Q

How does C-section increase your risk fro NRDS?

A

Going through birth canal is stressful, release cortisol, increase surfactant production

Don’t have that during c-section

105
Q

Complications of NRDS

A

Hypoxemia =Patent ductus arteriosus and necrotizing enterocoliits

Supplemental Oxygen can cause free radical injury

106
Q

Keratin pearls or intercellular bridges

A

Squamous cell carcinoma

*PTHrP

107
Q

Chromogranin positive

A

Neuroendocrine Tumor

Small cell and Carcinoid tumor

108
Q

Where does lung cancer like to metastasize to?

A

adrenal gland

USMLE REVIEW (25 decks)

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