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CRASH LEARNING-MUST MUST MUST. > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Stem cells of the lungs are?

A

Type 2 pneumocytes.–> They give rise to Type 1 and Type 2 pneumocytes BOTH.

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2
Q

Club cells are a regenerative source for which type of cells?

A

Club cells are non-ciliated cells themselves but regenerate ciliated cells in the terminal bronchiole.

Club cells are also called clara cells.

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3
Q

Autopsy examination of the lungs shows protein-rich fluid within the alveolar airspaces.What is the pathology?

A

This means, ARDS. There will be the following characteristics of lunch autopsy:

  1. Protein-rich fluid in alveolar spaces.
  2. Hyaline Membrane.
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4
Q

What barrier is broken down in ARDS? And what makes that barrier?
(Asked in uworld)

A

In ARDS, the alveolar-capillary barrier is broken down. The alveolar capillary barrier is made by Type 1 pneumocytes and endothelial cells of the capillary.

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5
Q

Which cells of the lung release elastase?

A

Alveolar Macrophages release proteinases to phagocytose foreign material.

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6
Q

Type 1 pneumocytes are _________, where as Type pneumocytes are ____________.

A

Type 1 pneumocytes are—> Squamous Cells.

Type 2 pneumocytes are—-> Cuboidal.

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7
Q

How is the surfactant related to the collapsing pressure?

A

Learn it like a story:
Suractant decreases surface tension (surf sey saaf kero farsh, tou tension kam hoti hai_—-> Decrease surface tension means decreased collapsing pressure.

Collapsing pressure is indirectly propotional to the radius of alveoli, so during EXPIRATION alveoli are small and hence the collapsing pressure is high.

(Imagine collapsing pressure as a hand trying to squeeze a balloon to burst out its air.)

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8
Q

Surfactant affects what properties of the lung?

A
  1. Decreases surface tension (surface tension kam hai, touw collapsing pressure kam hai)
  2. Decreases lung recoil (asked in uworld)
  3. Increases lung compliance.

(Surf maarnay sey tension bhee kam hoti hai, aur coils bhee remove ho jaatay hein, aur insaan kay collapse honay ka bhee khatra nahyin hota.)

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9
Q

Cause of NRDS in a diabetic mother and in C-section delivery?

A

In a diabetic mother—-> due to INCREASED FETAL INSULIN.

In a C-section delivery—-> due to DECREASED fetal glucocorticoids.

(Fetus mein masla hai, tou fetus ka hee cause hoga.)

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10
Q

Treatment of NRDS post-delivery is supplemental 02. What are the complications of this treatment?

A
  1. Retinopathy of prematurity–> Asked so many times in uworld–> Also called RETROLENTAL FIBROPLASIA/abnormal retinal neovascularization that extends into vitreous.
    (Fibro-means fibrous tissue which includes vessels–> retina mein vessels ki growth)
  2. Intraventricular Hmg—-> Now, they won’t say kay IVH ho gaya hai bachay go they’ll give you clues like:
    Hypotonia
    Hypotension
    Bulging anterior fontanelle in a PREMATURE kid.
    Aur they can ask the source of Hmg–> Germinal matrix in subventricular zone.
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11
Q

What the last zone of the respiratory tree where goblet cells are found?

A

Goblet cells end before terminal bronchioles–> No gobbling at the terminal, clara ordered.

(Goblet cells are last found in larger bronchioles)

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12
Q

What you need to know about different levels of the respiratory zone and their composition.

A
  1. Goblet cells are NOT PRESENT IN TERMINAL bronchioles. (No gobbling at the terminal)—> They are present in larger bronchioles.
  2. Cartilage+ Submucosal and Serous Glands—–> NOT PRESENT IN THE BRONCHIOLES. They are last seen in distal most-bronchi.
  3. Cilia are last to disappear. They are seen in respiratory bronchioles. (Cilia needs a respirator)
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13
Q

A person with HPV, has an increased risk in getting infection in which particular tissue of the respiratory system?

A

HPV has a predilection for stratified squamous epithelium, which is found in the anal canal, vagina, and cervix.
And stratified squamous epithelium in the respiratory system is only found in TRUE VOCAL CORDS.

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14
Q

Airway resistance is maximum in which part of the respiratory tree?

A

In large or medium-sized BRONCHI

(Bronchi—> do so much CHI CHI—> buhat resist kertay hein bhaee)
will have the smallest diameter—> because resistance is too much here.

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15
Q

Lingula is the remnant of?

A

Lingula in the left lung is homologous to RIGHT MIDDLE LOBE.

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16
Q

Dependant lung segments for aspiration?

A

Right lung-more common.

PUSL–> posterior segment of upper lobe, superior segment of lower lobe.

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17
Q

Which lobe of right lung will be damaged if intercostal space 4 is damaged?

A

Intercostal space 4.

(And at the back, for both lungs–> lungs before ICS4 are upper lobes, and below ICS4 are lower lobes.
(663 of internet FA)

Right middle lobe can also be damaged—> mid axillary line at 4 ics.

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18
Q

After a surgery done, the patient comes to you with complains of:

  1. Delayed gastric emptying
  2. Gastric hypochlorhydria

Which nerve is damaged and which surgery was performed?

A

Surgery to repair diaphragmatic hiatus or during fundiplication of stomach–> Vagus nerve that passed through the esophageal opening in the diaphragm is damaged. Hence, the symptoms.

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19
Q

Diaphragmatic openings?

A

T8–> VIP–> IVC opening, right phrenic nerve at central tendon (VIP people are always right and centre of attention)

T10–> VLOG–> Esophagus, left gastric vessels, Vagus Nerve trunks.

T12—> ATA—> Aorta, thoracic duct, Azygous vein

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20
Q

Which conditions are characteristic of an increased A-a gradient?

A

Fabric was limited, and mismatching ki waka sey rul gayay.
Fabric was limited—-> Diffusion limited such as in fibrosis, emphysema
Mismatching—> V/Q mismatching
RUL–> Right to left shunts.

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21
Q

How does the respiratory system respond to breathing in high altitude?

A

Low partial pressure of inspired oxygen (PIo2)—> Low Partial pressure of oxygen in arterial blood ( Pao2)—-> Hypoxemia—->This causes 2 things to happen:

  1. Chemoreceptors get triggered and cause hyperventilation—> this causes extra breathing out of CO2 and hence reduced PaCO2—-> Respiratory alkalosis. (Body starts trying to compensate it by metabolic acidosis, for this purpose acetazolamide is given to patients beause acetazolamide also causes Metabolic acidosis)
  2. Pulmonary vessels vasoconstriction—> increases the pulmonary vessel hydrostatic pressure and pushes the plasma out—-> causing pulmonary edema, pulmonary HTN leading to RV-hypertrophy.
22
Q

What are clinically significant changes seen during exercise?

A

1.NO CHANGE IN PARTIAL PRESSURES OF ARTERIAL BLOOD.
Only partial pressures of venous blood change during exercise—> Venous blood O2 reduces, Venous blood CO2 increases.

  1. V/Q along the lung becomes more uniform.
  2. Pulmonary blood flow increases.
  3. Ph of blood decreases (2° to lactic acidosis)
  4. Right shift of ODC (O2 unloaded easily in tissues)
23
Q

What is the clinical significance of field cancerization seen in head and neck tumours?

A

Field cancerization means that a carcinogen causes mutation in a wide mucosal area—> We can’t see these pre-cancerous cells on histology, as they appear NORMAL.
(So we cannot detect such cancers early)

24
Q

Clinical significance of Lines of Zahn?

A

interdigitating areas of pink (platelets, fibrin) and red (RBCs) found only in
thrombi formed before death; help distinguish pre- and postmortem thrombi

25
Q

How do you remember the respiratory parameters in pulmonary embolism?

A

As we all know, Hypoxemia with increased A-a gradient is: Fabric was limited, so mismatching ki waja sey rul gayay.
Mismatching—> here means Pulmonary embolism, pneumonia.

So decreased paO2—->

  1. hyperventilation (just like in high altitude)—> Respiratory alkalosis (Ph is INCREASED)
  2. Pulmonary vasoconstriction—-> INCREASED PVR—-> inability of blood to get into left ventricle so REDUCED LVEDP/LV PRELOAD–> Reduced CO—> death.

(PH, HR, R/R, PVR are increased)

26
Q

Flow Volume parameters of Obstructive lung disease and Restrictive Lung Disease?

A

Obstructive—-> INCREASED (O-IN), except for FEV1 greatly reduced and hence, reduction in FEV1
/FVC

And in restrictive—> Ecerything is reduced. (Restrictivw-reduced)–> except for FEV1
/FVC (which will be increased)

27
Q

What is Reid’s index and it is increased in which respiratory pathology?

A

Reid’s index is thickness of submucosal glands/ Submucosa and Lamina propria of mucosal layer.
AKA–> ratio of the thickness of the submucosal glands to the thickness of the bronchial wall between the epithelial basement membrane and the bronchial cartilage

A normal Reid index is 0.4. Higher values correlate with increased duration and severity of chronic bronchitis.

28
Q

What are peculiar features of the respiratory system in a patient of Asthma?

A
  1. Hyperresponsive bronchi (That is why give a negative methacholine challenge test—> They show decline in FEV1 at much smaller doses than in a normal person)
  2. Smooth muscle cell hypertrophy and hyperplasia.
  3. Curshmann spirals–> shed epithelium forms whorled mucous plugs
    (Diagnose Asthma, if they write whorled mucus plugs)
  4. Sputum biopsy shows—> Charcot-Leyden crystals (eosinophilic, hexagonal, double-pointed crystals formed from breakdown of eosinophils in
    sputum) , in uworld they said: The patient’s sputum has a lot of eosinophils.
29
Q

Most common cause of chronic mediastinitis?

A

Infection with histoplasm capsulatum

30
Q

Methacholine challenge is best to?

A

EXCLUDE ASTHMA (High sensitivity, High NPV)

31
Q

Permanently dilated airways vs permanently dilated alveolar spaces?

A

Permanently dilated airways—> Bronchiectasis seen in CF, ABPA, Kartagener syndrome.
permanently dilated alveolar spaces—? Emphysema–> Decreased recoil, and DLCO BV in capillaries, INCREASD COMPLIANCE.

32
Q

Sarcoidosis on histopathology:

A

Has a lot of potential to be asked.

Noncaseating granulomas made up of:

  • Multinucleated giant cells.
  • Crystalline starlike inclusions called asteroid bodies.
  • Calcified laminated concretions in multinucleated giant cells called schaumann bodies.

Bronchialveolar lavage has: d elevated CD4/CD8 ratio

33
Q

What will you see in thr BAL of sarcoidosis?

A

Ferrigunous bodies—> fusiform iron rods that can be seen if BAL is stained with Prussian blue!

34
Q

How does silica increase susceptibility to being infected with TB?

A

Affects phagolysosomes and impairs function of macrophages.

35
Q

How does Restrictive lung disease affect the heart?

A

It leads to Cor pulmonale.

36
Q

Mesothelioma, what should come to your mind first?

A
  1. Pleural plaques are pathognomic.

2. Hemorrhagic/ Exudative Pleural effusions

37
Q

Pleural biopsy histopathology of mesothelioma?

A

Proliferation of epitheloid-type cells that are joined by desmosomes, contain abundant TONOFILAMENTS and are studded with VERY LONG MICROVILLI.

38
Q

In ARDS, what’s the expected Harrowitz index?

A

P/F=Harrowitz index=Carrico index
(Normal is more than 400)
In ARDS—> it will be less than 300.

Decreased Pao2/Fio2 ratio in ARDS (less than 300)
FiO2 is fractional inspired O2

39
Q

Criteria to diagnose sleep apnea?

A

cessation of sleep for more than 10 seconds.
Such events should occur more than 15/hour in an asymptomatic patient, and 5/hour in a symptomatic patient too diagnose them with OSA,

40
Q

Which cells release a substance and cause polycythemia in a patient with low SaO2 due to OSA?

A

EPO released by Peritubular fibroblast cells–> secondary polycythemia?

41
Q

Cheyne-Stokes breathing is seen in?

A

Congestive heart failure.

42
Q

What is pickwickian syndrome, what is the most common pulmonary function indicator for this disease?

A

Pickwickian is another name for Obesity hypoventilation syndrome.
These people have:
Increased PaCO2 (As CO2 is being retained)
Decreased Tidal Volume, PAO2 (Alveolar hypoventilation), ERV.

Most common indicator is DECREASED ERV.

43
Q

Important clue to look for related to PAH in a vignette?

A
  1. Histopathology: Smooth muscle cell proliferation causes medial hypertrophy/ increased medial layer of BV, Intimal layer fibrosis into onion skin, capillary tufts in the lumen of the vessel called plexiform lesions.
  2. Can cause Right Ventricular Hypertrophy but they’ll tell it to you like RIGHT AXIS DEVIATION ON ECG/ elevated JVP/ Hepatic congestion/ loud pulmonic component of S2.
44
Q

How does chronic thromboembolism lead to PAH?

A

Recurrent microthrombi–> decreased cross-sectional area of pulmonary vascular bed.

45
Q

Why is tension pneumothorax an emergency, how does it cause death?

A

Tensionn pneumothorax—-> Air is trapped.

As intrathoracic pressure INCREASES–> Mediastinal shift—> KINKING OF IVC–> Decreased venous return (asked in uworld)—-> decreased cardiac output.

46
Q

Most common mutation causing Cystic fibrosis?

You always do this wrong

A

Abnormal post-translation processing (eg, improper folding and glycosylation) of CFTR, which is detected by the endoplasmic reticulum and degraded in proteosomes.

47
Q

Bordatella pertussis causing infection in a Karate-Teacher:

You got it wrong

A

So, it can occur in people who haven’t had Vaccination boosters since a long time.
It starts off as a mild flu-like illness, and when it enters the paroxysmal phase–> Buzz words:
–> Severe coughing spells/Bursts of cough
–> Post-tussive emesis/ vomiting after the cough spell.

48
Q

Culture on Sabourad agar, for a person who comes with cough will have which pathogen?

A

Histoplasma capsulatum

49
Q

Cause of hypercalcemia in Sarcoidosis?

A

1-alpha-hydroxylase expression in activated macrophages in the lung and lymph nodes causes PTH-independent production of 1,25-dihydroxyvitamin D. This leads to increased intestinal absorption of calcium and subsequent hypercalcemia.

50
Q

Necrotizing inflammation and pulmonary hemorrhage are commonly associated with

A

granulomatosis with polyangiitis, which involves both the lungs and the kidneys.

51
Q

Nodular densities in both lungs that are most prominent in the apical regions. Polarized microscopy shows birefringent particles surrounded by dense collagen fibers. What is the cause of this disease?

A

Silica
Numerous small, rounded nodulespredominant in theupper lobes
Silicosis is characterized by birefringent silicate particles within dense, whorled collagenous nodules surrounded by dust-laden macrophages.

52
Q

“currant jelly” sputum seen in pneumonia caused by Klebsiella pneumoniae and the “rusty” color occasionally seen in pneumococcal pneumonia are due to?

A

Extravasation of red blood cells and hemoglobin into the sputum caused by extensive inflammation and necrosis.

CRASH LEARNING-MUST MUST MUST. (17 decks)

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