uworld respiratory Flashcards
flu vaccine
includes antigens or virions to 3 or 4 a and b flue
wanes every year and strains change
inactivated about neutraling antibdoies.
inactivated does not invoke MHC1 response so no cellular immunity
length time bias
screening is better at picking up disease with slower progression, making it look like screening is doing a good thing
sensitive but not specific test for asthma
negative methacholine, good for ruling out
asthma x ray
often normal between attacks
asthma serum levels
elevated ige, eosionophilia
last to disappear in epithelial changes?
cilia
what genome does a virus need to be directly infectious?
positive sense rna
lung transplant recpients at risk for
cmv penumonitis
intranuclear and intracytoplasmic inclusions and owls eyes
a treatment for obstructive sleep apnea
implatable device that stimulated hypoglossal nerve to move tongue forward.
treats neuromuscular part of things
sarcoidosis chest x ray
riticular pulmonary infiltrates
sarcoidosis important cell type?
cd4
clinical findings of sarcoidosis
cough, dyspnea, chest pain
erythema nodosum
anterior/posterior uveitis
lofgren syndrome - bilateral hilar lympahdenopathy, erythema nodosum, and arthlagia
non caseating granulomas
sarcoidosis in BAL
high cd/cd8
cold agglutins
uncoagulated when in hand
features of restrictive obesity
most common indicator in rudction in the expiratory reserve volume.
has minimal effect on the residual volume.
frc is also decreased
can also cause decreases in rvc tlc and fev1 depedning on the severity but these deficits are modest in comparison to erv
what can be normal early in obstructive
the fvc
what was normal on chart for obstructive?
chart showed normal expiratory resever volume but everything else as expected.
remember this by remember all volumes increase equally, right?
what causes a decrease in po2 from alveolar capiallary blood to the systemic arterial blood?
the deoxygenated venous blood from bronchial circulation
supplied the bronchi and bronchioles dually with pulmonary artery
cxr of asthma
can be can show inflation during attack, i think i remember also that it can be normal inbtween
features of pulmonary fibrosis (as per the rheumatoid case)
small irregular (reticular) opaciteis on x ray
gradual onset of dyspnea on exertion and then at rest
can show end (late) inspiratory crackles
get decreased dlco and restrictive pattern
can progress to honeycombing
synthesis of elastin and what causes rubber like properties?
tropoelastin made inside and secreted.
microfibrils (fibrillin) acts as scaffold
next lysyl oxidase (requires copper) deaminated lysin residues which form desmosine crosslinks -> rubber like properties (stretching)
ppd anergy disease
sarcoidosis
what is found in the liver of sarcoidosis?
granulomas
what would cause the restrictive lung disease higher than expected for lung size flow rates
increased radial traction, vs emphysema where there is decreased radial traciton
picture showing large airways for restrive vs small airways for emphysema
what can happen to cystic fibrosis on hot summer day?
sweating and hyponatremia
general pathogesnsis of restrictive diseases
macrophage activation from ingulfment of particles causes release of PDGF and insulin like growth factor which stimulates fibroblasts to lay down collagen
penumonia can causes hypoxemia how?
v/q
how do lung abscesses form?
neutrophils and macs release lysosomal contents by macs that digest offending pathogens and recurit other WBCS
can damage parenchyma, setting the atage for abscess
involves necrosis of surrounding tissues
if abscess connects to air passage with see airf fluid levels
a man has mi and acute ventricular failure, what would you see histologically?
transudate accumulation in the alveolar lumen
hemisderin laden macs would be found later
pathnomic feature of chronic bronchits?
mucus hypersecretion
tlc in chornic bronchitis and emphysema
normal in chronic bronchitis and increased in emphysema
pulomnary complicant in bronchitis vs emphysema
normal in chronic bronchitis and increased in emphysema
bronchodilator response in bronchitis vs emphysema
bronchitis partial response, emphysema no response
copd asucultaroty findings
wheezes and decreased breath sounds
common findings in adenocarcinoma
clubbing and hypertrophic osteoarthopathy (clubbing plus periositis)
large cell carcinoma paraneoplastic syndromes
gynecomastia and glactorhea
adenocarcinoma epidemilogol
most common sybtype, occuring most frequently in women and nonsmokers
dlco in restrictie helps to distinguish between?
intrinsic or extrinsic causes
what falls in cyanide poisoning?
arterial venous o2 oxygen gradient falls
what does cyanide prefer to bind to?
fe3+
u world small cell markers
nerual cell adhension moclule (ncam, cd 56), synaptophsyin, neurofilaments
what is asthma laste phase characteized by?
eosinophils, basophils, and neutrophils.
in asthma what do basophils release?
heparin, histamine, SRA-S (leukotriene mixture)
what causes dyspnea in a case described as acute heat failure?
the high end diastolic pressure leads to -> transudation -> causes decreased compliance -> poor gas exchange and dyspnea
this is because transudate dilutes surfactant
asthma allergen inhalation
animal dander, dust mites, cockroachs, pollens, and molds.
respiratory irritants of asthma
ciggarettes smoke, air pollutants (exhause fumes), perfumes
infection asthma
viral URI, rhinosinusitis
pharmologic causes of asthma
aspirin (not acetomenaphin), nsaids, non selective beta blockers
other causes of asthma exacerbations
exercise, cold, dry air
GERD
emotions (stress, depression)
allerigic bronchopulmonary aspergillos can cause?
proximal bronchiectasis
farmers lung etiology
actinomycetes in moldy hay or contaminated compost
what is the etiology of symptoms from panic attack?
low co2 causing cerebral vasoconstriction
obesity hypoventilation syndrome
described patient that was foggy all the time.
said o2 arterial was low and co2 was high.
etiology? chronic hypoventilation
said it was a mix of increased co2 from increased body mass and surface area, sleep disordered breathing, and reduced lung volumes are compliance.
later said increase pco2 while awake.
said improtant causes of hypoxemia with normal aa
hypoventialsiton (normal aa gradient)
neuromuscule and obesity hypovenitlation
right to left shunt wout have?
increased A a gradient
copd hypoxia can lead to?
erythropoesis
hirshsprung vs meconmium ileus (CF)
hirsh, meconium
downsyndrome, cystic fibrosis
rectosigmoid, ileum
normal meconium, inspitssated (dry)
squire positive, negative
major cause of mortality in cystic fibrosis
pneumonia, bronchiectasis, and cor pulmonale
what do you see on biopsy in silicosis?
birefringent particles
findings in idiopathic pulmonary fibrosis
persistent non productive cough and dyspnea
non productive cough
usualy interstital pneumonia
alveolar collapse leads to honeycombing cystic spaces lined by hyperplastic type 2 pneumocytes
most prominent in subpleural and paraseptal spaces
four possible things asbestosis can cause
pleural plagues (most common)
asbestosis - progressive pulmonary fibrosis with asbestosis bodies
bronchogenic carcinoma - synergistic with smoking
malignant mesothelimoma
squamous cell carcinoma most similar too
barret’s esophagus metaplasia -> dysplasia
not similar to CIN/cervical cancer
what does centriacinar empyhsema involve?
the respiratory bronchioles (according to the image)
fat embolism pathogenesis
triad of acute onset neurologic abnormalities, hypoxemia, patehcial rash
long bone fracture -> fat embolism to lung -> imapired gas exchange leads to hypoxemia -> from there to brain (agitation and confused) -> and also to the dermal capillaries which causes rupture and pethciae
also you can get platelet addhearence to the fat microgolbules and thrombocytopenia
two causes or relative (vs) absolute polycythemia (erythrocytosis)
dehydration or excessive diuresis (example acute HF pt)
risk factors of second hand smoke in kids
prematurity, low birthweight sudden infant death syndrome middle ear disease (otitis media) asthma repsiratory tract infections (bronchitis, pneumonia)
abscesses of lung causes
orophyrangeal aspiration -> anaerobes with mixed aerobe component
complication of bacter pneumonia -> necrotizing pneumonias, staph, e coli, kelsiella, pseudomonas
sepiticemia or endo -> staphy and strep
asthma pt with sputum that shows many granule containing cells and crystalloid masses
eosionophils with charcot leyden crystals (eosinophil membrane protein)
lung processes with increased elastic resistance
acute respiratory distress syndrome, pulmonary edema, pulmonary fibrosis
how does sarcoidis present?
cough, dyspnea, chest pain accompanied by fatigue, fever, and weight loss.
in general for respiratory, late inspiratory crackles, dry cough, progressive exertional dyspnea
complication of o2 in copd
carotid body response becomes blunted.
decrease respitaroty drive
normally in healthy driven by co2 not o2, but in copd o2 drive rr
histology of mesthelioma
epithloid type cells with very long microvilli, desmosomes, tonofilaments.
mesothelioma signs and symptoms
dyspnea and chest pain
what can occur with a mediatinal mass?
SVC syndrome
said suprior sulcus could cause it, but would have other syptoms
normal lung fucntion changes with aging
decrease chest wall compliance and increased lung comliance.
leads to decreased fvc ( i think just because rv rises), increased rv (due to increased lung compliance) and no change in tlc due to (counter balance from decreased chest wlal comliance)
think like obesity
chronic lung transplant rejection
present with dyspnea and dry cough
total fibrotic obstruction in the terminal bronchioles
fev1 dropped, fev1/fvc dropped, fvc largely unchanged
co2 problems in COPD after adminstration of o2
can get rise in co2 leading to confusion and depressed conciousness
three causes
1. increased o2 causes perfusin of previously vascontricted poorly ventilated areas -> increased perfusion -> increased dead space (v/q mismatch)
- increased o2 dereased hb’s affinity for co2
- decreased ventilation
harmatoma
coin lesion with “popcorn” calcifications
occurs in pts 50-60
hyaline cartilage, fat, smooth muscle, clefts lined by repsitaroy epilethelium
chornic transplant rejection of lung occurs where?
small airways
retrolental fibroplasia (retinopathy of prematurity)
thought that transient increases in hyperoxia lead to increased vegf when taken off o2 from neonatal rds. leads to neovascularization with possible retinal detachement and blindness.
atelactasis from bronchial obstruction
decreased breath sounds (in fa), right hemithorax opacification, tracheal deviation
central lung tumor
systemic sclerosis in the lung
pulmonary artery hypertenstion (most common cause of death)
accentuated 2nd heart sound
showed normal lung values
what is increased in all obstructive diseases? a ratio
residual volume/tlc
says that
edema from ards is?
exudative
lung adenocarcinoma paraneoplastic syndromes
hyperiphic osteoarhropathy
dermatomyositis or polymyositis
migratory throbophelbetis (trosseau)
