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Flashcards in Respiratory Deck (83):
1

What are symptoms of DVT?

Swollen foot/ankle (unilateral)
+/- pain, +/- Homan's sign (pain with ankle dorsiflexion) +/- palpable cord

2

What causes elevated D-dimer? What is it?

Seen in DVT, PE
It is a fibrin degradation product that is elevated when plasmin is dissolving a clot

3

What are symptoms of PE

Pleuritic chest pain
SOB
Cough
Fever
Tachypnea
Tachycardia
Altered mental status/confusion

4

What are EKG changes seen in PE?

S1Q3T3
Wide S in lead 1
Large Q
Inverted T in lead 3

5

What are fat emboli associated with?

Long bone fractures
Liposuction

6

What is the classic triad of fat emboli?

Hypoxemia
Neurologic abnormalities
Petechial rash

7

What can amniotic fluid emboli cause?

DIC

8

How do you get air embolus?

With Caisson disease - the bends; decompression illness when you are scuba diving and come up too quickly
Could also be introduced from IV

9

How do you get bacterial embolus?

From bacterial endocarditis - shoots off clots all over body

10

What is pneumothorax?

Abnormal collection of air in the pleural space that interferes with normal breathing.

11

What are exam findings for pneumothorax?

Decreased breath sounds on affected side
CXR
CT scan

12

What is most concerning type of pneumothorax?

Tension pneumothorax - with every breath air escapes into pleural space and gets trapped (pushes organs of mediastinum to opposite side)

13

What is treatment for pneumothorax?

Need to get rid of air
Need a chest tube until lung has recovered

14

What is pathology in obstructive lung conditions?

There is obstruction of air flow resulting in air trapping the lungs (Can't get rid of air very well); The airways close prematurely at high lung volumes and cause increased RV and total lung volume is increased.

15

What happens on pulmonary function test in COPD?

The FEV1 is greatly decreased and FVC is decreased also but the ratio of FEV1/FVC is decreased. THIS IS HALLMARK OF COPD

16

What happens in restrictive lung disease?

There is restricted lung expansion that causes decreased lung volumes

17

What happens on pulmonary function test in restrictive lung disease?

Both FEV1 and FVC ratio are decreased but ratio stays close to normal; the lung volumes are lower than normal

18

What are Curschmann spirals?

Whorled mucus plugs formed by shed epithelium in asthma

19

What are Charcot-Leyden crystals?

Eosinophilic, hexagonal, double pointed needle-like crystals formed from breakdown of eosinophils in sputum

20

What is differential for Eosinophilia?

Drugs
Neoplasma
Atopic disease (allergy, asthma, Churg-Strauss)
Addison disease
Acute interstitial nephritis
Collagen vascular disease
Parasites (Ascaria, Strongyloides,)

21

What is the pathophysiology of Chronic Bronchitis?

Hyperplasia of mucus-secreting glands in bronchi --> Reid index >50%

22

What is the Reid Index?

The thickness of the gland layer/total thickness of bronchial wall

23

How do you diagnose Chronic Bronchitis?

Productive cough for > 3 months per year for > 2 years

24

What are symptoms of Chronic Bronchitis?

Wheezing, crackles, cyanosis, late-onset dyspnea, CO2 retention, secondary polycythemia

25

What are blue bloaters?

-Hypoxemia, hypercapnia
Seen in chronic bronchitis; refers to the poor oxygenation and pulmonary hypertension that can sometimes occur

26

What is pathophysiology of emphysema?

Enlargement of air spaces, decreased recoil, increased compliance, decreased diffusing capacity for CO resulting from destruction of alveolar walls

27

What are the types of emphysema?

1. Centracinar - associated with smoking - usually most prominent in upper lobes and superior segments of lower lobes
2. Panacinar - associated with alpha1-antitrypsin deficiency

28

Where is destruction in centriacinar emphysema?

In the respiratory bronchioles

29

Where is destruction in panacinar emphysema?

Entire acinus - respiratory bronchioles, acinar ducts, acinus

30

What are signs of alpha 1 antitrypsin deficiency?

Early onset emphysema (increased elastase activity, loss of elastic fibers)
Early onset cirrhosis (builds up in liver)

31

What is Bronchiectasis? What is it associated with?

Destruction and dilation of bronchial walls --> causes chronic recurrent infections, purulent sputum, hemoptysis
-Associated with CF and Kartagener syndrome

32

What are pink puffers?

Dyspnea, hyperventilation

33

Most common cause of pulmonary HTN

COPD

34

Inhaled treatment of choice for chronic asthma

Inhaled steroid

35

Inhaled treatment of choice for acute asthma

Albuterol or Levalbuterol - NOT Salmeterol long acting

36

Narrow therapeutic index, drug of last resort for asthma

Theophylline

37

Inhibits mast cells release of mediators, only used for prophylaxis in asthma

Cromolyn

38

Inhaled treatment that blocks muscarinic receptors

Ipratroprium, Tiotropium

39

Blocks conversion of arachidonic acid to leukotriene

Zileuton

40

Inhaled long acting Beta agonist

Salmeterol

41

What medication for nasal decongestant can cause rebound congestion?

Pseudoephedrine, phenylephrine

42

What is the pathophysiology of interstitial lung diseases? How does it affect breathing mechanics?

They decrease pulmonary diffusing capacity and increase A-a gradient

43

What is sarcoidosis characterized by?

Immune-mediated, widespread non-caveating granuloma, elevated serum ACE levels and elevated CD4/CD8 ratio

44

What does sarcoidosis look like on X-ray?

Bilateral hilar adenopathy and reticular opacities

45

Who is sarcoidosis common in?

Black females

46

Erythema nodosum and bilateral adenopathy

Sarcoidosis

47

What is the mnemonic for Sarcoidosis?

A GRUELING Disease
ACE increase
Granuloma
RA
Uveitis
Erythema nodosum
Lymphadenopathy
Idiopathic
Noncaseating granuloma
Gammaglobulinemia
Vitamin D increase

48

What type of reaction is hypersensitivity pneumonitis?

Mixed type II/IV reaction to environmental antigen --> dyspnea, cough, chest tightness, headache

49

What are the different types of Pneumoconiosis

Anthracosis
Asbestosis
Coal worker's lung
Silicosis
Berylliosis

50

a. What is Asbestosis associated with?
b. What are characteristic lung findings?
c. Affects which part of lung?
d. Increased risk of cancer?

a. Associated with shipbuilding, roofing, plumbing
b. Ivory white, calcified, supra diaphragmatic and pleural plaques; Asbestos (Ferruginous bodies) are golden brown fusiform rods resembling dumbbells found in alveolar septum
c. Affects lower lobes
d. Increased risk of bronchogenic carcinoma > mesothelioma

51

What is damage from in pneumoconiosis disease?

From the macrophages

52

a. the other name for Coal workers' pneumoconiosis
b. Caused by:
c. Affects which part of lung?
d. Increased risk of cancer?

a. Anthracosis
b. prolonged coal dust exposure --> macrophages become laden with carbon and cause inflammation/fibrosis (black lung disease)
c. Affects UPPER lobes
d. No risk of cancer

53

a. What is Silicosis associated with?
b. Characteristic lung findings?
c. Affects which part of the lung?
d. Increased risk of?

a. Foundries, sandblasting, mines
b. Macrophages respond to silica and release fibrogenic factors that cause fibrosis
c. Affects UPPER lobes
d. Increased susceptibility to TB (because silica disrupts phagolysosomes and impairs macrophages) Also increased risk of bronchogenic carcinoma

54

a. What is Berylliosis associated with?
b. Lung pathology?
c. Affects which part of lung?
d. Increased risk of?

a. Aerospace and manufacturing industries
b. Granulomas on histology
c. Upper lobes
d. Increased risk of carcinoma

55

Golden-brown fusiform rods resembling dumbbells

Ferruginous asbestos bodies

56

Lung findings in silicosis

Eggshell calcification of hilar lymph nodes

57

What is the pathophysiology of ARDS?

Shock, infection, toxic gas inhalation, aspiration, high [O2], pancreatitis --> inflammatory cells/mediators and oxygen free radicals --> damage to endothelial or alveolar epithelial (type I) cells --> diffuse alveolar damage and hyaline membrane disease

58

What is Hyaline membrane disease?

Seen in ARDS
Initial damage due to macrophage substances

59

What is cause of neonatal RDS?

Surfactant deficiency --> increased surface tension --> alveolar collapse

60

What is treatment of neonatal RDS?

Maternal steroids 24-48 hours before birth, artificial surfactant for infant

61

Which ratio is predictive of neonatal RDS?

Lecithin:Sphingomyelin ratio <1.5 in amniotic fluid

62

What are risk factors for neonatal RDS?

Prematurity
Maternal diabetes
C section

63

What is lung finding in neonatal RDS?

air space and interstitial opacities - ground glass appearance

64

Bilateral hilar adenopathy, uveitis

Sarcoidosis

65

Vasculitis and glomerulonephritis

Wegeners, Goodpastures

66

Anti-glomerular basement membrane antibodies

Goodpastures

67

Honeycomb lung on x-ray

Interstitial fibrosis

68

Tennis racket shaped cytoplasmic organelles

Birbeck granules

69

Iron-containing nodules in the alveolar septum

Ferruginous bodies - suggest Asbestosis

70

Cough, hemoptysis, bronchial obstruction, wheezing, pneumonic "coin" lesion on CXR or non-calcified nodule on CT

Lung cancer

71

Complications of lung cancer
(SPHERE of complications)

Superior vena cava syndrome
Pancoast tumor
Horner syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal nerve compression
Effusions (pleural or pericardial)

72

What does non-small cell carcinoma (oat cell) include?

Large cell
Squamous cell
Adenocarcinoma

73

Adenocarcinoma
a. Location
b. Characteristics
c. Histology

MOST COMMON TYPE
a. Peripheral
b. Most common lung cancer in NON Smokers but also associated with smoking; CEA positive, activating mutations include KRAS, EGFR, ALK.
c. Glandular pattern on histology, often stains mucin +.

74

What is Bronchioalveolar carcinoma? Characteristics?

Subtype of adenocarcinoma
CXR often shows hazy infiltrates similar to pneumonia (excellent prognosis)
Grows along alveolar septa --> thickens alveolar walls

75

Large cell Carcinoma
a. Location
b. Characteristics
c. Histology

a. Peripheral
b. Highly anapestic undifferentiated tumor; poor prognosis; Strongly associated with smoking
c. Giant cells, secretes bHCG

76

Squamous cell Carcinoma
a. location
b. charactersistics
c. histology

a. Central
b. hilar mass arising from bronchus; Cavitation, Cigarettes, hyperCALCEMIA (PTHrP produced)
c. Keratin pearls! and intracellular bridges

77

Small cell carcinoma
a. location
b. characteristics
c. histology

a. Central
b. N:C ratio is very high; produces ACTH, ADH or antibodies against presynaptic Ca channels (Lambert Eaton); amplification of myc oncogenes
c. Neoplasm of neuroendocrine Kulchitsky cells --> small dark blue cells; Chromogranin A

78

S MMnemonic for lung cancer

Squamous cell
Small cell
Smoking
Central
Secreting

79

What do you seen microscopically for Mesothelioma?

Psammoma bodies

80

Most common locations of lung cancer metastasis?

Brain
Bone
Liver
Adrenal

81

How is small cell carcinoma treated?

Chemotherapy; not amenable to surgical resection

82

What is FEV1/FVC ratio in obstructive disease? restrictive disease?

obstructive - decreased ratio; FEV1 decreases more than FVC
restrictive - greater than normal; FVC decreases more than FEV1

83

Why do you see hypercalcemia in sarcoidosis?

In the macrophages of the granuloma there is increased 1alpha hydroxyase that activates Vitamin D