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respiratory path Flashcards

1
Q

transudative pleural effusion is caused by…

A

increased cap. Pressure or decreased oncotic pressure secondary to CHF, cirrhosis or nephrotic syndrome (ie, either more of the fluid in the caps gets pushed out from increased hydrostat p, or less of the fluid gets pushed back into the caps due to decreased oncotic P)

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2
Q

exudative pleural effusion is caused by…

A

increased vascular permeability and inflammation secondary to lung ifxn, malignancy or pulm embolism

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3
Q

what is Kartagener syndrome?

A

aka immotile cilia syndrome– a defect in the protein dynein prevents cilia from moving properly —> impaired clearance of secretions and frequent resp ifxns, infertility and situs inversus (when all the organs in the thoracic cavity are reversed in their position) or situs ambiguus (heterotaxy)- (when the organs in the chest wall are all mixed up in their position– more fatal than situs inversus)

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4
Q

a shift right on the O2-sat/Hb curve means that it’s easier to…

A

unload O2 from Hb

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5
Q

A left ward shift in the O2-sat/Hb curve means that it’s easier to…

A

bind O2 on Hb

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6
Q

5 things that cause a rightward shift on the O2sat-Hb curve (making it easier for O2 to unload from Hb)

A
  1. Decrease pH
  2. Increase in Lactic acid
  3. Increase in temp
  4. Increase in PaCO2
  5. Increase in 2,30BPG

** Note, all of these things happen during exercising, and so you need to be able to ofload more O2 into the muscles!!)

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7
Q

typical lobar pneumonia in alcoholics with red, gelatinous sputum is caused by…

A

klebsiella pneumoniae

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8
Q

klebsiella pneumoniae (which causes typical lobar pneumonia in alcoholics with red/gelatinous sputum) is gram neg or gram pos? oxidase neg or oxidase pos? what shape?

A

gram neg, oxidase neg bacillis

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9
Q

what is the treatment for Klebsiella pneumoniae?

A

third-gen cephalosporin w/or w/out an aminoglycoside

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10
Q

what is the most common paraneoplastic syndrome resulting from small cell lung cancer?

A

cushing syndrome

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11
Q

what are the characteristic elements of cushing syndrome (the most common paraneoplastic syndrome resulting from small cell lung cancer)

A

moon facies, buffalo hump, striae and central obesity

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12
Q

tumor cells of small cell lung cancer have what distinguishing them (2 things)

A

1, hyperchromatic nuclei

2. scant cytoplasm

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13
Q

5 causes of hypoxemia

A
  1. hypoventilation
  2. decreased FI02
  3. shunt
  4. V/Q mismatch
  5. diffusion
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14
Q

in hypoventilation, what happens to Pa02, PaCO2 and A-a gradient?

A

PaO2: decreases
PaCO2: increases
A-a gradient: unchanged

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15
Q

in decreased FI02, what happens to Pa02? A-a difference?

A

PaO2: decreases, due to a decrease in PAO2

A-a diff: unchanged

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16
Q

in poor gas exchange, what happens to Pa02? A-a diff?

A

Pao2: decreases

A-a diff: increases

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17
Q

in what circumstances is hypoxemia a diffusion problem? (leads to a decreased DLCO)

A
  1. strenuous exercise
  2. pulm fibrosis
  3. emphysema (decreased SA for gas diffusion)
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18
Q

when is DLCO increased?

A
  1. intraparenchymal hemorrhage
  2. increased blood volume due to CHF
  3. polycythemia (increased hematocrit)
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19
Q

In V/Q mismatch, what happens to the PaO2? A-a gradient?

A

PaO2: decreases

A-a gradient: increases

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20
Q

the difference between V/Q mismatch and shunt?

A

V/Q mismatch is when there’s air but no blood flow (like a PE)— so V/Q is close to infinity.

Shunt: there’s blood, but no air (like in obstruction)- so V/Q is close to 0

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21
Q

in shunt, where there’s bloodflow but no V (like in airway obstruction, what happens to the Pa02? PaCO2? A-a diff?

A

PaO2: decreases (from about 100 —> 40 mmHg) (same level as mixed venous P)
PaCO2: increases from about 40-46mmHG (same level as mixed venous P)
A-a diff: increases

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22
Q

is R—> L or L—-> R shunt more common?

A

L—-> R because pressures are higher on the rt side of the heart

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23
Q

what is Eisenmenger syndrome?

A

when a L—> R shunt builds up P in the R heart until it eventually equals, and then surpasses the P in the L heart, leading to a R—-> L shunt.

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24
Q

5 types of lung path

A
  1. obstructive
  2. restrictive
  3. infectious
  4. malignant
  5. vascular
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25
Q

cause of unilateral diminished breath sounds?

A

pneumothorax

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26
Q

cause of acute bilateral diminished breath sounds?

A

respiratory distress (ARDS, asthma)

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27
Q

cause of chronic bilateral diminished breath sounds?

A

emphysema (reduced lung tissue)

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28
Q

fine crackles are assoc. with?

A

opening of collapsed alveoli in atelectasis

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29
Q

coarse crackles are assoc. w?

A

airway opening and fluid in the lungs

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30
Q

wheezes are assoc w?

A

obstructive diseases (asthma/COPD) or foreign body obstruction if sudden onset

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31
Q

what are rhonchi?

A

low-pitched monophonic sounds indicative of airway secretions and obstruction– like sicking in air through a straw at the bottom of a drink

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32
Q

what is stridor? what does it indicate?

A

high-pitced sound heard over the trachea, reflecting tracheal or laryngeal obstruction

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33
Q

Egophany– what is it? what is it a sign of?

A

Pt says E, but dr hears it as “A” in Egophany

- sign of lung consolidation (ie pneumonia)

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34
Q

dullness to percussion in lungs mt be sign of…

A

lung consolidation (eg pneumonia)

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35
Q

increased tactile fremitus is a sign of…

A

lung consolidation (pneumonia)

36
Q

decreased tactile fremitus is a sign of

A

something in the pleura

37
Q

3 major Obstructive diseases?

A
  1. asthma
  2. emphysema/chronic bronchitis
  3. bronchiectasis
38
Q

how does smoking lead to emphysema?

A

cig smoke attracts PMNs/macrophages —> they produce elastase and inhibit alpha1-antitrypsin

39
Q

presentations for emphysema

A
  1. chronic dyspnea w/or w/out a cough
40
Q

what is the “pink puffer” in reference to?

A

Pa02 in relatively normal in COPD (not cyanotic), but they have to mntn a high minute ventilation to mntn normal levels of Pa02 and PaCO2, so they “puff”, working hard to get air in

41
Q

what are the 2 major subtypes of emphysema and what are they assoc with?

A

panacinar- assoc with alpha 1 antitrypsis disorder

centriacinar- assoc w/smoking

42
Q

what is chronic bronchitis?

A

productive cough for at least 3 months per year over 2 yrs– characterized by excessive mucus production that is more viscous than normal in the airways

43
Q

extrinsic asthma-

A

type I hypersensitivity- IgE and Mast cells, begins in childhood in pt with a fam HO allergy. Common allergens = animal dander (esp cats), pollen, mold and dust mites

44
Q

Intrinsic asthma

A

asthma assoc w/chronic bronchitis as well as asthma induced by exercise, cold/hot temp, pollutants such as cig smoke, meds (esp aspirin), or stress

45
Q

what’s the methacholine/histamine challenge, and what happens in asthmatics?

A

pt inhales methacholine or histamine. Compared to pt with normal airways, person w/asthma will have bronchoconstriction at a lower dose of the drug- hyperreactive and increased severity (hyperresponsive)

46
Q

what do PaO2 and PaCO2 look like during an asthma attack?

A

PaO2: decreases because increased V/Q mismatch
PaCO2: reduced bc hyperventilation

** If PaCO2 is normal or elevated, you should start worrying bc it might indicate worsening airway obstruction or a tiring individual who can no longer mntn a high minute volume

47
Q

why is a normal or elevated PaCO2 worrying during an asthma attack?

A

bc it might indicate worsening airway obstruction or a tiring individual who can no longer mntn a high minute volume

48
Q

what type of cells do you see in asthma in the cellular infiltrates?

A

eosinophils and lymphocytes

49
Q

what is status asthmaticus?

A

a severe attack that is refractory to bronchodilators. It may require ventilation and can result in death.

50
Q

what is bronchiectasis?

A

an irreversible dilation of airways caused by inflammatory destruction of airway walls, leading to colonization by bacteria and pooling of secretions.

51
Q

4 causes of bronchiectasis

A
  1. Infection
  2. Obstruction (often a tumor)
  3. defect in airway clearance of bact. pathogens (Kartagener syndrome- genetic defect in dynein results in ciliary dysfunc and manifests as sinusitis, bronchiectasis and situs inversus)
  4. CF
52
Q

presentation of Bronchiectasis

A

cough, copious mucoid, mucopurulent or purulent sputum production; dyspnea; rhinosinusitis; hemoptysis

53
Q

what are the 3 components of Virchow’s triad

A
  1. hypercoagulability
  2. endothelial damage
  3. stasis of blood flow
54
Q

what causes a pleural rub like what might be heard in a PE?

A

fibrinous exudate that is reeased from the pleural surface overlying the region of ischemic lung tissue

55
Q

what lab tests will confirm a PE?

A

a D-dimer Level- provides evidence of thrombus formation (D-dimer is a fibrin degradation product)

56
Q

primary pulm HTN is assoc with…

A

mutations in genes linked to transforming growth factor beta (TGF-B) signalling and is characterized by vascular hyperreactivity and prolif. of smooth muscle

57
Q

what is the most common cause of persistent pulm HTN of the newborn?

A

Meconium aspiration at birth

58
Q

pulm HTN gives you what on heart sound exams?

A

Loud P2, right-sided S3 and S4

59
Q

what is the leading cause of cancer-related death in men and women?

A

primary lung cancer

60
Q

5 major types of lung cancer?

A
  1. squamous cell carcinoma
  2. adenocarcinoma (inc. the bronchioalvelar subtype)
  3. small-cell carcinoma
  4. large cell carcinoma
  5. carcinoid tumors
    .
61
Q

cigarettes are most closely assoc with what two types of lung cancer?

A
  1. squamous cell carcinoma

2. small cell carcinoma

62
Q

Superior Vena Cava Syndrome

A

compression of the SVC by tumor leads to facial swelling, cyanosis and dilation of the veins of the head, neck and upper extrem.

63
Q

pancoast tumor- what is it? what 3 things are commonly assoc w/it?

A

any type of lung cancer that arises at the apex of the lung —-> can cause

  1. Horner syndrome (ptosis, anhidrosis, miosis, enophthalmos, and loss of ciliospinal reflex),
  2. hoarseness (paralysis of recurrent laryngeal nerve),
  3. distant metastases to the brain, bone, liver or adrenals can manifest w/organ specific symp.
64
Q

what 2 paraneoplastic endocrine syndromes can be caused by small cell carcinoma?

A
  1. cushing syndrome (ACTH secretion)

2. Syndrome of inappropriate secretion f diuretic hormone (SIADH)

65
Q

what paraneoplastic endocrine syndrome is common in squamous cell carcinoma in lungs?

A

hypercalcemia- due to PTH-related protein (PTHrP) secretion

66
Q

which lung cancers tend to be centrally located?

A

squamous and small cell

67
Q

which lung cancers seem to be peripherally located?

A

adenocarcinoma and large cell (involvement of the hilar lymph nodes or pleura can also be seen)

68
Q

adenocarcinomas, with the exception of ____ tend to be peripherally located in the lungs

A

bronchioalveolar- which is more diffuse with ground glass opacity

69
Q

sites for metastasis of primary lung cancers ranked by frequency (5)

A
  1. hilar lymph nodes
  2. adrenal glands
  3. liver
  4. Brain
  5. bone (ostolytic)
70
Q

nasopharyngeal carcinoma is strongly linked to…

A

EBV ifxn (EBV infects host by replicating in the nasopharyngeal epithelium and hen infecting nearby tonsillar B lymph.)

71
Q

where is nasopharyngeal cancer frequent?

A

in the chinese population

72
Q

EBV makes prots that modulate growth signalling in B lymphocytes. As a result it is strongly assoc with what 3 cancers?

A
  1. nasopharyngeal
    2, Burkitt lymphoma
  2. Hodgkin lymphoma
73
Q

squamous cell carcinoma presents how on histology?

A

keratin pearls, may cavitate

74
Q

squamous cell carcinoma largely affects

A

proximal large airways

75
Q

squamous cell carcinoma is often caused by…

A

smoking

76
Q

adenocarcinomas originate from…

A

mucus glands

77
Q

adenocarcinomas are often seen in the

A

lung periphery, sites of scarring

78
Q

the most common primary lung cancer for non smokers is what subtype of adenocarcinoma?

A

bronchial

79
Q

large cell carcinoma originates from

A

epithelial cells, very poorly differentiated

80
Q

carcinoids originate from

A

neuroendocrine cells in lungs or GI tract

81
Q

characteristics of carcinoid syndrome?

A

secretes serotonin; can cause carcinoid syndrome (flushing, diarrhea, wheezing, salivation)

82
Q

origin of small cell lung cancer?

A

kulchitsky neuroendocrine cells of primary and secondary bronchi

83
Q

where small cell lung cancer presents

A

central bronchi

84
Q

the origin of a mesothelioma

A

pleural cells

85
Q

what is a meningioma assoc with? (2)

A
  1. asbestos

2. cig smoking

86
Q

4 pathologic findings assoc. with sarcoidosis- which is diagnostic?

A
  1. noncaseating granuloma w/epitheliod histiocytes (this is diagnostic! cell should be pale pink on H&E with nondistinct cell borders)
  2. multinuc giant cells of langerhans
  3. asteroid bodies
  4. schaumann bodies

Boards Respiratory (5 decks)

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