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STEP1 > Respiratory system > Flashcards

Respiratory system Flashcards

1
Q

at what week in utero does pneumocytes start to develop?

A

week 26 up until birth

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2
Q

embryo pathogenesis of bronchogenic cysts?

A

caused by abnormal budding of the foregut and dilation of terinal or large bronchi

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3
Q

what are club cells (aka clara cells)?

location? function?

A

nonciliated, low comunar/cuboidal cells with secretory granules.
located from bronchioles to respiratory bronchioles
fx: secrete component of surfactant, degrade toxins, act as reserve cells

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4
Q

most important lecithin in surfactant?

A

DPPC. Dipalmitoylphosphatidylcholine

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5
Q

Supplemental O2 of infant can result in: RIB

A

Retinopathy/blindness
Intraventricular hemorrhage
Bronchopulmonary dysplasia

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6
Q

what value on L/S ratio in amniotic fluid is predictive of NRDS? (neonatal respiratory distress syndrome)

A

Lecithin : Sphingomyelin ratio.
2+ is healthy
<1.5 is predictive of NRDS

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7
Q

2 complications of neonatal respiratory distress syndrome?

A

PDA (b/c of less O2 tension)

necrotizing enterocolitis. idk why

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8
Q

increase in what things results in right shift/decreased Hb O2 affinity? (5)

A

increased Cl-, H+, CO2, 2,3-BPG, temperature

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9
Q

how is it that fetal Hb (2alpha, 2gamma) has higher affinity for O2 than adult Hb, thereby driving diffusion of O2 across placenta from mother to fetus?

A

b/c it has decreased affinity of 2,3-BPG

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10
Q

is taut form or relaxed form of Hb increased or decreased O2 affinity

A

taut form -> right shift -> decreased O2 affinity

relaxed form = left shift = increased O2 affinity

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11
Q

How do you induce methemoglobinemia (to treat CN- poisoning)?

how to treat methemoglobinemia?

A

induce: nitrites followed by thiosulfate
treat: methylene blue and vitamin C

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12
Q

Nitrates cause CN poisoning but what other drug does too?

A

Benzocain (thiosulfate does too but i guess it’s not a drug in and of itself?)

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13
Q

pt comes in with cyanosis and chocolate covered blood. dx?

A

methemoglobinemia

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14
Q

posterior nose bleeds are from _____ artery, a branch of _____ artery

A

sphenopalatine artery. branch of maxillary artery

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15
Q

Virchow’s triad of thrombosis: SHE

A

Stasis
Hypercoagulability
Endothelial damage

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16
Q

HPV is associated w/ what type of cancer?

A

oropharyngeal

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17
Q

what lab test has high sensitivity to rule out DVT?

A

D dimer

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18
Q

where does CO2 bind to Hb?

A

N terminus

whereas O2 binds to heme part

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19
Q

what type of hypersensitivity rxn is Hypersensitivity penumonitis?

A

MIXED type III/IV

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20
Q

patient comes in with diffuse fibrosis, intrapulmonary nodules, pneumoconiosis, and RHEUMATOID ARTHRITIS.
what do they have?

risk factor?

A

Caplan syndrome = pneumoconiosis + RA

coal workers! carbon dust. can also get from silica and asbestos exposure, but mainly coal/carbon dust.

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21
Q

location in lung of the 4 pneumoconioses

A

Asbestosis is in base of lungs (it was used in roofing, but is located in base of lungs)

other 3 are in upper lobes of lungs

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22
Q

Pneumoconioses:

noncaseating granulomas in lung, hilar lymph nodes, and systemic organs

Dx and increased risk for what?

A

Berylliosis, seen in aerospace industry workers

increased risk for lung cancer.

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23
Q

Pneumoconioses: eggshell calcification of hilar lymph nodes. fibrotic nodules in upper lobes

Dx and increased risk for what?

A

Silicosis. seen in sandblasters and silica miners and those casting metal

increased risk for TB, since silica impairs phagolysosome formation by macrophages.

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24
Q

fibrosis of lung AND PLEURA (ivory white calicified plaques), lower lobes. may have golden brown fibers associated w/ iron

Dx? seen in who?
and increased risk for what?

A

Asbestosis

shipyard and construction workers, plumbers, roofing

inc risk for bronchiogenic cancer > mesothelioma (cancer of pleura

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25
Q

what is Anthracosis

A

when only mild exposure to carbon -> collections of carbon laden macrophages.
not clinically significiant

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26
Q

what 2 things are present in Mesotheliomas? is smoking a risk factor?

A 
Psamomma bodies on histology
calretinin positive (negative in most carcinomas)

smoking is NOT a risk factor!

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27
Q

what gene is mutated in familial pulmonary HTN? what is its function?

A

BMPR2 gene mutated (inactivated). normally inhibits vascular SM proliferation

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28
Q

pt has decreased breath sounds, dull percussion, decreased tactile fremitus. +/- tracheal deviation away from side of lesion

A

Pleural effusion

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29
Q

pt has decreased breath sounds, dull percussion, decreased tactile fremitus. tracheal deviates toward side of lesion

A

Atelectasis (bronchial obstruction)

30
Q

pt has decreased breath sounds, hyperresonant percussion, decreased tactile fremitus.

A

pneumothorax
note: trachea deviates TOWARDS spontaneous pneumothorax (collapsed lung), and AWAY from tension pneumothorax (air in pleural space)

31
Q

increased tactile fremitus

A

consolidation (pneumonia, edema)

32
Q

natural history of lobar pneumonia

days 1-2:
days 3-4:
days 5-7:
days 8+

A

days 1-2: congestion. red-purple. exudate w/ mostly bacteria

days 3-4: red hepatization. red/brown. exudate w/ fibrin, bacteria, RBCs, WBCs

days 5-7: gray hepatization. exudate full of WBCs and fibrin

days 8+: resolution. enzymes digest components of exudate

33
Q

looks like SVC syndrome but unilateral. which structure is compressed?

A

brachiocephalic vein

34
Q

horner syndrome can occur from invasion of cervical sympathetic chain by pancoast tumor, but can also occur from compression of what?

A

Stellate ganglion

35
Q

where does lung cancer like to metastasize to? (4)

A

adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly)

36
Q

metastasis to lung is more common than primary lung neoplasms. most common primary sites? (4)

A

breast, colon, prostate, bladder

37
Q

Amplication of what oncogenes is common in small cell/oat cell lung carcinoma?

A

myc oncogenes

38
Q

small cell/oat cell lung carcinoma is a neoplasm of what kind of cells? stain positive for?

location in lung?

A

neuroendocrine Kulchitsky cells -> small dark blue cells

chromogranin A positive, neuron-specific enolase positive

located in central portion of lung

39
Q

adolescent male comes in with profuse nose bleeds. what is the most likely cause?

A

angiofibroma: benign tumor of nasal mucosa composed of large blood vessels and fibrous tissue

40
Q

EBV -> nasopharyngeal carcinoma w/ enlarged cervical lymph nodes. what biopsy and stain of the carcinoma show?

A

“pleomorphic keratin-positive epithelial cells (poorly differentiated squamous cell carcinoma) in a background of lymphocytes”

41
Q

myxoid/degenerative connective tissue on true vocal cords (usually bilaterally)

what is it?

A

singer’s nodule. just need to rest voice

42
Q

2 modifiable risk factors for laryngeal carcinoma

A

alcohol and smoking

43
Q

2 most common causes of lobar pneumonia

A

Strep pneumo

Klebsiella pneumo

44
Q

common organisms causing 2ndry pneumonia, community acquired, and pneumonia superimposed on COPD

A

Haemophilus influenzae
Moraxella catarrhalis
Legionella

45
Q

2 complications of mycoplasma pneumoniae

what groups of ppl are at higher risk?

A

affects young adults. military recruits and college students in living in dorm

complications: autoimmune cold hemolytic anemia (IgM against I antigen on RBCs) ; erythema multiforme

46
Q

pneumonia + hepatitis

A

Q fever

coxiella burnetii

47
Q

PiZZ homozygotes are at significant risk for what?

A

panacinar emphysema (A1AntiTrypsin deficiency), and cirrhosis

48
Q

lay out the immuno pathway of asthma

what type of hypersensitivity rxn is it?

A

type I hypersensitivity

  • Th2 CD4 helper cells. IL4,5,10
  • reexposure to allergen -> IgE mediated activation of mast cells
  • early rxn = histamine, leukotrienes
  • delayed rxn = eosinophils release MBP
49
Q

mediator of idiopathic pulmonary fibrosis pathogenesis

A

TGF-beta from injured pneumocytes induces fibrosis

50
Q

immune mediators of sarcoidosis

A

TH1 cells, secrete IL-2 and IFN-gamma

51
Q

causes of bronchiectasis (5)

A
  1. cystic fibrosis
  2. Kartagener syndrome/primary cilia defective (dynein)
  3. foreign body
  4. necrotizing infection
  5. allergic bronchopulmonary aspergillosis
52
Q

why do you get hyper vit D-> hypercalcemia in sarcoidosis?

A

1-alpha hydroxylase activity of epithelioid histiocytes of granulomas converts vitamin D to its active form

53
Q

what cell mediates ARDS?

A

neutrophils. release protease and ROS to damage pneumocytes -> intra-alveolar hyaline membrane formation

54
Q

the 3 main risk factors of lung cancer

A
  1. cigarette smoke (polycyclic aromatic hydrocarbons and arsenic esp)
  2. radon (accumulates in closed spaces e.g. basements, uranium miners at risk)
  3. asbestos (shipyard workers, roofing, plumbing, construction workers)
55
Q

which lung cancer can produce PTHrP? (-> hypercalcemia)

A

squamous cell carcinoma

male smokers
keratin pearls or intercellular bridges of desmosomes on histology
central lung

56
Q

the official term for digital clubbing

A

hypertrophic osteoarthropathy

57
Q

what can small cell lung carcinoma cause besides paraneoplastic stuff and lambert eaton syndrome?

A

can produce neurons -> paraneoplastic nyelitis, encephalitis, subacute cerebellar degeneration

58
Q

“polyp like mass in the bronchus”

A

carcinoid tumor. chromogranin positive

59
Q

which lung cancer is more peripherally located and can metastasize to involve pleura

A

adenocarcinoma (but large cell carcinoma and carcinoid tumor can also be peripheral, those can be anywhere)

60
Q

EGFR mutation in lung cancer (adenocarcinoma) is commonly seen in what group of ppl? tx?

A

Asian females

tx: erlotinib

61
Q

ALK translocation in lung adenocarcinoma. tx?

A

crizotinib

62
Q

PD-L1 expression in a non-small cell lung carcinoma. tx?

A

pembrolizumab

63
Q

tumor encasing lung = mesothelioma. biggest risk factor?

A

asbestos

64
Q

Sildenafil treats pulmonary HTN and erectile dysfunction. MOA?

A

inhibit PDE-5 -> increase cGMP -> prolong NO effect

65
Q

major side effect of bosentan, an endothelin-1 receptor antagonist used for pulm HTN?

A

hepatotoxicity. increased LFE’s

66
Q

PGI2 analogs (2)

A

Epoprostenol, iloprost

67
Q

Pt is using Dextromethorphan as an antitussive (antagonizes NMDA glut receptors). what 2 things do u need to look out for?

A
  1. can act like opioid in over dose -> treat with Naloxone

2. serotonin syndrome if combined w/ other drugs

68
Q

MOA of Montelukast, zafirlukast, and Zileuton

A

Zileuton = inhibit 5-LOX

Montelukast, Zafirlukast = leukotriene receptor blockers (CysLT1)

69
Q

Theopylline (a methylxanthine) MOA

A

inhibit PDE -> increase cAMP-> bronchodilation.
also blocks action of adenosine
used for asthma/lung stuff

70
Q

Is Methacholine M1, M2, or M3 agonist?

A

M3 (smooth muscle)

71
Q

where are M1, M2, and M3 receptors found?

A

M1 is brain
M2 is heart
M3 is glands and SM

72
Q

Omalizumab MOA

A

binds unbound serum IgE and blocks binding to FceRI. good for atopic asthma where IgE level is high

STEP1 (10 decks)

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