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Flashcards in DIT Pulm Deck (38):
1

Mnemonic for shit peircing diaphragm?

I ate 10 eggs at 12.

Ivc 8
10 EsophaGus (vAGus)
Aorta Azygous Thoracic duct (AT) 12

so it is Ivc 8 10 EsophaGus vaGus AAT 12

(also vagus is cranial nerve 10)

2

What cells are able to divide in lung to fix damaged?

Type II cells

3

Volume of Physiologic Dead Space equation?

Think about it, no dead space, the PaCO2=PeCO2 b/c blowing off all the CO2 and it would be zero.

Taco paco peco paco

Vtidal volume X (paco2-peco2)/paco2

4

What can cause pulmonary HTN?

>/=25 mmHg at rest

Primary pulm HTN: BMPR2 gene inhibits vasc smooth muscle proliferation. Poor prognosis. QBANK. HIV and HHV-8 association (kaposi sarcoma)

Secondary: COPD, mitral stenosis, autoimmune L-R shunt, sleep apnea, recurrent thrombi, high altitude (hypoxic vasoconstriction)

5

Tx of pulmonary HTN?

Bosentan ambriensentan antagonize endothelin 1 receptors

Prostaglandin relax vessels

Sildenafil

Nifedipine

6

What favors T form of hemoglobin?

CO2, H+, increased temp, 2,3 DPG. cause release of oxygen, ALTITUDE (shifts curve to the right)

THINK ABOUT HOW muscle action makes heat so it would release oxygen when muscles are working and it needs oxygen.

7

What is a clinical use of methehemoglobin?

Soaks up cyanide! b/c cyanide binds Fe+++ ferric hemoglobin (thats what oxygen does not bind)

So giving nitrates will oxidize blood to soak up cyanide.

Thiosulfate also binds cyanide to excrete renal.

8

What can cause methemoglobinemia?

Nitrates
Chloroquine
Dapsone
Sulfonamides
Lidocaine
Metaclopramide

9

Alveolar gas equation?

PAO2 = PIO2-PaCO2/R

easier:
PAO2=150-PaCO2/0.8

10

Normal A-a gradient? What would mean it is bad?

PAO2-PaO2=10-15 normally. If higher, usually bad news.

REMEMBER big A is ALVEROLAR and little a is arterial

11

High A-a gradient is not necessarily a bad thing when?

High altitude with lower partial pressure of O2 or hypoventilating

12

What is EKG finding of pulmonary embolism?

S1Q3T3: Wide S in lead 1, a large Q in III and inverted III

13

Virchows triad?

Stasis, hypercoagulability, endothelial damage

14

FEV/FVC for normal? COPD? Restricted?

80%

less than 80

80 or more

15

What is pulses paradoxes?

Inhale, more venous return, RV can fill and push inter ventricular septum to left and decrease CO and BP drops ten points.

Happens in:
asthma
tampanade

16

Eosinonphilia differential?

DNAAACP

Drugs
neoplasm
Atropic diseaes (asthma, allergy, churg straus)
Addisons
acute interstitial nephritis
collagen vascular diseaes
parasites

17

Where is emphysema from smoking affecting you?

centriacinar emphysema in upper and superior segments of lower lobes

Destrucion of central portion of acini. Respiratory bronchioles are affected most

18

What are Curschman spirals?

shed epithelium forms mucous plugs in Asthma

19

Muscarinic antagonist in asthma?

ipratropium

20

Theophylline mechanism?

What do you need to know?

Bronchodiolate by inhibiting phosphodiesterase (could it give you boners?)

Narrow TI
Cardiotoxicity and neurotoxicity

Antidote is beta blocker for tachycardia (remember it is basically caffeine)

It blocks actions of adenosine (REMEMBER THATS WHAT CAFFEEINE DOES, blocks adenosine receptors when you a tired!)

21

What is guaifenesin?

Expectorant: thins respiratory secretions: so you can cough up shit

22

more antihistamine uses on page 396 of DIT

if you care

23

omalizumab?

anti IgE

24

Bilateral hilar lymphadenopathy and erythema nodosum in restrictive lung disease?

Sarcoidosis is widespread noncaseating granulomas (in black women). Tx steroids

A GRUELING Disease
ACE increase
Granulomase (noncaseating)
Rh arthritis
Uveitis of eye
Erythema noosum
Lymphadenopathy bilateral and hilar
Idiopathic
Noncaseating granuloma
Gammaglobulinemia
vit D increase

25

How and where is damage from pneumoconiosis?

Macrophage damage after taking up shit you inhaled. Normally upper lobes. CAUSES FIBROSIS

Restrictive

26

Asbestosis?

Bronchogenic carcinoma and mesothelioma risk

27

Berylliosis?

cell mediated immunity causing noncaseating granolamas and looks like sarcoid

Aerospace engineers

28

Bilateral hilar adenpathy and uveitis?

sarcoidosis

29

What is risk of silicosis? Describe how you recognize silicosis.

Silicone exposure with sand blasting and such. It may impair macrophage and INCREAASE RISK FOR TB and bronchogenic carcinoma

30

Describe findings with squamous cell carcinoma of the lung.

Locaiton

Histo

symptoms

C cancer of lung

Central

Cavitation, Cigarettes, hyperCaclemia (produces parathyroid related protein PTHrP and hypercalcemia may be first symptom)

Keratin (Ceratin for C theme) pearls in sheets of dysplastic squamous cells on histo.

31

Lambert Eaton syndrome?

Small cell carcinoma b/c Anti Ca++ channels causing myawsthenic syndrome (weakness, improves with use)

32

S mnemonic for lung cancer

Squamous cell
Small cell
smoking
central
secreting

33

Carcinoid syndrome symptoms?

B-FDR

Bronchospasm
Flushing
Diarrhea
Right sided heart lesions

34

Histo of mesotheliom?

Psammoma bodies

NOT ASSOCIATED WITH SMOKING.

can be in peritoneum

35

What is secreted in small cell carcinoma? Mnemonic alert!

ACTH, ADH, Antibodies against presynaptic Ca++ (lambert eaton syndrome)

Amplicifaction of myc oncogene is common

Not operable, need to do chemo, so poor prognosis

36

Where are the most common locations of cancer mets?

Brain, bone, adrenal, liver

37

Practice q's pg 404 of DIT

"if youc an handle these you will do well on step 1 pneumonia"

38

Most common cause of pneumonia in:

Birth-28 days old

Children less than a year

Children and young adults

Ventilator patients

E coli or GBS (neonate)

RSV (less than a year)

Mycoplasma (kids and young adults)

Psuedomonas (ventalator)