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UWorld Respiratory Flashcards

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USMLE® Step 1 flashcards
1
Q

What is one of the most important parts of an admissino?

A

Gettign an advanced directive. Should occur in the outpatient setting. Should be readdresses on admissino.

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2
Q

Lung CA categorization

A

Nonsmall cell vs Small cell. Far more Nonsmall cell.

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3
Q

Most common Lung CA in women and nonsmokers. Position

A

AdenoCA - nonhilar. Peripehral.

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4
Q

Another name for Lecithin

A

Phosphatidylcholine

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5
Q

Method of action of streptomycin

A

Inhibits intiation

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6
Q

Proteases such as elastase derived from?

A

N! and M!

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7
Q

What type of body response predominantes in Killed or viral component vaccines. How does this play out in subsequent infection?

A

humoral immune response. Ab prevent viral entry into cells.

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8
Q

Stab wound to fifth inercostal space along midclavicular line - most likely punctures

A

Left lung. If deep enough, left ventricle

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9
Q

Baby HIV prophylaxis in mothers w/ HIV? Drug and mechaism

A

Zidovudine (or AZT) - RETROVIRAL REVERSE TRNASCRIPTASE INHIBIOTR - reduces risk by 2/3. Initiate at 14 weeks of gestation and throughout remainder of pregnancy. IV ZDV during labor. Oral administration of ZDV six weeks postpartum.

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10
Q

Exertial dyspnea nd couhg in pt w/ RA

A

Rheumatoid lung disease - pulmonary ibrosis - diffuse, bilateral small irregular opacities (reticulonodular apperance) - more pronounced in lower lobes. Can get honeycomb lung in severe disease.

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11
Q

BIloped nuclei w/ large eosinophilic granules of uniform shape

A

Eoisinophils

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12
Q

SMoker w/ Centriacinar emphysema mediated by?

A

Macrophages eating cigarettes - neutrophils releasing neutrophil elastase, proteinase 3, cathepsin G, matrix metalloproteinases.

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13
Q

Describe Clara cells

A

Nonciliated, secretory constituents of terminal respiratory epithelium - secrete Clara Cell Secretory Proteins (CCSP) - INHIBITS N! recruitment/activation as well as N!-dependent mucin production

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14
Q

When is pleural pressure positive?

A

PNEUMOthorax only. IT IS NEVER NEGATIVE IN NORMAL inspiration or expiration.

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15
Q

What is FRC? What is pleural pressure value at FRC?

A

FRC is when tendency of chest to expand and lung to collapse are balanced. The intrapleural pressure is -5cm H2O. During inspiration inrapleural plressure DEC to -7.5 H2O.

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16
Q

Chronic Rejection of Lungs

A

Problem of small airways - causes bronchiolitis obliterans. Lymphocytic inflam, necrosis, fibrosis, bronchiolar wall, occlusions of bronchiolar lumen

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17
Q

Columnar cell joined by desmosomes w abundant tonofilaments and studded w/ very long microvilli. Imaging? Gold standard for dx?

A

Mesothelioma. Nodular OR smooth pleural thickening can be found. Electron microscopy is gold standard to see microvilli

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18
Q

Bronchioloalveolar CA presentation on histo and

A

Variant of adenoCA - rises at periphery of lung - distrubtion along alveolar septa w/o vascular and lymph spread - peripheral mass as an area of pneumonia like consolidation. I guess no slender microvilli?

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19
Q

Cave trip. Fever, cough, malaise. Pulmonary infiltrate and hilar adenopathy.

A

Histo. See ovoid cells w/in M!

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20
Q

Multinuclear spherules

A

Coccidiodes immitis. Endemic to southwestern US. not assoc w/ cave exploration

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21
Q

budding years w/ thick capsule

A

Cryptococcus neoformans. Pigeon droppings.

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22
Q

yeast w/ pseudohyphae

A

Candida. Usu not assoc w/ pulmonary infiltrates and LAN.

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23
Q

Septate hyphae w/ dichomatous branching

A

Aspergillus

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24
Q

Ethambutol mech. Tox

A

Inhibits mycobacterial cell wall synth by blocking arabinosyl transferase. Optic neuritis - can results in color blindess, central scotoma, DEC visual acuity. May be revesible w/ discontinuation

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25
Q

What TB drugs require you to monitor hepatic function?

A

Isoniazid, rifampin, pyrazinamide

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26
Q

What drugs should make you concerned for ototoxicity?

A

aminoglycoside or vancomycin. Aminoglycosides can also cause renal tox. Rare side effect of AG is flaccid paralysis due to NMJ blockade.

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27
Q

What antibiotics should make you want to get a CBC?

A

Chloramphenicol (aplastic anemia), dapsone (agranulocytosis), TMP-SMX (megaloblastic anemia). Also methimazole and PTU - worry about agranulocytosis

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28
Q

What TB drug works best in acidic conditions?

A

Pyrazinamide - works best in acidic pH (within phagolysosomes) - Most bactericidal to TB when organisms are engulfed by M!

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29
Q

In addition to pseudomembranous pharyngitis, C.dihtheriae synthesizes toxins that are assoc w/ which organ tox?

A

cardiac. neural

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30
Q

Why does Isoniazid lead to B6 problems?

A

Isoniazid is structurally similar to B6. Leads to urinary excretion of pyridoxine (B6). Also can compeete for binding site leading to defective synthesis of neurotransmitters such as GABA. Alway give supplemental B6

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31
Q

Dys[nea, bibasilar crackles, presence of S3 after MI indicates?

A

Left heart failure.

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32
Q

After influenza (fever, headache, myalgia, malaise, cough, throat pain), what are you concerned about - esp in elderly

A

Bacterial superimposed pneumoniaStrep pneumo> Staph aureus> H flu

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33
Q

What are your concerns following theophylline intox? Tx?

A

Seizures, Tachyarrhythmias. Ab pain vomiting. Gastric lavage followed by activated charcoal (reduces abs) and cathartics (INC elimination via GI track) - B blockers for cardiac tachyarrhythmias. Benzo and barbituates for theophylline induced seiures.

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34
Q

What does Iron poisoning cause?

A

hematemesis and melena - iron is directly toxic to gastric mucosal cells.

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35
Q

What is glucagon an antidoe for?

A

Beta blocker poisoning. Because glucagon INC intracellular cAMP and cardiac contractility. B2 usually INC cAMP. B2blockerDEC cAMP.

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36
Q

Theophylline - what is it? What is it used for - what is mechanism?

A

methylxanthine (xanthine!) structurally similar to caffeine - used to treat COPD and asthma. Relaxes bronchiol smooth muscle, INC heart muscle contractility, BP. BLOCKS adenosine (an inhibitory neurotransmitter, which RELAXES cardiac muscle function, contracts smooth muscle.) Since theophyline is anti-inhibitory, it can cause seizures and tachyarrhythmias

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37
Q

What fungal drugs DEC incorporation of ergosterol into cell membrane?

A

Amphoterici and Nystatin

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38
Q

CF channel is? Chr ? Genetic problem?

A

ATP gated. ABC. Chr 7, Phenylalanine deletion.

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39
Q

What channels play a role in vision?

A

cGMP

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40
Q

What are antibiotics that would make bacteria die in hypotonic test?

A

Ab that target peptidoglycan cell wall - penicillins, cephalosporins, vancomycin Example cefuroxime (cephalosporin - B lactam ab)

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41
Q

Cephalosporin (or any) anaphylaxis - release of what 2 things by mast cell degranulation?

A

Histamine and Tryptase.

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42
Q

Referred pain to neck and shoulder from respriatory disease - referred pain follows which nerve?

A

PHRENIC NERVE. Irritation of pleura picked up for phrenic.

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43
Q

Severe uncontrolled asthma even w/ oral glucocorticoids - what is next step in addition to long acting b agonists.

A

Anti-IgE ab. SubQ - omalizumab.

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44
Q

Which RBC has higher intracellular Cl? Venous or Arterial

A

Venous. Because you have more CO2, which diffuse to HCO3. HCO3 exchanges out with Cl coming in

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45
Q

X^2 Chi squared tests for?

A

2 categorical variables.

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46
Q

T test used to analyze

A

2 continuous variables. T test is more similar to ANOVA.

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47
Q

Encapsulated yeast w/ single broad based bud.

A

Looks almost like a weird Reed Sternberg cell. Rounge yeast w/ doubly refractive walls and broad based budding.

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48
Q

ropeline structures in mycobaterial organisms - what does this represent?

A

Cord factor - mycoside (2 mycolic acid molecules bound to disaccharide trehalose) - correlates w/ virulence.

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49
Q

What Ab do not work against mycplasma?

A

Those that inhibit cell wall snythesis - penicillins, cephalosporins, carbapenems, vanc. Their cells walls do contain cholesterol tho. This is why you use macrolides/tetracyclines against mycoplasma (atypical pneumonia etc)

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50
Q

Reid index - what does it include?

A

Mucus/ Everything EXCEPT CARTILAGE!

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51
Q

Why would a Virus have to generte a single large virally encoded precursos polypeptide that is spliced later?

A

Because eukaryotic cells are monocistronic. Not polycistronic (such as virus and bacteria)

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52
Q

What does Aminogylcoside do to 30s ribosome?

A

Inactivates it.

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53
Q

How do mycobacterium devo resistance t Isoniazid?

A

DEC bacterial catalase peroxidase. Required for isoniazid activation.

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54
Q

Granule containing cells and crystalloid masses. Think what? What cytokine levels are elvated?

A

Think Eos and Charcot Leyden crystals (eosinphil MBP) - Think Asthma! IL5

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55
Q

CFTR deletion in phenylalanine APC ATP channel, cAMP mediated phosphorylation. What abnormality exist in this channel from mRNA -> CHannel?

A

Abnormal trafficking of transmember protein - IMpairs POSTTRANSLATIONAL processing of the transcript leading to DEGRADATION of product before it can be transproted to cell surface. Causes a complete absence of the CFTR protein from apical membrane.

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56
Q

Cough reflex mediated by what nerve? Where is it located?

A

Internal laryngela nerve - mediates afferent limb of cough reflex above the vocal cords.Fish bones near PIRIFORM RECESS can cause damage to nerve (or surgery to remove bones can cause dmg to nerve)

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57
Q

What mediates the gag reflex? Afferent and Efferent?

A

Afferent - Glosopharyngeal (9)Efferent - Vagus

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58
Q

Longstanding COPD effect on blood gas as well as cerebral vasculature?

A

Hypoxic, Hypercapnia. DEC cerebral vascular resistance.

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59
Q

Competent patient - Right to refuse medical care and right to refuse medical information/diagnosis. What to do?

A

Just ensure they are well informed and find a surrogate decision maker if possible.

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60
Q

What is Ohm Law. How does expiratory flow rate change? What woudl you see w/ INC vagal tone?

A

Flow = Pressure/Resistance. INC pressure or DEC resistance.INC vagal tone - you would see INC resistance adn thus DEC flow rate. See INC work of breathing w/ INC vagal tone

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61
Q

Chronic Granulomatous Disease inheritance?

A

X linked

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62
Q

MHC1 seen where? Composed of what?

A

MHC1 seen on all cells. Composed of heavy chain and B2 microglobulin

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63
Q

IL-12 Def presentation? How to treat pt w/ IL-12 DEF?

A

Impaired cell immunity . See recurrent respiratory ifnections. Especially mycobacteriaIFN-y. Because they cant stimulate TH1 w/ IL12, give IFNgamma, which feedsback and selfstimualtes

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64
Q

What is rifampin prophylaxis used for? (2)

A

N. gonorrhea + H flu.

65
Q

Why does Amphotericin have AmphoTERRIBLE effects on humans?

A

Antifungal that binds ergosterol - however can also bind cholesterol to some degree, causing tox in humans. NEPRHOtox, HYPOKALEMIA

66
Q

Describe Mycolic Acid?

A

Long branched chain saturated fatty acid

67
Q

Legionella lab findings?

A

HyponatremiaGram stain show MANY N! BUT NO/FEW ORGANISMS. Tx- macrolides or fluoroquinolones

68
Q

Restrictive disease - reason for INC airway flow rates?

A

DEC compliance, and RADIAL TRACTION ON AIRWAY WALLS. INC elastic recoil.

69
Q

What kinds of lung disease do you see INC wall thickness of small airways?

A

Bronchial asthma. DEC flow rates.

70
Q

When does blood flow through pulmonary circuit equal that of systemic circuit?

A

ALWAYS

71
Q

When is Pulmonary Vascular Resistance LOWEST?

A

At the bottom of Tidal volume/beginning of FRC. When you inspire, PVR INC due to pressure on pulmonary vessels by expanding alveoli. When you ExpIRE

72
Q

Green pigment from pus or sputum is due to what?

A

Release of MPO from neutrophilil azurophilic granules. MPO is a heme containing pigemnted molecule.

73
Q

Etanercept - mech and used for?

A

Monoclonal Ab to TNF. Anti-inflam - used for RA, psoriasis, psoriatic arthritis

74
Q

Tx for Primary Pulmonary Arterial HTN before lung transplant? Mech?

A

Bosentan. Competitive antagonist to endothelin receptor.Endothein is vasoCONSTRICTOR. Block this! -> Vasodilation.

75
Q

Where is PO2 the highest in fetal circulation?

A

IVC. This is where the ductus venosum is. The attachment of umbilical vein (oxygenated)

76
Q

TIssue destruction in TB is caused by?

A

DIrect result of host immunity inlammation through T4 HSR (granulomatous/caseous)

77
Q

Major virulence factor of S. pneumo

A

Polysacch pcapsule - prevents phagoytosis by M! and PMLs. It is antigenic. But there are up to 82 diff capsule types. THe pneumococcal vaccine generates immunity agasint several important strains

78
Q

What ist he quellung reaction?

A

When Ab to capsule of strep pnuemo bind. The swelling of the capsule is calle dthe quellung rx.

79
Q

When would you see Polyribosyl-ribitol-phosphate (PRP).

A

PRP is a component of the Hib capsule. Hfu vaccine is composed of PRP. Causes memory B induction.

80
Q

What is HiB vaccine composed of?

A

PRP (type B capsular polysaccharide) + conjugated diphtheria toxoid

81
Q

Where is work of breathing minimized in pt w/ Restrictive disease? Where is work of breathing minimized in pt w/ Obstructive

A

WOB minimizes in Restrictive Disease by High RR and low tidal volume (fast shallow breaths) WOB minimized in Obstructive Disease w/ low RR and higher tidal volume (slow deep breaths)

82
Q

What stains Mucicarmine stain?

A

polysacch capsule of Crypto Neoformans

83
Q

HIV+ pt w/ normal CD4 count. What is most likely cause of community acquired pneumo?

A

Still strep neumo. Normal range is 500-1500 CD.

84
Q

Can asthma present without Eosinophilia/IgE?

A

Of course. There is allergic asthma (extrinsic), and non-immune mediate (intrinsic - viral, aspirin, cold air, stres, exercise, inhaled irritants). Dont need either eos or IgE to be asthma

85
Q

What does post-MI cardiogenic acute pulmonary edema look like on histology?

A

Transudate (ultrafiltrate) accumulating in alveolar lumen

86
Q

Do you see heart failure cells after MI?

A

Usu not. Heart failure cells take a while to devo - usu from pulmonary congestion and edema after CHF. Erythrocytes vasculature, are eaten up by M! (hemosiderin)

87
Q

Where in respiratory tract is pseudostratified, columnar, mucus secreting and whewre is stratified squamous?

A

Columnar - nose, paranasal sinus, nasopharnyx, most of larynx, tracheobronchial treeSquamous - Oropharynx, laryngopharynx, anterior epiglottis, upper half of posterior epiglottis, TRUE VOCAL CORDS

88
Q

Cause of hypoxemia in a pt who has been in the hospital for a few days?

A

PE. V/Q mismatch

89
Q

How do churg strass granulomas differ from sarcoid?

A

Churg strauss typically have central necrotic zone.

90
Q

Recurrent sinopulmonary/GI infections - think what immunodeficiency?

A

Selective IG deficiency (IgA) Also assoc w/ anapohylactic response to transfused blood products.

91
Q

Diffuse itching, skin rash, and bronchospasm after bllod transfusion of O neg?

A

IgA def - assoc w/ anaphylactic response.

92
Q

C1 complement def assoc w/?

A

SLE

93
Q

LeukocyteAdhesion Defeciency. What is this assoc w?

A

CD18 - delayed umbilical cord, recurrent cutaneous infections WITHOUT PUS FORMATION. Poor wound healing

94
Q

How can diagnosis of CF be made?

A

Urogenital anomaly (congenital bilateral abscence of vas deferens -> azoospermia) w/ abnormal sweat Cl test or Abnormal NASAL TRANSEPITHELIAL POTENTIAL DIFFERENCE.

95
Q

Other than buproprione, what can be used for smoking cessation? What is the mech?

A

Varenicline - partial agonist to nicotinic ACh receptors. Reduces craving and attenuates rewarding effects of nicotine

96
Q

Fetal assoc w/ maternal hyperglycemia?

A

INC rates of stillbirth, macrosomia, postnatal hypoglycemia in infant Also Transposition

97
Q

Contact dermatitis, granulomatous inflam, TB skin test, and Canida extract skin rx are all examples of?

A

Delayed HSR. T4. via T lymphocytes - peaks in one or two days. Stimualted Th release IFN-g, which recruits M!

98
Q

What B drug would cause culture to lose acid fastness and rapidly stop proliferating?

A

Isoniazid - ab against mycolic acid synthesis - long branched chain fatty aicds in outer portion of peptidoglycan cell wall - this makes acid fast when stained w/ CARBOLFUCHSIN dye and treated w/ acid-alcohol decolorizing agent

99
Q

Cheyne Stokes respiration - describe appearance and where it is found

A

cyclic breathing followed by apnea. During breathing, gradually INC tidal volumes, then gradually decreasing tidal volumes until apnea. Seen in CHF and Neuo disease (stroke, brain tumor, traumatic brain injury) THought to be due to slow respiratory feedback loops w/ PaCO2 overcompensatory respiration

100
Q

Treatmetn of RSV?

A

Ribavirin

101
Q

Bacteria that are natural able to perform Transformation?

A

Direct uptake of naked DNA - strep pneumo, H flu, N. gonorrhae and meningitidis

102
Q

Bone trauma + petechial rash on chest and dyspnea

A

Fat embolus (esp in bilateral femoral fractures! 33%!)

103
Q

Describe airway resistance along bronchial tree

A

Most of airway resistance occurs in 10 generations of bronchi, with maximal resitance in 2-5th generatiosn of bronchi. As you go further in the lung, the cross sectional area is massively INC, which slowsl airflow velocity and leads to low reistance laminar airflow

104
Q

Where is teichoic acid?

A

Molecule linking peptidoglycna wall of GP but NOT GN bacteria

105
Q

Where is N-acetylmuramic acid found?

A

Both GP and GN

106
Q

S. pneumo vacciens are based off of?

A

Variants to the capsular polysacch

107
Q

Adult vs infant pneumococcal vaccine diff?

A

Adult - unconjugated - no T helper responseInfant - conjugated - Helpter T response!

108
Q

What types of naked RNA virus can induce host viral protein synth and viral genome replication?

A

SS +. Double stranded or - sense RNA are not infectious

109
Q

Where is respiratory drive modulated in chronic COPD patients?

A

Normally in central chemoreceotrs. In Chronic hypercapnia - O2 regualted by peripheral chemoreceptors (carotid bodies)

110
Q

Most common benign lung tumor? How does it look on histo?

A

Hamartomas most common = often well defined coin lesions w/ popcorn calcification - incidental - can see HYALINE CARTILAGE, fat, smooth muscles.

111
Q

Elastin plasticity/recoil ability in alveoli due to?

A

Desmosine crosslinking between 4 different lysine residues on 4 different elastin chains. Chrosslinking by extracellularl LYSYL HYDROXYLASE

112
Q

Collagen and elastin - what kind of amino acids?

A

Nonpolar

113
Q

Why would you get DEC BP and INC HR w/ tensino pneumothorax to right side?

A

INC volume cause deviation of lungs/mediastinum to OPPOSITE side - INC pressure in lung DEC systemic venous return.

114
Q

Ciliated columnar where in airway tract? What size of particles can they clear?

A

From nose to terminal bronchioles. 2micrometers or smaller.

115
Q

Where are submucosal and mucoserous glands and goblets found?

A

Outermost airways through bronchi. NO MUCOUS SECRETING CELLS WTIHIN THE BRONCHIOLES. Cilia is primarily responsible. By the terminal bronchioles airway epithelium is ciliated SIMPLE CUBOIDAL.

116
Q

Strep pneumono? What resistant, Bile? Hemolysis?

A

Strep pneumo - optochin sensitive, Bile soluble (cant be cultured in bile), a hemolysis - green

117
Q

How are encapsulated vaccines made? ()Strep pneumo, N. mengingitidis, H flu)?

A

Polysacch capsule conjugated to nontoxic diptheria toxin, N . meningitidis outer membrane protein complex, tetanus toxoid.

118
Q

Pt who used inhaled corticosteroids should be instructed to?

A

Oral rinsing to prevent oropharyngeal candidiasis

119
Q

How to treat CF? Mech?

A

N-acetylcysteine containing aeorsol - cleaves intermolecular disulfide bonds within mucus glyocproteins, which loosenins thick sputum

120
Q

What happens to PaO2 and PaCO2 during exercise?

A

Remain normal.However, VENOUS PO2 is DEC and VENOUC PCO2 is INC.

121
Q

Stain that makes fat black?

A

Osmium tetroxide

122
Q

Size of particles and where they are trapped in lungs?

A

10-15 micrometer - upper respiratory2.5-10 micrometer - trachea/bronchi mucociliary transportless than 2 micrometer -> terminol bronchioles/alveoli - phagocytized by M!

123
Q

Common complication of nocturnal upper airway obstruction (snoring) and episodic nocturnal apnea/ obstructive sleep apmnea -> prolonged side effect->

A

Pulmonary HTN and Right Heart Failure

124
Q

What exactly is cold agglutinins in Mycoplasma pneumonia?

A

They are Ab that cross react between M. pneumo and RBC - think M pneumo does not have peptidoglycan cell wall, just phospholipid bilayer like RBC. The corss reaction leads to RBC lyses -> anemia

125
Q

Omalizumab mechZileuton mechZafirlukast Montelukast mechCromolyn, nedocromil

A

Omalizumab - inhibits IgE binding to mast cellsZileuton - selective inhibitor of Lipoxygenase pathwayZafirlukast, Montelukast - LTD4 receptor antagonistCromolyn, nedocromil - prevent mast cell degranulation

126
Q

What are the mediators of systemic inflammation that lead to INC ESR?

A

IL1, IL6, TNFa -> systemic inflam -> stimualte hepatic release of acute phase proteins (fibrinogen) -> INC ESR - nonspecific marker of inflam

127
Q

Mech of abscess formation?

A

Tissue damage and resultant abascess from lysosomal enzymes released from N! and M!

128
Q

What are clinical signs seen in hyper-IgM syndrome? Mech?

A

Lymphoid hyperplasia and recurrent sinopulmonay infections. Due to defect of CD40 ligand or ceptor

129
Q

Can the Right atrium be seen on coronal chest xray

A

Yes, form sthe right border. Right ventricle is what is in front.Barely see LV or LA.

130
Q

What is important when determining cause of metabolic alkalosis?

A

Urine Cl levels

131
Q

Mycoplasm requires what in order to grow on plate?

A

Cholesterol

132
Q

What do you see with loss of surfactant/neonatal RDS?

A

Patchy atelectasis. NOT pulmonary HTN.

133
Q

Why does a panic attack cause dizziness blurred vision, weakness?

A

Hyperventialte -> DEC pCO2 aka Hypocapnia. This causes cerebral vasoCONSTRICTION and DEC cerebral blood flow. Remember INC pCO2 causes vasoDILATIOn.So the converse is true too.

134
Q

General concept - columnar -> squamous metaplasia - can be caused by?

A

VitA def

135
Q

What does H flu require to grow?

A

F5 (NAD+) and FX (hematin)Can also be grown w/ Staph A, which lyses RBC and thus provides NAD+, hematin

136
Q

What bacteria can survive in 100 degress C heat for 15 minutes?

A

Bsically only spore forming bacteria - Bacillus and Clostridium

137
Q

Chronic granulomatous Diasease - at risk for what infections?

A

PseudomonasListeriaAspergillusCandidaE ColiS AureusSerratia

138
Q

Sepsis -> ARDS - what are lung fiundings?

A

Endothelial injury from endotoxin release of products/cytokines - > intra-alveolar edema (fluid accumulation) inflammation, hyaline membrane formation

139
Q

Chronic rejection affects what part on lungs? How does this differ than in renal transplantation?

A

Small airways - bronchiolitis obliterans syndrome. Inflam/fibrosis cause snarrowing of bronchiolar walls -> obstruction of bronchioli. Small way obliteration. Diff in renal, which is vascular obliteration.

140
Q

Nucleoli - what is going on and which polyermase is at work?

A

Ribosomal subunit maturation and assembly - RNA pol 1 synthesizes majority of rRNA.

141
Q

CD15 marker found on which cells?CD16 found on which cells?

A

15 - N! (also Reed Sternberg)16- NK cells and other cell types

142
Q

Where is V/Q the highest in the lung?

A

At the apex.Perfusion GREATLY INC from the apex -> base. Ventilation INC slightly from apex to base. Therefore, overall, V/Q INC from base to apex.

143
Q

Best way to Tx GBS in mom w/ baby? Why not just vaccine?

A

Screen at 35-37 weeks. Intrapartum penicillin/ampicillinNo vaccine available for GBS.

144
Q

What is most likely microbes to cause lung abscess, where do the bacteria usually reside? PresentationTx?

A

Oropharyngeal aspiration - Bacteroides, Fusobacterium, peptostreptococcusOR STAPH A. Presents as greenish foul smelling sputum. DONT THINK PSEUDOMONAS HERE.Tx/ w. Clindamycin - covers aerobes and anaerobes.

145
Q

Pathogenicity of H flu du e to?

A

presnce of antiphagocytic polysach CAPSULE. Type B strain is most invasive and virulent. it has a capsule w/ a ribose as sugar rather than hexose. Unencapsulated H flu are part of normal flora and only cause local infections.

146
Q

What is a characteristic of primary TB?Secondar?y

A

Primary = Ghon complex (lower lobe lung lesion - Ghon focus +(ipsilateral hilar adenopathy (can be calcified). YOu can get miliary TB (Severe bacteremia w/ primary)Secondary - apical cavitary lesion. You can also have hematogenous dissemination to whereever.

147
Q

First line test for CF?Second line test?

A

Sweat test - some people w/ CF may not be detectedSecond line - nasal transepithelial potential difference measurements.Only sweat is different. Nasal Epithelial and lung are the same.Cells are unable to secrete Cl out. Think of as action potential. If Cl cannot go out, then cell is is depolarized. Depolarized means Na channels open. SO INC NA ABS. Cell is usu -70 resting potential. Although Cl and Na compete, the initial defect is in Cl. So if Cl cant go out, hyperpolarized cell. THEREFORE WIDENED NEGATIVE potential diff. This leads to dehydrated mucus and WIDENED negative transepithelial potential difference.

148
Q

Where is Staph aureus colonized? (MRSA included)

A

Both - nasal colonization. 25-30% of ppl have nasal colonization w/ staph A.

149
Q

Why is there a drop in PO2 betwen alveolar lung (104) and left atrium (100)?

A

Admisture of deoxygnated bronchial blood w/ oxygenated pulmonary veins. (dual blood supply return) - some of bronchial veins return to right heart via azygous, accessory hemiazygous or itnercostal veins - HOWEVER MAJORITY OF LBOOD SUPPLIED TO BRONCHIAL ARTERIES RETURNS TO LEFT HEART VIA PULMONARY VEINS.

150
Q

H flu - differentiate typable and nontypable

A

Typable - have antiphagocytic capsule - 10% of cases - can cause SYSTEMIC diseaseNontypable - no capsule - 90% of cases, can cause same disease as typable minus systemic

151
Q

If you see normal pCO2 in smoker - what to think?What is normal person PaO2?

A

Dont assume they have obstructive lung disease. Not all do. PaO2 is >92.

152
Q

Cell wall anti-fungal. What is it?

A

Echinocandins (caspofungins and micafungin) - inhibit SYNTH of polysaccharide GLUCAN.

153
Q

Lower border of plural at midclaviular line, midaxillary line, Paravertebral line? In terms of ribs. Where is lung in relation to pleura?

A

Midclaviular - 7th ribMidaxillary - upper border of 10th ribParavertebral - 12th ribLung is usually 2 intercoastal spaces ABOVE pleural border.

154
Q

What pulmonary manifestations do you see in CREST?

A

Pulmonary HTN -> right sided HF (cor pulmonale)

155
Q

What is the pulmonary cap wedge pressure in ARDS

A

Usu normal. If INC usu suggests cardiogenic cause of pulmonary edema.

156
Q

Other Manifestations of sarcoid ?

A

Scattered Liver granulomas (75% of pt)Affect portal traid more than lobular parenchyma.Also erythema nodosum.

157
Q

Best way to prevent cellular reation in pt airways?

A

Fluticasone. High dose glucocorticoids. Steroids are best for prevention iof chronic tx. Better than Zileuton etc.

158
Q

Which drugs can prolong QT?

A

Some Risky Meds Can Prolong QT?SotalolRisperidone (antipsychotics)MacrolidesChloroquineProtease inhibitors (NAVIR)Quinidine (Class 1a, also class 3)Thiazide

USMLE (16 decks)

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