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UWorld > Tues Wk 2 Pulm 4 > Flashcards

Tues Wk 2 Pulm 4 Flashcards

1
Q

Vagus nerve stimulates release of __
this promotes __ by acting on muscarinic receptors
__ is anticholinergic agent that prevents bronchoconstriction

less effective than __ in tx asthma
but enhances __ effect of beta adrenergic agents by blocking __ NS stim of tracheobronchial submucosal glands in the lungs

A

Ach
bronchoconstriction
Ipratropium

B agonist
bronchodilatory, Parasymp

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2
Q

F___ is inhaled glucocorticoid used as prophylaxis for asthma

T__/A__ is PDE inhib that inc cAMP in bronchial smooth muscle

A

Flunisolide

Theophylline, Aminotheophylline

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3
Q 
SCLC arises from \_\_ layer of epithelium
composed of R\_\_/\_\_ cells w scant cytoplasm and large hyperchromatic nuclei
cells arranged in \_\_/\_\_
abundant \_\_ present
stain for \_\_ markers

Glandular differentiation is seen in __ lung cancer

___ is composed of tall, columnar cells that spread along alveolar septae and form papillary projections

A 
basal
round, oval
nests/clusters
mitoses
neuroendocrine

adenocarcinoma

CIS

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4
Q

in obstructive lung dz, __ and __ inc, w __ RV/TLC ratio

Tb granuloma seen w __ macros, Langerhans __, F an C

P__ is another RF for ARDS
releases large amount of inflam __ and panc __ into circ
__ infiltrate into lungs, resulting in injury and leaky alveolocapillary membrane and PE

__ is dx w hypoxemia refractory to O2 therapy and diffuse interstitial edema w/out __ cause
interstital/alveoalr __, fibrin depsotion result in formation of __ membranes
consist of __ exudate and __ rich edema w necrotic cells

A

RV, TLC, inc

epitheliod, giant cells, fibrosis, collagen

panc
cytokinse, enzymes
PMN

ARDS
cardiogenic
edema, hyaline
fibrin, protein

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5
Q 
normal tracheal pO2 is \_\_
alveolar pO2 should be a little \_\_
as blood enters pulm capillaries, equilibration normally occurs before \_\_ blood exits
this process is determined by \_\_ 
if perfusion is poor, \_\_ will not occur
example is \_\_

if process was diffusion limited, __ would be close to normal
such as E and P___
or in E__

A 
150
less
venous
perfusion
diffusion
pulm embolis

CO2
emphysema, PF
exercise

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6
Q

__ is hct >52 in males or 48 in women

first measure RBC __
if normal, then it is __ polycythemia

if high, and all cell lines inc, dx is __
EPO should be __

if only RBC inc and normal other cell lines, look for H__ and __ producing tumro
hypoxemia must be SaO2< __ and PaO2 < __

A

polycythemia

mass, relative

PV
low

hypxia, EPO
92, 65

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7
Q

__ is common comp of limited/diffuse scleroerma

process due to deposition of __ in tissues
triggered by proliferation/accumulation of monoclonal __ cells in tissues
TGFB is released, inc __ and __ prodxn by fibroblasts
earliest damage occurs in small __/___

overtime, hypertrophy of __ occurs w RHF

alveolar hypoxia resulting in PAH is seen in __ disease

A

PAH

collagen
T cells
collagen, ECM
arterioles/capillaries

RV

Chornic lung

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8
Q

aging results in dec chest __ due to stiffening from calcification
lung compliance __ due to loss of elastic recoil
process is __

this results in inc __
__ is unchanged due to counterbalance of chest/lungs
as RV inc, __ also dec

A 
compliance
inc
homogenous
RV
TLC
FVC
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9
Q

in ARDS, __ is usually normal
PCWP would be inc in __ edema

dec __ compliance, inc __ of breathing, worse __ mismtach do occur

causes of hypoxemia
normal A-a gradient
H__
low _ such as at altitude

inc A-a gradient
__ shunt, __ mismatch, impaired __

A

PCWP
cardiogenic

lung, work, VQ

hypoventilation
FiO2

RtoL, VQ, diffusion

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10
Q

pt w chronic fatigue, SOB, probs concentrating, inc PCO2 w obesity has ___
pt has inc CO2 due to inc __/__ and reduced lung __/__

heavy smoking, SOB, dilated airspaces indicates __ emphysema
activated __/__ release proteases resulting in damage

in allergic asthma, __ antags and antimuscarinic I are shown to provide benefit

A

OHS
body mass, SA
volume, compliance

centriacinar
macros/PMN

leukotriene, Ipratropium

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11
Q

chronic airway inflam, edema, bronchial wall thickening, remodeling leads to __ dx
worsened w __
__ is potent antiinflammatory that can be used acute/chronic
inhibit release of m__, leuk __, induce __ of inflam cells
also dec __ produced by goblet cells

Acid fast stains first w aniline dye like C__ to penetrate cell wall to bind mycolic acid
next tx w HCl and alcohol, to dissolve outer __ of nonTb
presence of __ prevents decolorization
methylene blue is then added, to stain __ bacteria
carbolfuschin AF stain shows __ Tb

A 
bronchial asthma
bronchonconstriction
GC
mediators, extravasation, apoptosis
mucus
carbolfuschin
membrane
mycolic acids
nonTb
red
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12
Q

w HF, LV contractility __ resulting in high end DP
inc hydrostatic pressure in pulm circulation cause __ of fluid into lung interstitium
lung becomes swollen and has dec lung __
pressure generated is not able to __ lungs, resulting in poor gas exchange

A1AT can build up in liver, leading to __ accumulation and cirrhosis
seen w/in __ hepatocytes, staining positive for __ and negative for __

A

dec
transudation
compliance
distend

intrahepatocyte
periportal
PAS, diastase

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13
Q

thick, ropelike cords in Tb w serpentine pattern indicate presence of __ factor
this is a m__ correlating w virulence
responsible for inactivating __, inducing release of TNF

in pt w severe asthma, add on __ antibody
L/T have not been effective
Omalizumab is recomb human __ directed against __

prevention of influenza virus occurs via __ response directed against hemagluttinin
block binding to __
CD4/CD8 t cells become responsible in __ the virus

A

cord
mycoside
PMN

IgE
Leukotrienes, theophylline
IgG1, IgE

humoral
host cells
killing

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14
Q

ABPA occurs in __/__ pt
high serum IgE and E__
IgE plus __ antibodies to aspergillus
may lead to transient pulm __ and proximal __

__ necrosis/granuloma in Tb leads to formation of __ lesions

__ protein of Strep pyo has antiphagocytic effects
binds to __ resulting in mediator release/leakage

A

CF, asthma
eosinophilia
IgG
infiltrates, bronchiectasis

caseous, cavitary

M
fibrinogen

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15
Q

peptidoglycan cell wall foun in __/_ orgs
mycoplasma genus, including __, __ cell wall
sngle phopsholipid bilayer consists of __

SOB, facial swelling, dilated veins on upper trunk indicates __ as dx
usually caused by intrathoracic spread of __ carcinoma
most commonly due to __ mass

SVC formed by union of left/right __ veins
close to perihilar/peritracheal __, sternum, T__ and aorta/pulm artery

A

gram +/-
Ureaplasma, lack
cholesterol

SVC syndrome
bronchogenic
mediastinal

brachiocephalic
LN, trachea,

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16
Q

central obesity most commonly dec __, as wel as FRC
__ maintains normal, while others values dec
example of __ lung dz

in emphysema, __ and __ are more likely to be inc

reactivated Tb has preference for __ lobes due to dec __ flow or inc O2 __
erosion into __ can cause hemoptysos

A

ERV
RV
restrictive

TLC, RV

upper
lymphatic, tension
pulm vasculature

17
Q

Contact dermatitis, granulomas, PPD and Candida skin test are type __ HS rxn
antigen taken up by DC and presented to MHC class __
release __ to activate macrophages
occurs via activation of __ cells

bronchial hyperreactivity is used to dx asthma w __ a muscarinic agonist

A

4
2
IFNG
TH1

Methacholine

18
Q

acute LHF leads to acute pulm edema, w inc filtration of plasma __ and __ into lungs
this fluid is __

PMN in alveolar fluid would indicate a __ process, such as bacterial

panacinar emphysema affects _ acinus bc AAT is deficient
usually present in __ lobes

hamartoma aka pulm __
coin lesion w __ calcifications
islands of __ cartilage, fat, SM

Mycoplasma require __ in culture to grow, since CM has single phospohlipid bilayer

A

water, electrolytes
transudative

exudative

entire
lower

chondroma
popcorn
hyaline

cholesterol

19
Q

grow K pneumo on __ agar as it contains bile to limit other orgs

P jirovecii best seen on __ stain

Reid index is ratio of thickness of __ gland layer in bronchial wall submucosa to thickness of bronchial wall bw resp epithelium/cartilage
used to determine severity of __
usually above __%

smoking results in __ metaplasia of the PS columnar epithelium
lack of cilia prevents __ and inc risk of infections
very similar to B__
Cervical cancer is due to __ inactivating tumor suppressors

A

Maconkey

silver

mucosal
CB
40

squamous
clearance
barret esophagus
HPV

20
Q

influenza virus attacks the __ epithelium
leads to loss of __
neuraminidase cleaves __ acid off glycoproteins, fostering bacterial growth
pt is at risk for secondary __ infections
usually due to S, S, H

high altitudes lead to __ w respiratory alkalosis due to hyperventilation
over days, bicarb __ w renal compensation

other effects of altitude
\_\_ 23DPG
\_\_ Hb prodxn (2nd polycythemia)
\_\_ DLCO
VEGF induced \_\_
inc \_\_
A 
transbronchial
cilia
silaic
bacterial
staph, strep, haemophilus

hypoxemia
dec

inc
inc
inc
angiogenesis
mitochondria
21
Q

stage 1 sarcoid has ___
stage 2 has bilateral hilar AN + pulm infiltrates in the __ lobes
stage 3 leads to __ of hilar AN w only __
stage 4 leads to lung __

can lead to scattered __ in liver, usually affecting the portal __

periportal fibrosis is seen in chronic __

A

bilateral hilar LAN
upper
regression, pulm infiltrates
fibrosis

granulomas, triad

viral hepatitis

22
Q

perfusion defect matched w ventilation defect indicates lung __ or consolidation

late phase of asthma attack results in mucosal infiltration of E/B/N
__ have bilobed nuclei w eosinophilic granules
release __ to destory parasites, epithelial/endothelial cells

PMN have __ nucleis w heterogeneous granules

__ stain dark blue, no apparent nucleus
granules contain H, H, S

A

collapse

eosin, PMN, basophils
Eosin
MBP

multilobed

basophils
histamine, heparin, SRSA

23
Q

acute rejection of transplant is __ mediated, using CD8
__ damage w perivascular/peribronchial lymph infiltrates

chronic rejection is due to inflammation of __ leading to BO

__ is most common malignancy assc w asbestos use

fat stains __ w osmium tetroxide

A

cell
vascular

small airways

bronchogenic carcinoma

black

24
Q

mesothelioma has tumor cells w long slender __ and abundant __
may stain for P__

SCC/SCLC arise from __, thus imaging shows hilar mass

dec breath sounds, hemithorax opacifiction, deviation of trachea towards involved side indicates __ lung due to bronchial obstruction
usually in __ via tumor

alveolar __ causes tracheal deviation

appears as comletely opacified __ on CXR

A

microvilli
tonofilaments
pancytokeratin

major bronchi

collapsed
mainstem

collapse
hemithorax

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