PULM Flashcards
(267 cards)
1
Q
what is the difference between atypical adenomatous hyperplasia and adenocarcinoma in situ?
A
- AAH has less atypia than in situ
2
Q
in zone 1, name the order of decreasing pressure (alveolar A, arterial a, venous v), explain why
A
- PA>Pa>Pv
- zone 1= apex, lowest blood flow, therefore lowest arterial pressure (Q=P/R)–> alveolar pressure greater than arterial, can theoretically collapse, esp during hemorrahge (dead space)
3
Q
what are some findings in a pneumothorax
A
- absent lung markers
- pleural lines
- deep sulcus sign- hemidiaphragm pushed downward (tension pneumo)
4
Q
what does isoproterenol do?
A
beta 2 agonist, dilates airways
5
Q
Name some pathophysiology of emphysema
A
- upper airways, increased mucus production (hyperplasia and hypertrophy), inflammation (cd8, neutrophils, macrophages, IL8, tnfA) –> narrowed airway
- smaller bronchioles, inflammation, fibrosis, narrowing
- parenchyma- breakdown of alveolar walls by elastase (decreased alpha one antitrypsin)
6
Q
name a few differences between chronic and acute bronchitis (cause, length of time, who’s affected)
A
- length of time: chronic lasts 3 months at least for 2+ years vs. acute lasts 1-2 weeks (6 weeks, self limited)
- cause- Chronic is smoking vs. acute is viral
- who’s affected: chronic is smokers >40 vs acute is anyone
7
Q
Should a chest xray be taken during inspiration or expiration?
How many posterior ribs should you see?
A
inspiration
- up until the 10th posterior rib
8
Q
is asthma obstructive or restrictive? what does it increase?
A
- obstructive
airway resistance
9
Q
which viruses can cause pneumonia (mnemonic)
A
- HAIR PieCe
- hanta virus
- adenovirus
- influenza (h1n1)
- RSV
- parainfluenza
- corona virus
10
Q
if you have emphysema do you seek a higher or lower frc? why?
what about fibrosis?
A
- in emphysema, you seek a higher frc because increased compliance increases expanding chest wall force, therefore to equalize collapsing force you have to increase volume (barrel shaped chest)
- in fibrosis, elastance increases, so collapsing force is greater, so in order to compensate, must seek lower frc (inhale less)
11
Q
Is chronic bronchitis a pathologic or clinical diagnosis?
What are the criteria?
A
- clinical
- persistant cough
- persistant sputum production
- cough most days for at least 3 month out of a year for 2+ years
12
Q
what does the ventral respiratory group do?
A
- controls forced expiration (normally passive)
13
Q
what does asbestos related plaques look like on chest x ray
A
- will see it on hemi diaphragm, will make it look dense/calcified
14
Q
asbestos-related disease mnemonic
A
FLIP ME ASS
- fibrous plaques
- lung carcinoma
- Interstitial fibrosis
- pleural effusion
- mesothelioma
- extrapulmonary neoplasm
- ASS= asbestos
15
Q
what is the difference between b2 agonists and muscarinic receptor antagonists (anticholinergic) in regards to where in the lungs they operate?
A
- b2 agonists: bronchiolar smooth muscle
- anticholingerics: larger airway tone
16
Q
Name some chest x ray characteristics of air space disease
- name 3 acute and 3 chronic causes
A
- lobar/segmental distribution that can then coaslesce/spread to larger area
- batwing pattern
- poorly marginated
- air bronchiogram (can still see air in bronchioles)
- acute: pulmonary edema, pneumonia, pulmonary hemorrhage
- chronic- alveolar proteinosis, alveolar carcinoma, lymphoma, sarcoidosis
17
Q
is the relationship between CO2 content and PCO2 sigmoidal or linear?
A
linear (even though hgb is saturable, linear relationship with dissolved and HcO3 forms)
18
Q
what is MMFR?
In which conditions would this be lower?
A
- maximal mid expiratory flow rate: flow rate between 25% and 75% of expiration- WHERE THE MOST SCOOPING IS
- decreased in COPD and obstructive diseases
19
Q
How much of tidal volume is usually anatomic dead space (Vd)?
A
1/3 or 150 mL
20
Q
what is the classic demographic for mycobacterium avium
A
- nonsmoking female above 50
21
Q
What is the main type of pathogen in pneumonia? what is the main pathogen
What is the main location of pneumonia?
A
- bacteria (strep pneumo)
- lobar
22
Q
if a patient suffers a complication of otitis media where it spreads to the bone behind the ear, what is it called?
what symptoms/signs would you see?
A
- acute mastoiditis
- pain, erythema, protruding ear, fever
23
Q
define forced vital capacity
A
- inspiratory reserve volume plus tidal volume plus expiratory reserve volume
- total amount of expiration possible after maximal inspiratioin
24
Q
in extremely low weight babies, is the compliance high or low? does this result in increased or decreased ipp? does the lung over expand or collapse (atelectasis?)
A
- decreased compliance
- decreased ipp
- atelectasis
25
what is the difference between an early asthmatic response vs a late one in regards to time of onset?
- early: 10-15 minutes, lasts an hour
| - late: 5-8 hours, last 24 hours
26
in zone 2, name the order of decreasing pressure (alveolar A, arterial a, venous v), explain why
what is driving the flow of blood?
- Pa>PA>Pv
- increased blood flow, so increased arterial pressure (Q=P/R)
- alveolar- arterial pressure difference
27
small cell carcinoma mnemonic
- small, HoNey, Crunch, OatS
- high nuclear/cytoplasmic ratio
- neuroendocrine
- central
- oat cell
- smokers
28
what are some risk factors for meconium aspiration syndrome
what are some side effects of meconium aspiration syndrome?
- larger than gestational age babies, babies older than 37 weeks (rectum can relax), bad fetal heart rate patterns
- inflammation, surfactant inhibition, pulmonary hypertension
29
what is the relationship between hiv and lung cancer?
- there is a risk, independent of smoking, of getting COPD and lung cancer if you have HIV
30
in panacinar emphysema, what is affected?
which lobe is affected most?
What condition is this associated with?
- all acinar structures from respiratory bronchioles and everything distal
- lower lobes
- alpha one anti trypsin
31
describe PO2 and PCO2 during UIP
- PO2 normal during rest, gets worse as disease progresses, decreases during exercise
- PCO2 normal or decreased, if increased, BAD
32
which asthma medication is very safe for children?
cromolyn!
33
if you have a partial obstruction of the trachea, bronchus, or larynx by a foreign object, describe the cough
- will have cough that is not constant (can go away for a while) or could go away and become pneumonia (haemophilus influenza)
34
what is another way to see ear wax? what is it called when it is causing fullness and hearing loss?
CERUMAN IMPACTION
35
what are chest x ray findings for atypical vs lobar pneumonia?
- atypical: patchy and diffuse
| - lobar: lobar consolidation
36
what is methemoglobin? what can cause methemoglobinemia?
does methemoglobin bind O2?
- hemoglobin that is in the Fe3+ (ferric) state due to either drugs (sulonamides, nitrates) or enzyme deficiency of methemoglobin reductase that keeps hgb in fe2+ (ferrous state)
- no
37
what is the name for the volume remaining in the lungs after maximal expiration?
what is the normal value?
can it be measured by spirometry?
- residual volume
- 1200 ml
NAH
38
if a patient presents with diplopia and can't turn their left eye to the left, pus from the ear, and pain behind the eyes, what do they have?
- petrositis
39
what is the best way to diagnose a DVT
What is the best way to diagnose a pulmonary embolism
- doppler US, D dimer
| - spiral CT, V/Q scan, D dimer
40
what is the common demographic for sarcoidosis?
what is the common presentation?
- 20-40 yrs, african american men= women
| - incidental finding or dyspnea and nonproductive cough
41
what is the smallest unit of the lung that can be identified on CT?
what is it composed of?
- secondary pulmonary lobule
- terminal bronchiole with adjacent pulmonary arteriole, it is surrounded by the interlobular septum (connective tissue sheath), which also contains lymphatics and pulmonary veins)
42
what is the formula for A-a gradient?
what is the normal value?
- PAO2 - PaO2
<10
43
what is atelectasis
- partial collapse of lung (or alveoli)
44
what is P50?
What is the standard p50 for O2?
____ (increase or decrease) in P50 is associated with decreased affinity, whereas ______ is associated with increased affinity
- the PO2 at which hemoglobin is 50% saturated
25
- increase, decrease
45
what type of hypersensitivity reaction is hypersensitivity pneumonitis
name some types of occupations that coudl be affected?
- type 4
| - farming, construction, manufacturing, animal handling
46
What would be a common presentation for oropharyngeal cancer?
- non healing ulcer
- referred ear pain
- hemoptysis
- smoker
47
what is acetazolomide and what can it help do?
- carbonic anhydrase inhibitor
can increase HCO3 excretion and can bring blood pH lower and back to normal faster than the kidneys
48
describe the histopathology of UIP
- subpleural fibrosis with temporal heterogeneity
- fibroblast loci surrounded by type 1 pneumocytes ( similar to poor wound healing)
- honeycomb lung
49
honecombing on chest x ray is indicative of what?
most likely interstitial fibrosis
50
in extrinsic (allergic) asthma, what lymphocyte dominates
in intrinsic (non allergic) asthma, what lymphocyte dominates
- eosinophils
| - neutrophils
51
adenocarcinoma mnemonic
- a DINNer on the SS PaWNinG
- SMALL
- (can form around) scars
- peripheral
- women
- non smokers
- gland formation
52
what causes neonatal respiratory distress syndrome?
what can happen to the lungs as a result? (3 things)
- lack of surfactant
| - atelectasis and right to left shunt and decreased lung compliance (increased surface tension)
53
what is one difference between copd and asthma in regards to airway obstruction?
asthma is reversible whereas copd is irreversible
| FEV1 will improve with bronchodilators for asthma but not much for copd
54
name four things that cause a right shift of the O2- hgb dissociation curve?
name 6 things that cause a left shift of the O2 hgb dissociation curve?
- increased PCO2, decreased pH, increased temperature, Increased 2,3 DPG
- decreased PCO2, increase pH, decreased temperature, decreased 2,3 dpg, Hgb F, carbon monoxide poisoning
55
what right heart catheterization values are indicative of pulmonary arterial hypertension
- normal PCWP
- increased mean pulmonary artery pressure (>25)
- increased pulmonary vascular resistance (above 3 wood units)
56
which age group is most likely to get pneumonia by mycoplasma?
young adults
57
if the rate of CO2 production is constant, alveolar ventilation is (inversely/directly) proportional to alveolar/arterial CO2
inversely!
58
between which weeks of gestation does surfactant appear?
24-35
59
what is the frontline acute drug for asthma
what about longterm
- short acting inhaled b2 agonist
| - inhaled corticosteroid
60
what are in order the most common things that a pulmonary embolus can be made of?
1) blood
2) foreign body (septic emboli from endocarditis or talc embolus from injected drugs)
3) aminionic emboli or fat
honorable mentions: air, pulmonary tumor
61
what is the alveolar ventilation equation?
- VA= VCO2 *K/ PACO2
or
PaCO2= PACO2= VCO2*K/VA
62
the chest wall has a tendency to ____ (collapse/expand) and the lung has tendency to ____ (collapse/expand)
- expand
| - collapse
63
# define inspiratory reserve volume
what is the normal value
amount of volume inspired above tidal volume during maximal inspiration
3000 mL
64
what is the triad of signs and symptoms for petrositis?
- draining ear pain, abducen's palsy, retroorbital pain
65
what is the haldane effect?
the less O2 that is bound to hemoglobin, the higher the CO2 content of the b lood because more CO2 that can bind to hemoglobin (amino group)
66
describe the concept hypoxic vasoconstriction; why does it happen?
describe the mechanism by which it happens?
what are two situations in which hypoxic vasoconstriction occurs, and what happens to PVR?
- alveolar hypoxia leads to vasoconstriction of the neighboring arterioles; if that area isn't properly ventilated, you don't want to waste perfusion to an inefficient area and instead want to divert that blood flow to an area of the lung that is well ventilated (tries to optimize V/Q matching)
- decrease PAO2 --> inhibition of NO synthesis --> decreased cGMP
- high altitude (generally decreased oxygen in air --> alveolar hypoxia) --> hella increase PVR --> pulmonary hypertension and RVH
- fetal lungs, global vasoconstriction, VERY HIGH pvr until first breath
67
The absence of ________ correlates with the lack of LRTI or pneumonia in infants.
what is the normal value in newborns, 6 months ,and 12 months
tachypnea
- 50,40,30
68
___ (low/high) lung volumes are associated with lower PVR and increased blood flow.
why?
high
- lung parenchyma pulls on blood vessels, keeps them open
69
what age group(s) are effected in pneumonia?
v young (<2) and v old (>65)
70
What are the three parts of the mediastinum and what is compromised in each part?
- anterior- heart and fat
- middle- posterior heart/anterior trachea to anterior vertebral column
- posterior- anterior vertebral column to posterior chest wall
71
What is the solubility of O2 in blood? CO2?
- .003
| - .07
72
which hemoglobin has the high affinity for oxygen: A, S, or F
Which has the least affinity?
- Highest affinity: F
| - Lowest affinity : S
73
Which pathogen that causes pneumonia can't be deteced via staining?
How can it be detected?
- LEGIONELLA
| - urinary antigen, pcr
74
What is Dalton's law of partial pressures, corrected for humidified air
Px= (Pb- Ph20) *F
```
Px= partial pressure
Pb= atmospheric pressure = 760
Ph20 = water vapor pressure = 47
F= fraction of gas concentration in air
```
75
explain the process by which hypoxia leads to polycythemia
- hypoxia --> increased hypoxia inducible factor 1a --> increase mRNA for EPO --> increased EPO production --> increased differentiation of proerythroblasts into rbcs --> polycythemia and increased O2 binding capacity
76
name four mediators implicated in asthma?
- platelet activating factor
- histamine
- leukotrienes (C,D,E)
- prostaglandins
77
what is the proteinase antiproteinase theory in regards to emphysema?
- elastase from neutrophils breaks down elastin in alveolar walls, but alpha one antitrypsin inhibits elastase
- in smokers/emphysema, there are more neurtrophils (aka increase elastance), and also oxidants from smoking/inflammation that inhibits alpha one antitrypsin, which increases alveolar wall breakdown (relatively normal antitrypsin levels still though)
78
what are the two forms O2 can be found in blood? which is most common?
- dissolved O2
| - bound to hemoglobin (most ocmmon)
79
early on at a high altitude, what happens to the pH? what is the term for this? how does the body compensate?
- pH gets more positive due to decrease in PCO2 (respiratory alkalosis), the kidneys release more HCO3- over time to bring the pH back down
80
name the two centers in the medulla and the two centers in the pons?
- medulla: ventral respiratory group and dorsal respiratory group
- pons: apneustic center and pontine pneumotaxic
81
define functional residual capacity
- expiratory reserve volume plus residual volume
| - amount of air in the lungs after a normal tidal expiration
82
in copd, what happens to fev1, fvc and peak expiratory volume/flow?
all decreased
83
which zone of the lung has the lowest ventilation, lowest flow, but highest v/q?
what about highest ventilation, highest flow, but lowest v/q
- zone 1
| - zone 3
84
Is the incidence of lung cancer increasing or decreasing?
is there a difference between men and women?
is there a difference between white and black people?
- overall rate is decreasing
- both are decreasing, men more than women
- incidence and mortality is increasing for black people, esp. men
85
what is irregular emphysema
what is it commonly associated with
- dilation/destruction and of any part along the acinus
| - scars
86
what is the best screening tool for lung cancer?
What is the best treatment for non small cell lung cancer
what is the best treatment for small cell lung cancer
- CT
- surgery, chemo at late stages
- CHEMO ( v aggressive cancer)
87
what does mesothelioma look like on chest x ray
- entire hemithorax is white, blurry nodules throughout and scalloped and thick pleura
88
what is rhinitis medicamentosa?
- condition due to use of over the counter nasal decongestants (ex: afrin)
- drug provides vasoconstriction but compensatory dilation after three days use which leads to dependence on using it
89
does gas that binds to proteins or is chemically modified contribute to partial pressure in blood?
no
90
what mallampati score is associated with increased risk for sleep apnea
3 and 4
91
how does strep pneumo confer it's virulence?
What does strep pneumo follow?
polysaccharide capsule
- upper respiratory infection
92
what demographic is most likely affected by primary spontaneous pneumothorax?
thin, tall males
93
why do people with emphysema expire with pursed lips?
- in order to increase airway pressure and prevent collapse
94
what is the most common place for metastases of oropharyngeal cancers?
- neck (cystic)
95
what does a pulmonary infarct look like gross and microscopically
- grossly- red-blue, then red brown, then eventually scar that is thickened/fibrotic
- microscopically- some blood cells in alveolar space, alveolar septa present, but have ischemic necrosis so have no nuclei
96
what are the three main causes of pleural effusion?
- CHF, pneumonia, malignancy
97
what are some causes of acute respiratory distress syndrome?
name some findings
what is a finding on ct?
- infection (sepsis, pneumonia)
- trauma
- burns
- pancreatitis
- drugs
- decreased lung compliance
tachypnea, work of breathing (accessory muscle use), v/q mismatch/ shunt/ dead space, hypoxemia, cyanosis, crackles, wheezing
- ground glass!
98
what two etiologies can cause usual interstitial fibrosis?
describe the process that goes from normal epithelium to UIP
- idiopathic or systemic disease that involves the lungs (SLE or scleroderma)
- caused by telomerase enzyme or surfactant protein mutations
- stimulus/alveolar injury leads to inflammation and release of cytokine mediators (tgf B and pdgf) which leads to fibrosis and remodeling
99
on which chromosome does cystic fibrosis affect?
which mutation?
what is the inheritance?
- chromosome 7
- Pe508
- autosomal recessive
100
what is atopy, name 3 conditions that you are at risk for ?
What demographic is more at risk?
- tendency to get an allergic disease (IgE mediated disease)
| - ezcema, asthma, allergic rhinitis
101
what is bacterial pneumonia exudate composed of (4)
- where is it located?
- leukocytes, rbc, edema, fibrin
| - alveolar space and distal bronchioles
102
what is the prototype hospital associated pneumonia caused by?
pseudomonas aeruginosa
103
what happens to PCO2 and PO2 levels during exercise?
nothing! they are constant!
104
besides break down alveolar walls, what else does neutrophil elastase do?
how does the lung counteract this
- increase mucus production
| - epithelium & mucus secreting cells release secretory leukoprotease inhibitor
105
what is carcinoma in situ
- epithelium is completely replaced by malignant cells BUT does not break through the basement membrane
106
early on when in high altitude, why does hyperventilation decrease?
- the decreased PCO2 levels causes central chemoreceptors to be inhibited, offseting the hyperventilation
107
What is the molecular formula for CO2 conversion to HCO3 and backwards
- CO2 + H2O --> H2CO3 --> H+ (stays in rbc) +HCO3 (leaves rbc via CL- HCO3 exchanger)
108
when are tree allergies most common? grass allergies? ragweed?
- early spring
- late spring to summer
- late summer to fall
109
in paraseptal emphysema, what is affected?
what area of the lungs are most affected?
what can it be assocaited with?
- distal acinar structures
- upper lobes
- areas of fibrosis
110
what four things can stop inspiration?
what center do they act on?
which two have the most influence/determine tidal volume?
- lung stretch receptors via the vagus
- central chemo receptors
- peripheral chemo receptors
- pontine pneumotaxic center
- dorsal respiratory group
- pneumotaxic center and lung stretch receptors
111
blunted costophrenic angle is a sign of what?
pleural fluid
112
squamous cell carcinoma mnemonic
- SK CCC
- smoking
- keratinization/intercellular bridging
- centrally located
- cavitations
- (hyper)calcemia
113
what are the most common metastases for lung cancer? what can help identify them?
- brain, bones, liver, adrenals IN THAT ORDER
| - PET scan
114
in centrilobular emphysema, what is affected?
Which lobe is affected most?
What condition is this associated with
- respiratory bronchioles and their alveoli, but nothing distal
upper lobe
- chronic bronchitis and smokers
115
what are the two major criteria and 3 minor criteria that determine whether children with rsv will get long term wheezing afterward
- major: parental asthma, eczema
| - minor: allergic rhinitis, wheezing when not having a cold, eosinophilia
116
what is the treatment for someone with mild symptoms vs someone with mild symptoms + comorbidities or severe symptoms/illness for pneumonia?
- doxycycline, macrolide
| - beta lactim + macrolide, fluoroquinone
117
what are hampton's hump and westermark's sign indicative of?
pulmonary embolism
118
what would you expect PaCO2 and PaO2 to be in most asthmatics
- both low
119
what is the difference between the anatomic dead space, physiologic dead space, and functional dead space?
- anatomic dead space is the volume of air in the conducting airways (not participating in gas exchange)
- functional dead space is the volume of the alveoli that are ventilated but not perfused by blood (no gas exchange)
- physiologic dead space is the sum of anatomic and functional dead space
120
what is the formula for O2 delivery?
- Cardiac output * O2 content in blood
O2 content= dissolved O2 + Hgb O2
121
what is the difference between staging of non small cell lung cancer vs small cell
- small cell: extensive (goes beyond hemithorax) or limited (doesn't)
- non small cell uses TNM system, IIIB (N3 = contralateral node or supraclavicular, T4- top and bottom lobe involved) and IV are non operable
122
define inspiratory capacity
- tidal volume plus inspiratory reserve volume
| - total volume for maximal inspiration
123
name two things that eosinophils release from their granules?
name one thing mast celsl release?
- major basic protein, eosinophilic cationic protein
| - histamine (and leukotrienes)
124
what is the bohr equation for physiologic dead space
- Vd= VT * (PaCo2- PE Co2)/PaCO2
PECO2= expired CO2 pressure
125
what are the three forms co2 can be found in the blood? which is most common?
- dissolved CO2
- HCO3 (most common)
- carbaminoglobin
126
What is the formula for concentration of a gas in blood?
- Cx= Px *S
```
Cx= concentration of gas
Px= partial pressure of gas
S= solubility of the gas in blood
```
127
when is RSV season?
october to may
128
what are two complications of silicosis?
- increased risk for mycobacterium infection
| - increased risk for connective tissue disease, esp rheumatoid arthritis and scleroderma
129
in bronchopneumonia (atypical), where does the infection start? what is it composed of?
- interstitium
| - fibrinous debris that can spill into alveolar space and leukocytes in severe cases (normally doesn't though)
130
most nodules on chest x ray end up being what?
granulomas
131
where are mechanoreceptors located?
what do they do?
- joints and muscles
| - detect movement of muscles and limbs; anticipate response to exercise and increase hr
132
what is the most common cause of bronchiolitis/lower respiratoyr tract infections?
RSV
133
what is silicosis?
what is the pathogenesis?
What are the two types and the difference between the two
- inhalation of crystalline silica
- macrophage eats silica, induces release of fibrogenic and inflammatory mediators (IL1 TNFa, fibronectic etc), induces aptosis, silica gets released and process starts over again
- acute: short term exposure, alveoli filled with lipoproteinaceous material
- chronic (more common): long term exposure, collagen hyaline nodules forms in upper lobes, multiple coalesce, interstitial fibrosis --> progressive massive fibrosis
134
what si the difference between hypoxia and hypoxemia?
```
hypoxia= decreased O2 delivery to tissues
hypoxemia= decreased PaO2
```
135
what is the final pathway for pulmonary arterial hypertension?
which layers of the blood vessel are effected
- plexiform arteriopathy (super proliferation of cells inward, vessel should be hollow but isn't)
- all three layers get thiickened and proliferate
136
when diagnosing pleural effusion, if the fluid is exudate, what causes of effusion should you consider?
what diagnoses should you consider?
- permeability problems
| - pneumonia, malignancy, pulmonary embolism, TB, autoimmune, pancreatitis, chylo thorax, post MI, post CABG
137
for auricular perichondritis,
what does it present with
which pathogen is most common?
what is the treatment?
- ERYTHEMA,swelling, tenderness,
- pseudomonas
- ciprofloxacin, drainage
138
name 5 causes of central sleep apnea
- opioid use
- obesity hypoventilation syndrome
- tumor
- heart disease
high altitude
stroke
SHHOOT
139
Kerley lines on chest x ray are indicative of what?
most likely pulmonary edema
140
What are the most common pathogens for lobar pneumonia vs atypical?
- lobar: strep, haemophilus klebsiella (SHooK)
| - ATYPICAL: mycoplasma and viruses
141
How does alpha one antitrypsin deficiency contribute to emphysema?
- what is the mechanism of action
- how much a1 antitrypsin is made in heterozygotes vs homozygotes?
- decreased alpha one antitrypsin to counteract elastase in the lungs
- misfolded a1 antitrypsin gets stuck in the liver
- 50% vs 15%
142
what is the histopathology of hypersensitivity pneumonitis?
- patchy peribronchiolar lymphocytic infiltrate
- poorly formed non necrotizing granulomas with giant cells
- Bronchiolitis obliterans-organizing pneumonia
- interstitial fibrosis in late stage (airspace disease in acute form)
143
is COPD reversible or irreversible?
irreversible
144
causes of apnea of prematurity mnemonic
```
Anemia
Feeding issues
Primary cardiac and pulmonary disorders
Infection
Hypoxia
Overstimulation
Disorders of body temperature regulation
```
PAID OHF
145
increased nutrition is associated with ______ in cystic fibrosis patients
improved lung function
146
what are three causes of traumatic tension pneumothorax?
- blunt trauma
- iatrogenic
- barotrauma (from mechanical ventilator)
147
which is more likely to have symptoms: adenocarcinoma or squamous cell carcinoma
squamous cell carcinoma (centrally located, interferes with bronchioles vs. peripherally located adenocarcinoma)
148
what are risk factors for venous thromboembolic disease?
- hypercoagulable state: favtor 5 leiden, protein c and s deficiency, prothrombin mutation, antiphospholipid antibody
- long term immobilization
- post operative state
- obesity, chf
- oral contraceptives
- malignancy (esp mucin creating adenocarcinoma)
149
what bacteria most often cause acute otitis media?
what are symptoms?
- strep, haemophilus
| - ear pain, hearing loss, bulging ear drum, erythema
150
signs of severe pneumonia
- delirium/confusion
- hypotension (as opposed to htn)
- hypothermia (as opposed to normal hyperthermia)
- leukopenia (as opposed to normal leukocytosis)
- thrombocytopenia
- hypoxia
- uremia
- increased rr
CURB (confusion, uremia, resp rate, bun)
151
# define expiratory reserve volume
what is the normal value
- amount of volume expired after tidal volume during maximal expiration
- 1200
152
what is pancoast's tumor? what symptoms is it associated with?
- tumor at the apex of the lung that infiltrates apical chest, sympathetic ganglia, brachial plexus (pan rhymes with stan, stans are top fans)
- horner's syndrome (facial drooping), arm pain
153
where are j (juxtacapillary) receptors located?
what do they do?
- alveolar walls
| - detect capillary congestion and cause shallow rapid breathing
154
name three ways you can get symptomatic tb
- primary disease (never initially contain disease)
- reactivation (initially contained but immune system fails later on)
- reinfection by someone else
155
what is leukoplakia vs erythroplakia?
What are they?
Which one is more dangerous
- white plaque vs. red plaque
- premalignant lesions
- erythroplakia (30% cancerous vs 10% cancerous)
156
for asthma, do you get wheezing on inspiration or expiration typically?
- expiration
- inspiration if severe
- no sounds at all if very severe
157
formula for collapsing pressure of alveoli?
P= 2T/r
158
what does silicosis look like on chest x ray
- areas of lung/pulmonary artery/diaphragm will be pulled upwards due to fibrosis/ loss of lung tissue
- costophrenic angle super sharp because everthing is being pulled up
159
Is oxygen a diffusion limited or perfusion limited process? Does it ever reverse?
- perfusion limited
- in fibrosis, septal walls are so thickened that delta x increases and therefore so does DL, O2 level will never equilibrate
160
What is the reid index?
What condition is it for?
What value is considered abnormal?
- ratio of the width of a submucosal gland to the length from the basal lamina to the epithelium
- chronic bronchitis
- >.4
161
why does hysteresis occur during inspiration and not expiration? why is the compliance different for inspiration and expiration
- during inspiration, intermolecular surfactant molecules are close enough to create significant surface tension, whereas during expiration, molecules are far enough where only compliance plays a role in expiration
162
what is a complication of otitis media that involves hearing loss and extreme vertigo?
labyrinthitis
163
for peripheral chemoreceptors:
1) where are they located?
2) what do they respond to the most? at what value?
3) what do they secondarily respond to? (2 things)
4) how do they transmit their message to the dorsal respiratory group?
1) carotid body and aortic arch
2) decreases in PaO2, but only activate when PaO2 <60 mmHg
3) increases in PaCO2 and decreases in pH
4) via vagus or glossopharyngeal
164
in zone 3, name the order of decreasing pressure (alveolar A, arterial a, venous v), explain why
what is driving the flow of blood?
- Pa>Pv>PA
- has highest blood flow, so both arterial and veins have increased pressure (Q=P/R), all capillaries will be open!
- arterial- venous pressure difference
165
what causes bronchopulmonary dysplasia/chronic lung disease in the newborn?
what are the factors that contribute to the causes?
what would the lungs look like on x-ray?
- iatrogenic use of oxygen in the newborn
- the pressure of oxygen used, the amount of oxygen used, the length of time oxygen was used, and prematurity, pda
- chewed up, areas of fibrosis or looks underdeveloped (can look like emphysema)
166
name two reasons why carbon monoxide poisoning is so dangerous for O2 delivery?
- it has higher affinity for hgb than O2 so it will bind preferentially to hgb --> less O2 bound
- for those O2 that are already bound, it increases the affinity of binding for those O2, decreasing ability for hgb to unload
167
what are the acute and chronic causes of interstitial lung diseases
acute: interstitial edema, viral pneumo
chronic- pneumoconiosis, bronchiectasis, scleroderma, sarcoidosis
168
what is the difference between squamous cell carcinoma in situ vs adenocarcinoma in situ
- squamous forms along bronchial epithelium, adeno forms along alveolar septa
169
is fibrosis restrictive or obstructive? what values does it change?
restrictive
| decrease compliance, increase elastance
170
In obstructive lung disease, does FEV1/FVC increase or decrease? What about restrictive lung disease?
- decrease (FEV1 decreases more than FVC)
| - increase (due to extensive decrease in FVC)
171
what are the three components of copd that can cause alveolar destruction and can cause each other?
- oxidative stress
- inflammation/inflammatory cells
- proteinase, antiproteinase imbalance
172
what is the role if IL4 and IL5 in ashtma response?
- IL4- differentiation of th2 and b cell activation (igE synthesis)
- IL5- attracts eosinophils
173
for kartagener syndrome/primary ciliary dyskinesia:
what is the pathophysiology?
What are common symptoms?
- absent or dysfunctional cilia which causes impaired mucociliary clearance in the respiratory tract, fallopian tube, eustachian tubes, and sperm; outside dynein arm, inside dynein arm, central structure etc can be affected
- recurrent pneumonia, recurrent ear infections, atelactasis, bronchiectasis, infertility (men), productive cough, ectopic pregnancy, SITUS INVERSUS/AMBIGUUS W OR W/OUT DEXTROCARDIA
174
what are the treatments for pulmonary embolism:
short term?
long term?
shock?
prophylaxis?
- short term: lmw or uf heparin, fondaparinux
- long term: warfarin, rivaroxiban, dabigatran, ivc filter
- thrombolytics unless contraindicated
- same as short term
175
what are the four stages of inflammatory response during pneumonia?
- CRunchy inflamed GRapes
- congestion (edema in spaces)
- red hepatization (extravasated rbc's from congested capillaries )
- grey hepatization (pus and leukocytes)
- resolution
176
Name 4 types of interstitial lung diseases?
- usual interstitial pneumonitis
- pneumoconiosis
- hypersensitivity pneumonitis
- sarcoidosis
177
what are three nonpulmonary causes of wheezing in babies?
- chf from congenital heart disease
- salicylate poisoning (causes respiratory acidosis)
- viral myocarditis
178
What is it called when you have prolonged inspiratory gasps?
What center is responsible for it?
which two muscles does it activate?
apneusis
apneustic center (stimulatory on DRG)
- abdominal and internal intercostal muscles
179
is acute rhinosinusitis usually viral or bacterial?
if bacterial, what is the common treatment?
viral
amoxicillin/clavulonate
180
what is the single most predictor of mortality for copd?
FEV1
181
In asthma, which is more prevalent: th2 or th1? what is the name of this theory?
- th2, hygiene hypothesis
182
What are the three types of coal worker's pneumoconiosis and how do they differ?
- asymptomatic anthracosis (just macrophages eaten the coal dust and residing along lymphatics)
- simple coal worker's pneumoconiosis- same as above + coal macules (accumulations of anthracotic macrophages <2 mm) + coal nodules (>2 mm with early fibrosis) in upper lobes and upper part of lower lobes
- complex coal worker's pneumoconiosis- massive progressive fibrosis that replaces lung parenchyma
183
Name four ausculation findings for pneumonia
- crackles
- tactile fremitus
- egophany
- bronchial breath sound (inspiration= expiration)
184
for folliculitis/furuncle,
what does it present with
which pathogen is most common?
what is the treatment?
- infection of hair root, ear pain
- staph aureus
- antibiotics, drainage of abcess
185
does emphysema seek a higher FRC or lower? Why?
- higher FRC, at baseline FRC expanding force is greater than collapsing force due to decrease elastance, so you increase FRC to increase collapsing force and reach equilibrium
186
what three factors are important when calculating the amount of oxygen bound to hgb?
what is the formula for oxygen bound to hgb?
- hemoglobin concentration in blood (usually 15)
- O2 binding capacity at 100% saturation (usually 1.34)
- %saturation of hgb by O2 (varies)
- multiply all three together
187
describe the three stages of whooping cough
- catarrhal stage- runny nose, fever, malaise, sneezing,
- paroxysmal stage- whooping on inspiration
- decline: cough starts to resolve
188
what percent of lifelong smokers develop cancer?
What percent of lung cancers are due to smoking?
- 10%
| - 85%
189
what is a hamartoma/what is it composed of?
is it malignant or benign?
what is the treatment?
mnemonic?
- tumor with proliferation of mostly cartilage, connective tissue, and fat
- benign
- resection
- the FCC is trying to HAMMER down on PORN (fat, connective, cartilage, hamartoma, peripheral)
190
what are chest x ray signs of copd
- hyperinflation
- flattened hemi diaphragms
- lack of lung sounds due to loss of lung tissue
191
What is the point of the conducting zone? name four things
- bring air in, warm, filter and humidify
192
what is an example of a diffusion limited gas?
what about perfusion limited?
- CO
| - CO2, O2, N2O
193
provide three pathologic findings for someone with asthma?
- globlet cell hyperplasia
- sub epithelial fibrosis
- increased smooth muscle
194
what is the hallmark sign of sarcoidosis?
what are other symptoms?
- lymphadenopathy
erythema nodosum, face lesions
195
which type pneumonia has a productive, sputum cough? (atpical or lobar)
- lobar
196
in which lobe is coal worker's pneumoconiosis common?
in which lobe is silicosis common?
in which lobe is asbestosis common?
- upper lobe
- upper lobe
- lower lobe
197
when diagnosing pleural effusion, if the fluid is transudate, what causes of effusion should you consider?
what diagnoses should you consider?
- hydrostatic pressure/oncotic pressure problem
| - SYSTEMIC PROBLEM: CHF, hepatic hydrothorax (liver cirrhosis), nephrotic syndrome, hypoalbunemia, atelectasis
198
WHAT IS SOMETHING THAT happens to heart rate during an episode of apnea of prematurity
bradycardia (diving reflex)
199
what normal age demographic is affected?
what are signs/symptoms?
what can be used to treat?
- 50-70
- dyspnea, dry cough, right heart failure (Cor pulmonale), clubbing, crackles
- ninedanib, perfinidone (poor prognosis)
200
for sleep apnea, what are the co2 levels?
for obesity hypoventilation syndrome?
- normal
| - INCREASED
201
what is the difference between an early asthmatic response vs a late one in regards to what is mediating it?
- early: histamine release from mast cells
| - late: IgE mediated
202
for otitis externa/swimmer's ear,
what does it present with
which pathogen is most common?
what is the treatment?
if it persists, what can happen? who is at risk for this?
- erythema, edema, discharge, pain
- pseudomonas
- abx
- can progress to necrotizing otitis externa that involves spread onto the skull base or soft tissue of face, immunocompromised (HIV, diabetes)
203
name four mechanisms by which you can get pneumonia, which one is most common?
- macro aspiration (throwup and swallow)
- micro aspiration (MOST COMMON)
- aerosolized droplets
- blood borne infections seeding lung parenchyma (septic pulmonary emboli from endocarditis)
204
name three differences between the parietal and visceral pleura
parietal: lymphatics and vessels closer to the surface (drains fluid), has innervation from intercostal and phrenic nerves, gets blood supply from intercostal and internal mammory arteries
- visceral: vessels and lymphatics further away from surface, does not receive innervation, blood supply from bronchial artery circulation
205
what is the histopathology of sarcoidosis
- alveolitis
- non-caseating compact, well defined granulomas
- bilateral hilar lymphadenopathy
206
for somatic cough disorder/tic cough, what core clinical features of a tic does it have?
supressability
suggestibility
distractibility
variability
207
what is asbestosis look like pathologically?
- progressive interstitial fibrosis, diffiicult to separate from other interstitial lung diseases except for presence of asbestos bodies, which are golden yellow fusiform bodies
- can get honeycombing later on
208
risk factors for pneumonia (name 6)
- SHIVam has AC
- smoking
- heart failure
- immunocompromised
- viral upper resp infection
- alcohol use disorder
- copd
209
O2 content is the same thing as what
O2 concentration
210
what condition is associated with hypercalcemia and increased angiotenson converting enzyme level (during active disease)
sarcoidosis
211
what is a lung abcess
suppurative process that results in necrosis in part of lung (can be single or multiple)
212
what value of FEV1 would produce dyspnea in copd? what about being bed bound?
- <2 liters
| - <1 liters
213
describe the pathway of primary tb infection
- infected the apex of the lungs and travels to the hilar nodes --> gohn complex (node plus granuloma) --> calcification= ranke complex
214
what are the three forms in which CO2 exists in the blood?
- dissolved form
- bound to hemoglobin or albumin (carbabiminohemoglobin or carbamino group)
- in HCO3 form
215
name four treatments for pulmonary hypertension
what are the four fda approved therapies in order of increasing potency and side effects
- calcium channel blockers
- coumadin
- oxygen
- cpap or bipap
- pdef inhibitor, soluble guanylate cyclase (not as relevant), endothelin receptor antagonist (ends in entan), prostacyclin analogue
216
what is empyema?
what are three other complications of pneumonia?
- when the infection moves to the pleural space and pus accumulates (complication of pneumonia)
- abcess formation, organization (exudate replaced by fibroblasts), bacteremia (BOA)
217
in the lung, which zone gets the highest blood flow, which gets the lowest? why?
- zone 1 (apex) lowest
- zone 3 (base) highest
- GRAVITY
218
what does the STOP BANG test assess?
what does it stand for?
obstructive sleep apnea
snoring
tired
obseerved apnea
blood Pressure
bmi
age
neck circumferncee
gender
219
what is the most common difference between metastatic lung cancer vs primary lung cancer
metastatic lung cancer usually has multiple nodules
220
what is the difference between dead space and shunt in regards to V/Q mismatch?
what are the values of PCO2 and PO2
name an example of each?
- dead space: ventilated but not perfused (V/Q= infinity, PACO2= PICO2, PAO2= PIO2)
- shunt: perfused but not ventiled (V/Q=0, PaCO2= PvCO2, PaO2= PvO2)
- dead space- pulmonary embolus
- shunt- airway obstruction
221
what are three complications of pulmonary embolism
- pulmonary infarct
- congestive atelectasis
- pleural effusion
222
in the clinical setting, which pathogen is associated with getting pneumonia with COPD
what about with alcohol use disorders?
- haemophilus influenza
| - klebsiella
223
does fibrosis seek a higher FRC or lower? Why?
- lower FRC, at baseline FRC collapsing force is greater than expanding force due to increase elastance, so you decrease FRC to increase expanding force and reach equilibrium
224
where are irritant receptors located?
what do they do?
detect noxious chemical and particles
- cause bronchoconstriction and increased hr
225
explain the steps from normal bronchial epithelium to carcinoma
- pseudostratified columnar epithelium --> metaplasia --> squamous epithelium --> dysplasia --> loss of polarity + hyperchromasia --> carcinoma in situ --> invasion of basement membrane = carcinoma
226
how does staph aureus cause pneumonia?
- hospital infection, complication with influenza, triscuspid endocarditis
227
what is name for the volume inspired and expired in normal quiet breathing?
what is the normal value
tidal volume
500 mL
228
what is superior vena cava syndrome? what symptoms is it associated with?
- superior vena cava gets compressed by lung tumor
| - dusky cyanosis of upper body, venous congestion
229
why might you have otitis media with effusion? (give 5
reasons)
what are symptoms/signs
what are some complications?
Following acute otitis media
Barotrauma (Flying,diving)
Obstruction of the eustachian tube (Tumors)
Dysfunction of the eustachian tube (Cleft palate)
Allergies
Idiopathic
children with shorter, more horiztonal eustacian tube
- retracted, amber ear drum, conductive hearing loss
- can get hearing loss/ speech delay, cholesteatoma, ear drum retraction
230
what is the alveolar Gas equation
- PAO2= PIO2 - (PaCO2 or PACO2)/R
```
PIO2= pressure of oxygen in air= PB- PH2O)*F
R= .8 (ration of co2 production to O2 consumption)
```
231
is emphysema a clinical or pathologic diagnosis?
What are the criteria?
- pathologic
- destruction of lung parenchyma and enlargement of airways distal to terminal bronchiole (respiratory bronchiole to alveoli)
232
for asthma exacerbations, what three drugs are good to use?
- short acting beta 2 agonist
- systemic steroid
- O2
233
What are central chemoreceptors trying to maintain?
What do they directly respond to?
What do they do in response to an increase in what they respond to?
where are they located?
- PCO2
- changes in H+ (indirect changes of CO2)
- hyperventilation (hypoventilation in response to low CO2)
- in the medulla near the dorsal respiratory group
234
how does surfactant decrease collapsing pressure of an alveoli?
what is the main component of surfactant and what is a special property it has?
- by decreasing surface tension
| - dipalmitoyl phosphatidylcholine, amphoteric, can break up liquid molecules that cause increased surface tension
235
describe the light criteria
- pleural protein : serum protein = >.5
- pleural LDH: serum LDH = >.6
- pleural LDH is upper 2/3 limit of serum ldh
if 0/3 almost always transudate
if 1/3, exudate
236
is cardiogenic edema due to hydrostatic, oncotic pressure, or permeability problems?
What lung can help key you in on cardiogenic edema?
name some causes of cardiogenic edema
- hydrostatic
- peribronchial cuffing
- mitral stenosis, aortic stenosis, rapid ventricular rhythm, MI, viral myocarditis, atrial myxoma, constrictive pericarditis
237
what makes up the acinus?
- respiratory bronchiole and everything distal
238
On a flow volume loop, what two things would distinguish a normal curve from the obstructive disease curve
- obstructive is shifted left and has scooping during expiration
239
what are the five causes of hypoxia?
CCHAD
```
CN poisoning
CO poisoning
Hypoxemia
Anemia
D- decreased cardiac output
```
240
how is PAO2 measured vs PaO2
PaO2 can just be measured in arterial blood gases, but PAO2 must use the alveolar gas equation (PAO2= PIO2- PaCO2/r)
241
What are three common features of asthma?
- airway inflammation
- variable/reversible airway obstruction
- airway/bronchioal hyperresponsiveness
242
total lung capacity
- SUM OF ALL THE VOLUMES
243
what are chest x ray findings for rsv/bronchiolitis?
is it necessary?
- interstitial markings, peribronchial cuffing, hyperinflation, flattened diaphragm, atelectasis
no
244
What are the common paraneoplastic syndromes for lung cancers?
- non small cell: hypercalcemia (squamous), blood clots, gynecomastia
- small cell: hyponatremia (ADH), cushings (ACTH)
- hypertrophic osteoarthrophy (bone pain), dementia, myopathy
245
what is the formula for the oxygen content of blood?
- O2- hemoglobin + dissolved O2 (concentration)
246
what is the most common pathology of head and neck cancers?
What are less common?
- squamous cell carcinoma
| - melanoma, sarcoma, lymphoma
247
state 5 causes of hypoxemia (decreased PaO2), then state whether the A-a gradient is decreased, increased, or normal
- high altitude (normal)
- hypoventilation (normal)
- V/Q mismatch( increased)
- R to L shunt (increased)
- diffusion defect (increased)
248
give characteristics of cough from GERD
- usually has initial allergy or infection insult,
- connected strongly to asthma
- will have acid brash
- will avoid acidic foods (picky eater)
249
which airway has the highest resistance?
- medium sized bronchi (would think ti's small bronchioles due to small radius in poiseuille's equation) but they are in parallel)
250
at equilibrium, what is the different between the partial pressure of oxygen in blood vs partial pressure of oxygen in the alveoli?
THEY ARE THE SAME (henry's law)
251
what is lofgren's syndrome?
- an acute form of sarcoidosis
mnemonic: I HAVE A LOFTY BEAAF WITH U
```
bilateral hilar lymphadenopathy
erythema nodosum
arthralgias
acute sarcoidosis
fever
```
252
- what is the formula for rate of diffusion?
What would increase DL (lung diffusion coefficient)?
What three things could decrease it, and for what specific reason?
Vx= D*A*P/x= DL*P
- exercise (imcrease capillaries and surface area for exchange)
- edema (increased Delta X), fibrosis (increased Delta X), emphysema (decreased surface area)
253
what do type II alveolar cells release
what are the purpose of type II cells?
- surfactant
| - increase surface tension of alveolar wall to prevent collapse
254
mnemonic for causes of pulmonary arterial hypertension
- his faaps
- hiv
- idiopathic
- scleroderma/SLE
- familial
- anorexigen/meth
- asd/vsd
- portopulmonary htn
- schistosomiasis
255
which part of the head or neck has the most incidence of hpv related cancer?
oropharynx
256
what is a patholigc finding of cmv pneumonia?
owl eye appearance to cells
257
for pulmonary arterial hypertension, when do you see symptoms?
what is the greatest predictor of prognosis?
- when the right heart starts to fail (can have very high pulm pressure but as long as right heart is functioning you are ok)
- right heart function (right ventricle)
258
How is TB spread?
Where in the lung does it grow best?
What stain is used to identify it?
what else can be identified via this stain
- aerosol droplets
- lung apices (where PO2 is highest)
- ziehl neelson aka acid fast stain
- ANY MYCOBACTERIA
259
what five things can pathologically fill airspace(alveoli) ?
- blood
- fluid
- pus
- cells (tumor)
- protein
260
What muscles are used during exercise for inspiration?
What about expiration?
- external intercostal muscles and accessory muscles
| - internal intercostal muscles and abdominal muscles
261
is copd obstructive or restrictive? what values does it change?
- obstructive
emphysema (increased airway resistance and compliance)
chronic bronchitis- increased airway resistance
262
what is the most common symptom of pulmonary embolism
what other symptoms can you get
- dyspnea
tachypnea, chest pain, syncope, right ventricular heave, loud p2, rales, pleural friction rub
263
what is the shape of the O2- hgb dissociation curve? why is it that way (name the term)
Under which range of PO2 is 100% saturation maintained?
- sigmoidal
- due to positive cooperativity, binding of one oxygen increases affinity for more oxygens to bind?
- 60- 100 mmHg
264
what two findings can you see on chest x ray for atelectasis?
- pulling of fissure lines toward alveolar collapse
| - segmented white space due to alveolar collapse
265
is wheezing more expiratory or inspiratory? monophonic or polyphonic?
is stridor more expiratory or inspiratory? monophonic or polyphonic?
- expiratory, polyphonic
| - inspiratory, monophonic
266
what are five different chest xray views
- AP - aka anterior posterior (beam is anterior)- upright, heart will appear enlarged
- PA- posterior anterior, preferred upright view
- lateral, commonly used
- decubitis- lay on side, can check for pleural effusion to see if fluid moves down (pneumothorax would actually move up)
- apical lordotic- shine beam upwards towards heart from the feet (helps look at apex, which is sometimes covered by clavicle)
267
pulmonary infarct from a pulmonary embolism is rare because ______
- triple circulation from bronchial artery, pulmonary artery, and alveoli
