AAW - respiratory Flashcards
(110 cards)
1
Q
BMPR2
A
gene mutation causing primary pulmonary hypertensions
normally it functions to regulate vascular smooth muscle proliferation.
2
Q
when do you see plexiform lesions on histology slides
A
long standing pulmonary hypertension
3
Q
tumor that may give you hypercalcemia
why does it do it
A
squamous cell carcinoma (lung)
tumor can produce PTHrP (parathyroid hormone related peptide)
4
Q
eaton-lambert syndrome is assc with what cancer
A
small cell carcinoma
5
Q
where do you see clara cells
A
bronchioles only
aka club cells
6
Q
lung cancers not related to smoking
A
bronchioalveolar cacinoma (an adenocarcinoma), carcinoid tumor
7
Q
when would you see something that is chromogranin positive
A
with neuroendocrine cells (like in a carcinoid tumor or small cell)
8
Q
what is a carcinoid tumor
A
tumor of the lung - well differentiated neuroendocrine cells, chromogranin positive, classically forms a polyp-like mass in proximal bronchus, low grade malignancy
john wayne had it
9
Q
when do you see columnar cells replacing alveolar cells in the lung
A
bronchioalveolar carcinoma
resembles pneumonia
10
Q
when do you see keratin pearls/intercellular bridges?
A
squamous cell carcinoma
11
Q
What does TGF-beta do pathologically in the lung
A
release from pneumocytes can cause idiopathic pulmonary fibrosis
12
Q
when do you see honeycomb change to the lung
A
idiopathic pulmonary fibrosis
13
Q
what does amiodarone do to the lungs
A
idiopathic pulmonary fibrosis
14
Q
what does bleomycin do to the lung
A
idiopathic pulmonary fibrosis
15
Q
silicosis of the lung presents where
What does the mech of damage in silicosis
increased risk of what
A
upper lobes
silica impairs the phagolysosome formation
get increased risk of TB
16
Q
calcified pleural plaque =
A
asbestosis
17
Q
if you see little bodies of iron in macrophages of the lung that look like pearls on a string, what are you thinking
A
asbestosis
18
Q
psittacosis - get it from what
A
can get Chlamydia psittaci infection from birds
19
Q
serum test associated with sarcoidosis
A
increased ACE
also hypercalcemia
20
Q
SE of steroids (long course)
A
avascular necrosis of hips
osteoporosis
glucose intolerance
increased risk of infection (esp fungal)
21
Q
what shows up as PAS positive in the liver in a lung disease
A
hepatocytes in the liver in alpha 1 antitrypsin are PAS positive (this is where the misfolded A1AT accumulates)
22
Q
how to Tx cyanide poisoning
A
use nitrites to oxidize hemoglobin to methemoglobin (which binds cyanide)
also use thiosulfate to bind cyanide
23
Q
what drug can you give prophylactically to someone who is going to go to a high altitude area and why
A
acetazolamide, CA inhibitor
this causes an increased renal excretion of bicarb to compensate for the respiratory alkalosis (get alkalotic because your are breathing faster and blowing off more CO2)
24
Q
what is the ried index
A
measuring the thickness of the glandular portion of the airway on histology
if >50%, then you have chronic bronchitis
25
charcot leyden crystals
seen in asthma
result of breakdown of eosinophils in sputum
26
what does it mean to be methacholine positive
it means you have asthma
27
farmer with exposure to birds has dyspnea, cough, chest tightness, headache. what is causing?
mixed type III/IV hypersensitivity pneumonitis reaction to antigen
28
Caplan syndrome
RA and pneumoconiosis with intrapulmonary nodules
29
white, calcified pleural plaques are what
asbestos
30
anthracosis
collection of carbon-laden macrophages (from coal classically) that is not clinically significant
can see it in smokers too
31
what pneumoconiosis increases your susceptibility to TB
silicosis
32
when do you see "eggshell calcification" of the hilar lymph nodes
silicosis
33
squamous cell carcinoma histology
sheets of large, dysplastic squamous cells surrounding dark, pink keratin pearls
34
psammoma bodies seen on histology mean what
mesothelioma
and other cancers
35
common causes of transudate in the lungs
CHF, cirrhiosis, nephrotic syndrome
36
dimenhydrinate
H1 blocker, 1st gen
37
first gen H1 blockers
diphenhydramine, dimenhydrinate, chlorpheniramine
38
second gen H1 blockers
usually end in "adine"
Loratadine, fexofenadine, desloratadine,
cetirizine.
39
expectorants
Guaifenesin (mucinex) - thins the sputum
N-acetylcysteine - used to loosen mucus plugs in patients with CF - this is also the antidote for acetaminophen overdose
40
Dextromethorphan
Antitussive (antagonizes NMDA glutamate receptors). Synthetic codeine analog. Has mild opioid
effect when used in excess. Naloxone can be given for overdose. Mild abuse potential
41
alpha agonists used to releave stuffiness
Pseudoephedrine, phenylephrine
42
steroids used in asthma and mech of action
fluticasone (flonase), beclomethasone, budesonide
inhibit the synthesis of virtually all cytokines, inactivate NF-kB
43
what inhibits 5- lipoxygenase and what does that do
zileuton, blocks synthesis of leukotrienes
44
omalizumab
monoclonal anti-IgE antibody, binds mostly unbound serum IgE and blocks binding to FceRI. used in allergic asthma resistant to inhaled steroids and long acting beta 2 agonists
45
what do you use in a bronchial provocation challenge, and what is it used to diagnose
methacholine, used to diagnose asthma
it's a muscarinic receptor agonist
46
bosentan
used to treat pulmonary arterial hypertension. competitively antagonizes endothelin-1 receptors, decreases pulmonary vascular resistance.
47
what happens to arterial O2 sat in someone who lives at very high altitudes
their O2 sat may be very low (~70%) but their hematocrit is up to compensate.
48
major source of blood supply to the nasal mucosa
sphenopalatine artery, the terminal branch of the maxillary artery (off external carotid)
49
right recurrent laryngeal artery loops under what
left recurrent laryngeal artery loos under what
right subclavian artery
left loops under the ligamentum arteriosum
50
common viral pneumonia in immunocompromised patients and pearls about it as well as viral characteristics
CMV
owls eye on histo
dsDNA (belongs to herpes virdae), enveloped, icosahedral virus
all herpes virdae are also icosahedral except for pox virus
51
viral characteristics of adenovirus
dauble stranded DNA, naked, icosahedral
52
what can you give to mommy to stop ARDS in the baby
glucocorticoids
they induce the synthesis of surfactant lipids
53
generally, what types of lung cancers cause coin lesions
the peripheral ones, so the ones besides squamous and small cell
54
what lung cancer is related to lung scarring due to old granulomatous disease
adenocarcinoma
makes sense because adenocarcinoma and granulomatous lung disease are more common in women!
55
what lung cancer can cause cushing syndrome
small cell - can cause release of ACTH
56
what disease will make smokers develop emphysema faster
A1AT
57
bronchiectasis
dilated airways
58
what bacteria have K capsule and what does it do
E. coli
causes pneumonia in newborns (got it from mommy)
59
what lung volumes cannot be measured on spirometry
RV - Residual lung volume (its whats left after you breath out all you can muster)
FRC - functional residual capacity (its the RV plus the expiratory reserve volume (what you can push out if you really try hard))
60
6 month old boy with recurrent pneumonia, foul smelling stool
what is it and how does it work
why the smelly stool
Cystic fibrosis
autosomal recessive defect in CFTR gene
get fat soluble vitamin deficiency, mucous plugs lungs
defective chloride ion channel (a gated ion channel that involves ATP hydrolysis regulated by protein kinase A phosphorylation)
foul smelling stool is because of meconium ileus (meconium plug obstructs the ilius)
61
mitral obstruction does what - causes obstructive or restrictive lung disease
causes restrictive lung disease (decreased compliance)
62
3 main obstructive lung diseases
emphysema, chronic bronchitis, asthma
63
What tends to be the smallest yeast that infects the lungs and what does it look like on histology
histoplasmosis, it hides within macrophages, is around 2-5 micrometers in diameter,
64
this fungus exhibits broad base budding
blasto broadly buds
65
this fungal lung infection of the lung can spread to skin and bones
blasto blasts your bones
but also coccidiomycoses
66
this fungal lung infection also causes painful red bumps classically on the shins. name both
coccidiomycosis
erythema nodosum
67
what are you thinking if you have a lung infection and the tissue has a captain's wheel appearance on histology
paracoccidioidomycosis
68
squamous cell mneumonic
sQuamous
hyperCalcemia (PTHrP)
Cavitation
Cigs
Keratin pearls
(hard C sound)
69
mneumonic for small cell
smAll cell
produces
ACTH
ADH
Antibodies agaisnt presynaptic Ca channels (lambert-eaton myasthenic syndrome)
Amplification of myc oncogenes
70
what are you thinking if you see white exudate in the pleural cavity
lymphoma
if it was pneumonia it would been green or yellow
71
when do you see Mycobacterium avium-intercellular infections
only when CD4 counts are like below 100
so FBA
(Full Blown Aids)
72
gram positive diplococci in the lung
what are they
antibiotic?
strep pneumo
macrolide
73
if you are using an aminoglycoside all on its own what are you probably trying to kill
aerobic gram - bacilli
74
what happens to an asthmatics' TLC,
it tends to increase because of hyperinflation due to air trapping
75
cushings disease is assc with what cancer
small cell
76
things other than horners assc with pancoast tumors
squamous cell
ulnar nerve pain due to compression of brachial plexus
SVC syndrome
77
Epstein barr virus is assc with what respiratory cancer in what type of patient
nasopharyngeal carcinoma
chinese adults and african kids
78
what types of lesions do you see in primary TB and what kind in secondary
primary - subjacent to the pleura usually in the middle region of the lung or in the mediastinal nodes
secondary - apex
79
anthracosis
heavy black pigment deposition in the lung tissue from tobacco
seen in emphysema
80
diaphragm is innervated by this nerve
phrenic
81
respiratory infection that tests positive for cold agglutinins
mycoplasma pneumonia
82
ceftazidimide
used for
3rd gen cephalosporine used for pseudomonas infections
83
if your ventilation rate doubles and your CO2 production remains the same, your arterial pCO2 changes by ________
if ventilation triples?
vent doubles, pCO2 halves
vent triples, pCO2 is now 1/3
84
equation for alveolar ventilation rate
RR * (tidal volume - dead space)
85
signs other than respiratory distress suggesting that you have a fat embolism from a broken long bone
cerebral signs, petechial rash, retinal fat globules
86
what type of cell mediates damage in Adult respiratory distress syndrome
What type of stuff forms in the lung
neutrophils release substances that damage the alveolar wall, causes activation of coagulation cascade, oxygen free radials
results in formation of a intra-alveolar hyaline membrane
87
long acting beta 2 agonists
Salmeterol
Formoterol
Bambuterol
88
BCG vacciene
for TB
can cause a false positive TB skin test
89
cavitation in the lung differential
squamous cell
primary bacterial pneumonia
fungi
TB
maybe wegeners
90
patient presents with cough, hemoptysis, hylar mass and mediastinal packing with adenopathy on CXR, hyponatremia
what is it
why the hyponatremia
small cell
hyponatremia because the tumor can produce ADH (causing SIADH)
91
what drug can you use to obliterate the pleural space
| what is the science name for obliterating the pleural space
Talc slurry
Tetracycline
Bleomycin
Called a pleurodesis
92
patient has diarrhea, flushing, and bronchospasm
what are you thinking
carcinoid syndrome
(results from secretion of serotonin by a carcinoid tumor)
if the tumor is in the intestines, you don't get symptoms because of metabolism of the serotonin
93
Nedocromil and cromolyn
prevent bronchoconstriction by decreasing the release of mediators of mast cells
94
pertussis toxin
mech of what it does
effects on the body
AB toxin
ADP ribosylates Gi leading to increased levels of cAMP:
increased insulin production -> hypoglycemia
increased histamine sensitivity
95
a kid with a crazy bad cough and gram negative encapsulated organisms
pertussis
96
heart changes with borrelia burgdorferi
first degree heart block (increased PR interval)
97
premature infant with respiratory distress and a biopsy showing surfactant-rich exudate and silver-staining cysts
what disease
Pneumocystis jiroveci
98
vasculitis assc with hep b
polyarteritis nodosa
99
most common pneumonia in CF patients
Pseudomonas aeruginosa
gram-negative bacillus, aerobic, oxidase positive, polysaccharide capsule (most important, prevents phagocytosis)
also causes hot tub folliculitis (to survive in the hot tub, you have to be aerobic because all the bubbles, oxidase positive to combat the harsh chemicals, and have a capsule so you can survive when they put the cap on the hot tub) its a mneumonic, w/e
also has a fruity odor
100
angiotensin converting enzyme elevated
patient has noncaseating granulomas in the lungs
what are you thinking
sarcoid - 60% of patients have elevated ACE
| provided the granulomas are negative for fungi or bacteria
101
another name for diffuse alveolar damage
what causes it
what is characteristcally seen on histo
adult respiratory distress syndrome (ARDS)
trauma, sepsis, shock, gastric aspiration
get hyaline membranes within the alveolar cavities (proteinaceous material of plasma origin and necrotic debris from desquamated epithelium)
102
red, thick, dark bloody sputum in someone with lobar pneumonia
organism is gram _____
oxidase _____
coccus or bacillius
Gram negative, oxidase negative bacillus
klebsiella
103
what type of bacteria most likely cause a lung abcess (and a pneumonia that progresses slowely)
S. aureus, and all of the anaerobic bacteria of the oral flora (bacteroides, peptococcus, fusobacterium)
Klebsiella, on the other hand, will cause an abrupt onset of symptoms and not normally makes an abcess
104
lecithin:sphingomyelin ratio
in amniotic fluid
L-S ratio of 2 or more indicates fetal lung maturity
L-S ratio of 1.5 or less is assc with fetal respiratory distress syndrome
105
what is deficient in the lungs of a newborn with respiratory distress, specifically
mostly dipalmitoylphosphatidylcholine (DPPC)
106
most common opportunistic lung infection in AIDS patients and how to treat
Pneumocystis j.
AKA PCP (PneumoCystisPneumonia)
treat with Bactrim
I.D. with silver stain, honeycomb appearance on H&Estain, ground glass appearance on chest x ray
start prophylaxis when CD4 counts are below 200
107
what are the types of cells that define a granuloma
epithelioid histiocytes (aka macrophages)
108
zileuton
5-lipoxygenase pathway inhibitor. blocks conversion of arachidonic acid to leukotrienes. hepatotoxic. used in asthma
109
pentamidine
used to treat pneumocystis j. in people who cannot tolerate TMP-SMX because of sulfa allergy
110
montelukast
leukotriene receptor antagonist
