Tues Wk 2 Pulm 4 Flashcards
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
Ach
bronchoconstriction
Ipratropium
B agonist
bronchodilatory, Parasymp
F___ is inhaled glucocorticoid used as prophylaxis for asthma
T__/A__ is PDE inhib that inc cAMP in bronchial smooth muscle
Flunisolide
Theophylline, Aminotheophylline
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
basal round, oval nests/clusters mitoses neuroendocrine
adenocarcinoma
CIS
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
RV, TLC, inc
epitheliod, giant cells, fibrosis, collagen
panc
cytokinse, enzymes
PMN
ARDS
cardiogenic
edema, hyaline
fibrin, protein
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__
150 less venous perfusion diffusion pulm embolis
CO2
emphysema, PF
exercise
__ 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 < __
polycythemia
mass, relative
PV
low
hypxia, EPO
92, 65
__ 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
PAH
collagen
T cells
collagen, ECM
arterioles/capillaries
RV
Chornic lung
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
compliance inc homogenous RV TLC FVC
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 __
PCWP
cardiogenic
lung, work, VQ
hypoventilation
FiO2
RtoL, VQ, diffusion
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
OHS
body mass, SA
volume, compliance
centriacinar
macros/PMN
leukotriene, Ipratropium
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
bronchial asthma bronchonconstriction GC mediators, extravasation, apoptosis mucus
carbolfuschin membrane mycolic acids nonTb red
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 __
dec
transudation
compliance
distend
intrahepatocyte
periportal
PAS, diastase
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
cord
mycoside
PMN
IgE
Leukotrienes, theophylline
IgG1, IgE
humoral
host cells
killing
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
CF, asthma
eosinophilia
IgG
infiltrates, bronchiectasis
caseous, cavitary
M
fibrinogen
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
gram +/-
Ureaplasma, lack
cholesterol
SVC syndrome
bronchogenic
mediastinal
brachiocephalic
LN, trachea,
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
ERV
RV
restrictive
TLC, RV
upper
lymphatic, tension
pulm vasculature
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
4
2
IFNG
TH1
Methacholine
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
water, electrolytes
transudative
exudative
entire
lower
chondroma
popcorn
hyaline
cholesterol
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
Maconkey
silver
mucosal
CB
40
squamous
clearance
barret esophagus
HPV
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 \_\_
transbronchial cilia silaic bacterial staph, strep, haemophilus
hypoxemia
dec
inc inc inc angiogenesis mitochondria
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 __
bilateral hilar LAN
upper
regression, pulm infiltrates
fibrosis
granulomas, triad
viral hepatitis
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
collapse
eosin, PMN, basophils
Eosin
MBP
multilobed
basophils
histamine, heparin, SRSA
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
cell
vascular
small airways
bronchogenic carcinoma
black
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
microvilli
tonofilaments
pancytokeratin
major bronchi
collapsed
mainstem
collapse
hemithorax
