Midterm Flashcards
(125 cards)
1
Q
What is the pathological hallmark of sarcoidosis?
A
Noncaseating granuloma
2
Q
What chest xray findings are highly suggestive of sarcoidosis?
A
Combination of diffuse interstitial infiltrates in the lung fields and hilar lymphadenopathy
3
Q
What looks like sarcoid?
A
Beryllium disease
4
Q
Asbestosis classic lesion
A
calcified parietal pleural plaque
5
Q
Zileuton
A
Asthma med
5-lipoxygenase pathway inhibitor
(leukotriene modifying)
6
Q
Omalizumab
A
Asthma med
anti IgE antibody
7
Q
Cromolyn sodium
A
Asthma med
stabilizes mast cells (inhibits degranulation), interferes with chloride channel function
nebulizer only, no MDI
very safe, but not sure how effective it actually is
8
Q
Theophylline
A
Asthma med
class of xanthine derivatives
Phosphodiesterase inhibitor
9
Q
What drug decreases clearance of theophylline?
A
Ciprofloxacin!
inhibits the cytochrome p450 enzyme
10
Q
Which disease causes the lung to grossly resemble cirrhosis?
A
UIP
11
Q
With what type of lung cancer could you see a cushings syndrome?
A
Small cell carcinoma
12
Q
What type of cancer might you see eaton-lambert syndrome in?
A
small cell carcinoma
13
Q
Brush cells
A
1 of the 5 cell types of respiratory epithelium
Has microvilli
Neurons seen in relation to them, suggesting they may have a sensory function
14
Q
Basal (short) cells
A
1 of the 5 cell types of respiratory epithelium
= progenitor cells of other cell types in the respiratory epithelium
15
Q
Small granule cell
A
1 of the 5 cell types of the respiratory epithelium
Secretes polypeptide hormones
May function to control serous & mucous secretion in the respiratory system
related to enteroendocrine cells of the GI system
16
Q
What are the 3 cell types of the olfactory epithelium?
A
olfactory cell
sustentacular cell
basal cell
17
Q
Sustentacular cell
A
1 of 3 cell types that make up the olfactory epithelium
a columnar cell with many microvilli
provides support, nourishment, and electrical insulation for the olfactory cells
18
Q
Bowman’s glands
A
mucoserous glands within the lamina propria underlying the olfactory epithelium
keep the olfactory surface moist
19
Q
BOOP
A
granulation tissue plugs project into lumen of distal bronchioles & air sacs
prognosis generally excellent
20
Q
Stellate shaped nodules (w/ area of central cavitation)
A
pulmonary eosinophilic granuloma
21
Q
The one with langerhans cells (histiocytes)
A
pulmonary eosinophilic granuloma
22
Q
“crazy-paving”
A
Pulmonary alveolar proteinosis
23
Q
Montelukast (singulair)
A
Asthma med
leukotriene receptor antagonist
24
Q
zafirlukast (accolade)
A
Asthma med
leukotriene receptor antagonist
25
What do you see an increased Reid index in?
chronic bronchitis
26
acetazolamide
carbonic anhydrase inhibitor
| for acute mountain sickness
27
Molecular defects in lung cancer
K-ras (adenocarcinoma)
p53 & Rb (50-60% NSCLC, and > 90% SCLC)
chr 3p deletion all types
28
SCLC staging
limited - extensive disease
29
NSCLC staging
stage I - small tumor, 65-85% 5yr
stage II - extension to chest wall/pleura, 40%
stage III - LN, 20%
stage IV - metastatic, 0%
30
Most common lung cancer in women & nonsmokers
adenocarcinoma
31
keratin pearls
Squamous cell lung cancer
32
treatment of SCLC
NO surgery
33
"oat cell" lung cancer
SCLC
34
nests of uniform cells
carcinoid tumor of lung
35
Lung cancers related to & not related to smoking
smoking:
SCLC, squamous cell lung cancer, large cell lung cancer
non-smoking:
adenocarcinoma, carcinoid tumor
36
popcorn lesion on xray
pulmonary hamartoma
37
most common tumors that metastasize to lung
solid tumors --> breast, colon, sarcomas
38
ferruginous bodies
asbestos
39
apneustic breathing
problem switching from inspiration to expiration, so pause at end of inspiration
40
Biot's breathing
apnea in the middle of normal breathing
41
Kussmaul breathing
deep & fast
42
indoor cooking with fossil fuels in underdeveloped countries is a risk factor for what?
Obstructive lung disease
43
paraseptal emphysema associated with what?
spontaneous pneumothorax of young men
44
strongest predisposing factor for asthma
atopy
45
Factors for predicted normal PFTs
height, age, sex
46
central to the management of COPD
inhaled bronchodilators
47
what determines risk assessment in asthma
of exacerbations
48
head & neck cancer risk factors
tobacco & alcohol (betel nut w/ chewing tobacco in india), genetic factors (nasopharyneal in southern china), mate (tea from south america), asbestos, hardwood dust (nasal & sinus tumors), HPV (oropharyngeal)
49
erythroplasia
premalignant lesion
| high incidence of carcinoma in situ
50
leukoplasia
premalignant lesion
| more common & less likely to become malignant than erythroplasia
51
Head & Neck cancer - molecular progression
heterozygosity, p53, p16
52
Isoretinoin
reduces incidence of 2nd primaries in H&N cancer
53
EGFR inhibitors
given in conjunction with XRT to treat H&N cancers
| EGFR is overexpressed in these cancers
54
Cetuximab (erbitux)
IgG monoclonal antibody against the binding domain in EGFR
| an EGFR drug to be used in H & N cancer
55
Which type of cancer is associated with HPV?
oropharyngeal
56
Which type of cancer has high incidence in southern China?
nasopharyngeal
57
Which type of cancer is associated with epstein barr virus?
nasopharyngeal
58
nasopharyngeal tumor presentation
blockage of eustachian tube (hearing loss, sensation of fluid in ears), headache, nose bleeds, double vision, proptosis & other cranial nerve symptoms
metastatic spread to posterior cervical chain
59
what is the most common head & neck tumor?
laryngeal
60
Treatment of early laryngeal tumors
radiation, vocal cord stripping, laser therapy, partial laryngectomy (not chemo)
61
prophylactic cranial radiation
used for both limited & extensive SCLC stages as long as there's response to tumor
NOT of any benefit for NSCLC
62
SCLC treatment
limited: chemo + chest radiation
Extensive: chemo
PCI for both stages
NO surgery
63
NSCLC treatment
Stage I/II = surgery (adjuvent chemo for stage II & radiation for high risk pts)
Stage III = chemoradiation
Stage IV = palliative chemo (sx curative if isolated brain or adrenal mets with stage I in lung)
no benefit of PCI
64
Bevucizumab
intravenous mAb against VEGF
used in combo with chemotherapy for NSCLC
associated w/ hypertension, GI perforation/wound healing problems
contraindicated in squamous type
65
EGFR tyrosine kinase mutations in NSCLC
prognostic of better survival outcomes in general
exon 19 deletion or L858R mutation predictive biomarker of tretment response to EGFR TKIs such as erlotinib
found in adenocarcinomas, with higher prevalence among non-smokers
66
Erlotinib
Oral EGFR tyrosine kinase inhibitor (TKI)
used alone (no proven benefit in combo with chemo)
common toxicities: skin rash & diarrhea
67
EML4-ALK translocation
3-5% of adenocarcinomas
| younger, never smokers
68
Crizotinib
oral inhibitor of ALK
| effective against adenocarnimomas with ALK transformation
69
Oncogenic drive mutations in squamous cell lung cancer
FGFR1 amplification
| DDR2 mutation
70
where does repiratory epithelium become columnar?
respiratory bronchiole
71
swell bodies
venous plexuses in the lamina propria of the concha
| direct the flow of ambient air to the opposite side
72
what muscle is the vocalis muscle a part of?
thyroarytenoid muscle
73
neuroepithelial bodies
in the bronchioles
| groups of 80-100 cells containing secretory granules which receive cholinergic nerve endings
74
clara/bronchiolar cell
lack cilia
secrete a surfactant like material
produce a clara cell secretory protein the decreases lung injury
divide to regenerate the bronchiolar epithelium
75
structures in the hilum
artery is superior
bronchus in middle
vein is inverior
76
secondary lobules of miller
contain terminal bronchioles, & respiratory bronchioles, alveolar ducts & alveoli
77
knob
a single smooth muscle cell that guards the opening to each alveolus as it branches from an alveolar duct
78
type II pneumocytes are aka
greater alveolar cells
| septal cells
79
Gold stages of COPD
1 mild >80
2 moderate 50-80
3 severe 30-50
4 very severe >30
80
noncaseating v. caseating granuloma
non caseating has center with intact viable cells
| caseating has necrosis in center
81
What infection in CF is pathognomonic?
culture positive presence of pseudomonas, esp the mucoid strain, in the lung of a child with chronic pulmonary disease
82
intercellular bridges
desmosome attachments
| in squamous cell carcinoma
83
when would you see a central softening or cavitation in a tumor due to necrosis?
squamous cell carcinoma
84
which is the most aggressive lung tumor?
small cell carcinoma
85
BOOP xray
patchy air spaces
86
UIP aka
UIP = usual interstitial pneumonia
IPF = idiopathic pulmonary fibrosis
Cryptogenic fibrosing alveolitis
87
simple nodular silicosis
2-4mm lesions w/ microscopic whorled appearance
needle shaped silica crystals in nodules
hilar lymph nodes enlarged w/ egg shell calcification
xray diagnosis, no respiratory dysfunction or symptoms
88
what do asbestos bodies look like?
central colorless fiber core & beaded protein coat
| "dumbbell in macrophage"
89
asbestosis
asbestos bodies & diffuse interstitial fibrosis
| inc risk of lung cancer & mesothelioma
90
hypersensitivity pneumonitis aka
extrinsic allergic alveolitis
91
UIP
peripheral SUBPLEURAL areas of honeycombing
**variation in age of lesions
fibroblast foci
poor prog
92
DIP v. RBILD micro
DIP has widespread alveolar macrophage infiltrate
| RBILD macrophage infiltrate is predominantly peribronchiolar
93
pulmonary eosinophilic granuloma aka
histiocytosis X
| langerhans cell granulomatosis
94
idiopathic pulmonary hemosiderosis (IPH)
similar to goodpastures but no renal failure or cytotoxic Abs
intraalveolar hemorrhage and hemosiderin filled macrophages
hyperplasia of type II pneumocytes and variable interstitial septal fibrosis
95
4 things that stimulate contraction pathway:
M3 muscarinic
Cysteinyl leukotriene 1
histamine H1
endothelin A/B
96
Contraction pathway
Gq receptors --> phospholipase C --> IP3 --> Ca release from SR --> Contraction
97
Methacholine
nonspecific M2-M3 agonist
98
Methacholine challenge test
dose at which FEV1 falls by 20% or more
| measure of airway hyperresponsiveness
99
Ipratroprium
nonspecific M2-M3 antagonist
contraction at low doses, relaxation at high doses
More M2 in central airways so helps with tracheomalacia
100
Tiotroprum
M3 specific antagonist
101
C fiber endings
release substance P & neurokinin A
| cause contraction
102
Relaxation pathway
Gs coupled receptors --> adenylate cyclase --> cAMP --> protein kinase A --> phosphorylates 4 things --> causing dec Ca release (among other things) --> Relaxation
103
Things that stimulate the relaxation pathway:
```
Epi
inhaled B2 agonists
prostacyclin
PGE2
VIP
adenosine
NO
```
104
Factors favoring Th1 phenotype
```
= protective immunity
presence of older sibling
early exposure to day care
tuberculosis, measles, or hep A infection
rural environment
```
105
Factors favoring Th2 phenotype
```
= allergic diseases including asthma
widespread use of antibiotics
western lifestyle
urban environment
diet
sensitization to house-dust mites & cockroaches
```
106
work exacerbated asthma
preexisting asthma made worse by employment
107
occupational asthma
precipitated by a particular occupational enviroment and not by stimuli outside the workplace
108
irritant induced asthma
follows exposure to workplace irritants
109
reactive airways dysfunction syndrome
suden inhalation of a large dose of highly irritating substance causing asthma symptoms
110
Asthma - impairment v. risk
```
impairment = immediate manifestations of the disease
risk = potential for exacerbations or decreased lung function
```
111
Salmeterol v. formoterol
salmeterol 10-20 min onset of action
formoterol 1-3 min onset of action
lower lipophilicity of formoterol
112
theophylline/aminophylline adverse effects
N/V, headache, insomnia, palpitations, tachycardia, convulsions, arrhythmias
metabolized in liver, so inc half life in liver disease
113
Candidates for omalizumab therapy
```
adolescent (12 and up) & adult pts
moderate to severe persistent asthma
perennial allergy
IgE bw 30-700 IU/mL
symptoms not well controlled with ICS or ICS + LABA
pts not elligible for immunotherapy
```
114
Infections in CF
staph aureus when young
pseudomonas when older
Also MRSA, cepacia complex, stenotrophomonas, atypical myocbacteria, fungi
115
What was the causative agent with popcorn workers lung?
diacetyl - a butter flavored ketone
116
Well controlled asthma - action
maintain current step
| consider step down if well controlled at least 3 months
117
Not well controlled asthma - action:
step up 1 step
| re-evaluate in 2-6 weeks
118
Very poorly controlled asthma - action:
consider oral steroids
| step up 1-2 steps & re-evaluate in 2 weeks
119
normal anion gap
12 +/- 4
120
Numbers for calculating compensation in acid base cases
met acid: 1.5 & 8
met alk: 0.9 and 16
resp acid: 1 and 3.5
resp alk 2 and 4
121
PFT used to determine severity in obstructive disease
FEV1 (% pred)
122
PFT used to determine severity in restrictive disease
TLC
123
Decreased DLCO
obstructive lung disease
parenchyma disease
pulmonary vascular disease
anemia
124
Increased DLCO
pulmonary hemorrhage
polycythemia
L --> R shunt
125
tree in bud sign
bronchiolitis
