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Respiratory Flashcards

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1
Q

Symptoms of walking pneumonia (3)

A

Low fever
Dry cough
Diffuse infiltrate on CXR

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2
Q

Bacterial causes of atypical pneumonia

A

Mycoplasma pneum.

Legionalla spp.

Chlamydophila psittacosaurus

Pneumocystis jirovecii

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3
Q

Common triad of symptoms in cystic fibrosis patients

A

Recurrent URI

Chronic diarrhea

Weight loss

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4
Q

Color of lymph exudate in lung and why; two reasons for their occurrence (chylothorax)

A

Milky-white due to high lipid content

1) Cancer (Lymphoma or adjacent tumors)
2) Trauma

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5
Q

Causes of transudative pleural effusion & appearance

A

Straw colored fluid

  • CHF
  • Cirrhosis
  • Nephrotic Syndrome
  • CKD (Na+ retention)
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6
Q

Causes of exudative pleural effusion & appearance

A
  • INFECTION: Pneumonia [yellow/green appearance]; TB [straw colored]
  • MALIGNANCY: Lung cancer, lymphoma, metastatic breast cancer, mesothelioma, ovarian cancer
  • PE
  • AUTOIMMUNE: Vasulitis, SLE, RA, sarcoidosis
  • TRAUMA
  • PANCREATITIS (ARDS)
  • HEMOTHROAX [red/blood]
  • CHYLOTHORAX (pseudo) [milky white]
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7
Q

What two components make up Light Criteria & what is it used for

A

Protein & LDH

Evaluate if a pleural effusion is transudate or exudate

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8
Q

Characteristics of sarcoidosis

A

Bilateral hilar adenopathy

Elevated ACE levels

Noncaseating granulomas

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9
Q

Which electrolyte is elevated in sarcoidosis?

A

Calcium (hypercalcemia)

Increased 1,25-dihydroxyvitamin D production from granuloma formation

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10
Q

How does asbestos exposure in a patient appear on chest X-ray?

A

Calcified pleural plaques

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11
Q

Causes of increased A-a gradient

A
  • Age
  • Right to left shunt (hypoxemic state)
  • Alveolar hypoventilation (interstitial lung disease, fibrosis)
  • V/Q mismatch (PE/pneumothorax)
  • Fluid in alveoli (CHF/ARDS/pneumonia)
  • High concentration of inhaled oxygen
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12
Q

Causes of decreased DLCO

A

In conditions that damage lung tissue and reduce surface area for gas exchange

  • COPD (emphysema only)
  • Fibrosis
  • Interstitial lung disease
  • Aspiration event
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13
Q

Causes of increased total lung capacity

A

COPD due to air trapping and lung hyperinflation

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14
Q

Signs of pan coast tumor

A

-HORNER SYNDROME:
Miosis
Ptsosis
Annhydrosis

  • Ulnar nerve compression
  • SVC Syndrome
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15
Q

Treatment of small cell carcinoma VS non-small carcinoma

A

Small cell: Aggressive & sensitive to chemotherapy & radiation

Non-small cell: Surgery if localized

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16
Q

Common cause of lung squamous cell carcinoma

A

Smoking

*Ciliated mucus secreting epithelium to squamous epithelium

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17
Q

Which cancer are Pancoast tumors associated with

A

Non-small cell carcinoma

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18
Q

Where does bronchioloalveolar carcinoma originate? What would chest X-ray show?

A

Type II pneumocytes or terminal bronchioles

Peripheral pneumonia-like consolidation rather than mass lesion

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19
Q

Purpose of A-a gradient

A
  • Measure of oxygenation (functionality of blood-air barrier)
  • Can help determine causes of hypoxemia as intra or extrapulmonary [PE vs CHF]
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20
Q

Normal A-a gradient

A

HEALTHY PATIENTS:

5-10 mmHg young person

15-20 mmHg old person

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21
Q

When could a sick person have a normal A-a gradient

A

Hypoventilation due to CNS & neuromuscular disorders (b/c no diffusion defect)

High altitude

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22
Q

Where do small cell carcinoma tumor cells arise from? How do they appear on chest X-ray?

A

Bronchial neuroendocrine cells

Centrally located, ill-defined edges, NO central cavitation [adenocarcinoma is peripheral]

**Very aggressive, associated with smoking

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23
Q

Difference in chest X-ray between small cell carcinoma and squamous cell carcinoma

A

SMALL CELL:
NO cavitary lesion with central necrosis

SQUAMOUS CELL:
Cavitary lesion with central necrosis

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24
Q

Demographic of bronchogenic adenocarcinoma

A

Non-smoking females

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25
Where is bronchogenic adenocarcinoma located & its appearance on chest xray
Bronchial or bronchiolar mucosa from club cells \*Usually in preexisting scars or inflammation \*\*Ill-defined solid lesion peripherally
26
When do we find charcot-leyden crystals?
Sputum of asthma or allergy patients
27
Why do charcot-leyden crystals form?
Rhomboid crystals from breakdown of eosinophilic granules (major basic protein)
28
Which pneumocyte produces surfactant?
Type II
29
Which week of gestation is surfactant adequately produced?
Week 35
30
Why does surfactant increase lung compliance?
DPPC inserts its hydrophilic head into the aqueous alveolar lining fluid Hydrophobic fatty acid tail goes into the air-filled alveolar lumen \*\*Reduces attraction between water molecules, reducing surface tension
31
Function of type 1 pneumocytes
Gas exchange (97% of alveolar surface)
32
3 main purposes of surfactant
1) Increase lung compliance to reduce work of breathing 2) Prevent atelectasis (surfactant repels when close together, preventing alveoli from collapsing; but surface tension increases when diluted, preventing large size increases) 3) Prevent pulmonary edema (surface tension promotes fluid filtration from capillaries)
33
Important function of the spleen pertaining to bacterial infections
Process bacteria Produce opsonizing antibody (C3b & antibodies are opsonins) \*Important to clear capsulated bacteria like S.pneumoniae
34
Gene mutation seen in small cell carcinoma and gross apperance
L-myc Grey-tan-white mass
35
Which 3 diseases is paraneoplastic syndrome associated with?
Small cell carcinoma SIADH Cushing Syndrome
36
Signs of hyper acute LUNG transplant rejection & timeframe
Within 24 hours - Rapidly progressing hypoxemia - Diffuse opacities on X-ray
37
Mechanism of hyperactive transplant rejection
Preformed antibodies against donor HLA or ABO blood antigens \*Abs bind endothelial cells in alveolar capillaries, activating compliment, and these lyse endothelial cells \*\*Activates coagulation cascade causing thrombosis/infarction
38
Pathomechanism of acute/chronic transplant rejection
T cell sensitization to donor antigens
39
Why does a pulse oximeter not detect anemia?
It only reflects how many Hb's 4 O2 binding sites are occupied, NOT concentration
40
Why is arterial PO2 independent of Hb concentration?
Represents partial pressure of DISSOLVED oxygen, never concentration of Hb
41
Pickwickian Syndrome
Obesity hypoventilation syndrome Form of alveolar hypoventilation
42
Diagnosis criteria for Pickwickian Syndrome
- Sleep apnea - Respiratory acidosis - Polycythemia (chronic hypoxia) - Normal or restrictive pulmonary function test - RV enlargement
43
Patient with lower lobe panacinar emphysema can be indicative of what 2 thing?
Ritalin abuse alpha-1 antitrypsin deficiency
44
Most common paraneoplastic syndrome of small cell carcinoma
Cushing syndrome \*\*tumors are neuroendocrine in origin, secreting ACTH in this case
45
Most common paraneoplastic syndrome of squamous cell carcinoma
Hypercalcemia \*Due to PTHrP
46
Does restrictive lung disease increase or decrease elasticity of the lung, and why?
INCREASE - There is enhanced radial traction (tethering to lung parenchyma), allowing airways to be held open to a greater extent - Increased airway diameter increases max expiratory flow - We know there is DECREASED lung compliance (less inspiratory flow)
47
Does expiratory flow increase or decrease in restrictive airway disease
Increase -Enhanced tethering to lung parenchyma
48
2 bacteria causing secondary pneumonia following influenza infection
S. aureus S. pneumoniae
49
Club cells: location & function
Bronchiolar epithelium Produce surfactant Can differentiate into goblet cells \*\*No role in infant ARDS
50
What must a mother with a premature labor take to stimulate surfactant production
Maternal corticosteroids
51
Rust colored sputum associated with which bacterial infection
S. pneumoniae
52
Salmon colored sputum associated with which bacterial infection
S. aureus
53
Foul smelling sputum associated with which bacterial infection
Bacteroides, Fusobacterium, Peptococcus \*oral cavity anaerobic bacteria
54
Secretion from carcinoid tumors & explanation
Histamin & serotonin \*can't be cleared from liver
55
Symptoms of carcinoid tumor
Diarrhea Flushing Wheezing Heart disease
56
Where are carcinoid tumors located typically
Lung Ileum Appendix
57
Trigger of carcinoid tumors
Alcohol \*triggers release of vasoactive substances
58
Treatment of carcinoid tumors
Surgery or chemo if metastatic
59
What acid-base disorder occurs in acute salicylate poisoning
Respiratory alkalosis \*metabolic acidosis is hours later
60
Explain steps of aspirin overdose in terms of acid-base pathophysiology
1) RESPIRATORY ALKALOSIS: metabolites stimulate respiratory centers to induce hyperventilation 2) MIXED [resp alkalosis + met. acidosis]: aspirin uncouples oxidative phosphorylation to cause this transition to met. acidosis and lactate + ketoacid levels build 3) RESPIRATORY & METABOLIC ACIDOSIS: ASA is weak acid, crosses BBB and induces brain edema & central respiratory paralysis, decreasing ventilatory drive and death
61
Reid Index & what disease is it increase in?
Ratio between thickness of mucous secreting gland and thickness of the wall between epithelium & cartilage in the bronchial tree \*\*Increased in chronic bronchitis where the ratio is \>0.5
62
Which medication can cause pulmonary fibrosis
Amiodarone
63
What is the most common respiratory cause of digital clubbing?
IPF [idiopathic pulmonary fibrosis] \*Also seen in bronchiectasis \*\*Not seen in COPD
64
What disease has a tram track line appearance on CT
Bronchiectasis (due to fibrosis of the bronchial wall) \*widened airways with honeycombing also seen
65
How is lung compliance & elastic recoil of the lung (increased or decreased) in emphysema VS restrictive lung disease
Emphysema: -Increased compliance (irreversibly enlarged lung spaces) -Decreased recoil (destruction of elastic tissue) RLD: -Decreased compliance -Increased recoil (higher tension between the alveolar and fibrosis that acts like a spring since they are "cemented" together)
66
Role of neutrophils in COPD
Neutrophils mediate inflammation, releasing elastase (which breaks down elastin-keeps lung pliable), resulting in destruction of alveolar walls and air trapping in emphysema
67
What would you hear on lung auscultation in pulmonary fibrosis? Is cough productive or nonproductive?
Nonproductive cough Inspiratory crackles
68
What would you hear on lung auscultation in COPD?
Wheezing with reduced breath sounds & rhonci
69
Normal pressure of pulmonary artery
4-12 mmHg
70
Anatomically speaking, what portion of the airway is responsible for asthma symptoms?
Terminal bronchioles
71
How is a pseudo allergic reaction different than a type 1 hypersensitivity, IgE mediated reaction?
Pseudoallergic reactions are due to inhibition of the COX pathway, causing conversion of arachidonic acid to the lipooxygenase pathway \*Flushing and bronchial inflammation occur
72
Severe asthma attack would demonstrate what for the following: - Chest auscultation - Chest percussion - Chest expansion - Tactile fremitus
- Chest auscultation: Decreased vesicular sounds - Chest percussion: Hyperresonant - Chest expansion: Symmetric - Tactile fremitus: Decreased
73
Pleural effusion would demonstrate what for the following: - Chest auscultation - Chest percussion - Chest expansion - Tactile fremitus
- Chest auscultation: Absent vesicular sounds - Chest percussion: Dull - Chest expansion: Asymmetric - Tactile fremitus: Decreased
74
Pneumothorax would demonstrate what for the following: - Chest auscultation - Chest percussion - Chest expansion - Tactile fremitus
- Chest auscultation: Absent breath sounds - Chest percussion: Hyperresonant - Chest expansion: Asymmetric - Tactile fremitus: Decreased
75
Pulmonary fibrosis would demonstrate what for the following: - Chest auscultation - Chest percussion - Chest expansion - Tactile fremitus
- Chest auscultation: Fine inspiratory crackles - Chest percussion: Dull - Chest expansion: Symmetric - Tactile fremitus: Increased
76
Chest X-ray of idiopathic fibrosis
Honeycomb fibrosis \*HRCT shows lower lobe involvement with reticular opacities bilaterally symmetric
77
Spirometry of asthma
FEV1 & FVC decrease TLC increases \*it behaves like COPD
78
What are the chest x-ray findings for each condition: - Pneumothroax - Pneumonia - PE - Pleural effusion - Asthma
-Pneumothroax: Radiolucency along chest wall -Pneumonia: Lobar infiltrate -PE: Wedge shaped opacity -Pleural effusion: Fluid along costophrenic angle [Kerley B lines] -Asthma/COPD (emphysema): Hyperinflation of both lung fields
79
Important lines on chest X-ray seen for: - PE - Pneumothorax - Pulmonary edema
PE: Fleishner Pneuothorax: Ellis Demoise Pulmonary edema: Kerley B lines
80
Digital clubbing seen in what diseases?
- Bronchiectasis - Pulmonary hypertension - Non small cell carcinoma - ILD & IPF - Hepatic cirrhosis
81
What causes panacinar emphysema & what for centrilobular emphysema?
Panacinar = A1AT --\> From respiratory bronchiole to distal alveoli Centrilobular = COPD
82
Extrapulmonary findings in A1AT
Cirrhosis HCC
83
Where is A1AT made?
Hepatocytes
84
Another name for digital clubbing
Hypertrophic osteoarthropathy

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