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Flashcards in Pulmonology Deck (124)
1

What is surfactant (chemically)?

Dipalmitoyl phosphatidylcholine

2

What is the shape of Type 1 and Type 2 pneumocytes respectively

Type 1 - squamous, Type 2 - cuboidal and clustered

3

What do clara cells do and what is their morphology?

Nonciliated columnar. Secrete component of surfactant, degrade toxins, act as reserve cells

4

What ratio in amniotic fluid is used to evaluate fetal lung maturity and what is the cutoff?

Licithin to spingomyelin ratio. If greater than 2 it indicates lung maturity

5

When does the lung epithelium become cuboidal ciliated?

After the terminal bronchiole

6

At what vertebral level does each of the three major structures pass through the diaphragm?

IVC - T8, Esophagus - T10, Aorta - T12

7

Formula for dead space

Vt * (PaCO2 - PeCO2) / (PaCO2)

8

What is responsible for the higher affinity for O2 of fetal hemoglobin?

A lower affinity for 2,3-BPG

9

Treatment for cyanide poisoning and what is the reasoning?

Nitrites. Oxidizes hemoglobin to methemoglobin (high affinity for cyanide). This keeps CN- away from cytochrome oxidase. Then give thiosulfate to bind cyanide

10

What does heme do regarding O2 and H+ in the lungs and tissue respectively?

Lungs - bind O2 and give up H+, Tissue - release O2 and pick up H+

11

Cause of primary pulmonary hypertension

Inactivation mutation of BMPR2 gene (normally inhibits vascular SM proliferation)

12

What type of cell mediates intimal fibrosis?

Smooth muscle cells

13

What is the pO2 in the LA relative to the end of the pulmonary capillaries and why?

Slightly lower in the LA because deoxygenated blood from bronchial veins mixes with oxygenated blood in the pulmonary veins

14

Formula for O2 content

(1.34 x Saturation) + pO2

15

Alveolar gas equation

PAO2 = PIO2 - PaCO2/R. Normally: PAO2 = 150 - PaCO2/0.8

16

Normal A-a gradient

10-15 mmHg

17

Causes of increased A-a gradient

Shunting, V/Q mismatch, fibrosis

18

Where in the lung are ventilation, perfussion, compliance, and pO2 respectively the highest?

Ventilation - highest at top lowest at bottom, Perfussion - highest at bottom, lowest at top. Compliance - highest at bottom, lowest at top. pO2 - highest at top, lowest at bottom

19

Give the relationship of PA, Pa, and Pv for each zone of the lung (Zone 1 is most superior, Zone 3 is most inferior)

Zone 1 - PA > Pa > Pv. Zone 2 - Pa > PA > Pv. Zone 3 - Pa > Pv > PA

20

What change is seen in renal excretion of bicarb at high altitude and what can you give to augment this?

Increased bicarb excretion, give acetazolamide to augment

21

What heart abnormality may be seen after living at high altitude for long time?

RVH due to pulmonary vasoconstriction

22

Imaging test of choice for pulmonary embolus

Helical CT

23

Virchows triad

Stasis, hypercoagulability, endothelial damage

24

Homans sign

Dorsiflexion of the foot leading to tender calf muscles, check in suspected DVT

25

Changes seen in RV, FVC and FEV1/FVC in obstructive lung disease

RV up, FVC down, FEV1/FVC down (characteristic)

26

Reid index

Measure of gland depth/total thickness of bronchial wall. Above 50 percent in COPD

27

Which is the blue bloater and which is the pink puffer?

Pink puffer is emphysema, blue bloater is chronic bronchitis

28

4 main obstructive lung diseases

Emphysema, Chronic Bronchitis, Asthma, Bronchiectasis

29

Is exercise-induced asthma immune? Is it more or less common than regular asthma?

Less common, it is non-immune

30

Change in FVC, TLC, and FEV1/FVC in restrictive lung disease

FVC and TLC down, FEV1/FVC normal or up (greater than 80 percent)

31

Interstitial restrictive lung diseases (9)

ARDS, neonatal RDS, Pneumoconioses, Sarcoid, Idiopathic pulmonary fibrosis, Goodpasture, Wegener, Eosinophilic granuloma (histiocytosis X), Drug toxicity (bleomycin, busulfan, amiodarone)

32

Which pneumoconiosis is associated with eggshell calcifications of hilar lymph nodes?

Silicosis

33

Caplans syndrome

RA in pt with coal miners pneumoconiosis

34

What part of the lung is primarily affected by each of the three major pneumoconioses?

Coal miners - upper lobes, Silicosis - upper lobes, Asbestosis - lower lobes

35

What cells are messed up by silicosis and what is the implication of this?

Macrophages. May increase susceptibility to Tb

36

Sites of exposure to silicon and asbestos respectively

Silicon - foundries, sandblasting, mines. Asbestos - shipbuilding, roofing, plumbing

37

Which pneumoconiosis is associated with ivory white calcified pleural plaques?

Asbestosis

38

What cancers are increased in asbestosis?

Bronchogenic carcinoma and mesothelioma

39

Which pneumoconiosis is associated with dumbell shaped rods in in macrophages?

Asbestosis

40

Fibrocalcific parietal pleural plaques in posterolateral mid-lung zones over the diaphragm

Asbestosis

41

At what point in gestation is surfactant made most abundantly?

35th week

42

Risk factors for neonatal RDS

Prematurity, maternal diabetes, cesarean delivery (decreased release of fetal glucocorticoids)

43

Treatment for neonatal RDS

Maternal steroids before birth, artifical surfactant, thyroxine

44

Major causes of ARDS (7)

Trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, amniotic fluid embolism

45

What causes the damage in ARDS?

Neurophils destroy alveolar wall, coagulation cascade is activated, oxygen free radicals go to town

46

What changes are seen in each of the following parameters during ARDS: capillary permeability, compliance, work of breathing, V/Q matching, and PCWP?

Capillary permeability down, compliance down, WoB up, V/Q matching down, PCWP normal

47

Why is it that FEV1/FVC may actually be increased in restrictive lung disease

Fibrosis is holding airway open (increased radial traction)

48

What CBC finding occurs in chronic sleep apnea?

Erythrocytosis (increased epo release secondary to hypoxia)

49

Which way does the trachea deviate in tension and spontaneous pneumothorax respectively?

Towards lesion in spontaneous and away in tension

50

What leads to SVC syndrome?

Mediastinal spread of a bronchogenic tumor

51

Give the location (central or peripheral) of the following lung cancers: small cell, adenocarcinoma, squamous cell, large cell

Small cell - central, adenocarcinoma - peripheral, scc - central, large cell - peripheral

52

In right heart failure what works to decrease pulmonary edema and what tends to increase it?

Lymphatic drainage can increase to compensate for it, however, aldosterone levels are usually high due to low CO, which makes it worse

53

Most common causes of lobar, broncho, atypical pneumonia respectively

Lobar - pneumococcus, klebsiella. Broncho - s aureus, h flu, klebsiella, s pneumoniae. Atypical - RSV, adenovirus, mycoplasma, legionella, chlamydia

54

Lung abscess - risk factors, most common organisms, and characteristic finding

Risk factors - alcoholism, seizure d/o, CVA, dementia. Organisms - S auerus, anerobes (bacteroides, fusobacterium, peptostreptococcus). Find air-fluid levels on CXR

55

What type of hypersensitivity is hypersensitivity pneumonitis and whom is it most commonly seen in?

Seen in farmers and people exposed to bird. Mixed type 3/4

56

What usually causes a spontaneous pneumothorax?

Rupture of apical blebs. Seen in tall, thin, young, males

57

Phases of lobar pneumonia and the time frames of each

Congestion (first 24 hrs), Red hepatization (days 2-3), Grey hepatization (days 4-6), Resolution

58

What are the typical endings for 1st and second generation H1 blockers respectively?

1st gen is -en/-ine or -en/-ate. Second gen is -adine

59

List the first generation H1 blockers (3)

Diphenhydramine, dimenhydrinate, chlorpheniramine

60

What are the main differences between first and second generation H1 blockers?

1st gen used for motion sickness and sleep aid in addition to allergy. Second gen less sedation due to decreased CNS penetration

61

List the second generation H1 blockers (4)

Loratadine, fexofenadine, desloratadine, cetirizine

62

Toxicities of 1st generation H1 blockers

Sedation, antimuscarinic, anti alpha adrenergic

63

Isoproterenol

Non specific B-agonist which relaxes bronchial smooth muscle but also causes tachycardia

64

Albuterol

B2 agonist, use in acute exacerbation

65

Salmeterol

Long acting b2 agonist. Use for prophylaxis. AEs are tremor and arrhythmia

66

Theophylline

Inhibits PDE, leading to bronchodilation. Narrow therapeutic window. Metabolized by P450. Blocks adenosine

67

Ipratropium

Blocks muscarinic receptors (prevents bronchoconstriction). Use in asthma and COPD

68

What corticosteroids are useful in asthma and how do they work?

Beclomethasone and prednisone. Inhibit NF-KB which induces TNF-a and other inflammatory agents. 1st line for chronic asthma

69

Zileuton

Lipoxygenase pathway inhibitor. Use in asthma

70

Zafirlukast and montelukast

Block leukotriene receptors. Use in asthma (esp aspirin induced)

71

What should you tell patients that are on chronic corticosteroids to do?

Wash mouth out recently to prevent oral candidiasis

72

Guaifenesin

Expectorant. Does not suppress cough reflex

73

N-acetylcysteine

Mucolytic. Use in CF. Antidote for acetaminophen overdose

74

Bosentan

Used in pulmonary HTN. Antagonizes endothelin-1 receptors.

75

Dextromethorphan

Antitussive. Antagonizes NMDA glutamate receptors. Synthetic analog of codeine. Mild opioid. Abuse potential

76

Pseudoephedrine and phenylephrine

Sympathomimetic alpha agonists for nasal decongestion.

77

Methacholine

Muscarinic receptor agonist. Use in asthma challenge testing

78

Asthma in patient with chronic pain syndrome

Likely to be NSAID asthma

79

Type of hypersensitivity in NSAID asthma

TRICK QUESTION. It is not hypersensitivity, it is because block of COX overactivates LOX pathway

80

Liver cell adenoma in body builder

Assume its anabolic steroids

81

What direction will the diaphgram move on the side of the lesion in spontaneous and tension pneumothorax respectively?

Spontaneous - up on side of lesion, tension - down on side of lesion

82

Give the most common cause of 3 types of pneumonia - community typical, community atypical, and nosocomial infections

Community typical - strep pneumo, comunity atypical - mycoplasma pneumo, nosocomial - e coli, pseudomonas, staph aureus. Do not get strep pneumo in hospital

83

Decreased percussion, increased tactile fremitus, egophony, pectoriloquy

Consolidation (eg lobar pneumonia)

84

What is the most common cause of bronchiolitis?

RSV

85

What is the target of the influenza vaccine?

A antigen

86

Staccato cough

Chlamydia trachomatis in newborn

87

Most common cause of conjuctivitis in second week of life

Chlamydia trachomatis

88

Typical source of legionella

Water coolers (is a water loving bug like pseudomonas)

89

When you have an atypical pneumonia, what finding should make you suspect legionella?

Hyponatremia

90

Extrapulmonary effects of legionella

Interstitial nephritis (kills JG cells, lowering renin levels which is how you get hyponatremia)

91

Treatment for legionella

Erythromycin

92

Fungal infections in indwelling catheters

Candida

93

Fungus carried by starlings and bats

Histoplasmosis

94

Narrow based buds

Cryptococcus

95

Pigeons

Cryptococcus

96

Where does cryptococcus hide out?

Air conditioners

97

Treatment for cryptococcus

Amphotericin B

98

Broad based bud

Blastomyces

99

Fungus associated with earthquakes

Coccidioides

100

Most common complication of aspergilloma

Massive hemoptysis

101

Most common cause of space occupying lesion in the brain of an AIDS patient

Toxoplasmosis

102

Most common AIDS defining lesion

PCP

103

Name a systemic fungus, a cancer, and a bacterium that can cavitate like Tb

Histoplasmosis, SCC of the lung, Klebsiella

104

What do acid fast stain actually stain?

Mycolic acids

105

Where will a foreign body go if you are sitting or standing up?

Posterobasal segment of right lower lobe

106

Where will a foreign body go if you are lying down

Superior segment of right lower lobe

107

Where will a foreign body go if you are lying on your right side

1) Middle lobe or 2) Posterior segment of right upper lobe

108

Where will a foreign body go if you are lying on your left?

Lingula

109

What is the most common site for embolization?

Femoral vein (as opposed to thrombosis, where most common site is deep veins of leg)

110

What do you have increased risk of with coal workers pneumonconiosis?

Tb but not cancer

111

Treatment and main extrapulmonary symptom in sarcoidosis

Uviitis. Steroids

112

Cause of silo fillers disease

Fermation of gas leads to nitrogen dioxide, which gets inhaled. Wheezing, dyspnea

113

Cause of farmers lung

Thermophilic actinomyces (a mold) causes a hypersensitivity reaction and restrictive lung disease

114

Bysinosis

Textile industry worker with dyspnea, feel better on weekend. Hypersensitivity and restrictive lung disease

115

Is the lung disease in Goodpasture obstructive or restrictive?

Restrictive

116

What is the site of disease in chronic bronchitis, asthma, and bronchiolitis?

Terminal bronchioles

117

Histologic findings in chronic bronchitis

Goblet cell metaplasia, mucus gland hyperplasia, mucous plugs

118

Type of gas exchange defect in chronic bronchitis

Ventilation perfusion mismatch

119

What is the gas exchange defect in emphysema?

Even loss of ventilation and perfusion (will not have retention of CO2)

120

Centrilobular emphysema

Most associated with smoking. Primarily upper lobes. Destruction of respiratory bronchiole.

121

Panacinar emphysema

Entire respiratory unit destroyed, associated with total lack of a1 antitrypsin. Mostly affects lower lobes

122

Pathogenesis of bronchiectasis

Infection, destruction of elastic tissue support, dilation of airways. Segmental bronchi, filling with pus

123

Patient coughing up huge amounts of pus

Likely to be bronchiectasis. Most common cause is CF

124

Most common primary lung cancer

Adenocarcinoma, followed by squamous and then small cell