Respiratory Flashcards
1
Q
A 2 year old swallows a coin… where is it most likely to lodge?
A
Right mainstem bronchus
2
Q
When sampling amniotic fluid, what indicates fetal lung maturity?
A
Lecithin-to-sphingomyelin ration > 2
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
4
Q
V/Q during airway obstruction
A
V/Q approaches 0
100% O2 does not improve PaO2
5
Q
V/Q during blood flow obstruction
A
V/Q approaches infinity
100% O2 improves PaO2
6
Q
V/Q at apex of lung
A
Greater than 1 (wasted ventilation)
7
Q
V/Q at base of lung
A
Less than 1 (wasted perfusion)
8
Q
3 ways CO2 is transported from tissues to the lungs
A
HCO3
Carbaminohemaglobin
DIssolved in blood
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
10
Q
Drug used for altitude sickness?
A
Acetazolamide
11
Q
Tx for carbon monoxide poisoning?
A
Hyperbaric O2
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
13
Q
S1Q3T3
Deep S in lead 1
Large Q and inverted T in lead 3
A
Pulmonary Embolism
14
Q
Stroke after multiple long bone fractures… what caused the infarct?
A
Fat emboli
15
Q
FEV1/FVC in normal lung
A
80%
16
Q
FEV1/FVC in obstructive disease
A
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
18
Q
Eosinophilic
hexagnal
Double pointed- needle like crystals
Formed from breakdown of eosinophils in sputum
A
Charcot-Leyden crystals
19
Q
Charcot-leyden cyrstals
Curschmann spirals
A
Asthma
20
Q
Hyperplasia of mucus-secreting glands in brochi
Reid index > 50%
A
Chronic Bronchitis
21
Q
Thickness of gland layer/ thickness of bronchial wall
A
Reid Index
22
Q
Daily productive cough > 3 months for at least 2 consecutive years
A
Chronic Bronchitis
23
Q
Blue Bloaters
A
Chronic bronchitis
24
Q
Centriacinar emphysema
A
Associated with smoking
25
Panacinar Emphysema
Associated with alpha1-antitrypsin deficiency
26
Barrel-shaped chest
| Exhalation through pursed lips
Emphysema = pink puffer
27
```
Increased ACE enzyme
NONcaseating granulomas
Hilar Lymphadenopathy
Uveitis
Hypercalcemia
```
Sarcoidosis
28
Honey comb lung
Idiopathic pulmonary fibrosis
*prolonged will increase EPO release from kidney to better perfuse tissues, increasing hematocrit
29
"Tennis rack" shaped cytoplasmic organelles
Birbeck Granules
| Langerhang cell histiocytosis
30
Iron-containing nodules in the alveolar septum
Ferriginous Bodies = Asbestosis
31
4 complications of lung cancer
- Superior vena cava syndrome
- Horner syndrome
- Paraneoplastic Syndromes
- Hoarsness
32
4 common places for lung cancer mets?
Brain
Bone
Liver
Adrenal Glands
33
Lung cancer associated with SIADH
Small cell carcinoma
34
Tumor associated with Horner syndrome
Pancoast
35
Lung Cancer associated with hypercalcemia
Squamous cell carcinoma
36
Lung cancer associated with Cushing Syndrome
Small cell carcinoma
37
Lung cancer associated with weakness
Small cell - produces Ab to Ca+ channels (Lambort-Eaton Syndrome)
38
Substances associated with lung cancer
Smoke
Radon
Silica
Asbestos
39
Atypical Pneumonia bugs
Mycoplasma Pneumoniae
Legionella
Chlamydophila pneumoniae
40
Situs Inversus
Chronic sinusitis
Bronchiectasis
Kartagener
Dynein defect
*Bronchiectasis due to a nonfunctional mucociliary elevator
41
Cancer associated with a shipyard worker?
Asbestos --> mesothelioma
42
Curshmann Spirals
Charcot-Leyden crystals
Eosinophils in sputum
Bronchial asthma
43
Pneumonia in immunocompromised
Pneumocystis jirovecii
44
Most common atypical/walking pneumonia
Mycoplasma Pneumonia
45
Pneumonia in alcoholics
Klebsiella pneumoniae
46
Pneumonia in bird handlers
Chlamydophila psittaci
47
Pneumonia w/ exposure to bats or bat droppings
Histoplasma
48
Pneumonia w/ recent travel to Cali, New mexico or west texas
Coccidioies
49
Pneumonia with "currant jelly" sputum
Klebsiella
50
q fever
Coxiella burnetti
51
Pneumonia acquired from air conditioners
Legionella pneumophlia
52
Most common cause of pneumonia in children 1 year or younger
RSV
53
Pneumonia in a neonate
Group B strep
| E. Coli
54
Most common cause of pneumonia in children and young adults (college students, military, prison)
Mycoplasma
55
Pneumonia in ventilator patients
Pseudomonas, MRSA
56
Pneumonia in cystic fibrosis
Pseudomonas
57
Pontiac Fever
Legionella
58
What is the relationship of the arteries to the airway in a bronchopulmonary segment?
Arteries run with the airways in the center of the segments
59
Mucoid exudate forming a cast of the airways
Curschmann spirals found in viscous mucus of asthma patients
60
Collections of crystalloid made up eosinophil membrane protein
Charcot-Leyden crystals found in viscous mucus of asthma patients
61
Neutropenic Patient
| "Air-crescent sign"
Asperigillus fumigatus
**45 degree branching septae hyphae
62
Absent breath sounds and positive peristaltic bowel sounds in chest
Congenital diaphragmatic hernia = failure of pleuroperitoneal canal to close completely
63
Most common cause of death in congenital diaphragmatic hernia
Pulmonary hypoplasia, secondary to lack of space for the lung to grow
64
What molecules are diffusion limited?
O2 in emphysema or fibrosis
CO
*gas does not equilibrate by the time blood reaches the end of the capillary
65
Bronchiolitis
RSV
| ssRNA non-segmented genome
66
Initial phase: malaise, dry cough, chest pressure
Second phase: ARDS, hemorrhagic mediastinitis, bloody pleural effusion, mediastinal widening
Bacillus anthracis
"Wool-sorter's disease"
Death in 24 hours if not treated due to septic shock from exotoxin.
**protein capsule
67
Detection of mycoplasma pneumoniae
Cold agglutinin testing
68
Symptomatic difference between cystic fibrosis and kartagners syndrome?
Kartagner's will NOT have steatohrea
69
Clinical difference between granulomatosis with polyangiitis and goodpastures?
Granulomatosis w/ polyangitis will have mucosal ulcers and a + c-ANCA
70
Two lung cancers commonly associated with pancoast tumors?
Adenocarcinomas
| Squamous Cell carcinomas
71
Infectious complication arising from pulmonary silicosis?
Silica may disrupt phagolysosomes & impair macrophages
**increased susceptibility to TB
72
Substances causing methemoglobinemia
Nitrates/Nitrites
| Anti-malarial drugs
73
Methemoglobinemia
Oxidized form of Hb (ferric, Fe3+) that does not bind O2 as readily, but has increased affinity for cyanide
74
Carboxyhemoglobin
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
Decreased breath sounds
Decreased percussion
Decreased tactile fremitus
Pleural effusion
**pneuomnia has INCREASED tactile fremitus
76
Child with nasal polyp
CYSTIC FIBROSIS!
77
Adults with nasal polyp
Allergic polyp (allergic rhinitis)
78
Adults with:
Asthma
Aspirin induced bronchospams
Nasal Poly
Aspirin Intolerant Asthma
79
Nasopharyngeal carcinoma is associated with what infection?
Ebstein Barr Virus
80
Life threatening nose bleed
```
Posterior segment
Sphenopalantine artery (branch of maxillary)
```
81
Atypical pneumonia in infant
RSV
82
Most common bug in atypical pneumonia
Mycoplasma Pneumoniae
83
Complication of mycoplasma Pneumoniae
Hemolytic anemia (IgM = cold)
84
Atypical pneumonia with post transplant immunosuppressive therapy
CMV
85
Post viral secondary infection
Staph Aureus
86
Atypical Pneumonia
High Fever
Farmer or Vet
Coxiella Burnetii = Q fever
| Found in tick poo or cow placenta
87
Chronic necrotizing infection of bronchi
Permanently dilated airways
Purulent, foul selling sputum
Recurrent Infections
Hemoptysis
Bronchiectasis
Smoking
Kartagener
Cystic Fibrosis
Allergic bronchopulmonary aspergillosis
88
What induces fibrosis in intestial pulmonary fibrosis?
TGF-B from injured pneumocytes induces fibrosis
89
anthrocosis
Carbon-laden macrophages - found in urban dwellers exposed to sooty air
90
Caplan Syndrome
Coal worker's pneumoconiosis associated with Rheumatoid arthritis
91
Sanblaster
Silicosis
92
How does silica affect macrophages
Silica impairs phagolysosome formation by macrophages
Increased risk for TB
93
Only pneumoconoiosis with increased risk for TB?
Silicosis
Also increased risk for lung cancer
94
Miners and aerospace industry
Berylliosis
95
Noncaseating granulomas in lung and hilar lymph nodes and systemic organs in aerospace worker
Berylliosis!
Sounds like sarcoid, don't get confused!
96
Construction workers
Plumbers
Shipyard Workers
Asbestosis
97
Furrigonous body
Asbestos body, Iron deposits
Dumbbell shaped
98
Dyspnea/ Cough
Elevated serum ACE
Hypercalcemia
Sarcoid
99
Why is there hypercalcemia in Sarcoid?
Non caseating granulomas have an increased 1 alpha hydroxylase activity that activates Vit. D
100
Inactivating mutation of BMPR2
Leads to proliferation of vascular smooth muscle and primary pulmonary HTN
>25 mmHg
101
Treatment for ARDS
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
Main component of surfactant
Lecithin = phosphatidylcholine
103
How does Maternal diabetes increase risk for NRDS?
Increased blood sugar
Baby produces more insulin
Insulin INHIBITS surfactant production
104
How does C-section increase your risk fro NRDS?
Going through birth canal is stressful, release cortisol, increase surfactant production
Don't have that during c-section
105
Complications of NRDS
Hypoxemia =Patent ductus arteriosus and necrotizing enterocoliits
Supplemental Oxygen can cause free radical injury
106
Keratin pearls or intercellular bridges
Squamous cell carcinoma
*PTHrP
107
Chromogranin positive
Neuroendocrine Tumor
Small cell and Carcinoid tumor
108
Where does lung cancer like to metastasize to?
adrenal gland
