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Pharmacology > uworld respiratory > Flashcards

uworld respiratory Flashcards

1
Q

flu vaccine

A

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

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2
Q

length time bias

A

screening is better at picking up disease with slower progression, making it look like screening is doing a good thing

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3
Q

sensitive but not specific test for asthma

A

negative methacholine, good for ruling out

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4
Q

asthma x ray

A

often normal between attacks

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5
Q

asthma serum levels

A

elevated ige, eosionophilia

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6
Q

last to disappear in epithelial changes?

A

cilia

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7
Q

what genome does a virus need to be directly infectious?

A

positive sense rna

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8
Q

lung transplant recpients at risk for

A

cmv penumonitis

intranuclear and intracytoplasmic inclusions and owls eyes

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9
Q

a treatment for obstructive sleep apnea

A

implatable device that stimulated hypoglossal nerve to move tongue forward.

treats neuromuscular part of things

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10
Q

sarcoidosis chest x ray

A

riticular pulmonary infiltrates

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11
Q

sarcoidosis important cell type?

A

cd4

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12
Q

clinical findings of sarcoidosis

A

cough, dyspnea, chest pain

erythema nodosum

anterior/posterior uveitis

lofgren syndrome - bilateral hilar lympahdenopathy, erythema nodosum, and arthlagia

non caseating granulomas

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13
Q

sarcoidosis in BAL

A

high cd/cd8

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14
Q

cold agglutins

A

uncoagulated when in hand

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15
Q

features of restrictive obesity

A

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

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16
Q

what can be normal early in obstructive

A

the fvc

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17
Q

what was normal on chart for obstructive?

A

chart showed normal expiratory resever volume but everything else as expected.

remember this by remember all volumes increase equally, right?

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18
Q

what causes a decrease in po2 from alveolar capiallary blood to the systemic arterial blood?

A

the deoxygenated venous blood from bronchial circulation

supplied the bronchi and bronchioles dually with pulmonary artery

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19
Q

cxr of asthma

A

can be can show inflation during attack, i think i remember also that it can be normal inbtween

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20
Q

features of pulmonary fibrosis (as per the rheumatoid case)

A

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

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21
Q

synthesis of elastin and what causes rubber like properties?

A

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)

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22
Q

ppd anergy disease

A

sarcoidosis

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23
Q

what is found in the liver of sarcoidosis?

A

granulomas

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24
Q

what would cause the restrictive lung disease higher than expected for lung size flow rates

A

increased radial traction, vs emphysema where there is decreased radial traciton

picture showing large airways for restrive vs small airways for emphysema

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25
Q

what can happen to cystic fibrosis on hot summer day?

A

sweating and hyponatremia

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26
Q

general pathogesnsis of restrictive diseases

A

macrophage activation from ingulfment of particles causes release of PDGF and insulin like growth factor which stimulates fibroblasts to lay down collagen

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27
Q

penumonia can causes hypoxemia how?

A

v/q

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28
Q

how do lung abscesses form?

A

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

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29
Q

a man has mi and acute ventricular failure, what would you see histologically?

A

transudate accumulation in the alveolar lumen

hemisderin laden macs would be found later

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30
Q

pathnomic feature of chronic bronchits?

A

mucus hypersecretion

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31
Q

tlc in chornic bronchitis and emphysema

A

normal in chronic bronchitis and increased in emphysema

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32
Q

pulomnary complicant in bronchitis vs emphysema

A

normal in chronic bronchitis and increased in emphysema

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33
Q

bronchodilator response in bronchitis vs emphysema

A

bronchitis partial response, emphysema no response

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34
Q

copd asucultaroty findings

A

wheezes and decreased breath sounds

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35
Q

common findings in adenocarcinoma

A

clubbing and hypertrophic osteoarthopathy (clubbing plus periositis)

36
Q

large cell carcinoma paraneoplastic syndromes

A

gynecomastia and glactorhea

37
Q

adenocarcinoma epidemilogol

A

most common sybtype, occuring most frequently in women and nonsmokers

38
Q

dlco in restrictie helps to distinguish between?

A

intrinsic or extrinsic causes

39
Q

what falls in cyanide poisoning?

A

arterial venous o2 oxygen gradient falls

40
Q

what does cyanide prefer to bind to?

A

fe3+

41
Q

u world small cell markers

A

nerual cell adhension moclule (ncam, cd 56), synaptophsyin, neurofilaments

42
Q

what is asthma laste phase characteized by?

A

eosinophils, basophils, and neutrophils.

43
Q

in asthma what do basophils release?

A

heparin, histamine, SRA-S (leukotriene mixture)

44
Q

what causes dyspnea in a case described as acute heat failure?

A

the high end diastolic pressure leads to -> transudation -> causes decreased compliance -> poor gas exchange and dyspnea

this is because transudate dilutes surfactant

45
Q

asthma allergen inhalation

A

animal dander, dust mites, cockroachs, pollens, and molds.

46
Q

respiratory irritants of asthma

A

ciggarettes smoke, air pollutants (exhause fumes), perfumes

47
Q

infection asthma

A

viral URI, rhinosinusitis

48
Q

pharmologic causes of asthma

A

aspirin (not acetomenaphin), nsaids, non selective beta blockers

49
Q

other causes of asthma exacerbations

A

exercise, cold, dry air

GERD

emotions (stress, depression)

50
Q

allerigic bronchopulmonary aspergillos can cause?

A

proximal bronchiectasis

51
Q

farmers lung etiology

A

actinomycetes in moldy hay or contaminated compost

52
Q

what is the etiology of symptoms from panic attack?

A

low co2 causing cerebral vasoconstriction

53
Q

obesity hypoventilation syndrome

A

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

54
Q

hypoventialsiton (normal aa gradient)

A

neuromuscule and obesity hypovenitlation

55
Q

right to left shunt wout have?

A

increased A a gradient

56
Q

copd hypoxia can lead to?

A

erythropoesis

57
Q

hirshsprung vs meconmium ileus (CF)

A

hirsh, meconium

downsyndrome, cystic fibrosis
rectosigmoid, ileum
normal meconium, inspitssated (dry)
squire positive, negative

58
Q

major cause of mortality in cystic fibrosis

A

pneumonia, bronchiectasis, and cor pulmonale

59
Q

what do you see on biopsy in silicosis?

A

birefringent particles

60
Q

findings in idiopathic pulmonary fibrosis

A

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

61
Q

four possible things asbestosis can cause

A

pleural plagues (most common)
asbestosis - progressive pulmonary fibrosis with asbestosis bodies
bronchogenic carcinoma - synergistic with smoking
malignant mesothelimoma

62
Q

squamous cell carcinoma most similar too

A

barret’s esophagus metaplasia -> dysplasia

not similar to CIN/cervical cancer

63
Q

what does centriacinar empyhsema involve?

A

the respiratory bronchioles (according to the image)

64
Q

fat embolism pathogenesis

A

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

65
Q

two causes or relative (vs) absolute polycythemia (erythrocytosis)

A

dehydration or excessive diuresis (example acute HF pt)

66
Q

risk factors of second hand smoke in kids

A 
prematurity, low birthweight
sudden infant death syndrome
middle ear disease (otitis media)
asthma
repsiratory tract infections (bronchitis, pneumonia)
67
Q

abscesses of lung causes

A

orophyrangeal aspiration -> anaerobes with mixed aerobe component

complication of bacter pneumonia -> necrotizing pneumonias, staph, e coli, kelsiella, pseudomonas

sepiticemia or endo -> staphy and strep

68
Q

asthma pt with sputum that shows many granule containing cells and crystalloid masses

A

eosionophils with charcot leyden crystals (eosinophil membrane protein)

69
Q

lung processes with increased elastic resistance

A

acute respiratory distress syndrome, pulmonary edema, pulmonary fibrosis

70
Q

how does sarcoidis present?

A

cough, dyspnea, chest pain accompanied by fatigue, fever, and weight loss.

in general for respiratory, late inspiratory crackles, dry cough, progressive exertional dyspnea

71
Q

complication of o2 in copd

A

carotid body response becomes blunted.

decrease respitaroty drive

normally in healthy driven by co2 not o2, but in copd o2 drive rr

72
Q

histology of mesthelioma

A

epithloid type cells with very long microvilli, desmosomes, tonofilaments.

73
Q

mesothelioma signs and symptoms

A

dyspnea and chest pain

74
Q

what can occur with a mediatinal mass?

A

SVC syndrome

said suprior sulcus could cause it, but would have other syptoms

75
Q

normal lung fucntion changes with aging

A

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

76
Q

chronic lung transplant rejection

A

present with dyspnea and dry cough

total fibrotic obstruction in the terminal bronchioles

fev1 dropped, fev1/fvc dropped, fvc largely unchanged

77
Q

co2 problems in COPD after adminstration of o2

A

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)

  1. increased o2 dereased hb’s affinity for co2
  2. decreased ventilation
78
Q

harmatoma

A

coin lesion with “popcorn” calcifications

occurs in pts 50-60

hyaline cartilage, fat, smooth muscle, clefts lined by repsitaroy epilethelium

79
Q

chornic transplant rejection of lung occurs where?

A

small airways

80
Q

retrolental fibroplasia (retinopathy of prematurity)

A

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.

81
Q

atelactasis from bronchial obstruction

A

decreased breath sounds (in fa), right hemithorax opacification, tracheal deviation

central lung tumor

82
Q

systemic sclerosis in the lung

A

pulmonary artery hypertenstion (most common cause of death)

accentuated 2nd heart sound

showed normal lung values

83
Q

what is increased in all obstructive diseases? a ratio

A

residual volume/tlc

says that

84
Q

edema from ards is?

A

exudative

85
Q

lung adenocarcinoma paraneoplastic syndromes

A

hyperiphic osteoarhropathy
dermatomyositis or polymyositis
migratory throbophelbetis (trosseau)

Pharmacology (33 decks)

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