Respiratory Flashcards
what disease?
what are these called?
what are they?
asthma
Curschmann spirals
break down of epithelium in mucus plug giving dark spiral appearance
panacinar emphysema in the lower lobes suggests what causative factor?
alpha-1 anti-trypsin deficiency
mass of the large brochi uniform sheets of ‘salt-and-pepper’ cells (chromatin in coarse and fine clumps)
carcinoid tumour
(4) stages of the natural history of lobar pneumonia
- congestion (1-2 d) 2. red hepatisation (3-4 d) 3. grey hepatisation (5-7 d) 4. resolution (8+ d)
silicosis association?
TB
Rx methaemoglobinaemia
methylene blue vitamin C
which cancer? Kulchitsky cells chromogranin +ve neuron-specific enolase +ve neural cell adhesion molecule (NCAM) myc oncogene amplification
small cell carcinoma
which cancer? central keratin pearls intercellular bridges PTHrP
squamous cell carcinoma
which cancer? pleomorphic giant cells
Large cell carcinoma
presence of the Lines of Zahn indicated what pathology? what tissue sample may we be looking at?
LoZ - interdigitating pink (fibrin, plts) and red (RBCs) areas found only in thrombi formed before death thromboembolism formed before death vessel
Which cancer? mucin +ve glandular growth KRAS, EGFR, ALK activating mutations
adenocarcinoma
mass of the major bronchi oval-shaped cells with scant cytoplasm and hyperchromatic nuclei; chromogranin +ve
small cell carcinoma
structures perforating the diaphragm at T12?
aorta thoracic duct azygos vein
at which week of gestation has the mature level of surfactant been produced in the lungs?
35 weeks
at what level of the respiratory tree is there no longer a ciliated epithelium?
respiratory bronchioles
a PaO2/FiO2 ratio < 300 is a diagnostic criteria for what condition?
acute respiratory distress
which pneumoconioses may respond to steroids?
berylliosis
aetiological factors for thrombosis (famous triad)
Virchow triad: stasis hypercoagulability endothelial damage
Rx altitude sickness how does this work?
acetazolamide increases renal bicarb excretion to rapidly compensate the respiratory alkalosis
CREST syndrome pulmonary sequella
pulmonary hypertension
inhaled FB when supine enters which lobe?
right upper lobe
pathoG - eggshell calcification of hilar lymph nodes on CXR
silicosis
typical vital capacity
4.8 L
2 congenital conditions associated with pulmonary hypoplasia?
- renal agenesis (potter sequence) 2. congenital diaphragmatic hernia
dyspnoea and chest pain, lung mass haemorrhagic pleural effusion; tonofilaments and long slender microvilli
mesothelioma
which medication can induce asthma? how?
aspirin COX inhibition - LKT overproduction –> airway constriction
mass of the major bronchi keratinisation and intercellular bridges
squamous cell carcinoma
typical tidal volume
500 mL
inhaled FB when erect enters which lobe?
right inferior lobe
hypertrophy and hyperplasia of the mucus-secreting layer in the bronchi which disease?
COPD
intraluminal plugs of granulation tissue and inflammatory debris in the distal airways
negative sputum culture or fever
suggests what pathology?
cryptogenic organizing pneumonia
staphylococcus and streptococcus can cause lung abscess. aetiology?
haematogenous spread from IE or septicaemia
of the pneumoconioses, anthracosis is suggestive of?
coal dust
at which week of gestation is respiration possible?
25 weeks
structures perforating the diaphragm at T8?
inferior vena cava phrenic nerve
structures perforating the diaphragm at T10?
oesophagus vagus nerve
pancreatitis is associated with which lung pathology?
ARDS
error in week 4-7 embryonic development of lung leads to what condition?
tracheo-oesophageal fistula
important values in lecithin/sphingomyelin ration
=> 2 is healthy < 1.5 is predictive of RDS
pathoG intra-alveolar hyaline membrane
acute respiratory distress syndrome
key inflammatory cells of COPD & key enzymes?
neutrophils, macrophages and CD8+ T cells
MMP9 and neutrophil elastase
equation for determination of physiologic dead space
dead space = Vt x ((PaCO2 - PECO2)/PaCO2)
major cellular mediator of damage in COPD?
neutrophils secrete proteases leading to alveolar destruction and mucus hypersecretion in bronchi
in NRDS (and other conditions), what are the complication of supplimental oxygen?
RIB
R - retinopathy of prematurity
I - intraventricular haemorrhage
B - bronchopulmonary dysplasia
typical total lung capacity
6 L
which lung cancers are commonly caused by cigarette smoking?
small cell carcinoma & squamous cell carcinoma
what electrolyte abnormality causes symptoms in children with CF? Why?
hyponatraemia (also hypocholraemia, but asymptomatic) Cl- usually resorbed from sweat in eccrine glands. when this doesn’t work, Na+ and water do not follow so sweat is isotonic and too much Na+ is lost through the skin.
IL-5 activates which cell type? secreted by which cell type?
mast cells/eosinophils Th2 cells
diagnostic criteria of COPD?
> 3 months per year productive cough for > 2 years in a row
define the Reid index? what value is suggestive of COPD?
Reid index - thickness of the mucosal gland layer to thickness of bronchial wall, from epithelium to cartilage > 50%
pathoG - chocolate coloured blood When is this a good thing?
methaemoglobinaemia treatment of cyanide poisoning –> binds cyanide with high affinity stops it binding to ETC components causing cell death
pathoG Charcot-Leyden crystals
disease? what are they?
asthma breakdown of eosinophils in sputum give hexagonal, pink (eosinophilic), double pointed crystals
centriacinar emphysema in the upper lobes suggests what causative factor?
smoking
Rx cyanide poisoning
nitrites then thiosulphate
a decreased FEV(1)/FVC ratio
obstructive lung disease (COPD, emphysema, asthma, bronchiectasis)
which cancer? nests of chromogranin +ve neuroendocrine cells
bronchial carcinoid tumour (adenocarcinoma)
hypercalcaemia is associated with what lung cancer?
PTHrP secreting squamous cell carcinoma
apparent thickening of the alveolar septa with tall, columnar cells stainign +ve for mucin. CXR similar to pneumonia
bronchioalveolar subtype of adenocarcinoma of the lung.
better prognosis than other adenocarcinoma and not associated with smoking
prognosis of large cell carcinoma?
association with smoking?
location within the lung?
very bad, poorly responsive to chemotherapy
strongly associated with smoking
peripheral
on what time scale does lung ischaemia-reperfusion injury occur?
a few days following lung transplant
at what lung volume is the pulmonary vascular resistance at its lowest?
near the functional residual capacity
what antibiotic is used for aspiration pneumonia?
clindamycin - good anaerobic cover that also kills Strep pneumoniae
binds to the 50S ribosomal subunit
what are the landmarks for thoracocentesis in all three planes
what is the anatomic space you are introducing the needle to?
mid-clavicular - 6-8th intercostal space
mid-axillary - 8-10th intercostal space
paravertebral - 10-12th space
costodiaphragmatic recess (where pleural exudate will accumulate in the erect thorax)
what are the layers passes through when inserting a chest drain in the mid-axillary line?
skin & subcut
serratus anterior
external, internal and innermost intercostal muscle
parietal and visceral pleura
in cricothyrotomy, what are the layers through which you cut?
- skin & sub cut
- superficial cervical fascia
- parts of the deep cervical fascia (investing and pretracheal)
- cricothyroid membrane
at what sensory tissue does hypoxaemia increase respiratory rate?
what about hypercarbia?
carotid bodies
CO2 has effect at central chemoreceptors in medulla
how long does it take for renal compensation to follow respiratory acid-base distrubance?
about 2 days
what type of channel is the one responsible for cystic fibrosis?
CFTR is an ABC
ATP-binding casette protein
binding of 2 ATP molecules transports Cl- against its concentration gradient
which asthma medication inhibits vesicle release of histamine from mast cells?
cromoglycates - cromolyn and nedocromil
which asthma medication inhibits leukotriene production from arachadonic acid precursors?
Zileuton
which asthma medication inhibits IgE binding to mast cells?
omalizumab
what is virenicline?
partial agonist at alpha4beta2 nicotinic AchR present in CNS
mildly activates receptor to prevent withdrawal symptoms, but blocks binidng site for nicotine so smoking does not seem enjoyable
what are the chemical challeneges you can try when evaluating asthma in a patient with good spirometry at rest?
methacholine and histamine
also cold air inhalation
an inactivating mutation in BMPR2 gene causes what disease?
pulmonary arterial hypertension from mutation in this pro-apoptotic gene, allowing endothelial and smooth muscle cell proliferation
what is bostenan?
endothelin-receptor antagonist
vasodilator (helps symptoms), stops the progression of vascular and right ventricular hypertrophy
what is the mechanism of theophylline?
adenosine receptor antagonist and PDE inhibitor
increases intracellular cAMP (similar to beta-agonist)
