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STEP 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

In COPD, the fraction of air in the lungs that is not involved in respiration, the RV/TLC ratio, is ______

A

increased *A high RV/TLC ratio correlates with poor outcomes in patients with COPD.

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2
Q

In emphysema, Diffusing capacity of the lung for carbon monoxide (DLCO) is ________

A

decreased *due to emphysematous destruction of the alveolar-arterial membrane.

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3
Q

How is a Normal A-a gradient clinically estimated?

A

(age/4) + 4

(ex: for a person <40 years old, gradient should be <14).

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4
Q

hemorrhagic pleural effusion (exudative), nodular pleural thickening Psammoma bodies Desmosomes, Tono-filaments, long Microvilli

A

Mesothelioma

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5
Q

Lung Malignancy not associated with smoking at all

A

Mesothelioma

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6
Q

Calretinin + Cytokeratin 5/6+

A

Mesothelioma

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7
Q

↑ CD4/CD8 ratio on BAL fluid ↓ PTH ↑ Calcium in serum Coarse Reticular Opacities

A

Sarcoidosis Also, ↑ ACE

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8
Q

Non-Caseating Granulomas containing calcium + Protein Giant cell called what?

A

Schaumann bodies (Sarcoidosis)

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9
Q

Non-Caseating Granulomas containing lipids/MQs in giant cell

A

Asteroid bodies (Sarcoidosis)

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10
Q

Constitutional symptoms Cough, dyspnea & chest pain Extrapulmonary findings

Anterior/posterior uveitis

Löfgren syndrome

Parotid gland swelling

Erythema Nodosum

migratory polyarthritis

A

Sarcoidosis

Lofgren syndrome → a classic triad of fever, erythema nodosum, and bilateral hilar adenopathy; however, this characteristic triad is not always present and has also been associated with migratory polyarthritis, especially involving ankles

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11
Q

Neutrophils, macrophages, and _______ are the primary mediators of disease in chronic obstructive pulmonary disease.

A

CD8+ T lymphocytes

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12
Q

Can Acetaminophen exacerbate Asthma symptoms?

A

No, Acetaminophen is only a weak inhibitor of cyclooxygenase. Aspirin and other nonsteroidal anti-inflammatory drugs that inhibit cyclooxygenase can precipitate asthma attacks due to leukotriene overproduction in the airways.

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13
Q

Expiratory airflow rates are reduced in COPD due to inflammatory and _________ of the bronchi in chronic bronchitis

and decreased alveolar elastic recoil in emphysema.

A

fibrotic narrowing

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14
Q

Prolonged, untreated obstructive sleep apnea can cause what complications (2)?

A

pulmonary hypertension

right heart failure

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15
Q

BMPR2 gene mutations cause idiopathic ______

A

pulmonary hypertension

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16
Q

What is seen here

A

Dilsted Air spaces

Emphysema

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17
Q

Farthest Left graph is normal what causes the other two?

A

Middle:

Increased elastic resistance | Restrictive Lung Disease

WOB is minimized when the tidal volume is low. To compensate for low lung volumes, rapid, shallow breathing is favored

Right:

Increased airflow resistance | COPD

WOB is minimized with lower respiratory rates and higher tidal volumes (ie, relatively slow, deep breathing)

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18
Q

Patients with severe emphysema typically have chronic _____ leading to chronic respiratory acidosis

with metabolic compensation (high bicarbonate, slightly acidic pH),

often accompanied by hypoxemia

(PaO2<75 mm Hg on room air).

A

CO2 retention

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19
Q

neutrophil elastase, that cause alveolar damage, reduced ciliary motion, and increased ______.

A

mucus secretion by goblet cells

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20
Q

_______, a disease characterized by chronic airway inflammation, airway hyperresponsiveness, and intermittent, reversible bronchoconstriction.

A

Uncontrolled Asthma

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21
Q

Uncontrolled asthma causes chronic inflammation, composed mainly of eosinophils, helper T cells, and mast cells, which cause ____ & increased smooth muscle which further worsens airway obstruction and symptoms.

A

bronchial wall thickening

*& increased smooth muscle

(airway remodeling)

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22
Q

_________ inhibit the production of inflammatory mediators (cytokines, prostaglandins, leukotrienes), reduce leukocyte extravasation into the respiratory epithelium, and induce apoptosis of inflammatory cells.

In addition, they decrease smooth muscle proliferation and mucus production by goblet cells.

(Asthma)

A

inhaled corticosteroids (ex: fluticasone)

reduce the frequency and severity of exacerbations

used for long-term asthma control

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23
Q

Histologic findings of idiopathic pulmonary fibrosis include

  • patchy lymphoplasmacytic infiltrates,
  • focal fibroblastic proliferation with dense fibrosis,
  • honeycombing
  • hyperplasia of type 2 pneumocytes

Therapies are directed at slowing the progression of fibrosis by…..

A

inhibiting TGF ß

and

other fibrogenic growth factors (PDGF, FGF, and VEGF).

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24
Q

for any given lung volume the transpulmonary pressure will be significantly increased

is called what and in what is it a hallmark of?

A

Decreased Compliance

Pulmonary Fibrosis

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25
Q

____ stimulates bronchodilation via blockade of the binding of acetylcholine (a neurotransmitter) to muscarinic receptors. Inhaled form is more commonly used for chronic obstructive pulmonary disease

A

Ipratropium

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26
Q

At high altitude, the low partial pressure of inspired oxygen (PiO2) leads to hypoxemia with consequent hyperventilation and ______.

A

respiratory alkalosis

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27
Q

Lithium-induced _____ is the result of lithium’s antagonizing effect on the action of vasopressin on principal cells within the collecting duct system.

A

diabetes insipidus

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28
Q

Beta-adrenergic activity increases the activity of the Na-K-ATPase pump;

therefore, both endogenous catecholamines and therapeutic beta-2 agonists (eg, albuterol, dobutamine) can cause transient hypokalemia due to

A

increased transport of potassium intracellularly

via

Na-K-ATPase pump

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29
Q

Increased urinary concentrations of calcium, oxalate, and uric acid promote salt crystallization,

whereas increased urinary _____ concentration and high fluid intake prevent calculi formation.

A

citrate

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30
Q

Because low Cl- impairs renal excretion of ____________, total body chloride depletion often plays an important role in the pathogenesis of ___________.

A

HCO3-

metabolic alkalosis

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31
Q

The work of breathing is minimized when the tidal volume is ___ in Restrictive Lung Disease

A

low

*due to Increased elastic resistance

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32
Q

The work of breathing is minimized with ___ respiratory rates and ___ tidal volumes in COPD

A

lower

higher

*due to Increased airflow resistance

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33
Q

Uncontrolled asthma causes chronic inflammation, composed mainly of eosinophils, helper T cells, and mast cells, which cause bronchial wall thickening & _____ which further worsens airway obstruction and symptoms.

A

increased smooth muscle

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34
Q

What is seen here

A

Honeycombing

(pulmonary Interstitial fibrosis)

*hyperechoic outlines and really tiny bubbles seen as opposed to lighter outlines and bigger bubbles seen in emphysema

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35
Q

Inhaled corticostroids (Fluticasone)

inhibit the production of inflammatory mediators

(cytokines, prostaglandins, leukotrienes),

reduce leukocyte extravasation into the respiratory epithelium, and induce _____ of inflammatory cells.

In addition, they decrease smooth muscle proliferation and mucus production by goblet cells.

(Treats Asthma)

A

apoptosis

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36
Q

Inhaled corticostroids (Fluticasone)

inhibit the production of inflammatory mediators

(cytokines, prostaglandins, leukotrienes),

reduce leukocyte _____ into the respiratory epithelium, and induce apoptosis of inflammatory cells.

In addition, they decrease smooth muscle proliferation and

______

(Treats Asthma)

A

Extravasation

mucus production by goblet cells.

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37
Q

Inhaled corticostroids (Fluticasone)

inhibit the production of inflammatory mediators

(cytokines, prostaglandins, leukotrienes),

reduce leukocyte extravasation into the respiratory epithelium, and induce apoptosis of inflammatory cells.

In addition, they decrease ______ and

mucus production by goblet cells.

(Treats Asthma)

A

smooth muscle proliferation

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38
Q

Functional Residual Capacity

FRC

A

Reserve volume

+

Expiratory Reserve Volume

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39
Q

Vital Capacity

VC

A

TV

+

IRV

+

ERV

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40
Q

Total Lung Capacity

TLC

A

TV + IRV + ERV + RV

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41
Q

Minute Ventilation

A

Tital Volume x Resp Rate

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42
Q

Alveolar Ventilation

A

Tital Volume – Dead Space

x

Respiratory Rate

*Dead space = 150 usually

43
Q

Equation to determine Physiological dead space

A

Tidal Volume

x

(PaCO – PeCO/ PaCO)

*PeCO = expired Carbon Dioxide

44
Q

Compliance is increased by ___ & decreased by wall stiffness

A

Surfactant

45
Q

Aging is associated with decreased

lung compliance

FVC & FEV1

Ventilatory response to hypoxia/hypercapnia

What remains the same though?

A

TLC

46
Q

Hemoglobin concentration in:

CO poisoning

Anemia

Polycythemia

A

Normal

Decrease

Increase

47
Q

Total O2 content in:

CO poisoning

Anemia

Polycythemia

A

Decreased

Decreased

Increased

*PaO2 remians normal for all 3

48
Q

% O2 sat of Hemoglobin in:

CO poisoning

Anemia

Polycythemia

A

Decreased

Normal

Normal

49
Q

Ferric

Ferous

A

Fe 3+

Fe 2+

*Iron in Hemoglobin needs to be Ferous to bind

50
Q

___ Hb has more affinity for Cyanide than oxygen

A

Ferric (Fe3+)

51
Q

Chocolate blood

Cyanosis

A

Methemeglobinemia

(Cyanide poisoning)

*treat with Methelyne blue/ Vit. C

52
Q

What factors cause a right shift in the Oxygen hemoglobin dissociation curve?

A

↑ Acid H+ (↓pH)

↑ PCO2

Exercise

↑ 2,3 BPG

↑ Altitude

↑ Temperature

ACE BAT

53
Q

What factors cause a left shift in the Oxygen hemoglobin dissociation curve?

A

↓ H+ (↑pH)

↓ PCO2

↓ 2-3 BPG

↓ Temperature

↑ Carbon Monoxide

↑ Myoglobin

↑ Fetal Hemoglobin

54
Q

Left or right shift in the Hb-O2 curve?

↑ Myoglobin

↑ Fetal Hemoglobin

A

Left

55
Q

Left or right shift in the Hb-O2 curve?

↑ Carbon Monoxide

A

Left

56
Q

Almond odor breath

A

Cyanide poisoning

57
Q

Classically associated with bilateral globus pallidus lesions on MRI

A

Carbon Monoxide poisoning

58
Q

Inhibit aerobic metabolism via inhibition of complex IV (cytochrome-c) causing hypoxia that does not correct with O2

A

Cyanide

59
Q

Low PAO2 causes a hypoxic ______ of the blood vessels

A

vasoconstriction

*shunts blood to well ventilated areas

60
Q

Both ventilation and perfusion are greater at the ____ of the lung

A

Base

61
Q

V/Q = infinity

indicates a ____ obstruction

A

Blood Flow

(Pulmonary embolism)

Oxygen supplementation helps

62
Q

V/Q = zero

indicates a ____ obstruction

A

airway

(aspiration)

Oxygen supplementation does not help

63
Q

V/Q mismatch

Diffusion limitation (fibrosis/ emphysema)

Right to Left Shunt (Terrible Ts)

__ A-a gradient

A

Increase

64
Q

V/Q = 3 at apex of lung

wasted ventilation or perfusion?

A

ventilation

65
Q

V/Q = 0.6 at base of lung

wasted ventilation or perfusion?

A

perfusion

(3V.6P)

66
Q

In response to high altitude there is a chronic INCREASE in (2)

A

ventilation

Mitochondria

67
Q

Patients with ____can develop interstitial lung diseases, both from the pulmonary manifestations of the disease itself and from certain therapies (methotrexate, cyclophosphamide, sulfasalazine).

A

rheumatoid arthritis

68
Q

Subpleural areas of dense collagen deposition, lymphocyte infiltration, and fibroblast proliferation intermixed with areas of normal lung tissue. Diagnosis?

A

Idiopathic Lung Fibrosis

69
Q

Microscopy may show fibrosis and honeycombing.

Presence of brown, beaded rods coated with iron-containing material and inorganic particles with a similar ferrous material. Calcified pleural plaques are also common.

A

Asbestosis

Asbestos bodies (brown, beaded rods coated with iron-containing material)

Ferruginous bodies (inorganic particles with a similar ferrous material)

70
Q

Histologic findings include noncaseating granulomas, peribronchiolar fibrosis, and patchy lymphocytic infiltrates.

A

Chronic hypersensitivity pneumonitis

71
Q

Women with dry cough and dyspnea

Diagnosis?

A

Sarcoidosis

72
Q

Diagnosis

A

Mesothelioma

(Shipbuilding, insulation, asbestos exposure)

73
Q

internalized ___ particles impair macrophage function by disrupting phagocytosis and promoting apoptosis. This increases the risk of mycobacteria infection (particularly M tuberculosis).

A

silica

(Silicosis)

74
Q

Just review

A

Sarcoidosis

75
Q

Fever, Night sweats, Weight loss, Cough

biopsy would typically show caseating granulomas and acid-fast bacilli.

A

TB

76
Q

Dry cough + exertional Dyspnea

BAL shows increased neutrophils and characteristic lipid-laden macrophages that result from

A

GERD causing

micro-aspiration

77
Q

Dry cough + Exertional Dyspnea

Bronchoalveolar lavage shows high lymphocyte count

A

Hypersensitivity Pneumonitis

(restrictive lung disease)

78
Q

Chest x-ray: diffuse reticular interstitial opacities

suggests?

A

interstitial fibrosis

(Restrictive lung diseases like sarcoidosis, Hypersensitive pneumonitis etc.)

79
Q

BAL in ______ often demonstrates hemosiderin-laden macrophages

A

cardiogenic pulmonary edema

*From elevated pulmonary capillary hydrostatic pressure leading to extravasation of red blood cells into the alveoli. Leukocyte percentages are not significantly affected.

80
Q

Th1, IL-2, IFN - ɣ

mediators of what lung disease?

A

Sarcoidosis

81
Q

IFN-γ activates _____ and promotes granuloma formation. Activated macrophages and T cells also produce _____, further assisting in leukocyte recruitment and granuloma maintenance.

A

macrophages

tumor necrosis factor-alpha

82
Q

Cytokines involved with ___ include IL-4 and IL-5, which are secreted by Th2 cells.

A

asthma

83
Q

What are those????

A

Ferruginous bodies

(asbestosis)

84
Q

Chest x-ray reveals bilateral midalveolar and lower alveolar opacities.

Transbronchial lung biopsy reveals lipoproteinaceousmaterial that is positive on periodic acid–Schiff stain and fills up the terminal bronchioles and alveoli.

Electron microscopy of the substance shows lamellar bodies.

What cells are bad?

A

Macrophages

Pulmonary alveolar proteinosis

85
Q

a rare condition characterized by progressive respiratory dysfunction due to the accumulation of surfactant

(PAS positive material forming lamellar bodies) within the alveolar spaces.

The condition occurs most often due to the impaired clearance of surfactant by alveolar macrophages (decreased GM-CSF signaling).

A

Pulmonary alveolar proteinosis is

86
Q

histology demonstrates nodules composed of whorled collagen fibers and dust-laden macrophages. Imaging demonstrates innumerable upper lobe–predominant nodes within the pulmonary parenchyma.

A

silicosis

87
Q

composed of a thick, fibrinous exudate and pus

Typically occurs when bacteria infect the pleural space (typically from an associated pneumonia).

Patients often present with fever, chills, and (occasionally) sepsis, not months of weight loss and dyspnea.

A

Empyema

88
Q

Review

A

Histologically, mesothelioma can appear as cuboidal or flattened cells (epithelium-like) or spindle cells (stromal-like).

89
Q

Pirfenidone is an antifibrotic agent that inhibits ____ used to treat Idiopathic Pulmonary Fibrosis

No drug is curative, but slow progressive fibrosis in patients with IPF.

A

TGF-β

another treatment option is nintedanib, a tyrosine kinase inhibitor that inhibits PDGF, FGF, and VEGF.

90
Q

Histologic findings of _____ include patchy lymphoplasmacytic infiltrates, focal fibroblastic proliferation with dense fibrosis, honeycombing, and hyperplasia of type 2 pneumocytes.

A

idiopathic pulmonary fibrosis

91
Q

Interstitial lung disease is associated with:

decreased lung volumes

increased lung elastic recoil (b/c fibrotic tissue)

A

*NOT AN INCREASE FEV1, Steph

92
Q

increased elastic recoil results in increased ______ on the airways, leading to increased expiratory flow rates when corrected for the low lung volume.

(Restrictive lung disease)

A

radial traction (outward pulling)

*NOT an INCREASED FEV1

93
Q

Thickening of the bronchioles, which occurs in ___ , leads to narrowing of the airways.

Although reduced airway radius leads to local increase in airflow velocity, overall the increased resistance causes a decrease in expiratory flow rates.

A

Asthma

94
Q

is defined as the change in lung volume for a given change in pressure.

A

Lung compliance

*Increased compliance means that the lung tissue stretches and expands more in response to increased pressure. Restrictive lung diseases cause decreased lung compliance

95
Q

Chronic disease presents with gradually progressive cough, dyspnea, fatigue, and weight loss

Lung biopsy reveals lymphocytic infiltrate, poorly formed noncaseating granulomas, and alveolar septal fibrosis

x-ray reveals reticular densities in both lung fields

A

Hypersensitivity Pneumonitis

96
Q

Idiopathic Pulmonary Fibrosis effects on

Type 1 pneumocytes

Type 2 pneumocytes

Basement Membrane

Fibroblast

A

↓

↑

Abnormal

↑

*focally repairs by fibroblast proliferation/collagen deposition instead of normal restoration via type 2 pneumocyte differentiation

97
Q

Review

A

Restrictive lung disease has

DECREASED compliance

Obstructive is INCREASED compliance

98
Q

Restrictive or Obstructive disease?

A

Restrictive

Graph shows lowered FEV1

*The black curve (normal PFT) results with an FEV1 of 4 liters, an FVC of 5 liters, and an FEV1/FVC ratio of 80%.

Red curve shows a reduced FEV1 of 3 liters, a reduced FVC of 3.5 liters, and a slightly increased FEV1/FVC ratio of 86%.

99
Q

FVC/ FEV-1 ratio is ____

A

decreased

100
Q

ARDS due to inhalational injury

what cell type is most damaged?

A

Type 1 pneumocyte

(Alveolar epithelial lining for gas exchange)

101
Q

Surfactant production

Stem cell reservoir for pneumocytes

A

Type 2 pneumocyte

102
Q

Hyaline membrane disease of prematurity

What cell type is disfunctional?

A

Type 2 pneumocyte

103
Q

In

Ciliary dyskinesia (Kartagener syndrome)

Cystic fibrosis: airway desiccation

What cell type has a disfunction?

A

Ciliated airway epithelial cell

( FXN: Mucociliary escalator, Salt, water & moisture homeostasis)

STEP 1 (88 decks)

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