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uworld respiratory Flashcards

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1
Q

flu vaccine

A

includes antigens or virions to 3 or 4 a and b flue

wanes every year and strains change

inactivated about neutraling antibdoies.

inactivated does not invoke MHC1 response so no cellular immunity

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2
Q

length time bias

A

screening is better at picking up disease with slower progression, making it look like screening is doing a good thing

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3
Q

sensitive but not specific test for asthma

A

negative methacholine, good for ruling out

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4
Q

asthma x ray

A

often normal between attacks

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5
Q

asthma serum levels

A

elevated ige, eosionophilia

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6
Q

last to disappear in epithelial changes?

A

cilia

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7
Q

what genome does a virus need to be directly infectious?

A

positive sense rna

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8
Q

lung transplant recpients at risk for

A

cmv penumonitis

intranuclear and intracytoplasmic inclusions and owls eyes

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9
Q

a treatment for obstructive sleep apnea

A

implatable device that stimulated hypoglossal nerve to move tongue forward.

treats neuromuscular part of things

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10
Q

sarcoidosis chest x ray

A

riticular pulmonary infiltrates

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11
Q

sarcoidosis important cell type?

A

cd4

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12
Q

clinical findings of sarcoidosis

A

cough, dyspnea, chest pain

erythema nodosum

anterior/posterior uveitis

lofgren syndrome - bilateral hilar lympahdenopathy, erythema nodosum, and arthlagia

non caseating granulomas

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13
Q

sarcoidosis in BAL

A

high cd/cd8

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14
Q

cold agglutins

A

uncoagulated when in hand

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15
Q

features of restrictive obesity

A

most common indicator in rudction in the expiratory reserve volume.

has minimal effect on the residual volume.

frc is also decreased

can also cause decreases in rvc tlc and fev1 depedning on the severity but these deficits are modest in comparison to erv

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16
Q

what can be normal early in obstructive

A

the fvc

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17
Q

what was normal on chart for obstructive?

A

chart showed normal expiratory resever volume but everything else as expected.

remember this by remember all volumes increase equally, right?

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18
Q

what causes a decrease in po2 from alveolar capiallary blood to the systemic arterial blood?

A

the deoxygenated venous blood from bronchial circulation

supplied the bronchi and bronchioles dually with pulmonary artery

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19
Q

cxr of asthma

A

can be can show inflation during attack, i think i remember also that it can be normal inbtween

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20
Q

features of pulmonary fibrosis (as per the rheumatoid case)

A

small irregular (reticular) opaciteis on x ray

gradual onset of dyspnea on exertion and then at rest

can show end (late) inspiratory crackles

get decreased dlco and restrictive pattern

can progress to honeycombing

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21
Q

synthesis of elastin and what causes rubber like properties?

A

tropoelastin made inside and secreted.

microfibrils (fibrillin) acts as scaffold

next lysyl oxidase (requires copper) deaminated lysin residues which form desmosine crosslinks -> rubber like properties (stretching)

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22
Q

ppd anergy disease

A

sarcoidosis

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23
Q

what is found in the liver of sarcoidosis?

A

granulomas

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24
Q

what would cause the restrictive lung disease higher than expected for lung size flow rates

A

increased radial traction, vs emphysema where there is decreased radial traciton

picture showing large airways for restrive vs small airways for emphysema

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25
what can happen to cystic fibrosis on hot summer day?
sweating and hyponatremia
26
general pathogesnsis of restrictive diseases
macrophage activation from ingulfment of particles causes release of PDGF and insulin like growth factor which stimulates fibroblasts to lay down collagen
27
penumonia can causes hypoxemia how?
v/q
28
how do lung abscesses form?
neutrophils and macs release lysosomal contents by macs that digest offending pathogens and recurit other WBCS can damage parenchyma, setting the atage for abscess involves necrosis of surrounding tissues if abscess connects to air passage with see airf fluid levels
29
a man has mi and acute ventricular failure, what would you see histologically?
transudate accumulation in the alveolar lumen hemisderin laden macs would be found later
30
pathnomic feature of chronic bronchits?
mucus hypersecretion
31
tlc in chornic bronchitis and emphysema
normal in chronic bronchitis and increased in emphysema
32
pulomnary complicant in bronchitis vs emphysema
normal in chronic bronchitis and increased in emphysema
33
bronchodilator response in bronchitis vs emphysema
bronchitis partial response, emphysema no response
34
copd asucultaroty findings
wheezes and decreased breath sounds
35
common findings in adenocarcinoma
clubbing and hypertrophic osteoarthopathy (clubbing plus periositis)
36
large cell carcinoma paraneoplastic syndromes
gynecomastia and glactorhea
37
adenocarcinoma epidemilogol
most common sybtype, occuring most frequently in women and nonsmokers
38
dlco in restrictie helps to distinguish between?
intrinsic or extrinsic causes
39
what falls in cyanide poisoning?
arterial venous o2 oxygen gradient falls
40
what does cyanide prefer to bind to?
fe3+
41
u world small cell markers
nerual cell adhension moclule (ncam, cd 56), synaptophsyin, neurofilaments
42
what is asthma laste phase characteized by?
eosinophils, basophils, and neutrophils.
43
in asthma what do basophils release?
heparin, histamine, SRA-S (leukotriene mixture)
44
what causes dyspnea in a case described as acute heat failure?
the high end diastolic pressure leads to -> transudation -> causes decreased compliance -> poor gas exchange and dyspnea this is because transudate dilutes surfactant
45
asthma allergen inhalation
animal dander, dust mites, cockroachs, pollens, and molds.
46
respiratory irritants of asthma
ciggarettes smoke, air pollutants (exhause fumes), perfumes
47
infection asthma
viral URI, rhinosinusitis
48
pharmologic causes of asthma
aspirin (not acetomenaphin), nsaids, non selective beta blockers
49
other causes of asthma exacerbations
exercise, cold, dry air GERD emotions (stress, depression)
50
allerigic bronchopulmonary aspergillos can cause?
proximal bronchiectasis
51
farmers lung etiology
actinomycetes in moldy hay or contaminated compost
52
what is the etiology of symptoms from panic attack?
low co2 causing cerebral vasoconstriction
53
obesity hypoventilation syndrome
described patient that was foggy all the time. said o2 arterial was low and co2 was high. etiology? chronic hypoventilation said it was a mix of increased co2 from increased body mass and surface area, sleep disordered breathing, and reduced lung volumes are compliance. later said increase pco2 while awake. said improtant causes of hypoxemia with normal aa
54
hypoventialsiton (normal aa gradient)
neuromuscule and obesity hypovenitlation
55
right to left shunt wout have?
increased A a gradient
56
copd hypoxia can lead to?
erythropoesis
57
hirshsprung vs meconmium ileus (CF)
hirsh, meconium downsyndrome, cystic fibrosis rectosigmoid, ileum normal meconium, inspitssated (dry) squire positive, negative
58
major cause of mortality in cystic fibrosis
pneumonia, bronchiectasis, and cor pulmonale
59
what do you see on biopsy in silicosis?
birefringent particles
60
findings in idiopathic pulmonary fibrosis
persistent non productive cough and dyspnea non productive cough usualy interstital pneumonia alveolar collapse leads to honeycombing cystic spaces lined by hyperplastic type 2 pneumocytes most prominent in subpleural and paraseptal spaces
61
four possible things asbestosis can cause
pleural plagues (most common) asbestosis - progressive pulmonary fibrosis with asbestosis bodies bronchogenic carcinoma - synergistic with smoking malignant mesothelimoma
62
squamous cell carcinoma most similar too
barret's esophagus metaplasia -> dysplasia not similar to CIN/cervical cancer
63
what does centriacinar empyhsema involve?
the respiratory bronchioles (according to the image)
64
fat embolism pathogenesis
triad of acute onset neurologic abnormalities, hypoxemia, patehcial rash long bone fracture -> fat embolism to lung -> imapired gas exchange leads to hypoxemia -> from there to brain (agitation and confused) -> and also to the dermal capillaries which causes rupture and pethciae also you can get platelet addhearence to the fat microgolbules and thrombocytopenia
65
two causes or relative (vs) absolute polycythemia (erythrocytosis)
dehydration or excessive diuresis (example acute HF pt)
66
risk factors of second hand smoke in kids
``` prematurity, low birthweight sudden infant death syndrome middle ear disease (otitis media) asthma repsiratory tract infections (bronchitis, pneumonia) ```
67
abscesses of lung causes
orophyrangeal aspiration -> anaerobes with mixed aerobe component complication of bacter pneumonia -> necrotizing pneumonias, staph, e coli, kelsiella, pseudomonas sepiticemia or endo -> staphy and strep
68
asthma pt with sputum that shows many granule containing cells and crystalloid masses
eosionophils with charcot leyden crystals (eosinophil membrane protein)
69
lung processes with increased elastic resistance
acute respiratory distress syndrome, pulmonary edema, pulmonary fibrosis
70
how does sarcoidis present?
cough, dyspnea, chest pain accompanied by fatigue, fever, and weight loss. in general for respiratory, late inspiratory crackles, dry cough, progressive exertional dyspnea
71
complication of o2 in copd
carotid body response becomes blunted. decrease respitaroty drive normally in healthy driven by co2 not o2, but in copd o2 drive rr
72
histology of mesthelioma
epithloid type cells with very long microvilli, desmosomes, tonofilaments.
73
mesothelioma signs and symptoms
dyspnea and chest pain
74
what can occur with a mediatinal mass?
SVC syndrome said suprior sulcus could cause it, but would have other syptoms
75
normal lung fucntion changes with aging
decrease chest wall compliance and increased lung comliance. leads to decreased fvc ( i think just because rv rises), increased rv (due to increased lung compliance) and no change in tlc due to (counter balance from decreased chest wlal comliance) think like obesity
76
chronic lung transplant rejection
present with dyspnea and dry cough total fibrotic obstruction in the terminal bronchioles fev1 dropped, fev1/fvc dropped, fvc largely unchanged
77
co2 problems in COPD after adminstration of o2
can get rise in co2 leading to confusion and depressed conciousness three causes 1. increased o2 causes perfusin of previously vascontricted poorly ventilated areas -> increased perfusion -> increased dead space (v/q mismatch) 2. increased o2 dereased hb's affinity for co2 3. decreased ventilation
78
harmatoma
coin lesion with "popcorn" calcifications occurs in pts 50-60 hyaline cartilage, fat, smooth muscle, clefts lined by repsitaroy epilethelium
79
chornic transplant rejection of lung occurs where?
small airways
80
retrolental fibroplasia (retinopathy of prematurity)
thought that transient increases in hyperoxia lead to increased vegf when taken off o2 from neonatal rds. leads to neovascularization with possible retinal detachement and blindness.
81
atelactasis from bronchial obstruction
decreased breath sounds (in fa), right hemithorax opacification, tracheal deviation central lung tumor
82
systemic sclerosis in the lung
pulmonary artery hypertenstion (most common cause of death) accentuated 2nd heart sound showed normal lung values
83
what is increased in all obstructive diseases? a ratio
residual volume/tlc says that
84
edema from ards is?
exudative
85
lung adenocarcinoma paraneoplastic syndromes
hyperiphic osteoarhropathy dermatomyositis or polymyositis migratory throbophelbetis (trosseau)

Pharmacology (33 decks)

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