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KAPLAN FLASH CARDS > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Symptoms of walking pneumonia (3)

A

Low fever
Dry cough
Diffuse infiltrate on CXR

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2
Q

Bacterial causes of atypical pneumonia

A

Mycoplasma pneum.

Legionalla spp.

Chlamydophila psittacosaurus

Pneumocystis jirovecii

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3
Q

Common triad of symptoms in cystic fibrosis patients

A

Recurrent URI

Chronic diarrhea

Weight loss

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4
Q

Color of lymph exudate in lung and why; two reasons for their occurrence (chylothorax)

A

Milky-white due to high lipid content

1) Cancer (Lymphoma or adjacent tumors)
2) Trauma

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5
Q

Causes of transudative pleural effusion & appearance

A

Straw colored fluid

  • CHF
  • Cirrhosis
  • Nephrotic Syndrome
  • CKD (Na+ retention)
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6
Q

Causes of exudative pleural effusion & appearance

A
  • INFECTION: Pneumonia [yellow/green appearance]; TB [straw colored]
  • MALIGNANCY: Lung cancer, lymphoma, metastatic breast cancer, mesothelioma, ovarian cancer
  • PE
  • AUTOIMMUNE: Vasulitis, SLE, RA, sarcoidosis
  • TRAUMA
  • PANCREATITIS (ARDS)
  • HEMOTHROAX [red/blood]
  • CHYLOTHORAX (pseudo) [milky white]
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7
Q

What two components make up Light Criteria & what is it used for

A

Protein & LDH

Evaluate if a pleural effusion is transudate or exudate

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8
Q

Characteristics of sarcoidosis

A

Bilateral hilar adenopathy

Elevated ACE levels

Noncaseating granulomas

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9
Q

Which electrolyte is elevated in sarcoidosis?

A

Calcium (hypercalcemia)

Increased 1,25-dihydroxyvitamin D production from granuloma formation

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10
Q

How does asbestos exposure in a patient appear on chest X-ray?

A

Calcified pleural plaques

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11
Q

Causes of increased A-a gradient

A
  • Age
  • Right to left shunt (hypoxemic state)
  • Alveolar hypoventilation (interstitial lung disease, fibrosis)
  • V/Q mismatch (PE/pneumothorax)
  • Fluid in alveoli (CHF/ARDS/pneumonia)
  • High concentration of inhaled oxygen
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12
Q

Causes of decreased DLCO

A

In conditions that damage lung tissue and reduce surface area for gas exchange

  • COPD (emphysema only)
  • Fibrosis
  • Interstitial lung disease
  • Aspiration event
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13
Q

Causes of increased total lung capacity

A

COPD due to air trapping and lung hyperinflation

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14
Q

Signs of pan coast tumor

A

-HORNER SYNDROME:
Miosis
Ptsosis
Annhydrosis

  • Ulnar nerve compression
  • SVC Syndrome
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15
Q

Treatment of small cell carcinoma VS non-small carcinoma

A

Small cell: Aggressive & sensitive to chemotherapy & radiation

Non-small cell: Surgery if localized

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16
Q

Common cause of lung squamous cell carcinoma

A

Smoking

*Ciliated mucus secreting epithelium to squamous epithelium

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17
Q

Which cancer are Pancoast tumors associated with

A

Non-small cell carcinoma

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18
Q

Where does bronchioloalveolar carcinoma originate? What would chest X-ray show?

A

Type II pneumocytes or terminal bronchioles

Peripheral pneumonia-like consolidation rather than mass lesion

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19
Q

Purpose of A-a gradient

A
  • Measure of oxygenation (functionality of blood-air barrier)
  • Can help determine causes of hypoxemia as intra or extrapulmonary [PE vs CHF]
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20
Q

Normal A-a gradient

A

HEALTHY PATIENTS:

5-10 mmHg young person

15-20 mmHg old person

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21
Q

When could a sick person have a normal A-a gradient

A

Hypoventilation due to CNS & neuromuscular disorders (b/c no diffusion defect)

High altitude

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22
Q

Where do small cell carcinoma tumor cells arise from? How do they appear on chest X-ray?

A

Bronchial neuroendocrine cells

Centrally located, ill-defined edges, NO central cavitation [adenocarcinoma is peripheral]

**Very aggressive, associated with smoking

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23
Q

Difference in chest X-ray between small cell carcinoma and squamous cell carcinoma

A

SMALL CELL:
NO cavitary lesion with central necrosis

SQUAMOUS CELL:
Cavitary lesion with central necrosis

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24
Q

Demographic of bronchogenic adenocarcinoma

A

Non-smoking females

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25
Q

Where is bronchogenic adenocarcinoma located & its appearance on chest xray

A

Bronchial or bronchiolar mucosa from club cells

*Usually in preexisting scars or inflammation

**Ill-defined solid lesion peripherally

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26
Q

When do we find charcot-leyden crystals?

A

Sputum of asthma or allergy patients

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27
Q

Why do charcot-leyden crystals form?

A

Rhomboid crystals from breakdown of eosinophilic granules (major basic protein)

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28
Q

Which pneumocyte produces surfactant?

A

Type II

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29
Q

Which week of gestation is surfactant adequately produced?

A

Week 35

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30
Q

Why does surfactant increase lung compliance?

A

DPPC inserts its hydrophilic head into the aqueous alveolar lining fluid

Hydrophobic fatty acid tail goes into the air-filled alveolar lumen

**Reduces attraction between water molecules, reducing surface tension

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31
Q

Function of type 1 pneumocytes

A

Gas exchange (97% of alveolar surface)

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32
Q

3 main purposes of surfactant

A

1) Increase lung compliance to reduce work of breathing
2) Prevent atelectasis (surfactant repels when close together, preventing alveoli from collapsing; but surface tension increases when diluted, preventing large size increases)
3) Prevent pulmonary edema (surface tension promotes fluid filtration from capillaries)

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33
Q

Important function of the spleen pertaining to bacterial infections

A

Process bacteria

Produce opsonizing antibody (C3b & antibodies are opsonins)

*Important to clear capsulated bacteria like S.pneumoniae

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34
Q

Gene mutation seen in small cell carcinoma and gross apperance

A

L-myc

Grey-tan-white mass

35
Q

Which 3 diseases is paraneoplastic syndrome associated with?

A

Small cell carcinoma

SIADH

Cushing Syndrome

36
Q

Signs of hyper acute LUNG transplant rejection & timeframe

A

Within 24 hours

  • Rapidly progressing hypoxemia
  • Diffuse opacities on X-ray
37
Q

Mechanism of hyperactive transplant rejection

A

Preformed antibodies against donor HLA or ABO blood antigens

*Abs bind endothelial cells in alveolar capillaries, activating compliment, and these lyse endothelial cells

**Activates coagulation cascade causing thrombosis/infarction

38
Q

Pathomechanism of acute/chronic transplant rejection

A

T cell sensitization to donor antigens

39
Q

Why does a pulse oximeter not detect anemia?

A

It only reflects how many Hb’s 4 O2 binding sites are occupied, NOT concentration

40
Q

Why is arterial PO2 independent of Hb concentration?

A

Represents partial pressure of DISSOLVED oxygen, never concentration of Hb

41
Q

Pickwickian Syndrome

A

Obesity hypoventilation syndrome

Form of alveolar hypoventilation

42
Q

Diagnosis criteria for Pickwickian Syndrome

A
  • Sleep apnea
  • Respiratory acidosis
  • Polycythemia (chronic hypoxia)
  • Normal or restrictive pulmonary function test
  • RV enlargement
43
Q

Patient with lower lobe panacinar emphysema can be indicative of what 2 thing?

A

Ritalin abuse

alpha-1 antitrypsin deficiency

44
Q

Most common paraneoplastic syndrome of small cell carcinoma

A

Cushing syndrome

**tumors are neuroendocrine in origin, secreting ACTH in this case

45
Q

Most common paraneoplastic syndrome of squamous cell carcinoma

A

Hypercalcemia

*Due to PTHrP

46
Q

Does restrictive lung disease increase or decrease elasticity of the lung, and why?

A

INCREASE

  • There is enhanced radial traction (tethering to lung parenchyma), allowing airways to be held open to a greater extent
  • Increased airway diameter increases max expiratory flow
  • We know there is DECREASED lung compliance (less inspiratory flow)
47
Q

Does expiratory flow increase or decrease in restrictive airway disease

A

Increase

-Enhanced tethering to lung parenchyma

48
Q

2 bacteria causing secondary pneumonia following influenza infection

A

S. aureus

S. pneumoniae

49
Q

Club cells: location & function

A

Bronchiolar epithelium

Produce surfactant
Can differentiate into goblet cells

**No role in infant ARDS

50
Q

What must a mother with a premature labor take to stimulate surfactant production

A

Maternal corticosteroids

51
Q

Rust colored sputum associated with which bacterial infection

A

S. pneumoniae

52
Q

Salmon colored sputum associated with which bacterial infection

A

S. aureus

53
Q

Foul smelling sputum associated with which bacterial infection

A

Bacteroides, Fusobacterium, Peptococcus

*oral cavity anaerobic bacteria

54
Q

Secretion from carcinoid tumors & explanation

A

Histamin & serotonin

*can’t be cleared from liver

55
Q

Symptoms of carcinoid tumor

A

Diarrhea
Flushing
Wheezing
Heart disease

56
Q

Where are carcinoid tumors located typically

A

Lung
Ileum
Appendix

57
Q

Trigger of carcinoid tumors

A

Alcohol

*triggers release of vasoactive substances

58
Q

Treatment of carcinoid tumors

A

Surgery or chemo if metastatic

59
Q

What acid-base disorder occurs in acute salicylate poisoning

A

Respiratory alkalosis

*metabolic acidosis is hours later

60
Q

Explain steps of aspirin overdose in terms of acid-base pathophysiology

A

1) RESPIRATORY ALKALOSIS: metabolites stimulate respiratory centers to induce hyperventilation
2) MIXED [resp alkalosis + met. acidosis]: aspirin uncouples oxidative phosphorylation to cause this transition to met. acidosis and lactate + ketoacid levels build
3) RESPIRATORY & METABOLIC ACIDOSIS: ASA is weak acid, crosses BBB and induces brain edema & central respiratory paralysis, decreasing ventilatory drive and death

61
Q

Reid Index & what disease is it increase in?

A

Ratio between thickness of mucous secreting gland and thickness of the wall between epithelium & cartilage in the bronchial tree

**Increased in chronic bronchitis where the ratio is >0.5

62
Q

Which medication can cause pulmonary fibrosis

A

Amiodarone

63
Q

What is the most common respiratory cause of digital clubbing?

A

IPF [idiopathic pulmonary fibrosis]

*Also seen in bronchiectasis
**Not seen in COPD

64
Q

What disease has a tram track line appearance on CT

A

Bronchiectasis (due to fibrosis of the bronchial wall)

*widened airways with honeycombing also seen

65
Q

How is lung compliance & elastic recoil of the lung (increased or decreased) in emphysema VS restrictive lung disease

A

Emphysema:
-Increased compliance (irreversibly enlarged lung spaces)

-Decreased recoil (destruction of elastic tissue)

RLD:
-Decreased compliance

-Increased recoil (higher tension between the alveolar and fibrosis that acts like a spring since they are “cemented” together)

66
Q

Role of neutrophils in COPD

A

Neutrophils mediate inflammation, releasing elastase (which breaks down elastin-keeps lung pliable), resulting in destruction of alveolar walls and air trapping in emphysema

67
Q

What would you hear on lung auscultation in pulmonary fibrosis? Is cough productive or nonproductive?

A

Nonproductive cough

Inspiratory crackles

68
Q

What would you hear on lung auscultation in COPD?

A

Wheezing with reduced breath sounds & rhonci

69
Q

Normal pressure of pulmonary artery

A

4-12 mmHg

70
Q

Anatomically speaking, what portion of the airway is responsible for asthma symptoms?

A

Terminal bronchioles

71
Q

How is a pseudo allergic reaction different than a type 1 hypersensitivity, IgE mediated reaction?

A

Pseudoallergic reactions are due to inhibition of the COX pathway, causing conversion of arachidonic acid to the lipooxygenase pathway

*Flushing and bronchial inflammation occur

72
Q

Severe asthma attack would demonstrate what for the following:

  • Chest auscultation
  • Chest percussion
  • Chest expansion
  • Tactile fremitus
A
  • Chest auscultation: Decreased vesicular sounds
  • Chest percussion: Hyperresonant
  • Chest expansion: Symmetric
  • Tactile fremitus: Decreased
73
Q

Pleural effusion would demonstrate what for the following:

  • Chest auscultation
  • Chest percussion
  • Chest expansion
  • Tactile fremitus
A
  • Chest auscultation: Absent vesicular sounds
  • Chest percussion: Dull
  • Chest expansion: Asymmetric
  • Tactile fremitus: Decreased
74
Q

Pneumothorax would demonstrate what for the following:

  • Chest auscultation
  • Chest percussion
  • Chest expansion
  • Tactile fremitus
A
  • Chest auscultation: Absent breath sounds
  • Chest percussion: Hyperresonant
  • Chest expansion: Asymmetric
  • Tactile fremitus: Decreased
75
Q

Pulmonary fibrosis would demonstrate what for the following:

  • Chest auscultation
  • Chest percussion
  • Chest expansion
  • Tactile fremitus
A
  • Chest auscultation: Fine inspiratory crackles
  • Chest percussion: Dull
  • Chest expansion: Symmetric
  • Tactile fremitus: Increased
76
Q

Chest X-ray of idiopathic fibrosis

A

Honeycomb fibrosis

*HRCT shows lower lobe involvement with reticular opacities bilaterally symmetric

77
Q

Spirometry of asthma

A

FEV1 & FVC decrease

TLC increases

*it behaves like COPD

78
Q

What are the chest x-ray findings for each condition:

  • Pneumothroax
  • Pneumonia
  • PE
  • Pleural effusion
  • Asthma
A

-Pneumothroax:
Radiolucency along chest wall

-Pneumonia:
Lobar infiltrate

-PE:
Wedge shaped opacity

-Pleural effusion:
Fluid along costophrenic angle [Kerley B lines]

-Asthma/COPD (emphysema):
Hyperinflation of both lung fields

79
Q

Important lines on chest X-ray seen for:

  • PE
  • Pneumothorax
  • Pulmonary edema
A

PE: Fleishner

Pneuothorax: Ellis Demoise

Pulmonary edema: Kerley B lines

80
Q

Digital clubbing seen in what diseases?

A
  • Bronchiectasis
  • Pulmonary hypertension
  • Non small cell carcinoma
  • ILD & IPF
  • Hepatic cirrhosis
81
Q

What causes panacinar emphysema & what for centrilobular emphysema?

A

Panacinar = A1AT
–> From respiratory bronchiole to distal alveoli

Centrilobular = COPD

82
Q

Extrapulmonary findings in A1AT

A

Cirrhosis
HCC

83
Q

Where is A1AT made?

A

Hepatocytes

84
Q

Another name for digital clubbing

A

Hypertrophic osteoarthropathy

KAPLAN FLASH CARDS (10 decks)

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