1
Q
pulsus paradoxus - seen in
A
- cardiac teponade 2. asthma 3. obstructive sleep apnea
4. pericarditis 5. croup
2
Q
asthma - histology
A
- smooth muscle hypertrophy
- Curschmann spirals: shed epithelium forms whorled mucus plugs
- Charcot - Leyden crystals: eosinophilic, hexagonal, double-pointed, needle-like crystal from breakdown of eosinophils in sputum
3
Q
asthma drugs
A
- β2 agonists (albuterol, salmeterol, formoterol)
- corticosteroids (fluticasone, budesonide)
- Muscarinic antagonists (ipratropium)
- Antileukotrienes (montelukast, zafirlukast, zileuton)
- omalizumab
- Methylxanthines (theophylline)
- Metacholine
4
Q
role of corticosteroids (fluticosine, budesonide) in asthma therpay
asthma - albuterol used in
A
- 1st line therapy for chronic asthma
- during acute exacerbation
5
Q
asthma - ipratropium vs tiotropium according to action
A
tiotropium is long acting
6
Q
montelukast, zafirukast mechanism of action
A
block leukotriene receptor (CysLT1)
7
Q
Zileuton mechanism of action / SE
A
5-lipoxygenase pathway inhibitor. Block conversion of arachnoid acid to leukotrienes
- hepatotoxic
8
Q
adenosine receptor antagonists
A
- theophylline
2. caffeine
9
Q
theophylline adverse effects
A
- cardiotoxicity
- neurotoxicity
narrow therapeutic index
10
Q
think asthma as a diagnosis when
A
- Recurrent episodes of wheezing
- Cough at night
- Coughing or wheezing after exercise
- Cough, wheezing, chest tightness after exposure to allergens or pollutants
- Colds “go down to the chest” or take longer than 10 days
11
Q
inspiratory reserve volume (IRV)
A
air that can still be breathed in after normal inspiration (3.3L)
12
Q
Expiratory reserve volume (ERV)
A
air that can be breathed out after normal expiration (1L)
13
Q
Inspiratory capacity (IC)
A
inspiratory reserve volume (IRV) + tidal volume (TV)
3.8L
14
Q
Vital capacity (VC)
A
Maximum volume of gas that can be expired after a maximal inspiration (4.8L)
inspiratory reserve volume (IRV) + tidal volume (TV) + Expiratory reserve volume (ERV)
15
Q
Functional residual capacity (FRC)
A
Volume of gas in lungs after normal expiration (2.2L) Residual volume (RV) + Expiratory reserve volume (ERV)
16
Q
minute ventilation (Ve)
A
total volume of gas that entering lungs per minute
Ve = tidal volume x respiratory rate
17
Q
Alveolar ventilation (Va)
A
volume of gas per unit time that REACHES ALVEOLI
Va = (tidal volume - physiological dead space) x respiratory rate
18
Q
situations that alter FEV1/FVC
A
decreased: obstructive lung disease
increased: restrictive lung disease
19
Q
IRV is used during
A
exercise
20
Q
Lung volumes that cannot be measured by spirometry
A
- residual volume
- Total lung capacity
- Functional residual capacity
21
Q
Causes of increased Vital capacity
A
acromegaly
22
Q
physiologic dead space equation
A
tidal volume (Vt) x (arterial PCO2- expired PCO2)/ arterial PCO2
23
Q
physiologic dead space definition
A
anatomic dead space of conducting airways plus alveolar dead space
Volume of inspired air that does not take part in gas exchange
24
Q
alveolar dead space distribution
A
apex of healthy lung is largest contributor of dead space
25
Physiologic dead space (per breath) normal
150 ml/breath
26
pathologic dead space
when part of the respiratory zone becomes unable to perform gas exchange (ventilated but not perfused)
27
Lung cancer - complication
mnemonic: SPHERE + dysphagia + phrenic nerve paresis - heart or pericardial invasion +pleural invasion
1. Superior vena cava syndrome 2. Pancoast tumor
3. Horner syndrome 4. Endocrine (paraneoplastic)
5. Recurrent laryngeal nerve compression (hoarseness)
6. Effusions (pleural or pericardial)
28
Lung cancer - risk factors
1. smoking 2. secondhand smoking 3. radon 4. asbestos 5. family history 6. Asbestosis 7. Silicosis
8. Coal
29
primary lung cancer - types (small or non small?) / location
1. small cell (oat cell) carcinoma - central
2. adenocarcinoma (non-small) - peripheral
3. Squamous cell carcinoma (non-small) - central
4. Large cell carcinoma (non-small) - peripheral
5. Bronchial carcinoid tumor (non-small) - central or peripheral
30
lung small cell (oat cell) carcinoma may cause/produce
1. Cushing syndrome (ACTH) 2. SIADH
3. antibodies against presynapitc Ca2+ channels (Lambert-Eaton myasthenic syndrome)
4. or neurons (paraneoplastic myelitis/encephalitis, sabacute cerebellar degeneration)
31
lung small cell (oat cell) carcinoma - gene amplification
MYC
32
lung small cell (oat cell) carcinoma - histology
1. neoplasm of neuroendocrine Kulchitsky cells (small dark blue cells)
2. chromogranin A positive
3. undifferentiated (very aggressive)
4. Neuron specific enolase positive
33
lung squamous cell carcinoma - may cause/produce
1. cavitation
| 2. hypercalcemia (produce PTHrP)
34
lung squamous cell carcinoma - CXR
Hillar mass arising from bronchus b
35
bronchial carcinoid tumor - histology
nests of neuroendocrine cells
| chromogranin A positive
36
chromogranin A positive lung tumors
1. bronchial carcinoid tumor
| 2. lung small cell (oat cell) carcinoma
37
bronchial carcinoid tumor - presentation/symptoms
1. symptoms due to mass effect
| 2. carcinoid syndrome (flashing, diarrhea, wheezing)
38
lung Large cell carcinoma - treatment / it can secrete ...
1. less responsive to chemotherapy
2. remove surgically
- β-hCG
39
MC primary lung cancer
| MC lung cancer in non smokers
adenocarcinoma
40
lung adenocarcinoma activating mutations / paraneoplastic
1. KRAS 2. EGFR 3. ALK
| - hypertrophic osteorarthropathy (clubbing)
41
adenocarcinoma in siitu
bronchioarveolar subtype (hazy infiltrates similar pneumonia)
42
bronchioarveolar subtype - smoking
| Bronchial carcinoid tumor - smoking
both no relationship
43
mesothelioma - risk factors
asbestosis
| smoking is not a risk factor
44
mesothelioma - histology / RF
- psammoma bodies
- calretinin and cytokeratin (+) in almost all mesotheliomas, ((-) in most carcinomas)
- RF: ASBESTOSIS (not smoking)
45
pancoast tumor (superior sulcus tumor) may cause
Compression of locoregional structures:
1. Horner syndrome
2. Superior vena cava syndrome
3. hoarseness
4. sensorimotor deficits
46
superior vena cava syndrome - medical emergency because
it can raise intracranial pressure (if obstruction is severe)
--> headaches, dizziness, increased risk of aneurysm/rupture of intracranial arteries
47
Lung Ca - MC symptom
| Lung Ca - single most common area of metastasis
- cough (75%)
| - brain
48
primary spontaneous pneumothorax is due to
rupture of apical blebs or cysts in tall, thin, young males
49
secondary spontaneous pneumothorax is due to
1. diseased lung (bullae in emphysema, infections)
| 2. mechanical ventilation with use of high pressures (barotrauma)
50
thrombi pulmonary emboli - histology
lines of Zahn: interdigitating areas of pink (platelets, fibrin) and red (RBCs) found only in thrombi formed before death
51
lobar pneumonia - typical organisms
1. S pneumonia
2. Legionella
3. Klebsiella
52
Bronchopneumonia - typical organisms
1. S. pneumonia
2. S. aureus
3. H. influenza
4. Klebsiella
53
interstitial (atypical) pneumonia - typical organisms
1. Viruses (influenza, CMV, RSV, adenovirus)
2. Mycoplasma
3. Legionella
4. Chlamydia
54
organism that causes BOTH Lobar and Bronchopneumonia
Klebsiella
| S. pneumonia
55
bronchopneumonia - distribution
patchy distribution involving >= 1 lobe
56
walking pneumonia
interstitial (atypical) pneumonia --> generally follows a more indolent course
57
interstitial atypical pneumonia - typical presentation
relatively mild URI symptoms
58
lung abscess - organisms
1. anaerobes (bacteroids, peptostreptococcus, fusobacterium)
2. S aureus
3. Klebsiella
59
S. aureus - pneumonia type?
Bronchopneumonia (or lung abscess)
60
H. infl - pneumonia type?
bronchopneumonia
61
Lung abscess 2ry to aspiration is most often found in .... (location)
right lung:
upright --> basal segment of right lowr lobe
supine --> posterior segment of right upper lobe or superior segment of right lower lobe
62
structure perforating diaphragm (an where)
T8: IVC
T10: esophagus vagus
T12: aorta, thoracic duct, azygos vein
63
Screening test for fetal lung maturity
1. lecithin/sphingomyelin ration in amniotic fluid -->
- if more than 2 --> healthy
- if less than 1.5 --> predictive of NRDAS
2. foam stability test
3. surfactant/albumin ratio
64
Pulmonary surfactant synthesis by time
begins around week 26 of gestation, but mature levels are not achieved until around week 35
65
hemoglobin (hb) - properties
1. positive cooperativity
| 2. negative allostery
66
hemoglobin (hb) - positive cooperativity
tetrameric Hb molecule can bind 4 02 molecules and has higher affinity for each subsequent O2 molecule bound
67
methemoglobin vs normal hemoglobin - iron status
normal: resuced state Fe2+ (FERROUS)
methemoglobin: oxidized state Fe3+ (FERRIC)
68
methemoglobin properties
- it does not bind 02 as readily
| - it has increased affinity for cyanide
69
methoglobinemia may present with
1. cyanosis 2. chocolate-colored blood
70
methoglobinemia can can be treated with
1. methylene blue
| 2. vitamin C
71
how to treat cyanide poisoning (and the mechanism)
nitrites followed by thiosulfate
nitrites: hemoglobin --> methoglobin which bind cyanide
thiosulfate: to bind cyanide, forming thiocyanate , which is renally excreted
72
substance that cause poisoning by oxidizing F2+ to F3+ (found in)
1. nitrites (from dieaary intake or polluted/high altitude water)
2. benzocaine
73
methylene blue is used to
treat methoglobinemia
74
1st generation H1 blockers - drugs
1. diphenhydramine
2. dimenhydrinate
3. chlorpheniramine
75
2nd generation H1 blockers - drugs
- ADINE + cetirizine
1. loratadine
2. fexofenadine
3. desloratadine
4. cetirizine
76
1st generation H1 blockers vs 2nd - used for
1st: 1. allergy 2. motion 3. sleep aid
2nd: allergy
77
1st generation H1 blockers - toxicity
1. sedation
2. antimuscarinic
3. anti-a-adrenergic
78
2nd generation H1 blockers - toxicity
sedation (much less than 1st generation)
79
pulmonary hypertension drugs - categories and drugs
1. endothelin receptor antagonists --> BOSENTAN
2. PDE-5 inhibitors --> SILDENAFIL
3. Prostacyclin analogs --> EPOPROSTENOL, ILOPROST
80
bosentan toxicity
hepatotoxicity
81
pulmonary hypertensrion - prostacyclin analogs side effects
1. flushing
| 2. jaw pain
82
chronic bronchitis - pathology
hyperplasia of mucus-secreting glands --> Reid index >50%
83
chronic bronchitis - definition
productive cough for >3 months PER YEAR (not necessarily consecutive) for >2 years
84
bronchiectasia symptoms
1. purulent sputum
2. recurrent infections
3. hemoptysis
4. digital clubbing
85
causes of poor ciliary motility
1. smoking
| 2. kartegener syndrome
86
bronchiectasia is associated with (like predisposition)
1. bronchial obstruction
2. poor ciliary motility (SMOKING, kartegener syndrome)
3. cystic fibrosis
4. allergic bronchopulmonary aspergillosis
87
emphysema types - associations and area
1. centriacinar: associated with smoking --> upper lobes
| 2. Panacinar: associated with α1 - antitrypsin --> lower lobes
88
emphysema - diffusion capacity of CO test (and mechanism)
decreased diffusing capacity for CO resulting from destruction of alveolar walls
89
blue bloaters vs pink puffer
blue: chronic bronchitis
pink: emphysema
90
Restricted lung disease - poor breathing mechanics properties
1. extrapulmonary
2. peripheral hypoventilation
3. normal A-a gradient
91
Restricted lung disease - poor breathing mechanics --> situations (and causes)
1. poor muscular effort (polio, myasthenia gravis)
| 2. poor structural apparatus (scoliosis, morbid obesity)
92
Restricted lung disease - drug toxicity
1. bleomycin 2. busulfan
| 3. amiodarone 4. methotrexate
93
restrictive vs obstructive according FEV1
obstructive: FEV1 is MORE dramatically reduced compared to FVC
restrictive: FEV1 is LESS dramatically reduced compared to FCV
94
pneumoconioses - types
1. asbestosis
2. Berylliosis
3. Coal workers' pneumoconiosis
4. silicosis
95
pneumoconioses (except berylliosi) - increased risk for
1. cor pulmonale
2. Caplan syndrome
3. cancer
96
Caplan syndrome
rheumatoid arthritis and pneumoconiases (coal, asbestosis, silicosis) with intrapulmonary nodules
97
Asbestosis is associated with (exposure)
1. shipbuilding
2. roofing
3. plumbing
98
pathognomonic lesions of asbestosis (gross)
Ivory white, calcified supreadiaphragmatic and pleural plaques
99
areas of asbestos plaques
1. supreadiaphragmatic
| 2. pleural plaques
100
carcinomas associated with asbestosis
1. bronchogenic carcinoma (More common
| 2. mesothelioma
101
berylliosis associated with (exposure)
berryllium in
1. aerospace
2. manufacturing industries
102
lung Asbestosis - histology
ferruginous (asbestos) bodies: golden-brown fusiform rods resembling dumbbells, found in alveolar septum (visulized using PAS stain), often obtain by branchoalveolar lavage)
103
ferruginous bodies are found in
alveolar septum
104
berylliosis affects (area) / histology / treatment
- upper lobes
- noncaseating granoulomas in lung, hilar lymph nodes and systemic organs
- occasionally responsive to steroids
105
Coal workers' pneumoconiosis is also known s / area
black lung disease
| - upper lobes
106
Coal workers' pneumoconiosis - pathophysiology
prolonged coal dust exposure --> macrophages laden with carbon --> inflammation and fibrosis
107
Anthracosis is caused by
mild exposure to carbon (collection of macrophages laden with carbon)
108
Anthracosis - symptoms/found in
asymptomatic condition found in many urban dwellers exposed to sooty air
109
Anthracosis - occupation
found in many urban dwellers exposed to sooty air
110
Silicosis is associated with ....(occupation)
1. foundries (factory that produces metal castings)
2. sandblasting
3. Mines
111
Silicosis - pathophysiology
Macrophages respond to silica and release fibrogenic factors, leading to fibrosis. it is thought that silica may disrupt phagolysosomes and impair macrophages
112
silicosis - increased risk for
1. TB
| 2. bronchogenic carcinoma
113
silicosis affects (area)
upper lobes
114
silicosis - CXR
Eggshell calcification of hilar lymph nodes
115
pneumoconiases that affect upper lobes
1. coal workers' pneumoconiosis
2. Silicosi
3. Berylliosis
116
pneumoconiases that affect lower lobes
asbestosis
117
which are the classicfication group of pulmonary hypertension
1. pulmonary arterial hypertension (PAH)
2. PH due to left heart disease
3. PH due to lung disease or hypoxia
4. chronic thromboembolic PH
5. multifactorial PH
118
multifactorial pulmonary hypertensions - causes
1. hematologic disorders
2. systemic disorders
3. metabolic disorders
119
pulmonary arterial hypertension (PAH) - causes
1. idiopathic
2. drugs
3. connective tissue disease
4. HIV infection
5. portal hypertension
6. congenital heart disease
7. schistosomiasis
120
pulmonary arterial hypertension (PAH) - idiopathic - pathophysiology
often due to inactivation mitation in BMPR2 gene -->
| inhibits vascular SMCs proliferation
121
neonatal respiratory distress syndrome - persistently low O2 tension - risk of
1. PDA
2. metabolic acidosis
3. necrotizing enterocolitis
122
neonatal respiratory distress syndrome - therapeutic supplemental of O2 can result in
1. retinopathy of prematurity
2. Intraventricular haemorrhage (brain)
3. Bronchopulmonary dysplasia
123
ARDS definition
clinical syndrome characterized by
1. acute onset respiratory failure,
2. bilateral lung opacities
3. decreased Pa02/Fi02 ratio
4. no HF
124
ARDS management
1. mechanical ventilation with LOW TIDAL VOLUMES
| 2. address underling cause
125
sleep apnea - definition (and result)
repeated cessation of breathing > 10 seconds during sleep --> disrupted sleep --> daytime somnolence
126
sleep apnea - PaO2 levels
normal during the day
| noctural hypoxia
127
sleep apnea - complications (how)
noctural hypoxia -->
1. systemic/pulmonary hypertension
2. arrhythmias (atrial fibrillation/flutter)
3. sudden death
128
sleep apnea - arrhythmia
1. atrial fibrillation
| 2. atrial flutter
129
sleep apnea - types
1. obstructive sleep apnea
2. central sleep apnea
3. Obesity hypoventilation syndrome
130
obstructive sleep apnea - associated with
1. obesity
| 2. loud snoring
131
obstructive sleep apnea - caused by
1. excess parapharyngeal tissue in adults
| 2. adenotonsillar hypertrophy in children
132
obstructive sleep apnea in children vs adults - is caused by
children: adenotonsillar hypertrophy excess parapharyngeal
adults: excess parapharyngeal tissue
133
obstructive sleep apnea - treatment
1. weight loss
2. CPAP (continuous positive airway pressure)
3. surgery
134
central sleep apnea - due to
1. CNS injury
2. CNS toxicity
3. opioids
4. Heart failure
135
Obesity hyperventilation syndrome - respiratory rate / BMI
decreased
| >=30Kg/m2
136
Obesity hyperventilation syndrome is also known as
Pickwickian syndrome
137
Obesity hypoventilation syndrome - pathophysiology
BMI >=30Kg/m2 --> hypoventilation (decreased RR) --> decreased PaO2 and increased PaCO2 during sleep --> increased PaCO2 DURING WAKING HOURS (retention)
138
Obesity hypoventilation syndrome - symptoms
1. Poor sleep quality
2. Sleep apnea
3. Daytime sleepiness
4. Depression
5. Headaches
139
Obesity hypoventilation syndrome - blood gases abnormalities
1. increased PaCO2 during sleep
2. decreased PaO2 during sleep
3. Increased PaCO2 during waking hours (retention)
respiratory
flashcards
Decks in class (27)
# Cards
-
Asthma and drugs68
-
Lung volumes28
-
Lung cancer84
-
lung - physical findings25
-
Pleural effusions - pneumothorax26
-
Rhinosinusitis - epistaxis - DVT/PE39
-
Pneumonia - Lung abscess33
-
Diaphragm structures - Lung relations27
-
respiratory tree - pneumocytes44
-
Lung and chest wall20
-
hemoglobin67
-
alveolar gas equation/oxygen deprivation/ V/Q29
-
CO2 transport22
-
drugs40
-
Obstructive lung disease70
-
Pneumoconiases42
-
pulmonary hypertension and drugs40
-
Respiratory distress syndrome (Acute and Neonatal)22
-
sleep apnea20
-
Restrictive lung disease25
-
Pulmonary circulation18
-
embryology25
-
others109
-
other 218
-
FA 1139
-
UW 181
-
UW 255
