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Pulmonary > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Albuterol

A

relaxes bronchial smooth muscle (beta2 agonist). Use during acute exacerbation.

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2
Q

Salmeterol/formeterol

A

long acting agents for prophylaxis (beta2 agonists). May cause tremor and arrhythmia

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3
Q

Methylxanthines

A

Theophylline. Inhibits phosphodiesterase > decrease in cAMP hydrolyis. Narrow Therapeutic window (cardiotoxicity, neurotoxicity). Block adenosine. Metabolized by p450

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4
Q

Ipratropium

A

muscarinic competitive antagonist. Prevents bronchoconstriction. Used in COPD

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5
Q

tiotropium

A

long-acting muscarinic competitive antagonist. Prevents bronchoconstriction. Used in COPD

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6
Q

Beclomethasone/fluticasone

A

Corticosteroids. Inactivates NFkB > decrease in TNF-alpha. 1st line for chronic asthma

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7
Q

Montelukast/zafirlukast

A

block leukotriene receptors (great for aspirin induced asthma

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8
Q

Zileuton

A

5-lipooxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes

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9
Q

Omalizumab

A

monoclonal anti serum IgE. Used in allergic asthma resistant to inhaled steroids and long-acting beta2-agonists.

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10
Q

Guaifenesin

A

Expectorant. Thins respiratory secretions; does NOT suppress cough reflex

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11
Q

N-acetylcysteine

A

Mucolytic: can loosen mucous plugs in CF. hydrolyses disulfide bonds

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12
Q

Bosentan

A

Used to treat pumonary arterial HTN. Competitive antagonist of endothelin-1 receptors > decreased PVR

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13
Q

Dextromethorphan

A

Anti-tussive (antagonist of NMDA receptors). Synthetic codeine analog. Mild opiod effect at high dose. Some abuse potential

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14
Q

Pseudoephedrine, phenylephrine

A

alpha-agonists. Reduce hyperemia, edema, nasal congestion. Opens obstructed eustachian tubes. Can cause HTN or CNS stimulation (anxiety)

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15
Q

Methacholine

A

Muscarinic receptor agonist. Used in asthma challenge testing.

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16
Q

H1 blockers gen. 1

A

diphenhydramine, dimenhydrinate, chlorpheniramine (allergy, motion sickness, sleep aid) anti-muscarinic, anti-alpha-adrenergic

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17
Q

H1 blockers gen. 2

A

Loratadine, fexofenadine, desloratadine, cetirizine (allergy)

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18
Q

Define chronic bronchitis

A

productive cough > 3mo./yr for > 2 years (small airway disease i.e. bronchioles and terminal bronchioles)

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19
Q

Define bronchiectasis

A

chronic necrotizing infection of bronchi > permanently dilated airways, purulent sputum, recurrent infections, hemoptysis (smoking, Kartagener’s, CF, allergic bronchopulmonary aspergillosis)

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20
Q

Anthracosis

A

coal miners lung. Affects upper lobes

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21
Q

pneumoconioses

A

anthracosis, silicosis, and asbestosis > increased risk of cor pulmonale and Caplan’s syndrome

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22
Q

Caplan’s syndrome

A

pneumoconiosis plus rheumatoid arthritis

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23
Q

Risk factors for neonatal RDS

A

prematurity, maternal diabetes, cesarean delivery (fewer glucocorticoids because baby is not stressed)

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24
Q

Risk factors for ARDS

A

trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, amniotic fluid embolism.

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25
Q

central sleep apnea

A

no respiratory effort. Repeated cesation of breathing > 10 sec during sleep

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26
Q

obstructive sleep apnea

A

respiratory effort. Repeated cesation of breathing > 10 sec during sleep

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27
Q

Which lung cancer types are not associated with smoking?

A

bronchioloalveolar and bronchial carcinoid

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28
Q

Adenocarcinoma of lung

A

most common in non-smokers and females. K-ras mutations common. Bronchioalveolar subtype has excellent prognosis

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29
Q

SCC of lung

A

located centrally. Hilar mass. Cavitation, Cigarettes, hyperCalcemia (PTHrP): keratin pearls and intercellular bridges.

30
Q

Small Cell Carcinoma

A

Located centrally. Kulchitsky cells, myc oncogenes, ACTH, ADH or antibodies against Ca++ channels (Lambert-Eaton syndrome)

31
Q

Lambert-Eaton syndrome

A

Like myasthenia (AChE-I won’t help. Ab anti presynaptic Ca++ channels)

32
Q

Large Cell Carcinoma

A

Located peripherally. Pleomorphic giant cells. Poor prognosis. Surgically remove.

33
Q

Bronchial carcinoid.

A

Excellent prognosis. Mass effect causes symptoms. Sometimes carcinoid syndrome

34
Q

Mesothelioma

A

Pleural cancer. Asbestos. Psammoma bodies.

35
Q

Pancoast tumor

A

Carcinoma in lung apex. May cause Horner’s (affects cervical sympathetic plexus)

36
Q

Superior vena cava syndrome

A

SVC is obstructed. JVP, facial plethora, edema in upper extremities. Medical emergency as it will raise ICP

37
Q

Lobar pneumonia

A

S. pneumo. > Klebsiella

38
Q

Bronchopneumonia

A

S. pneumo. > S. aureaus >H. influenza > Klebsiella

39
Q

Interstitial (atypical) pneumonia

A

Viral (influenza, RSV, adenovirus) Mycoplasma, Legionella, Chlamydia

40
Q

Lung abscess

A

Caused by obstruction. (Think S. aureus and anaerobes)

41
Q

Hypersensitivity pneumonitis

A

farmers and fanciers

42
Q

Chylothorax

A

lymphatic pleural effusion (thoracic duct injury)

43
Q

What drugs do you use to treat TB?

A

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

44
Q

Rifampin

A

P-450 inducer, minor hepatotoxicity. Works by blocking DNA-dependent RNA polymerase

45
Q

Isoniazid

A

Prophylaxis for TB. Injures Neurons and Hepatocytes. Decreased synthesis of mycolic acid. Bacterial catalase needed to activate INH. Depletes B6.

46
Q

Pyrazinamide

A

Acidification of lysosomes with MTB? Hyperuricemia and hepatotoxicity

47
Q

Ethambutol

A

blocks arabinosyltrasnferase and inhibits polymerization of cell wall. Causes red-green color blindness

48
Q

DPPC

A

dipalmitoyl phosphatidylcholine made by type II pneumocytes

49
Q

What is a mature level of surfactant?

A

Lecithin: Sphingomyelin is >2:1

50
Q

Where is resistance highest in the lung?

A

medium sized bronchi (smallest airways are in parallel)

51
Q

How do you calculate O2 content of blood?

A

(O2-binding capacity x %saturation) + dissolved O2

52
Q

What causes of hypoxemia have a normal A-a gradient?

A

High altitude and hypoventilation

53
Q

Hypoxemia vs hypoxia

A

low PaO2 vs low O2 delivery to tissue (CO x O2 content of blood)

54
Q

Central chemoreceptor

A

Medulla, senses low pH/ high CO2

55
Q

Peripheral chemoreceptors

A

Carotid and aortic bodies. Sense low pH/high CO2 AND low O2 (if lower than 60mmHg)

56
Q

What are other receptors involved in breathing?

A

Lung stretch (reflex decrease in frequency), Irritant receptors, Juxtacapillary receptors (engorgement causes rapid shallow breathing), Joint and muscle receptors (early stimulation of breathing in exercise)

57
Q

What type of person benefits most from O2 administration?

A

A person with low V/Q (but not shunt)

58
Q

How far do Goblet cells go?

A

End of bronchi

59
Q

How far do cilia go?

A

End o terminal bronchioles

60
Q

If you aspirate a peanut while standing where will it go?

A

INFERIOR portion of right inferior lobe

61
Q

If you aspirate a peanut while supine where will it go?

A

SUPERIOR portion of right inferior lobe

62
Q

What level does IVC go through diaphragm?

A

T8

63
Q

What level does esophagus (and vagus) pass through diaphragm?

A

T10

64
Q

What level does aorta (and thoracic duct and azygos vein) pass through diaphragm?

A

T12

65
Q

What is Homan’s sign?

A

Dorsiflexion of foot causes calf pain (sign of DVT)

66
Q

Curschmann’s spirals and Charcot-Leyden crystals

A

Seen in asthma. (shed eipthelium forms mucus plugs and eosinophil breakdown)

67
Q

Restrictive lung disease with normal A-a gradient

A

poor musclular effort, poor sturctural apparatus

68
Q

Restrictive lung disease with increased A-a gradient

A

ARDS, NRDS, pneumoconioses, sarcoid, IPF, Goodpasture’s, Wegener’s, Langerhan’s histio, hypersensitivity pneumonitis, drug toxicity

69
Q

What drugs cause restrictive lung disease?

A

bleomycin, busulfan, amiodarone, methotrexate

70
Q

Why does silicosis predispose to TB infection?

A

disrupts phagolysosomes and impaires macrophages

71
Q

What causes initial damage in ARDS?

A

release of neutrophilic substances toxic to alveolar wall, activation of coagulation, and O2-derived free radicals

Pulmonary (1 decks)

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