March 17 - Pulmonary Flashcards Preview

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Flashcards in March 17 - Pulmonary Deck (61):

Four stages of lobar pneumonia: timing, macro and micro findings

1. Congestion: Seen in first 24 hours. Macro: red, heavy, boggy lobe. Micro: vasodilation, exudate full of bacteria

2. Red hepatization: Seen in days 2-3. Macro: red and firm. Micro: exudate with red cells, PMNs, fibrin.

3. Gray hepatization: Seen in days 4-6. Macro: grey-brown firm lobe. Micro: disintegrated RBCs, exudate with PMNs and fibrin.

4. Resolution: Enzymatic digestion of exuate. Return to normal


Three pneumonia types

Bronchopulmonary: patchy inflammation of multiple lobules

Interstitial: inflammatoyr infiltrate of aveolar walls

Lobar: involves entire lobe of lung


Three ways to diagnose CF

1. Increased sweat chloride (can be normal in mild disease.)
2. Nasal potential difference measurements (more negative than normal)
3. Genetic testing for CFTR mutations


Pathophysiology of CF in respiratory and gastric glands

Normal: CFTR increases Na+ and water content by secreting Cl-. Na+ stays extracellular for charge balance rather than being reabsorbed by ENAC channels.

CF: CFTR is impaired. Cl- can't be secreted so Na+ reabsortpin is increased through the ENAC channels. Water follows resulting in viscous mucus.


Pathophysiology of CF in sweat glands

Normal: CFTR reabsorbs Cl-. Na+ follows through ENAC channels. Low salt content in sweat

CF: CFTR can't reabsorb Cl- so high Cl- in sweat. Na+ follows for charge balance resulting in salty sweat



Polyene that inhibits ergosterol similar to amphotericin B. Given as swish and swallow agent for thrush (not absorbed in stomach)


Histoplasma vs coccidioides vs cryptococcus in clinical specimens

Histoplasma: Oval or round yeasts within macrophages
Coccidioides: large thick walled spherules containing endospores
Cryptococcus: Extracellular encapsulated yeast


Clearance of respiratory contaminants

Airways through the terminal bronchioles: mucociliary system
Distal to terminal bronchioles: alveolar macrophages


Airway anatomy: cartilate, goblet cells, epithelium types, smooth muscle, gas exchange

Cartilage: Present in trachea and bronchi
Goblet cells: Present in trachea and bronchi
Pseudostratified ciliated columnar epithelium: Trachea through terminal bronchioles
Cuboidal epithelium: Respiratory bronchioles
Simple squamous epithelium: Aveoli
Smooth muscle: Present through terminal bronchioles (in the conducting airways)
Gas exchange: respiratory bronchioles and aveoli; through the terminal bronchioles is conducting zone


Basis of ESR

Fibrinogen, an acute phase reactant, causes erythrocytes to form stacks that sediment faster. TNF-alpha, IL-1, and IL-6 stimulate production of acute phase reactants by liver, stimulating the systemic inflammatory response.


Airway resistence

Highest in medium sized bronchi, then drops dramatically as airways branch more


Elastin structure

Mostly nonpolar amino acids with proline and lysine like collagen but unlike collagen, not hydroxylated. Lysine deaminated, allowsing for desmoline cross links to form which gives elastin its rubber like properties


Aspiraiton pneumonia: locations

Supine: posterior segment of RUL, superior segment of RLL
Upright: basilar segments of lower lobes


Chediak-higashi presentation

Oculocutaneous albinism
Pyogenic infections
Neurologic dysfunction


Wiskott Aldrich syndrome: presentaiton and cause

Presentation: recurrent infections that worsen with age, easy bleeding, eczema

Cause: abnormal cytoskeleton, B and T cell dysfunction


Polyribosyl-ribitol-phosphate (PRP)

component of H flu capsule, immunogenic


Nocardiasis: cause, presentation, transmission

Cause: infection with Nocardia - branching gram pos rod that is partially acid fast

Transmission: spore inhalation or skin inoculation. Bacteria present in soil

Presentation: Pneumonia, brain abscess in elderly/immunocompromised


Listeria vs nocardia

Both gram pos rods. Listeria has tumbling motility; nocardai has branching filaments.

Listeria causes meningoencephalitis but not pulmonary disease. Nocardia causes pulmonary disease and brain abscess


Hamartoma: imaging and path

Most common benign lung tumor. Contains mature hyaline cartilage, fat, smooth muscle lined by respiratory epihtlieum. Coin shaped lesion on imaging.


Distinguishing between alpha hemolytic strep

Strep pneumo: optochin sens, bile soluble
Viridans strep: optochin resistance, bile insoluble


Bacteria asociated with hyponatremia



Fungus associated with cave exploration



Langerhans giant cells

Multiple nuclei in horseshoe chape. Nonspecific finding in granulomatous inflammation. Form of activated macrophages


DHR flow cytometry

Alternative method to diagnose CGD. In CGD see absence of green fluorescence.


Intercostal vessels and nerve location

In subcostal groove on the lower border of the rib


Cord factor

TB virulence factor responsible for serpentine growth pattern. Inactivates PMNs, damages mitochondria, causes release of TNF



Caused by gram pos anaerobe that colonizes mouth, colon, vagina. Disruption of mucosa can cause systemic infection. Aspiration can cause pulmonary actinomyces. Bacteria has filamentous branching pattern and sulfur granules


Obesity - PFTs

Greatest change is decrease in ERV
RV is relatively unchanged


Complication of inhaled corticosteroids

Deposition of steroid in oral cavity leading to oral candidiasis. Can prevent with a spacer and oral rinsing


Accenutated second heart sound

indicative of pulmonary artery hypertension


Regulation of breathing: three receptors

1) Central chemoreceptors: predominantly sense pH. Located in medulla. H+ can't cross BBB but CO2 can, so primarily sense PaCO2.

2) Peripheral chemoreceptors. Located in carotid and aortic bodies. Primarily sense and respond to PaO2. Also can sense PaCO2/pH.

3) Pulmonary stretch receptors. C fibers in lungs and airways. Protect against lung hyperinflation through regulation of duration of inspiration based on lung distension.



Drug used for smoking cessation. Partial agonist at nicotinic ACh receptor in CNS that mediates nicotine dependence. Competes with nicotine and prevents it from binding. Mildly stimulates receptor, decreases withdrawal symptoms,


Treatment of lung abscesses and diagnosis

Diagnosis - see air fluid levels on imaging

Most often caused by aspiration pneumonia which is often mixed anaerobe/aerobe infection. So need to cover for both. Clindamycin a good option. MEtronidazole covers anaerobes but not aerobes. Cipro covers aerobes, not anaerobes


Functional residual capcity and intrapleural pressure

Point at which positive alveolar transmural pressure is equal to the negative chest wall pressure. Airway pressure is zero. Intrapleural pressure is negative, around -5cm H2O. Will decrease to around -7.5 during inspiration.


Zones of lung

Zone 1: Alvolear pressure is greater than areterial and venous. Vessels collapsed and there is no flow. Seen at apex of lung. V greater than Q.

Zone 2: Arterial pressure higher than alveolar, but alveolar higher than venous. Pulsatile flow when arterial pressure is increased during systole. Seen in upper regions of lung. V=Q.

Zone 3: Arterial and venous pressure higher than alveolar pressure. Continuous blood flow with squished alveoli. Seen in lower lung regions. V less than Q.

Hypoxic vasoconstriction occurs in zone 3 to increase blood flow going to zone 2, increasing size of zone 2 and decreasing size of zone 1. When take a deep breath such as during excercise, open up some of zone 3 and increase amt of lung being used.


Cheyne stokes breathing

Seen in advanced CHF at night due to chronic hyperventilaion with hypocapnea. During sleep, CO2 falls below threshold. This is sensed by central chemoreceptors which decrease respiratory drive leading to apnea. The mechanism overshoots so that CO2 goes above threshold and the patient goes back to hyperventilation. Occurs cyclically.



Intermediate filament. Marker of sarcoma,


Complication of untreated OSA

Pulmonary HTN and cor pulmonale


Pulmonary vascular resistance: how it varies with lung volume

Increased lung volume such as during inspiration causes alveolar expansion which stretches interstitial alveolar BVs, increasing resistance.

Decreased lung volumes such as during expiration narrows vessels by decreasing radial traction, also increasing resistance.

Sweet spot is at FRC - when PVR is lowest. Increases above and below FRC.


Risks of secondhand smoke exposure to child

Sudden infant death syndrome
Otitis media
Pulmonary infections


Bosentan: MOA and use

Endothelin receptor antagonist. Blocks endothelin's vasoconstrictive effects resulting in vasodilation. Used to treat PAH.


Indomethacin MOA

Nonspecific cyclooxygenase inhibitor.


Coal miners pneumoconiosis

Upper lung nodules on imaging. Carbon gets into alveoli, macrophages take it up and cause massive fibrosis because can't "kill" it. Black shrunken lung grossly, Associated with RA.



Seen in silica miners and sandblasters. Impairs phagolysosome formation in macrophages, increasing risk for TB infection. Fibrotic nodules in upper lobe.


Beryllium pneumoconiosis

Seen in miners and aerospace workers. Resembles sarcoidosis: noncaseating granulomas in lung, hilar nodes, and other organs. Increased risk for lung cancer.


ARDS pathophysiology and presentation, risk factor, treatment, complication

Pathophys: Damage to alveolar-capillary interface causes leak of protein rich fluid, which forms hyaline membranes along the air sacs. This thickens the diffusion barrier resulting in hypoxemia and cyanosis. In addition, the membranes are sticky, increasing surface tension and causing collapse of the lung.

Presentation: SOB, hypoxemia, and diffuse white out on CXR

Risk factor: acute pancreatitis

Treatment with PEEP

Complication of recovery is interstitial fibrosis.


Forms of lung transplant rejection

Hyperacute: vessel spasm, DIC, and ischemia

Acute: vascular damage, perivascular and peribronchial infiltrates

Chronic: bronchiolitis obliterans with inflammation of small bronchioles. Presents with dyspnea, cough, weezing


MAC: population, prophylaxis, distinction from TB

-seen with CD4+ count less than 50
-prophylax with azithromycin
-distinguished from TB by growth at high temps (optimal at 41 degrees C)


Vit A deficiency in CF

Can lead to squamous metaplasia in the pancreas. Vitamin A and retinoic acid required for maintenance of specialized epithelia


Abscess formation in lung

Neutrophils and macrophages release lysosomal enzymes that destroy tissue, setting stage for abscess formation


Monteleukast: MOA and USe

Leukotriene receptor inhibitor that doesn't inhibit leukotriene production. Used for asthma, esp good for aspirin-induced asthma


Zileuton: MOA and USe

MOA: Inhibits 5-lipoxygenase, preventing leukotriene synthesis

Use: Asthma


Theophylline: MOA and USE

MOA: inhibits phosphodiesterase, increasing cAMP and cuasing bronchodilation

Use: Asthma


Congenital diaphragmatic hernia: pathophys and presentation

Pathophys: gailure of diaphragm to close and form properly, resulting in herniation of bowel into the thorax. Results in underdevelopment of lungs and pulmonary vasculature and can push mediastinal structures to contralateral side. 90% of time on the left.

Presentaiton: Bowel sounds in lung zone. Heart sounds heard better on right side. Lack of lung sounds on left. Respiratory distress. Scaphoid abdomen. Pulm HTN


Distinguishing causes of atypical pneumonia on sputum

Chlamydia pnuemonia has cytoplasmic inclusions, mycoplasma does not


Treatment of pseudomonas

Three cephalosporins effective: cefoperazone, ceftazidime, cefepime


TB drug that causes drug-induced lupus



Ethambutol MOA

inhibits arabinosyl transferase


Change in lung during strenuous exercise

Oxygen fails to equilibrate and becomes diffusion limited


CF most common mutation

Defective ER processing


Amphotericin toxicity

Fever and chills, hypotension, nephrotoxicity, QT prolongation, arrhythmia