Pulm Flashcards
1
Q
What is the gram stain of strep pneumo?
A
Gram + lancet shaped diplococci
2
Q
What is the most common cause of lobar pneumonia?
A
Strep pneumo
3
Q
Why is pO2 in the left atrium and ventricle lower than the pulmonary capillaries?
A
Oxy blood from the pulmonary veins mixes with deoxy blood from the bronchial arteries/thebesian veins in the LA.
4
Q
Where does aspiration pneumonia normally develop?
A
“Swallow a bite, goes down the right”
Right main bronchus is larger, shorter, and straighter.
Due to gravity, people who are supine aspirate to the posterior parts of the upper lobes and superior parts of the lower lobes.
Patients who are upright aspirate into the basilar segments of lower lobes.
5
Q
What nerve is impaired by foreign bodies lodged in the piriform recess?
A
Internal laryngeal nerve, branch of the superior laryngeal (CN X)
This damages the cough reflex
6
Q
What do dyspnea, facial swelling, and dilated collateral veins in the upper trunk indicate?
A
SVC syndrome–tumor compressing the SVC. Most common are lung cancer, then non-Hodgkin’s lymphoma.
7
Q
What is indicated by shoulder pain and Horner’s syndrome?
A
Pancoast tumor of the superior sulcus, arising at the apex of the lungs.
8
Q
How do patients with pulmonary fibrosis minimize the work of breathing?
A
High respiratory rate, low tidal volume (fast, shallow breaths)
This is due to increased elastic resistance
9
Q
How do patients with COPD and asthma minimize the work of breathing?
A
Low respiratory rate/high tidal volume (slow, deep breaths)
This is due to increased airflow resistance
10
Q
What is the difference between minute ventilation and alveolar ventilation?
A
Alveolar ventilation does not include dead space.
11
Q
What is the formula for minute ventilation?
A
Minute ventilation =
tidal volume x breaths/min
12
Q
What is the formula for alveolar ventilation?
A
Alv ventilation =
(tidal vol - dead space vol) x breaths/min
13
Q
Biopsy of a lung lesions shows a large spherule with small, round endospores. What is the cause?
A
Coccidioides.
- Dimorphic fungus that exists in the environment as mold hyphae
- Desert of US and Mexico
- Silver stain shows thick walled spherule packed with endospores
- Sabouraud’s agar also used
- Lung disease in immucompetent people and disseminated disease in immunocompromised
14
Q
What are the non-selective beta blockers?
A
Nadolol
Timolol
Propanolol
Not Target Pros
15
Q
What are B1 selective beta blockers?
A
Atenolol
Acebutolol
Metoprolol*
Esmolol
AAME (“Aim”) for one target.
16
Q
How do macrophages activate native helper T cells in TB infection?
A
Through IL-12, they induce differentiation into the TH1 subtype
17
Q
How do TH1 cells activate macrophages to improve their ability to ingest TB?
A
Through IFN-gamma
18
Q
What substance produced by macrophages allows them to recruit more monocytes and macrophages?
A
TNF-alpha
19
Q
What is seen in pulmonary actinomyces?
A
Filamentous branching pattern
Sulfur granules
20
Q
What is a risk factor for actinomyces infection?
A
Any mucosal disruption
- Poor dentition
- Alcoholics at greater risk
21
Q
What is the treatment for actinomyces?
A
Pencillin
22
Q
What stimulates granuloma formation in TB?
A
CD4+ lymphocytes stimulate macrophages to wall off the bacteria
CD8 does not have a strong role
23
Q
What is the most common lab abnormality seen with Legionella pneumonia?
A
Hyponatremia
- May be related to inappropriate ADH secretion
- May be related to renal tubuloiterstitial disease, imparing Na reabsorption
24
Q
What variables determine the total O2 content of blood?
A
- Hg concentration
- O2 saturation of the Hg (SaO2)
- Partial pressure of dissolved O2 (PaO2)
25
What is the cause of:
- PaO2: normal
- SaO2: decreased
- O2 content: decreased
CO poisoning.
Normal amount of O2 dissolved in the blood, but not bound to Hg.
26
What is the cause of:
- PaO2: normal
- SaO2:normal
- O2 content: decreased
Anemia (low Hg)
Normal amount of O2 dissolved and the Hg present is saturated, but there is not enough Hg present!
27
What is the cause of:
- PaO2: normal
- SaO2: normal
- O2 content: increased
Polycythemia (high Hg)
28
Why is EPO increased in COPD?
Hypoxia is sufficient to stimulate EPO production in cortical cells of kidney
29
What is the best antibiotic for treating lung abscess?
Clindamycin
| - Covers anaerobic oral flora AND aerobic bacteria
30
What drug prevents bronchoconstriction *produced by acetylcholine*?
Ipratroprium
- Blocks action of Ach at muscarinic receptors
- Less effective than a b2 agonist in treating asthma
31
What differentiates MAC infection from TB?
Anemia
Hepatosplenomegaly
Elevated alk phos and LDH
Grows well at high temperatures, optimum growth at 41C
32
What is used for MAC prophylaxis?
Azithromycin
33
What kind of metabolic derangement does heroin OD cause?
ACUTE respiratory acidosis
- Suppresses resp centers
- Causes hypoventilation
- CO2 retention
34
How does MI impact the lungs?
Causes LV failure, fluid accumulates in the lung interstitium, results in decreased compliance
35
What is the most common diagnosis for a "coin lesion" with "popcorn calcifications"?
Hamartoma
- Excessive growth of a tissue type native to the organ of involvement
- Most common in lungs
- Often contains hyaline cartilage, fat, smooth muscle cells, and clefts lined by respiratory epithelium
- Benign
36
What is the most common benign lung tumor?
Hamartoma, aka pulmonary chondroma
| - Disorganized cartilage, fibrous, and adipose tissue
37
What is the respiratory defense mechanism for particles 10-15 microns in size?
Trapping in the URT
38
What is the respiratory defense mechanism for particles 2.5-10 microns in size?
Enter the trachea and bronchi, cleared by mucociliary transport
39
What is the respiratory defense mechanism for particles less than 2 microns in size?
These are the smallest particles. They reach the terminal bronchioli and alveoli, and are phagocytosed by macrophages
40
How to pneumoconioses arise?
Alveolar macros take up dust particles and release cytokines
Cytokines produce injury and inflamm of alveolar cells
Growth factors in PDGF and IGF are released, stimulating fibroblasts to proliferate and produce collagen
Inflammation and fibrosis result
41
What is the normal tracheal PO2 and alveolar PO2?
What is responsible for the difference?
Air enters at 150mmHg in the trachea, and then equilibrates in the alveoli to about 104 (balance between tracheal 150 and venous 40)
42
Is O2 equilibration diffusion or perfusion limited?
Perfusion
- Means the rate of alveolar capillary perfusion determines the speed at which alveolar air equilibrates with venous blood gases
- If perfusion is poor, equilibration may not occur
43
What is the mechanism of Rifampin resistance?
Rifampin blocks DNA-dep RNA-poly, inhibiting transcription.
Riframpin resistance = modification of rifampin binding site on the DNA-dep RNA-poly
44
What do erythema nodosum + arthralgias + hilar lymphadenopathy + elevated ACE levels suggest?
Sarcoidosis
45
What is liver involvement of sarcoidosis?
Non-caseating granulomas
Seen in 75%
46
What are the possible presentations of sarcoidosis?
```
Erythema nodosum
Arthralgias
Hilar lymphadenopathy
Elevated aCE
Non-caseating granulomas of liver
```
47
What does the triad of
- Acute onset neuro abnormality
- Hypoxemia
- Petechial rash
in the background of long bone/pelvic fracture indicate?
Fat embolism syndrome
| - Traumatic event dislodges fat from bone marrow, and is lodged in pulmonary microvessels
48
What are EM findings in mesothelioma?
Many long, slender microvilli
Abundant tonofilaments
Gross: pleural thickening + effusions
49
What is the FVC expected in COPD?
Normal or decreased
50
What is the expected FEV1 in COPD?
Decreased--the whole problem is an issue getting air out
51
What is the FEV1/FVC expected in COPD?
Decreased
52
What is the total lung capacity expected in COPD?
Chronic bronchitis-normal
| Emphysema-increased
53
What is the expected FRC in COPD?
Increased!
54
What is the expected pulmonary compliance in COPD?
Chronic bronchitis-normal
| Emphysema-increased
55
What is the bronchodilator response expected in COPD?
Chronic bronchitis-partial response
| Emphysema-none
56
What is the expected DLCO in COPD?
Chronic bronchitis-normal
| Emphysema-decreased
57
What does a PV loop with reduced expiratory flow rate, and increased total volume indicate?
COPD
| - chronic bronchitis and/or emphysematous destruction of interalveolar walls
58
What values of:
- pH
- PaO2
- PaCO2
- HCO3
are expected after 5 days at high altitude?
Breathe a lot to get rid of CO2, so:
- Alkalosis
- Low PaO2 (~60, bc thin air)
- Low paCO2 (~20)
- Low HCO3 (compensate for alkalosis by excreting HCO3)
59
Why don't you use Isoniazid monotherapy for active TB?
Fast resistance muts
- Decrease in bacterial expression of catalse-peroxidase enzyme required for INH activation
- Modification of protein target binding site for INH
Can use INH only in PPD+ and CXR- indivs (no evidence of clinical disease)
60
How does streptomycin work?
Inhibits INITIATION of protein synthesis by binding to the 30s ribosomal subunit and distorting it
61
In a child, what is the differential for rhonchi, wheezing secondary to airway obstruction?
Asthma or bronchiolitis caused by RSV
62
What is the rx for RSV bronchiolitis?
Ribavarin
- Nucleoside analog that inhibits the synthesis of gunanine nucleotides
- Active against RSV and HCV
63
What would happen if the lamellar bodies produced by type II pneumocytes were destroyed?
No surfactant (which is released in these lamellar bodies)
Patchy atelectasis would result, i.e. NARDS
64
What is responsible for stimulating ventilatory drive in individuals with chronic COPD?
These patients are desensitized to CO2, so O2 plays a significant role.
- Peripheral chemoreceptors in the carotid and aortic bodies are stimulated by hypoxemia
65
What does oral thrush, interstitial pneumonia, and severe lymphopenia in the first year of life indicate?
Vertical HIV transmission
Treat with Zidovudine (ZDZ/AZT)
- NRTI
66
What are the 4 main cause of hypoxemia (low PaO2)?
1. Diffusion impairment (high A-a)
2. V/Q Mismatch (high A-a)
3. R-L shunt (high A-a)
4. Hypoventilation (normal A-a)
67
When does impaired gas diffusion occur?
Diseases that cause thickening of alveolar capillary membranes
- Alveolar hyaline membrane dsieases
68
When does V/Q mismatch occur?
Pneumonia
Obstruction: COPD, asthma
PE
69
What is the main pulmonary effect of increased Vagus stimulation?
Bronchoconstriction
- Mediated by Ach released from post-ganglionic parasymps
- Act on M3 receptors
- M3 also causes increase secretions
Bronchoconstriction + mucous = increased work of breathing
70
How do muscarinic Ach antagonists work?
Tiotropium
Ipratropium
Block M3 receptor, lessening bronchoconstriction + secretions
Useful in asthma and COPD
71
What cells and interleukins are involved in allergic asthma?
Allergen activated TH2 cells release IL-5
| IL-5 recruits eosinophils
72
What are sputum findings in allergic asthma?
Charcot-Leyden crystals (crystalloid bodies containing eosinophil membrane protein)
Eos (granule containing cells)
73
What is the most common site of colonization of MRSA?
Nasopharynx--nares
74
What is a common complication of aspiration pneumonia?
Lung abscess caused by bacteria of the gingivodental suclus
- Fever, malaise, weigth loss, clubbing, leukocyosis
- Cough with copious foul-smelling sputum
75
What is the mechanism of chronic rejection in lung transplant?
Attack of the small airways--bronchioles
Causes Bronchiolitis Obliterans
- Inflammation and fibrosis of bronchiolar walls, leading to narrowing and obstruction of affected bronchioli
- Dyspnea, non-productive cough, wheezing
76
What is the difference between chronic rejection in lung transplant and other organs, like renal transplant?
Lung: attack on small airways
- Bronchiolitis Obliterans
Renal: vascular obliteration
77
What ratio indicates fetal lung maturity?
Lecithin (phosphatidylcholine): sphingomyelin
- Lecithin increases sharply after 30 wks
- Sphingomyelin stays the same
78
What is the same in the pulmonary and systemic circulations?
- Arterial oxygen content
- Arterial pressures
- Blood flow/min
Blood flow! Must be the same because they are part of a continuous circuit.
79
What are the 5 catalase + infections that occur predominantly in CGD?
```
Burkholderia
Aspergillus
Nocardia
Serratia
Staph aureus
```
NADPH "BANSS" infection, except in CGD
80
What effect does the CFTR mutation have in respiratory and gastric glands?
Normally, the CFTR channel increases salt and water content be secreting Cl-, and inhibits the ENaC that absorbs Na
Less CFTR = more Na absorbed > dehydrated, viscid mucus
81
What effect does the CFTR mutation have in sweat glands?
Normally, the channel reduces salt content of sweat, activating ENaC to increase Na absorption
Mutation = too much NaCl
82
If steroids do not work in asthma, what is a moAb therapy that could work?
Omalizumab targets IgE
- Useful in asthma because Ig-E may be excessively high in asthmatics
- Inhibits IgE binding to mast cells
OmaNOasthma
83
Where is aspergillus likely to colonize?
Old lung cavities, from TB, emphysema, or sarcoidosis
Aspergillus can be
- Colonizing (aspergilloma)
- Invasive (aspergillosis)
- Allergic (ABPA)
84
When is PVR in the lungs highest?
At max inspiration AND max expiration
Increased lung volume causes alveolar expansion and stretching of the blood vessels.
INSPIRATION increases length and REDUCES DIAMETER, increasing alveolar vessel resistance
Decreased lung vol causes extra-alv arteries and veins to become narrowed due to decreased radial traction from adjacent tissues and compression by positive intrathoracic pressure
EXPIRATION causes increase in extra-alveolar resistance
85
When is PVR it he lungs lowest?
At FRC, right between max inspiration (top of IC) and expiration (bottom of VC)
86
What immune cells respond/react in sarcoidosis, and are found in the granulomas?
CD4+
Look for CD4:CD8 ratio > 2:1 in bronchoalveolar lavage to make diagnosis
87
What do TH2 CD4 cells secrete?
IL-13, IL-4 > B cell class switching to IgE
IL-5 > activates eos, promotes IgA
Part of humoral adaptive immunity
88
What do TH1 CD4 cells secrete?
IFN-gamma, IL-2 > activate macrophages, stimulate CD8 killer T cells
Part of cell-mediated adaptive immunity and type IV delayed hypersensitivity
89
How does PE cause hypoxemia?
V/Q mismatch
- Occludes pulmonary circulation, raises pulmonary resistance, raises RV afterload
- Less blood to lungs
90
What are the affects of theophylline OD?
Methylxanthines cause mild cortical arousal and insomnia, like caffeine.
Tox = abdominal pain, vomiting, seizures (main cause of death)
Can also get tachyarrhythmias
Rx: gastric lavage, charcoal, cathartics, beta blockers for heart, benzos/barbs for seizure
91
Biopsy of lung shows columnar mucin-secreting cells lining alveolar spaces without invading the stroma or vessels.
What is this? Is it malignant or bening?
Adenocarcinoma in situ
- Most common type of lung cancer in the US
- Arises from alveolar epithelium
- Located at lung periphery
- Growth along intact septa
- Well-diff, dysplastic, column cells
- +/- mucin
MALIGNANT
- Can easily become invasive
92
What is indicated by an increased ESR?
Non-specific inflammation
93
What cytokines cause increase in ESR?
IL-1, IL-6, and TNF-a are released from neutrophils and macros
Stimulate hepatic production of acute phase reactants
Acute phase reactants bind to microbes and fix complement
Fibronogen, an acute phase reactant, causes erythrocytes to form stacks (rouleaux) that sediment more slowly
94
What do IL-1, IL-6, and TNF-a do?
They are released from neutros and macros and stimulate acute phase reactants in inflammation
95
What cellular process occurs in the nucleolus?
Nucleolus is round, dense, basophilic body in the nucleus
Site of rRNA transcription
-Conducted by RNA pol I
96
Lack of which vitamin in CF can cause squamous metaplasia of epithelia to a keratinizing epithelium?
Vitamin A
ADEK are poorly absorbed in CF
(pancreatic insufficiency)
Vitamin A maintains differentiation of specialized epithelia
97
What are apical subpleural blebs a precursor to?
Spont pneumothorax
98
At what level should thoracocentesis be performed?
Above the 7th rib in the midclavicular line
Above the 9th rib along the midaxillary line
Above the 11th rib at the posterior scapular line
Insertion below may penetrate ab organs
Insertion on the inferior rib margin injures NAV
99
In what disease in Cheyne-Stokes respiration seen?
CHF
100
What is the definitive treatment for idiopathic pulmonary arterial HTN?
Lung transplant
101
What is the intermediate treatment for idiopathic pulmonary arterial HTN?
Bostentan
- Endothelin R antagonist
- Endothelin is a vasoconstrictor that also stimulates endothelial proliferation
102
What is the airway pressure at FRC?
Zero
103
What is the intrapleural pressure at FRC?
About -5
104
How does H flu achieve pathogenicity?
Capsule
105
What are polyenes?
Class of anti-fungals that include amphotericin B and nystatin
106
How do amphotericin B and nystatin kill fungi?
Bind to ergosterol in the fungal MEMBRANE
107
What is the treatment for chronic preventative treatment of bronchial asthma?
INHALED corticosteroids, like fluticasone
High dose systemic steroids are used for initial management of acute asthma exacerbations
108
How does cell structure progress distally down the respiratory tract?
Pseudostratified ciliated columnar > ciliated simple cuboidal (at the terminal bronchioles)
Goblet cells, mucous glnads, serous glands, and cartilage end at the smallest bronchi
Epithelial cilia persist to the end of the respiratory bronchioles (important to have cilia beyond mucin-secreting cells to clear obstruction)
109
How do you differentiate absolute vs. relative erythrocytosis?
RBC mass
- If normal > relative
- Relative = dehydration or diuresis
- If increased > absolute
- Absolute = PV or secondary
110
How do you differentiate primary vs. secondary (Absolute) erythrocytosis?
- Polycythemia Vera: all 3 cell lines increase
- Secondary erythrocytosis: only RBCs increase
- 2: hypoxia or EPO tumors (differentiate with O2 sat
111
From where does small cell carcinoma arise, and where is it located?
Basal layer of cells
- Round or oval cells with scant cytoplasm and large hyperchromatic nuclei
- Smaller than lymphos
Centrally located in the lung
112
What does small cell carcinoma stain for with immunohistochemistry?
Neuroendocrine markers
- Enolase
- Chromogranin
- Synaptophysin
113
What kind of channel is the CFTR?
Transmembrane ATP-gated chloride channel
114
Where does the antifungal Caspofungin (Echinocandin) act?
Cell WALL
115
Where does the antifungal Flucytosine act?
DNA & RNA synth
116
Where do the antifungal Azoles act?
Cell Membrane
| - Inhibit synth of ergosterol
117
Where do the antifungals Amphotericin B and Nystatin (Polyene) act?
Cell membrane
| - Bind erogsterol
118
What are the most frequent bacterial causes of lung abscess?
Anaerobes found in the oral cavity
- Peptostreptococcus
- Prevotella
- Bacterioides
- Fusobacterium
119
What are risk factors for lug abscess?
Anything that causes oropharyngeal aspiration
- Loss of consciousness
- Dysphagia
Alcoholism, drug OD, seizure, prolonged anesthesia, severe neuro disease like stroke, dementia
120
In what stage of TB infection is a Ghon complex found?
Primary infection
- Lower lobe lesion (Ghon focus) and ipsilateral hilar adenopathy
- It does not remain, but is resolved!
121
What stimulates neutrophil migration to a site of inflammation?
Leukotriene B4
122
What infections do CGD patients get?
Recurrent infection with catalase + bacteria and fungi:
- Pneumonia
- Skin and organ abscesses
- Suppurative adenitis
- Osteomyelitis
123
What are the tests to assess neutrophil superoxide production?
Nitroblue tetrazolium
- Normal = reduce yellow to blue
Dihydrorhodamine flow cytometry
- Fluorescent green = NADPH oxidase activity is normal
124
What type of cell is impaired in CGD?
Neutrophils!
| - Lack NADPH oxidase
125
What are the markers of small cell carcinoma?
Neuroendocrine markers:
- Enolase
- Chromogranin
- Synpatophysin
+/- Neurofilaments
126
How does cerebral resistance change with increased CO2?
Decreased resistance to allow for increased blood flow
- Avoid hypoxia
- Also increases ICP
127
What are the liver sequelae of a1 anti-trypsin deficiency?
Liver damage from stored enzyme can cause cirrhosis or HCC
128
What is seen on liver histology in a1 anti-trypsin deficiency?
Pink granules on PAS (unsecreted enzyme)
129
How does increased CO2 (as seen in COPD) affect cerebral ICP?
Vasodilation (decreased resistance) to increase perfusion
This increases ICP.
130
The nose, paranasal sinuses, nasopharynx, most of the larynx, and tracheobronchial tree contain what kind of epithelium?
Pseudostratified columnar--mucous secreting
131
The oropharynx, laryngopharnynx, anterior epiglottis, upper 1/2 posterior epiglottis, and vocal folds (true vocal folds) contain what kind of epithelium?
Stratified squamous
132
What cells release elastase?
Macrophages & neutrophils
133
What inhibits elastase?
a1 anti-trypsin
134
What disease is caused by increased balance of elastase?
Emphysema
135
Where in the bronchial tract does the mucociliary escalator end?
Continues up to terminal bronchials
136
What are the sputum findings in ALLERGIC asthma?
Charcot Leyden crystals & eosinophils
137
How are eosinophils activated in allergic asthma?
By IL-5 released by Th2 cells
HOT T BONE stEAK
138
What is the MOA of Ipratopium?
Antimuscarinic
Reverses vagally-mediated bronchoconstriction
139
What is the clincal use of Ipratopium?
Antimuscarinic that enhances the bronchodilatory effects of B2 agonists
140
What do the following symptoms indicate?
- Chronic nasal discharge
- Atrophic nasal mucosa
- Thinning of nasal septum
- Headache
Cocaine abuse
- Vasoconstrictor
- Intranasal use
141
What are the possible long term nasal consequences of cocaine abuse?
Septum perforation
Oropharyngeal ulcers
Osteolytic sinusitis
142
What is the pathogenesis of dyspnea in LH failure?
LV failure (post- MI) >
Fluid in lung interstitium >
Decreased lung COMPLIANCE >
Dyspnea
143
What is the result of the F508 mutation on the channel protein implicated in Cystic Fibrosis?
POST TRANSLATIONAL PROCESSING is altered
| - Mut. impairs FOLDING and GLYCOSYLATION
144
What are the 2 less common mutations that can cause Cystic Fibrosis?
Premature termination
Defective ATP binding
Post translational processing impairment, as a result of F508, is the most common
145
How do patients with obstructive lung disease (COPD, asthma) minimize the work of breathing?
Slow, deep breathing
Because they have increased airways resistance
146
How do patients with restrictive lung disease (fibrosis) minimize the work of breathing?
Fast, shallow breathing
147
From what type of bond does elastin derive its elastic properties?
Covalent bonds between LYSINE residues
| - Called desmosine cross-linking
148
What enzyme is responsible for cross-linking elastin?
Lysyl hydroxylase
149
What molecule is hydroxylated, is linked by disulfide bridges, and forms triple helixes?
Collagen
NOT Elastin
150
What is the superior extension of the lung apices?
Above the clavicle and first rib, through superior thoracic aperture
151
What types of globin show a hyperbolic O2 binding curve?
Myoglobin and individual subunits of hemoglobin (unbound a, b chains)
152
Where does deoxygenated bronchial blood drain?
Directly into the LA
153
What is the differential for hypoxemia + normal A-a gradient?
Hypoventilation (of any cause)
154
What are the lung effects of acute heart failure?
Transudate of plasma into lung interstitium + alveoli >
| Acute pulmonary edema + pulmonary venous congestion
155
What are the lung effects of chronic heart failure?
Hemosiderin laden macrophages = "heart failure cells"
156
What is the pulmonary defense against particles 10-15 microns?
Trapped in the upper respiratory tract
157
What is the pulmonary defense against particles 2.5-10 microns?
Mucociliary escalator
158
What is the pulmonary defense against particles
Phagocytosed by macrophages in terminal bronchioles
159
What metabolic (Acid/base) derangement is seen heroin OD?
Respiratory acidosis
- Heroin suppresses respiratory centers > hypoventilation
- Low pH, high CO2, normal HCO3 (no time to compensate)
160
At what point is Pulmonary Vascular Resistance lowest?
Functional Residual Capacity (FRC)
- Balance between muscles pulling out at higher lung vol and lack of radial traction at lower lung vol
161
How does silicosis impact TB?
Increased susceptibility
Silica damages macrophage phagolysosomes
Macro killing of TB is impaired
162
On what type of lung cancer is surgery NOT performed?
Small cell carcinoma
- Bc it's a very invasive cancer
163
What does air-fluid level on CT indicate?
Inflammation and abscess
164
What is the process of inflammation and abscess formation in the lung?
Lysosomal enzymes are released from macros and neutros, causing pus > abscess
165
What lung disease is indicated with meconium ileus at birth?
Cystic Fibrosis
166
What is the problem with the respiratory mucosa in CF?
It's dehydrated!
167
What's the pathogenesis of dehydrated respiratory mucosa in CF?
Less Cl- secreted, so less Na secreted, so less H20 secreted
168
What is the change in conductance of the CFTR channel in the lungs in CF?
Decreased Cl- out
169
What is the change in conductance of the CFTR channel in sweat glands in CF?
Increased Cl- out
170
What leukotrienes are involved in bronchospasm?
LTC4, D4, E4
171
What leukotriene is NOT involved in bronchospasm?
LTB4
| - It is chemotactic
172
Why do you see granulomas in the lungs of IV drug users?
Foreign substances in the drugs, like talc
173
What is a cough suppressant with minimal analgesia and some abuse potential?
Dextromethorphan
174
What is the MOA of Bosentan?
Endothelin receptor blocker
175
What is the indication for Bosentan?
Pulmonary Arterial Hypertension
176
List the steps in fetal circulation.
1. Umbilical vein
2. Ductus venosus (bypass hepatic artery)
3. IVC
4. Heart
- Pulmonary Veins, Ductus arteriosus, Descending aorta
OR
- PFO, L heart, Body
5. Umbilical arteries
6. Placenta
177
What does the umbilical vein of fetal circulation become?
Lig. teres hepatis
TV MArt
178
What do the umbilical arteries of fetal circulation become?
Medial umbilical ligaments
TV MArt
179
Where is thoracocentesis performed?
9th rib, midscapular/clavicular line
ABOVE rib to avoid NAV
180
What is the MOA of Cromolyn Sodium
Mast cell stabilizer
181
What is the indication for Cromolyn Sodium?
Asthma, immediate + long term
182
What nerve is likely severed in a jaw break?
Inferior alveolar nerve = dental nerve
| - Branch of Mandibular, V3
183
What controls respiration in COPD?
PaO2, though PaCO2 controls respiratory drive in healthy people, it is blunted in COPD
184
What is the treatment for inflammatory asthma?
Corticosteroids, like Fluticasone
| not Albuterol!
185
What lung volumes increase with COPD?
Residual volume and TLC
