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USMLE S1 > Respiratory > Flashcards

Respiratory Flashcards

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USMLE® Step 1 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
Q

dyspnoea and chest pain, lung mass haemorrhagic pleural effusion; tonofilaments and long slender microvilli

A

mesothelioma

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26
Q

which medication can induce asthma? how?

A

aspirin COX inhibition - LKT overproduction –> airway constriction

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27
Q

mass of the major bronchi keratinisation and intercellular bridges

A

squamous cell carcinoma

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28
Q

typical tidal volume

A

500 mL

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29
Q

inhaled FB when erect enters which lobe?

A

right inferior lobe

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30
Q

hypertrophy and hyperplasia of the mucus-secreting layer in the bronchi which disease?

A

COPD

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31
Q

intraluminal plugs of granulation tissue and inflammatory debris in the distal airways

negative sputum culture or fever

suggests what pathology?

A

cryptogenic organizing pneumonia

32
Q

staphylococcus and streptococcus can cause lung abscess. aetiology?

A

haematogenous spread from IE or septicaemia

33
Q

of the pneumoconioses, anthracosis is suggestive of?

A

coal dust

34
Q

at which week of gestation is respiration possible?

A

25 weeks

35
Q

structures perforating the diaphragm at T8?

A

inferior vena cava phrenic nerve

36
Q

structures perforating the diaphragm at T10?

A

oesophagus vagus nerve

37
Q

pancreatitis is associated with which lung pathology?

A

ARDS

38
Q

error in week 4-7 embryonic development of lung leads to what condition?

A

tracheo-oesophageal fistula

39
Q

important values in lecithin/sphingomyelin ration

A

=> 2 is healthy < 1.5 is predictive of RDS

40
Q

pathoG intra-alveolar hyaline membrane

A

acute respiratory distress syndrome

41
Q

key inflammatory cells of COPD & key enzymes?

A

neutrophils, macrophages and CD8+ T cells

MMP9 and neutrophil elastase

42
Q

equation for determination of physiologic dead space

A

dead space = Vt x ((PaCO2 - PECO2)/PaCO2)

43
Q

major cellular mediator of damage in COPD?

A

neutrophils secrete proteases leading to alveolar destruction and mucus hypersecretion in bronchi

44
Q

in NRDS (and other conditions), what are the complication of supplimental oxygen?

A

RIB

R - retinopathy of prematurity

I - intraventricular haemorrhage

B - bronchopulmonary dysplasia

45
Q

typical total lung capacity

A

6 L

46
Q

which lung cancers are commonly caused by cigarette smoking?

A

small cell carcinoma & squamous cell carcinoma

47
Q

what electrolyte abnormality causes symptoms in children with CF? Why?

A

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
Q

IL-5 activates which cell type? secreted by which cell type?

A

mast cells/eosinophils Th2 cells

49
Q

diagnostic criteria of COPD?

A

> 3 months per year productive cough for > 2 years in a row

50
Q

define the Reid index? what value is suggestive of COPD?

A

Reid index - thickness of the mucosal gland layer to thickness of bronchial wall, from epithelium to cartilage > 50%

51
Q

pathoG - chocolate coloured blood When is this a good thing?

A

methaemoglobinaemia treatment of cyanide poisoning –> binds cyanide with high affinity stops it binding to ETC components causing cell death

52
Q

pathoG Charcot-Leyden crystals

disease? what are they?

A

asthma breakdown of eosinophils in sputum give hexagonal, pink (eosinophilic), double pointed crystals

53
Q

centriacinar emphysema in the upper lobes suggests what causative factor?

A

smoking

54
Q

Rx cyanide poisoning

A

nitrites then thiosulphate

55
Q

a decreased FEV(1)/FVC ratio

A

obstructive lung disease (COPD, emphysema, asthma, bronchiectasis)

56
Q

which cancer? nests of chromogranin +ve neuroendocrine cells

A

bronchial carcinoid tumour (adenocarcinoma)

57
Q

hypercalcaemia is associated with what lung cancer?

A

PTHrP secreting squamous cell carcinoma

58
Q

apparent thickening of the alveolar septa with tall, columnar cells stainign +ve for mucin. CXR similar to pneumonia

A

bronchioalveolar subtype of adenocarcinoma of the lung.

better prognosis than other adenocarcinoma and not associated with smoking

59
Q

prognosis of large cell carcinoma?

association with smoking?

location within the lung?

A

very bad, poorly responsive to chemotherapy

strongly associated with smoking

peripheral

60
Q

on what time scale does lung ischaemia-reperfusion injury occur?

A

a few days following lung transplant

61
Q

at what lung volume is the pulmonary vascular resistance at its lowest?

A

near the functional residual capacity

62
Q

what antibiotic is used for aspiration pneumonia?

A

clindamycin - good anaerobic cover that also kills Strep pneumoniae

binds to the 50S ribosomal subunit

63
Q

what are the landmarks for thoracocentesis in all three planes

what is the anatomic space you are introducing the needle to?

A

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
Q

what are the layers passes through when inserting a chest drain in the mid-axillary line?

A

skin & subcut

serratus anterior

external, internal and innermost intercostal muscle

parietal and visceral pleura

65
Q

in cricothyrotomy, what are the layers through which you cut?

A
  1. skin & sub cut
  2. superficial cervical fascia
  3. parts of the deep cervical fascia (investing and pretracheal)
  4. cricothyroid membrane
66
Q

at what sensory tissue does hypoxaemia increase respiratory rate?

what about hypercarbia?

A

carotid bodies

CO2 has effect at central chemoreceptors in medulla

67
Q

how long does it take for renal compensation to follow respiratory acid-base distrubance?

A

about 2 days

68
Q

what type of channel is the one responsible for cystic fibrosis?

A

CFTR is an ABC

ATP-binding casette protein

binding of 2 ATP molecules transports Cl- against its concentration gradient

69
Q

which asthma medication inhibits vesicle release of histamine from mast cells?

A

cromoglycates - cromolyn and nedocromil

70
Q

which asthma medication inhibits leukotriene production from arachadonic acid precursors?

A

Zileuton

71
Q

which asthma medication inhibits IgE binding to mast cells?

A

omalizumab

72
Q

what is virenicline?

A

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
Q

what are the chemical challeneges you can try when evaluating asthma in a patient with good spirometry at rest?

A

methacholine and histamine

also cold air inhalation

74
Q

an inactivating mutation in BMPR2 gene causes what disease?

A

pulmonary arterial hypertension from mutation in this pro-apoptotic gene, allowing endothelial and smooth muscle cell proliferation

75
Q

what is bostenan?

A

endothelin-receptor antagonist

vasodilator (helps symptoms), stops the progression of vascular and right ventricular hypertrophy

76
Q

what is the mechanism of theophylline?

A

adenosine receptor antagonist and PDE inhibitor

increases intracellular cAMP (similar to beta-agonist)

USMLE S1 (16 decks)

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