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Flashcards in AAW - respiratory Deck (110):
1

BMPR2

gene mutation causing primary pulmonary hypertensions

normally it functions to regulate vascular smooth muscle proliferation.

2

when do you see plexiform lesions on histology slides

long standing pulmonary hypertension

3

tumor that may give you hypercalcemia

why does it do it

squamous cell carcinoma (lung)

tumor can produce PTHrP (parathyroid hormone related peptide)

4

eaton-lambert syndrome is assc with what cancer

small cell carcinoma

5

where do you see clara cells

bronchioles only

aka club cells

6

lung cancers not related to smoking

bronchioalveolar cacinoma (an adenocarcinoma), carcinoid tumor

7

when would you see something that is chromogranin positive

with neuroendocrine cells (like in a carcinoid tumor or small cell)

8

what is a carcinoid tumor

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

when do you see columnar cells replacing alveolar cells in the lung

bronchioalveolar carcinoma

resembles pneumonia

10

when do you see keratin pearls/intercellular bridges?

squamous cell carcinoma

11

What does TGF-beta do pathologically in the lung

release from pneumocytes can cause idiopathic pulmonary fibrosis

12

when do you see honeycomb change to the lung

idiopathic pulmonary fibrosis

13

what does amiodarone do to the lungs

idiopathic pulmonary fibrosis

14

what does bleomycin do to the lung

idiopathic pulmonary fibrosis

15

silicosis of the lung presents where

What does the mech of damage in silicosis

increased risk of what

upper lobes

silica impairs the phagolysosome formation

get increased risk of TB

16

calcified pleural plaque =

asbestosis

17

if you see little bodies of iron in macrophages of the lung that look like pearls on a string, what are you thinking

asbestosis

18

psittacosis - get it from what

can get Chlamydia psittaci infection from birds

19

serum test associated with sarcoidosis

increased ACE

also hypercalcemia

20

SE of steroids (long course)

avascular necrosis of hips

osteoporosis

glucose intolerance

increased risk of infection (esp fungal)

21

what shows up as PAS positive in the liver in a lung disease

hepatocytes in the liver in alpha 1 antitrypsin are PAS positive (this is where the misfolded A1AT accumulates)

22

how to Tx cyanide poisoning

use nitrites to oxidize hemoglobin to methemoglobin (which binds cyanide)

also use thiosulfate to bind cyanide

23

what drug can you give prophylactically to someone who is going to go to a high altitude area and why

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

what is the ried index

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