Test 1 Flashcards
(270 cards)
1
Q
What is the normal epithelium of the conducting ariways of the lung?
A
ciliated, pseudostratified columnar with goblet cells
2
Q
What are the three levels of the suface topography of the visceral surface of the lung?
A
6/8/10
3
Q
What are the three levels of the suface topography of the parietal surface of the lung?
A
8/10/12
4
Q
RALS refers to what two structures?
A
pulmonary artery in relation to primary bronchus
5
Q
What is the epithelium of the vocal cords?
A
stratified squamous
6
Q
What is Reinke’s space?
A
potential space between vocal ligament and overlying epithelium
7
Q
What are more diverse in their epithelial contents, upper airways or lower airways?
A
upper
8
Q
What is the reid index?
A
ratio between thickness of glands and thickness of epithelium to the basement membrane
9
Q
What is the reid index during chronic bronchitis?
A
> 0.5
10
Q
According to Canby, lung cancer arises from which divisions most often?
A
first three
11
Q
Does a bronchiole have cartilage?
A
no
12
Q
Does a bronchiole have a submucosa?
A
no
13
Q
Does a bronchiole have goblet cells?
A
yes
14
Q
Which bronchioles are club cells found in?
A
terminal and respiratory
15
Q
Where in the brainstem is the respiratory center?
A
medulla
16
Q
Which cranial nerves carry peripheral chemoreceptor afferents?
A
9 and 10
17
Q
Where is the voluntary respiratory center located?
A
cerebral cortex
18
Q
What is the Reynolds equation?
A
8(viscosity)(Length)/piR^4
19
Q
What is the largest determinant of airway resistance?
A
radius
20
Q
What is the epithelium of the alveoli?
A
squamous
21
Q
What are the prominent cells of the interstitium of the lung?
A
fibroblasts
22
Q
What is the diffusion equation?
A
PAS/d(square root MW)
23
Q
Which pleura contains stomata?
A
parietal
24
Q
What is the function of stomata?
A
absorb pleural fluid
25
What is the blood supply to the visceral pleura?
bronchial
26
What is the blood supply to the parietal pleura?
intercostal arteries
27
What is the most common cause of pleural effusion?
CHF
increased pulmonary venous pressure
28
Where do stomata drain into?
mediastinal lymph nodes
29
Which vascular channel contributes to hemoptysis?
bronchial artery
30
What type of shunt would the bronchial arteries be?
right to left
31
Do left-to-right shunts cause hypoxemia?
no
32
What two components do fibroblasts synthesize?
collagen and elastin
33
Would CHF increase the pressure of fluid on the visceral or parietal side?
visceral
34
Is sarcoidosis restrictive or obstructive?
restrictive
35
What is the normal V/Q ratio?
0.8 - 1.0
36
Does the increase in resistance due to asthma originate from the small or large airways?
small
37
Which embryological layer do the lungs originate from?
endoderm
38
What is the main driving factor of lung growth in utero?
amniotic fluid
39
What weeks is the embryonic phase of lung development?
0-8
40
What is paradoxical breathing?
diaphragm contracts and thorax moves inward
41
When is the pseudoglandular phase? What happens?
8-17 weeks
pneumocytes begni to appear
42
What phase does the production of amniotic fluid begin?
canalicular
43
What weeks is the canalicular phase?
16-26
44
What weeks compose the saccular phase?
24-38
45
What is the main happening of the saccular phase?
sacs develop on terminal bronchioli
46
In what structure is surfactant stored?
lamellar bodies
47
What marks the functional maturation of alveoli?
development of lamellar bodies
48
At what week does the lecithin/sphingomyelin ratio increase?
32
49
What is the main inhibitor of surfactant production?
maternal diabetes
50
What do glucocorticoids do to surfactant production?
increase
51
What do thyroid hormones do to surfactant production?
increase
52
What does cAMP do to surfactant production?
increase
53
What does EGF do to surfactant production?
increase
54
What do beta2 agonists do to surfactant production?
increase
55
What does adenosine do to surfactant production?
increase
56
Is pulmonary vascular resistance high or low in utero? Why?
high
relative hypoxia
57
Which hormone promotes fetal lung fluid reabsorption?
epinephrine
58
According to Tran, at what week does alveolar growth begin? Till when?
28th
two weeks post birth
59
Which surfactant proteins are required for immune defense?
A and D
60
Which surfactant proteins are required for surface activity of surfactant?
B and C
61
In an infant, is the chest wall high compliance or low compliance?
low
62
What are the chemical stimuli to breathing that present at birth?
increased pCO2
decreased pO2
63
Which receptor in the lung is stimulated by external stimuli?
J receptor
64
Which two lipophilic hormones stimulate fetal lung fluid reabsorption?
steroid and thyroid hormones
65
What is the most useful indicator of the severity of dyspnea?
level of activity
66
How can hyperventilation and tachypnea be differentiated?
hyperventilation will have low pCO2
67
Do inspiratory wheezes suggest upper or lower airway obstruction?
upper
68
Is pleuritic chest pain caused by irritation of parietal or visceral pleura?
parietal
69
Which wall of the trachea are cough receptors most prominent?
posterior
70
What is the time period for acute cough?
less than 3 weeks
71
What is the time period for subacute cough?
3-8 weeks
72
What is the time period for chronic cough?
longer than 8 weeks
73
What must be excluded first when working up a chronic cough?
ACE inhibitor use
74
According to Shumate, when does inspection occur?
when you first enter room
75
What causes rhonchi? Pitch?
thick secretions
low pitch
76
Are wheezes high pitched or low pitched?
high
77
What causes crackles/rales?
"explosive opening of small airways as surface tension is overcome"
78
How many mL of oxygen are dissolved in 100 mL of blood?
0.3
79
Is oxygenated or deoxygenated hemoglobin in the T form?
deoxygenated
80
Is oxygenated or deoxygenated hemoglobin in the R form?
oxygenated
81
Does the T-form have high or low affinity for O2?
low
82
Which amino acid residue blocks the oxygen binding site in the Tform?
valine
83
Which two amino acid residues does 23BPG interact with?
lysine and histidine
84
What is the Bohr effect?
protons bind histidines and salt bridges are formed that stabilize the Tform
85
What does CO2 binding to Hb form?
Carbamates
86
Which is a stronger base, deoxyhemoglobin or oxyhemoglobin?
deoxyhemoglobin
87
Does oxygen bind to the alpha or beta subunit of Tform Hb first?
Alpha
88
What does the formation of a carbamate generate?
a proton
89
What is a consequence of deoxygenated Hb accepting protons?
more formation of HCO3
90
According to Aoki, less than what percent is considered severe on pulmonary function testing?
less than 50%
91
Which has a fast rise to plateau phase, obstructive or restrictive?
restrictive
92
A methacholine provocation test is considered positive if what percentage decrease is achieved on FEV1?
greater than 20% decrease
93
What is the purpose of body plethysmograph?
to assess chest volume
94
What two things does a low DLCO indicate?
interstitial issues
circulation problems
95
When comparing arm exercise to leg exercise, which has a higher HR?
arm
96
When comparing arm exercise to leg exercise, which has a greater pulmonary ventilation?
arm
97
When comparing arm exercise to leg exercise, which has a higher perceived exertion?
arm
98
Outside of SANS, what mechanism increases HR during exercise?
vagus withdrawl
99
Is skin a low-compliance or high-compliance circuit?
high-compliance
100
Why does lactate buildup?
glycolysis proceeds faster than lactate can be removed
101
Is insulin increased or suppressed during exercise?
suppressed
102
Do high density object appear more white or black?
white
103
Do low density object appear more white or black?
black
104
The midpoint of the right hemidiaphragm should be where?
9th or 10th posterior rib
105
Does the spine darken or lighten as you move caudally?
darken
106
Are fissures visible when the Xray is parallel or perpendicular to the fissures?
parallel
107
What nerve would be present in the AP Window?
left recurrent laryngeal
108
Which hilum should be higher, right or left?
left
109
Which hemidiaphragm is higher, right or left?
right
110
According to Shumate, is asthma reversible?
yes
111
According to Shumate, which population has the highest liklihood of developing asthma?
young, african american males
112
According to Shumate, which two cells infiltrate during asthma?
lymphocytes and eosinophils
113
According to Shumate, what are the three inflammatory mediators of asthma?
histamines
leukotrienes
kallekrine
114
According to Shumate, what two happenings occur to smooth muscle during asthma?
contraction and hypertrophy
115
According to Shumate, what type of air exacerbates asthma?
cold and dry
116
According to Shumate, is asthma a productive or nonproductive cough?
non-productive
117
A false positive may follow what during asthma testing?
Upper respiratory tract infection
118
A false negative may follow what during asthma testing?
bronchodilators
119
According to Shumate, what percentage increase in FEV1 is required to advocate bronchodilator testing?
> 12%
120
What is the racemic isomer of albuterol? Used when?
levalbuterol
intolerant to albuterol
121
What type of drug should never be used as a monotherapy in asthma? Which two are the exception?
long acting beta agonist
salmeterol or formoterol
122
According to Shumate, which PDE's are inhibited by theophylline?
3 and 4
123
Drugs that block Leukotriene receptors have what common suffix?
lukast
124
What is the lipo-oxygenase inhibitor?
Zileuton
125
According to Shumate, What type of steroid should be used for an acute exacerbation of asthma? Which one?
systemic
oral prednisone
126
Which electrolyte can be used to control asthma in acute settings?
magnesium sulfate
127
According to Aoki, is COPD reversible?
no
128
According to Aoki, is COPD a productive cough?
yes
129
According to Aoki, at what age or less does A1AT deficiency arise?
less than 45
130
According to Aoki, therapy can benefit A1AT patients if the disease is what?
moderate in progression
131
Oral glucocorticoids have what common suffix?
-tasone
132
According to Aoki, what are the two PDE4 inhibitors?
Cilomilast
Roflumilast
133
According to AOki, is chronic use of systemic steroids associated with an increase or decreased risk in M and M?
increased
134
According to AOki, is there a change in M and M mucoactive agents?
no
135
According to AOki, what is the only therapy that has been shown to increase survival in COPD patients?
oxygen
136
According to AOki, what two vaccines are recommended for COPD patients?
influenza
pneumococcal
137
According to AOki, what can too much Oxygen do to a COPD patient?
V/Q mismatch
138
According to Carnevale, what is atelectasis in an infant?
incomplete expansion
139
According to Carnevale, what is atelectasis in an adult?
collapse
140
According to Carnevale, does emphysema have fibrosis?
no
141
According to Carnevale, which immune cell is present in greater numbers in the lung in a patient with emphysema?
Neutrophils
142
According to Carnevale, smoking increases the release of what enzyme? From what two cells?
elastase
neutrophils and macrophages
143
According to Carnevale, elastase released from what cell is not inhibited by A1AT?
Macrophage
144
According to Carnevale, what causes paraseptal emphysema?
fibrosis
145
According to Carnevale, Where in the lung does panacinar emphysema occur?
basilar
146
According to Carnevale, where in the lung does centriacinar emphysema occur?
upper lobes
147
According to Carnevale, which type of emphysema occurs in the adjacent to the pleura of the lung?
paraseptal
148
According to Carnevale, Which type of emphysema is not associated with smoking?
paraseptal
149
Which branch of emphysema is more likely to develop cor pulmonale?
blue bloaters
150
What is the definition of chronic bronchitis?
greater than three months for two consecutive years
151
What two cells may undergo metaplasia during chronic bronchitis?
goblet
squamous
152
According to Carnevale, which two bacteria can superimpose during chronic bronchitis?
S. pneumo
H. influenzae
153
According to Carnevale, which two viruses can superimpose on chronic bronchitis?
adenovirus
RSV
154
According to Carnevale, during asthma are there CD4 or CD8 cells present?
CD4
155
According to Carnevale, during asthma which interleukins is secreted by CD4 cells?
IL4 and IL5
156
According to Carnevale, during asthma what are the two functions of IL4?
promote switching to IgE
promote growth of mast cells
157
According to Carnevale, during asthma what is the function of IL5?
promote growth of eosinophils
158
According to Carnevale, during asthma what is found in Curschmann spirals?
shed epithelium
159
According to Carnevale, during asthma what is found in Charcott Leyden Crystals?
eosinophilc major basic protein
160
Is IPF a productive or non-productive cough?
non-productive
161
What two parts of the lung does IPF effect?
lower lobes and peripheral
162
According to Aoki, what two new drugs are available IPF?
Perfenidone
Nintedanib
163
What restrictive lung disease effects young people?
Non-specific interstitial pneumonitis
164
What part of the lung does NSIP effect?
lower
165
Does NSIP produce honeycombing over time?
no
166
Which restrictive lung disease can occur rapidly?
acute interstitial pneumonitis
167
How does COP present? What does this stand for?
URTI that doesnt respond to antibiotics
cryptogenic organizing pneumonia
168
What is treatment for COP?
steroids
169
Bird hobbyists?
Hypersensitivity pneumonitis
170
What cell invades during hypersensitivity pneumonitis?
CD8
171
What is the onset of Hypersensitivity Pneumonitis like?
abrupt
172
What are the nodules in hypersensitivity pneumonitis?
ill-defined granulomas
173
According to Aoki, what two drugs can cause pulmonary fibrosis?
amiodarone and nitrofurantoin
174
Who does LAM effect?
women of childbearing age
175
What other disease is LAM associated with?
tuberous sclerosis
176
What cell proliferates during LAM?
smooth muscle cells
177
What is the PCWP during ARDS?
less than 18
178
What is the PaO2/FiO2 for a patient with ALI?
less than 300
179
What is the PaO2/FiO2 for a patient with ARDS?
less than 200
180
What cell becomes activated during ARDS?
neutrophil
181
Inhalation of what substance can help ARDS?
nitric oxide
182
What cytokine drives IPF? These effects are normally inhibited by what protein?
TGF-beta
caveolin
183
What is the most dangerous crystal?
quartz
184
What cytokine drives silicosis?
TNF
185
Silicosis drives what infection?
TB
186
Is silicosis carcinogenic?
yet
187
Which form of asbestos is more pathogenic?
Amphibole
188
Does asbestos affect the upper or lower lobes?
lower
189
Where space does asbestos affect?
subpleural space
190
What is the Tx for radiation pneumonitis?
steroids
191
What is Hamptons Hump?
wedge shaped pulmonary infarct
192
Which gas can be given during a PE?
nitric oxide
193
What are the two situations for an IVC filter?
proximal DVT
cant use anticoagulants
194
What does the mean pulmonary arterial pressure have to be greater than to Dx pulmonary HTN?
25 mm Hg
195
What is group 1?
pre-capillary pulmonary artery HTN
196
What is group 2?
left heart failure
197
What is group 3?
chronic hpoxemia
198
What is group 4?
thrombo-embolic
199
Which group of pulmonary HTN would have increased PCWP?
group 2
200
What drug can be used for pulmonary HTN? In what patient groups?
CCBs
respond to vasodilator challenge
201
Treatment for group 4?
remove embolism
202
What is the best approach for thoracocentesis?
posterior
203
What cell secretes lactoferrin?
neutrophil (s)
204
According to Shumate, a chronic cough needs to last for at least how long?
3 weeks
205
What is PD20?
Dose required to drop FEV1 by 20%
206
If only DLCO is abnormal think what?
circulation issues
207
In what phase does central command function?
anticipatory
208
What is pleurodesis?
create fibrosis to prevent recurring pneumothorax
209
Does bronchitis occur in large airways or small airways?
large
210
Does panacinar emphysema occur in the apex or base of lung?
base
211
Does IPF more often present in base or apex of lungs?
base
212
Who does DIP effect? What does this stand for?
former smokers
De-squamative interstitial pneumonitis
213
What cell proliferates during RB-ILD? What does RB-ILD stand for?
pigmented macrophages
Respiratory Bronchiolitis interstitial Lung disease
214
What cell hypertrophies during ARDS?
Type two pneumocytes
215
What two antibodies are present during TRALI?
anti-HLA
anti-HNA
216
Which protein normally inhibits the fibrotic effects of TGF-beta?
caveolin
217
What is the preferred drug for pulmonary HTN?
CCBs
218
Test for Pulmonary HTN?
Echo
219
What is the diagnostic test for pulmonary HTN?
right heart catheterization with vasodilator therapy
220
According to WHO, who are the only candidates for Pulmonary HTN specific therapies?
group 1
221
What is the most important prognostic factor in patients with Group 1 Pulmonary HTN?
right heart function
222
What causes air bronchograms?
parenchymal consolidation
223
What do air bronchograms indicate?
open airways
224
What is the most diagnostic sign for direct lung collapse?
loss of fissures
225
What are the most diagnostic sign for direct lung collapse?
hemidiaphragm elevation
hilum deviation
226
What happens to the height of the hilum during upper love collapse?
elevation
227
What happens to the height of the hilum during lower love collapse?
depression
228
Does the trachea deviate away or towards the site of lung collapse?
towards
229
Does the rib cage narrow or widen on the side of lung collapse?
narrow
230
What is the cutoff in the difference of size between a nodule and a mass?
3cm
231
What rib does the pleural space extend to posteriorly?
12th
232
What rib does the pleural space extend to laterally?
10th
233
Which is a better view for pleural effusions, PA or lateral?
lateral
234
Does the mediastinum shift towards or away from a large pleural effusion?
away
235
What is the most common cause of mass in the mediastinum?
enlarged lymph nodes
236
What happens to the upper lobe vessels during CHF?
enlarge
237
In what structure do Kerley B lines develop?
interlobular septa
238
What is the superior pulmonary sulcus?
concavity of thoracic wall
239
Does TPR increase or decrease during exercise?
decrease
240
What happens to TPR if more muscle mass is involved?
TPR drops more
241
Does core temp. rise during exercise?
yes
242
Presece of antigens in the urine for what two bacteria require a sputum sample?
Pneumococcos
Legionella
243
What is the onset of Acute Eosinophilic Pneumonia associated with?
new onset or resumption of smoking
244
What part of the bronchiole is affected by centriacinar emphysema?
respiratory bronchiole
245
What is paraseptal emphysema associated with?
spontaneus pneumothorax
246
What is irregular emphysema associated with?
scarring
247
What two species of pneumonia causing bacteria did carnevale say can contribute to bronchiectasis?
Klebsiella
staph aureus
248
What causes ARDS?
diffuse destruction of alveoli capillaries
249
What cell plays a central role during Diffuse Interstitial Disease?
Macrophage
250
What three autoimmune disorders can result in lung involvement?
SLE
Rheumatoid
Scleroderma
251
Do smaller or larger particles affect the lung more during pneumoconioses?
smaller
252
Does CWP have an increased risk for TB?
No
253
Does CWP have an increased risk for cancer?
No
254
What is Caplan Syndrome?
pneumoconioses
Rheumatoid
255
What fibrosis is caused by asbestos?
diffuse interstitial pulmonary fibrosis
256
Idiopathic pulmonary HTN is most common in what patient population group?
young women
257
Pulmonary HTN can be present during what two connective tissue diseases?
Scleroderma and SLE
258
Which is anterior, left or right fissure?
right
259
Does the mediastinum shift to or away from pleural effusion?
away
260
Does the mediastinum shift to or away from atelectasis?
toward
261
What do asbestos bodies act as in relation to carcinoma?
initiator and promoter
262
Which anti-inflammatory drug can causes lung disease?
aspirin
263
Proper place for evacuating a pneumothorax?
2nd ICS
midclavicular line
264
Needle drainage and decompression can be life-saving if what?
done with the correct equipment
265
What is another name for ALI?
non-cardiogenic pulmonary edema
266
TRALI occurs within how long of transfusion?
6 hours
267
What does temporal heterogeneity mean?
early and late lesions occur at same time
268
Does silicosis begin in the upper lungs or lower lungs? Peripheral or cental?
upper
central
269
PEs are what order of most common hospital admission ?
3rd
270
What does the systolic blood pressure have to be less than to use lytics during a PE?
less than 90
