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USMLE S1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

what disease?

what are these called?

what are they?

A

asthma

Curschmann spirals

break down of epithelium in mucus plug giving dark spiral appearance

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2
Q

panacinar emphysema in the lower lobes suggests what causative factor?

A

alpha-1 anti-trypsin deficiency

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3
Q

mass of the large brochi uniform sheets of ‘salt-and-pepper’ cells (chromatin in coarse and fine clumps)

A

carcinoid tumour

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4
Q

(4) stages of the natural history of lobar pneumonia

A
  1. congestion (1-2 d) 2. red hepatisation (3-4 d) 3. grey hepatisation (5-7 d) 4. resolution (8+ d)
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5
Q

silicosis association?

A

TB

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6
Q

Rx methaemoglobinaemia

A

methylene blue vitamin C

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7
Q

which cancer? Kulchitsky cells chromogranin +ve neuron-specific enolase +ve neural cell adhesion molecule (NCAM) myc oncogene amplification

A

small cell carcinoma

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8
Q

which cancer? central keratin pearls intercellular bridges PTHrP

A

squamous cell carcinoma

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9
Q

which cancer? pleomorphic giant cells

A

Large cell carcinoma

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10
Q

presence of the Lines of Zahn indicated what pathology? what tissue sample may we be looking at?

A

LoZ - interdigitating pink (fibrin, plts) and red (RBCs) areas found only in thrombi formed before death thromboembolism formed before death vessel

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11
Q

Which cancer? mucin +ve glandular growth KRAS, EGFR, ALK activating mutations

A

adenocarcinoma

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12
Q

mass of the major bronchi oval-shaped cells with scant cytoplasm and hyperchromatic nuclei; chromogranin +ve

A

small cell carcinoma

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13
Q

structures perforating the diaphragm at T12?

A

aorta thoracic duct azygos vein

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14
Q

at which week of gestation has the mature level of surfactant been produced in the lungs?

A

35 weeks

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15
Q

at what level of the respiratory tree is there no longer a ciliated epithelium?

A

respiratory bronchioles

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16
Q

a PaO2/FiO2 ratio < 300 is a diagnostic criteria for what condition?

A

acute respiratory distress

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17
Q

which pneumoconioses may respond to steroids?

A

berylliosis

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18
Q

aetiological factors for thrombosis (famous triad)

A

Virchow triad: stasis hypercoagulability endothelial damage

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19
Q

Rx altitude sickness how does this work?

A

acetazolamide increases renal bicarb excretion to rapidly compensate the respiratory alkalosis

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20
Q

CREST syndrome pulmonary sequella

A

pulmonary hypertension

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21
Q

inhaled FB when supine enters which lobe?

A

right upper lobe

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22
Q

pathoG - eggshell calcification of hilar lymph nodes on CXR

A

silicosis

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23
Q

typical vital capacity

A

4.8 L

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24
Q

2 congenital conditions associated with pulmonary hypoplasia?

A
  1. renal agenesis (potter sequence) 2. congenital diaphragmatic hernia
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25
dyspnoea and chest pain, lung mass haemorrhagic pleural effusion; tonofilaments and long slender microvilli
mesothelioma
26
which medication can induce asthma? how?
aspirin COX inhibition - LKT overproduction --\> airway constriction
27
mass of the major bronchi keratinisation and intercellular bridges
squamous cell carcinoma
28
typical tidal volume
500 mL
29
inhaled FB when erect enters which lobe?
right inferior lobe
30
hypertrophy and hyperplasia of the mucus-secreting layer in the bronchi which disease?
COPD
31
intraluminal plugs of granulation tissue and inflammatory debris in the distal airways negative sputum culture or fever suggests what pathology?
cryptogenic organizing pneumonia
32
staphylococcus and streptococcus can cause lung abscess. aetiology?
haematogenous spread from IE or septicaemia
33
of the pneumoconioses, anthracosis is suggestive of?
coal dust
34
at which week of gestation is respiration possible?
25 weeks
35
structures perforating the diaphragm at T8?
inferior vena cava phrenic nerve
36
structures perforating the diaphragm at T10?
oesophagus vagus nerve
37
pancreatitis is associated with which lung pathology?
ARDS
38
error in week 4-7 embryonic development of lung leads to what condition?
tracheo-oesophageal fistula
39
important values in lecithin/sphingomyelin ration
=\> 2 is healthy \< 1.5 is predictive of RDS
40
pathoG intra-alveolar hyaline membrane
acute respiratory distress syndrome
41
key inflammatory cells of COPD & key enzymes?
neutrophils, macrophages and CD8+ T cells MMP9 and neutrophil elastase
42
equation for determination of physiologic dead space
dead space = Vt x ((PaCO2 - PECO2)/PaCO2)
43
major cellular mediator of damage in COPD?
neutrophils secrete proteases leading to alveolar destruction and mucus hypersecretion in bronchi
44
in NRDS (and other conditions), what are the complication of supplimental oxygen?
**RIB** **R** - retinopathy of prematurity **I** - intraventricular haemorrhage **B** - bronchopulmonary dysplasia
45
typical total lung capacity
6 L
46
which lung cancers are commonly caused by cigarette smoking?
small cell carcinoma & squamous cell carcinoma
47
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.
48
IL-5 activates which cell type? secreted by which cell type?
mast cells/eosinophils Th2 cells
49
diagnostic criteria of COPD?
\> 3 months per year productive cough for \> 2 years in a row
50
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%
51
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
52
pathoG Charcot-Leyden crystals disease? what are they?
asthma breakdown of eosinophils in sputum give hexagonal, pink (eosinophilic), double pointed crystals
53
centriacinar emphysema in the upper lobes suggests what causative factor?
smoking
54
Rx cyanide poisoning
nitrites then thiosulphate
55
a decreased FEV(1)/FVC ratio
obstructive lung disease (COPD, emphysema, asthma, bronchiectasis)
56
which cancer? nests of chromogranin +ve neuroendocrine cells
bronchial carcinoid tumour (adenocarcinoma)
57
hypercalcaemia is associated with what lung cancer?
**PTHrP** secreting squamous cell carcinoma
58
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
59
prognosis of large cell carcinoma? association with smoking? location within the lung?
very bad, poorly responsive to chemotherapy strongly associated with smoking peripheral
60
on what time scale does lung ischaemia-reperfusion injury occur?
a few days following lung transplant
61
at what lung volume is the pulmonary vascular resistance at its lowest?
near the functional residual capacity
62
what antibiotic is used for aspiration pneumonia?
clindamycin - good anaerobic cover that also kills *Strep pneumoniae* binds to the 50S ribosomal subunit
63
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)
64
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
65
in cricothyrotomy, what are the layers through which you cut?
1. skin & sub cut 2. superficial cervical fascia 3. parts of the deep cervical fascia (*investing* and *pretracheal*) 4. cricothyroid membrane
66
at what sensory tissue does hypoxaemia increase respiratory rate? what about hypercarbia?
carotid bodies CO2 has effect at central chemoreceptors in medulla
67
how long does it take for renal compensation to follow respiratory acid-base distrubance?
about 2 days
68
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
69
which asthma medication inhibits vesicle release of histamine from mast cells?
cromoglycates - cromolyn and nedocromil
70
which asthma medication inhibits leukotriene production from arachadonic acid precursors?
Zileuton
71
which asthma medication inhibits IgE binding to mast cells?
omalizumab
72
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
73
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
74
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
75
what is bostenan?
endothelin-receptor antagonist vasodilator (helps symptoms), stops the progression of vascular and right ventricular hypertrophy
76
what is the mechanism of theophylline?
adenosine receptor antagonist and PDE inhibitor increases intracellular cAMP (similar to beta-agonist)

USMLE S1 (16 decks)

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