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Respi_Kaplan
| Question | Answer |
|---|---|
| High altitude will have what effects in the pulmonary system in regards to Hct, PaO2, and O2? | Inc HCt, low PaO2 and low O2 sat |
| What will happen to oxygen delivery to tissues if a person is anemic? | Compensate O2 extraction - if O2 content of arterial blood dec, loss of O2 to tissues will cause venous O2 tension to fall lower than normal at rest and to lower levels when exercise attempted |
| What happens when a person's breathing during phrenic nerve damage? | intercostal ms contraction during inspiration - diaphragm sucked up and abdomen drawn inward - in normal both are pushed outward |
| What is the formula for TLC? | FRC + IC |
| What is the formula for FVC? | TLC - RV |
| What is the FEV1/FVC for emphysema? | FEV1/FVC is < 0.8 |
| What is FVC? | VC + forced expiration |
| What is the FEV1? | amount of air expelled in the 1st second |
| What does the oxygen-Hb dissociation curve look like for a patient with anemia? | plateau lower b/c O2 carrying capacity is less and the arterial oxygen content will be lower |
| What happens to the PaO2 during CO poisoning? | not affected so remains 100 mmHg - only 1/3 CO bound to Hb so there will be a left shift of the oxygen-Hb dissociation curve |
| What is the MEFV? | mean expiratory flow volume is a diagnostic tool to identify obstructive and restrictive lung ds |
| What happens to the MEFV curve in restrictive lung disease? | small curve shifted right - increased radial traction of airways |
| What happens to the MEFV curve in obstructive lung disease? | curve shifted left - increased TLC |
| A patient has a decreased FEV1, and an increased RV and increased TLC. What is the diagnosis? What is the cause of the decreased FEV1? | Emphysema - decreased FEV1 due to loss of elastic recoil |
| What is the alveolar gas equation? | PAO2 = PiO2 - PACO2/R |
| What are the blood gas values for severe anemia? | decreased arterial O2 with normal arterial O2 sat and normal arterial pO2 |
| What happens to the cardiovascular system in severe anemia? | increased CO = increased SV + increased HR |
| What directly monitors systemic arterial blood - PCO2? | Peripheral chemoreceptors then central after |
| What are the changes in a patient with emphysema given supplemental O2? | Inc PAO2, Inc PO2 A-a, Inc PaO2, NC lung diffusion capaci4ty |
| In an infant with PaO2 of 140-200, what could be the problem? | Shunt - VSD and pulmonic valve stenosis |
| Minute alveolar ventilation can be measured how? | VA = (TV - VD) x F -> Tidal volume - Dead space x RR |
| If a patient's alveolar ventilation increases by 4, what happens to PACO2? | decreases by 4 |
| Hb nearly 100% sat'd in arterial blood w/ PO2 of 100 mmHgso what will sat'n be if px has Hb concentration of 75%? | arterial blood will have 75% as much O2 bound as compared to someone with normal Hb |
| What is the FEV1/FVC and TLC in asthma? | normal or increased FEV1/FVC and increased TLC |
| Patient with rib fracture develops hypoxemia how? | Hypoventilation of peripheral origin |
| Muscarinic 3 cholinergic receptors are responsible for what? | change in FVC - in lungs, M3 receptors produce bronchoconstriction and increase mucus secretion |
| What is the action of B2 on the lungs? | bronchodilation |
| What is the result if a blood vessel is stimulated directly w/ M3 and B2? | decrease in BP will cause an increase in HR (reflex) |
| What if the effect of alpha 1? | increase BP causes decrease HR (reflex) |
| What confirms the diagnosis of sarcoidosis? | epithelioid histiocytes (noncaseating granulomata) |
| What is the difference btwn SVC syndrome and carcinoid syndrome? | SVC does not cause diarrhea and presents with dyspnea. Carcinoid = diarrhea. |
| What tumors arise peripherally and cause coin lesions? | adenoCA, bronchioalveolar CA, and large cell CA |
| Lung scarring indicates which peripheral tumor that causes a coin lesion? | adenoCA (not otherwise specified - means not subtype such as bronchioalveolar CA) |
| Hyperchromatic nuclei and scant cytoplasm in the lung indicates which pathology? This is a part of which syndrome? | Small cell CA of the lung. Cushing's syndrome |
| How do you treat H. influenzae pneumonia? | Fluoroquinolones (severe gram neg infections - hepatic enzyme inhibitors) |
| Which drug group inhibits DNA gyrase and topoisomerase such as DNA topoisomerase IV | Fluoroquinolones |
| When an entire acinus is enlarged from the respiratory bronchiole to the distal alveoli, what is this deficiency called? What is the type? | alpha-1-antitrypsin deficiency. Panacinar |
| Patient with alcoholism is likely to be infected with which organism? How do you treat? | Klebsiella. Cefotaxime, Ceftriaxone, Ceftazidime |
| Which drug inhibits DNA dependent RNA polymerase? | Rifampin |
| What is the defect in cystic fibrosis? | chloride channel (CFTR) gated by ATP hydrolysis and regulated by PKA phosphorylation |
| What is the classification of salmeterol and how does it act? | b2 agonist. increases CAMP and smooth muscle relaxation |
| What is the difference between cystic fibrosis and kartagener's syndrome? | CF = positive sweat test. Kartagener's = negative sweat test. |
| What is the chemical composition of exudate (pleural fluid/serum protein, LDH ratio, pleural LDH)? | pleural fluid/serum protein = >0.5, LDH ratio > 0.6, LDH pleural > 2/3 normal serum |
| What is the treatment for strep pneumo? | azithromycin (treats gram (+) diplococci) |
| What is the treatment for strep pneumo if the patient is allergic to macrolides? | 2nd gen cephalosporin - Cefuroxime |
| How is the immunity to strep pneumo based? | antibodies to capsule |
| What pathway clears Neisseria? What makes susceptible? | alternative complement pathway - if decreased levels or deficient in c5-c8, susceptible to Neisseria |
| MOA of Zileuton? | inhibits LOX |
| MOA of glucocorticoids? | inhibits PLA2 |
| Which drug class inhibits COX1 and COX2? | NSAIDs |
| Which drug class inhibits COX2? | -Coxibs |
| Which drug inhibits leukotrienes? | -Lukasts |
| What drug is used in the treatment of COPD? | Theophylline |
| What is the MC lung CA? | Bronchogenic CA |
| Which beta blocker can patients with lung disease tolerate at low doses? | Metoprolol - B1 blockers (and Atenolol) |
| Patient has foul smelling and air fluid levels. What is the most likely bacteria? | anaerobic bacteria |
| Patient presents with hoarseness. What is the pathology? | left recurrent laryngeal nerve damage |
| Patient with mycoplasma pneumonia can be treated with which medication? | Erythromycin |
| What is the MC pneumonia in young adults? | Mycoplasma pneumonia |
| Patient presents with nonproductive cough, low grade fever, headache, serous OM or bullous myringitis. What is the diagnosis and treatment? | Mycoplasm pneumonia. Erythromycin, Azithromycin, Tetracycline, Fluoroquinolones |
| What does Erythromycin treat? | gram (-), gram (+), and atypical infections |
| What is the treatment for RSV and its MOA? | Palivizumab - monoclonal antibody against fusion protein of RSV |
| What is the blood supply for the nasal mucosa? | sphenopalatine artery - terminal branch of maxillary artery - branches from external carotid artery |
| Pleural effusion which is unilateral indicates what kind of pathology? | Bacterial pleuritis |
| Drug indicated for pain and fever but not inflammation. This drug is also not associated with GI irritation or CV risk. What is this drug? | Acetaminophen |
| Drug that relaxes bronchial smooth muscle (b2) and has an adverse effect of tachycardia (b1). | Isoproterenol |
| Drug that relaxes bronchial smooth muscle (b2) which you use during acute exacerbation. | Albuterol |
| Drug that is a long-acting agent for prophylaxis whose adverse effects are tremor and arrhythmia. | Salmeterol |
| Drug that likely causes bronchodilation by inhibiting phosphodiesterase decreasing cAMP hydrolysis. | Theophylline (Methylxanthine) |
| Drug that competitively blocks muscarinic receptors preventing bronchoconstriction and also used for COPD. | Ipratropium (muscarininc antagonist) |
| Drug that prevents the release of mediators from mast cells. | Cromolyn |
| When is Cromolyn effective in asthma? | only for prophylaxis |
| When is Cromolyn not effective in asthma? | during an acute asthmatic attack |
| What drug inhibits the synthesis of virtually all cytokines? | Corticosteroids (beclomethasone, prednisone) |
| What drug inactivates NF-kB, the transcription factor that induces that production of TNF-a. | Corticosteroids (beclomethasone, prednisone) |
| What is the 1st-line therapy for chronic asthma? | corticosteroids (beclomethasone, prednisone) |
| Drug that is a 5-LOX pathway inhibitor. | Zileuton (antileukotrienes) |
| Drug that blocks conversion of arachidonic acid to leukotrienes. | Zileuton (antileukotrienes) |
| Drug that blocks leukotriene receptors and is especially good for aspirin-induced asthma. | Zafirlukast, montelukast (antileukotrienes) |
| Drug that removes excess sputum but large doses necessary; does not suppress cough reflex. | Guaifenesin (Robitussin) |
| Drug that is a mucolytic which can loosen mucous plugs in CF patients and is also used as an antidote for acetaminophen overdose. | N-acetylcysteine |
| Oxidized form of hemoglobin (ferric, Fe3+) that doesn't bind O2 as readily but has increased affinity for CN- | methemoglobin |
| Iron in hb is normally in which state | reduced (ferrous, Fe2+) |
| How do you treat cyanide poisoning? | nitrites oxidize hb to methemoglobin |
| In the treatment of cyanide poisoning, what does methemoglobin bind? | cyanide |
| In the treatment of cyanide poisoning, what does methemoglobin binding to cyanide do? | allows cytochrome oxidase to function |
| What do you use to bind cyanide for it to be renally excreted? | thiosulfate which will form thiocyanate |
| What is the form of hb bound to CO in place of O2? | carboxyhemoglobin |
| What are the effects of carboxyhemoglobin? | decreases oxygen-binding capacity w/ a left shift in oxygen-hb dissociation curve |
| What does the left shift in the oxygen-hb dissociation curve do? | decreases oxygen unloading in tissues |
| What is the mutation in primary pulmonary hypertension? | BMPR2 gene |
| What is the function of the BMPR2 gene? | inhibits vascular smooth muscle proliferation |
| What is secondary pulmonary hypertension usually due to? | COPD, mitral stenosis, recurrent thromboemboli, autoimmune ds, left-to-right shunt, and hypoxic vasoconstriction |
| What is the normal pulmonary artery pressure? | 10-14 mmHg |
| What is the pressure in pulmonary hypertension? | >=25 mmHg or >35 mmHg during exercise |
| What is a consequence of pulmonary hypertension? | cor pulmonale and subsequent right ventricular failure |
| What is the primary form CO2 is transported in? | bicarbonate (90%) |
| What happens to PaO2, PaCO2, and venous CO2 in response to exercise? | no change in PaO2 and PaCO2 but increase in venous CO2 content |
| Carcinoma with hilar mass arising from bronchus and linked to smoking. | Squamous cell CA |
| Carcinoma with parathyroid-like activity -> PTHrP | Squamous cell CA |
| Histology reveals keratin pearls and intercellular bridges. | Squamous cell CA |
| Lung carcinoma that develops in the site of prior pulmonary inflammation or injury and is the MC lung cancer in nonsmokers and females? | Adenocarcinoma: Bronchial |
| Lung carcinoma is not linked to smoking; grows along airways and can present like pneumonia. | Bronchioloalveolar adenocarcinoma |
| Lung carcinoma that is undifferentiated and very aggressive; often associated with ectopic production of ACTH or ADH. | Small cell (oat cell) carcinoma |
| Lung carcinoma that may lead to Lambert-Eaton syndrome (autoantibodies against calcium channels). | small cell (oat cell) carcinoma |
| Lung carcinoma that is responsive to chemotherapy. | small cell (oat cell) carcinoma |
| Neoplasm of neuroendocrine Kulchitsky cells -> dark blue cells. | small cell (oat cell) carcinoma |
| Cells that stain positive for chromogranin indicate which lung carcinoma? | small cell (oat cell) carcinoma |
| Lung cancer that shows pleomorphic giant cells with leukocyte fragments in the cytoplasm on histology. | large cell carcinoma |
| Lung cancer that secretes serotonin and can cause carcinoid syndrome (flushing, diarrhea, wheezing, and salivation). | carcinoid tumor |
| Carcinoma that occurs in the apex of the lung and may affect cervical sympathetic plexus causing Horner's syndrome. | Pancoast's tumor (superior sulcus tumor) |
| Patient with ptosis, miosis, and anhidrosis has which syndrome? | Horner's syndrome |
| Asbestosis mainly affects which lobes of the lung? | lower lobes |
| Ferruginous bodies in lung indicates which lung pathology? | asbestosis |
| Asbestosis and smoking greatly increase the risk of which cancer? | bronchogenic cancer |
| Which lung pathology is usually seen in shipbuilders, roofers, and plumbers? | asbestosis |
| Which sleep apnea has no respiratory effort? | central sleep apnea |
| Which lung pathology may be caused by trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, or amniotic fluid embolism? | ARDS |
| Which lung pathology has diffuse alveolar damage which increases alveolar capillary permeability so there is protein-rich leakage into alveoli? | ARDS |
| What is the PCWP in ARDS? | normal PCWP |
| Lung cancer that stains positive for neuroendocrine markers, enolase, and synaptophysin. | small cell CA |
| Localized pleural thickening with calcification of parietal pleura of posterolateral mid-lung zones and diaphragm. | asbestosis |
| Panacinar emphysema has what deficiency? | alpha-1-antitrypsin |
| What does an increased A-a gradient indicate? | hypoxemia of pulmonary origin |
| What defect has impaired O2 delivery to the alveoli for gas exchange? | ventilation defect |
| What is an example of ventilation defect? | airway collapse due to respiratory distress syndrome |
| What defect has decreased or absent blood flow to the alveoli? | perfusion defect |
| What is an example of perfusion defect? | pulmonary embolus |
| What defect doesn't allow O2 to diffuse through the alveolar-capillary interface? | diffusion defect |
| What are some examples of diffusion defect? | interstitial fibrosis, pulmonary edema |
| What are some causes of hypoxemia with a normal A-a gradient? | depression of respiratory center in medulla, upper airway obstruction, chest bellows dysfunction |
| What are some examples of depression of the respiratory center in the medulla? | barbiturates and brain injury |
| What are some examples of upper airway obstruction? | cafe coronary (food blocking airway), epiglottitis due to H. influenzae, croup due to parainfluenza virus (narrows the trachea) |
| What are some examples of chest bellows (muscles of respiration) dysfunction? | paralyzed diaphragm, ALS with degeneration of anterior horn cells |
| What is spirometry useful in? | distinguishing restrictive from obstructive lung disease |
| What is the MCC of hemoptysis? | chronic bronchitis |
| What drugs cause cough? | ACEI and ASA |
| How does ASA cause cough? | causes increase in LT C-D-E4 (bronchocontrictors) |
| How do ACEI cause cough? | inhibit degradation of bradykinin, causing mucosal swelling and irritation in tracheobronchial tree |
| What has nocturnal cough? | GERD (acid reflux in tracheobronchial tree at night) and bronchial asthma (bronchoconstriction) |
| Newborn that turns cyanotic when breast-feeding and becomes pink when crys has what? | choanal atresia |
| What is choanal atresia? | unilateral of bilateral bony septum btwn nose and pharynx |
| What is the MC polyp? | allergic polyps |
| Pathogenesis of nasal polyps? | drugs block COX leaving LOX pathway open so LT C-D-E4 increased causing bronchoconstriction |
| What is the clinical triad of nasal polyps? | nonsteroidal drugs, asthma, and nasal polyps |
| What do you order if you see nasal polyps in a child? | sweat test to rule out cystic fibrosis |
| What is the MCC of sinusitis? | upper respiratory infections |
| What is the MC pathogen that causes sinusitis? | S. pneumoniae |
| What causes chronic sinusitis? | rhinoviruses and anaerobes |
| What pathogen commonly causes sinusitis in diabetics? | mucor |
| What is the pathogenesis of sinusitis? | blockage of drainage into nasal cavity |
| What are the clinical findings of sinusitis? | fever, nasal congestion, pain over sinuses |
| What is the most sensitive test for sinusitis? | CT scan |
| What is the sinus involved in adults? | maxillary |
| What is the sinus involved in children? | ethmoid |
| What is the MC malignant tumor of the nasopharynx? | nasopharyngeal carcinoma |
| What pathologic findings occur in nasopharyngeal carcinoma? | squamous cell CA or undifferentiated cancer and metastasizes to the cervical lymph nodes |
| What is the MCC of laryngeal carcinoma? | cigarette smoking |
| What are other risk factors for laryngeal CA? | alcohol (synergistic with smoking), squamous papillomas and papillomatosis (HPV 6 and 11) |
| Where are majority of laryngeal CA located? | true vocal cords |
| What is the histology of laryngeal CA? | keratinizing squamous cell carcinomas |
| What clinical findings are seen in laryngeal carcinoma? | persistent hoarseness often associated with cervical lymphadenopathy |
| What is the MCC of fever 24-36 hours after surgery? | resorption atelectasis |
| What is it called when air or fluid in the pleural cavity under increased pressure collapses small airways beneath the pleura? | compression atelectasis |
| What are examples of compression atelectasis? | tension pneumothorax (air compresses lung) and pleural effusion (fluid compresses lung) |
| In compression atelectasis which way does the trachea deviate? | contralateral side |
| Where is surfactant stored? | lamellar bodies |
| When does surfactant synthesis begin? | 28th week of gestation |
| What is the major component of surfactant? | phosphatidylcholine (lecithin) |
| What increases the synthesis of surfactant? | cortisol and thyroxine |
| What decreases the synthesis of surfactant? | insulin |
| What condition in newborns is due to a decrease in surfactant? | RDS |
| What does the chest radiograph show in RDS? | "ground glass" appearance |
| What are complications of RDS? | superoxide free radical damage from O2 therapy may cause blindness and permanent damage to small airways (bronchopulmonary dysplasia), intraventricular hge, PDA (b/c persistent hypoxemia), necrotizing enterocolitis, hypoglycemia |
| What is hypoglycemia in a newborn due to? | excess insulin in response to fetal hyperglycemia |
| What is the MCC of pulmonary edema? | left sided heart failure |
| Pulmonary edema due to altered Starling pressure (transudate) is due to what? | increased hydrostatic pressure in pulmonary capillaries and decreased oncotic pressure |
| What are examples of increased hydrostatic pressure in pulmonary capillaries? | left sided heart failure, volume overload, mitral stenosis |
| What are examples of decreased oncotic pressure? | nephrotic syndrome, cirrhosis |
| Pulmonary edema due to microvascular or alveolar injury (exudate) is due to what? | infections (sepsis, pneumonia), aspiration (drowning, gastric contents), drugs (heroin), shock, massive trauma, high altitude |
| ARDS is due to what? | acute alveolar-capillary damage |
| What is the MCC of ARDS? | sepsis |
| What are the risk factors for ARDS? | gram-negative sepsis, gastric aspiration, severe trauma with shock, diffuse pulmonary infections, heroin, smoke inhalation |
| What is the pathogenesis of ARDS? | alveolar macrophages release cytokines |
| What are chemotactic to neutrophils? | cytokines |
| How do neutrophils transmigrate into alveoli? | through pulmonary capillaries |
| What causes leakage of protein-rich exudate producing hyaline membranes? | capillary damage |
| What do neutrophils damage? | type I and II pneumocytes |
| Decrease in surfactant causes what? | atelectasis with intrapulmonary shunting |
| What are the clinical findings to ARDS? | dyspnea with severe hypoxemia not responsive to O2 therapy, acute respiratory acidosis |
| MCC of typical community-acquired pneumonia? | streptococcus pneumoniae |
| Pathogenesis of typical community-acquired pneumonia? | inhalation of aerosol from an infected patient, aspiration of nasopharyngeal flora while sleeping |
| What begins as an acute bronchitis and spreads locally into the lungs? | bronchopneumonia |
| What usually involves the lower lobes or right middle lobe? | bronchopneumonia |
| What has patchy areas of consolidation in the lung? | bronchopneumonia |
| What is in the patchy areas of consolidation in the lung? | microabscesses |
| What has complete or almost complete consolidation of a lobe of lung? | lobar pneumonia |
| What are the complications of pneumonia? | lung abscess, empyema (pus in the pleural cavity), sepsis |
| What are the clinical findings of pneumonia? | sudden onset of high fever with productive cough, signs of consolidation (alveolar exudate) |
| What are the signs of consolidation? | dullness to percussion, increased vocal tactile fremitus, inspiratory crackles |
| What is the gold standard for diagnosing pneumonia? | chest radiograph |
| What are the lab findings in pneumonia? | positive gram stain, neutrophilic leukocytosis |
| What is the MCC of atypical pneumonia? | mycoplasma pneumoniae |
| What are other pathogens that cause atypical pneumonia? | C. pneumoniae (TWAR agent), viruses (RSV, influenza, adenovirus), C trachomatis (newborns) |
| What is the pathogenesis of atypical pneumonia? | inhalation (droplet infection) |
| What is patchy interstitial pneumonia? | atypical pneumonia |
| What does patchy interstitial pneumonia have? | mononuclear infiltrate, alveolar spaces usually free of exudate |
| What are the findings of atypical pneumonia? | insidious onset, low-grade fever, nonproductive cough, flu-like symptoms (pharyngitis, laryngitis, myalgias, headache, no signs of consolidation |
| What are the risk factors for nosocomial pneumonia? | severe underlying disease, antibiotic therapy, immunosuppression |
| What is the MCC of nosocomial pneumonia? | respirators |
| What are the pathogens that cause nosocomial pneumonia? | gram-negative bacteria (pseudomonas aeruginosa (respirators), E. coli, gram-positive bacteria (e.g. staph aureus) |
| Pneumonia in immunocompromised hosts is a complication of what? | AIDS and bone marrow transplants |
| What is the MC pathogen causing pneumonia in the immunocompromised? | pneumocystis jiroveci |
| What are common opportunistic infections that cause pneumonia in the immunocompromised? | CMV, P. jiroveci, aspergillus fumigatus |
| What is the treatment and prophylaxis of P. jiroveci? | TMP-SMX |
| Where is primary TB? | subpleural - upper lower lobes or lower upper lobes |
| What usually is the result of primary TB? | usually resolves and produces calcified granuloma or area of scar tissue |
| What is secondary TB due to? | reactivation of previous primary TB site |
| What is the location of secondary TB? | involves one or both apices in upper lobes |
| Where is ventilation (oxygenation) the greatest in secondary TB? | upper lobes |
| What is the cavitary lesion due to in secondary TB? | release of cytokines from memory T cells |
| What are the clinical findings of secondary TB? | fever, drenching night sweats, weight loss |
| What are the complications of secondary TB? | miliary spread in lunds due to invasion into bronchus or lymphatics, miliary spread to extrapulmonary sites, massive hemoptysis, branchiectasis, scar carcinoma, and granulomatous hepatitis, spread to vertebra (Pott's disease) |
| What is the MC extrapulmonary site of TB? | kidneys |
| What is miliary spread to extrapulmonary sites due to? | invasion of pulmonary vein tributaries |
| When does mycobacterium avium-intracellulare complex (MAC) occur in AIDS? | when CD4 Th count falls below 50 cells/uL |
| What are lung abscesses most often due to? | aspiration of oropharyngeal material (e.g. tonsillar material) |
| What are the oropharyngeal material? | aerobic and anaerobic streptococci and Staph, Prevotella, Fusobacterium |
| How do patients aspirate on oropharyngeal material? | depressed cough reflexes (e.g. after anesthesia) |
| What is the MCC of the common cold transmitted by hand to eye-nose contact? | rhinovirus |
| What is the MC viral cause of atypical pneumonia and bronchiolitis (wheezing) in children occurring in late fall and winter? | RSV |
| MCC of croup (laryngotracheobronchitis) in infants? | parainfluenza |
| What is the clinical finding in croup? | inspiratory stridor (upper airway obstruction) due to submucosal edema in trachea |
| What is seen on anterior x-ray of the neck in croup? | "steeple sign" representing mucosal edema in trachea (site of obstruction) |
| Common pneumonia in immunocompromised host? | CMV |
| Enlarged alveolar macrophages/pneumocytes, contain basophilic intranuclear inclusions surrounded by a halo describes which pathogen? | CMV |
| Which influenza viruses are most often involved? | influenza A |
| What binds the virus to the cell receptors in the nasal passages? | hemagglutinin |
| What dissolves mucus and facilitates the release of viral particles? | neurominidase |
| What may be complicated by a superimposed bacterial pneumonia (usually S. aureus)? | influenza A pneumonia |
| What has fever, cough, conjunctivitis, and excessive nasal mucus production with Koplik spots in the mouth preceding onset of rash? | Rubeola |
| What is the characteristic finding for Rubeola? | Warthin-Finkeldey multinucleated giant cells |
| What is the 2nd MCC of atypical pneumonia? | C. pneumonia |
| What occurs in newborn pneumonia (passage through birth canal), afebrile, stocatto cough (choppy cough), conjunctivitis, hepatitis? | C. trachomatis |
| What is the only rickettsia transmitted without a vector? | Coxiella burnetti |
| What is contracted by dairy farmers and veterinarians? | Coxiella burnetti |
| What is the MCC of atypical pneumonia? | M. pneumoniae |
| What are the clinical findings in atypical pneumonia? | insidious onset with low-grade fever |
| What are seen in the blood is atypical pneumonia? | cold agglutinins |
| What are the complications of M. pneumonia? | bullous myringitis, cold autoimmune hemolytic anemia due to anti-IgM antibodies |
| What is the MCC of typical CAP? | s. pneumonia |
| What has rapid onset, productive cough and signs of consolidation? | s. pneumonia |
| Gram-positive coccus in clumps that produces yellow sputum? | s. aureus |
| What is commonly superimposed on influenza pneumonia and measles pneumonia? | s. aureus |
| Major lung pathogen in cystic fibrosis and IV drug abusers? | s. aureus |
| Hemorrhagic pulmonary edema, abscess formation, and tension pneumatocyts (intrapleural blebs), which may rupture and produce tension pneumothorax? | s. aureus |
| Gram-positive rod whose toxin inhibits protein synthesis by ADP-ribosylation of EF2 involved in protein synthesis? | C. diphtheria |
| What does C. diphtheria's toxin also impair in the heart? | B-oxidation |
| What does C. diphtheria's toxin produce? | pseudomembranous inflammation and shaggy gray membranes in oropharynx and trachea |
| What gram-negative rod is a common cause of sinusitis, OM, and conjunctivitis (pink eye)? | H. influenza |
| What clinical finding may occur in acute epiglottitis? | inspiratory stridor |
| What is seen on lateral x-ray of the neck in H. influenza? | thumbprint sign |
| What is the MC bacterial cause of acute exacerbation of COPD? | H. influenza |
| Gram-negative diplococcus that is a common cause of typical pneumonia especially in the elderly? | Moraxella catarrhalis |
| Second MC pathogen causing acute exacerbation of COPD? | Moraxella catarrhalis |
| Moraxella catarrhalis is a common cause of what? | chronic bronchitis, sinusitis, and OM |
| Gram-negative rod that causes green sputum? | pseudomonas aeruginosa |
| MCC of nosocomial pneumonia and death due to pneumonia in CF? | pseudomonas aeruginosa |
| Pneumonia often associated with infarction due to vessel invasion? | pseudomonas aeruginosa |
| Gram-negative fat rod surrounded by a mucoid capsule? | Klebsiella pneumoniae |
| MC gram-negative organism causing lobar pneumonia and typical pneumonia in elderly patients in nursing homes? | klebsiella pneumoniae |
| Common cause of pneumonia in alcoholics and associated with blood-tinged, thick, mucoid sputum? | klebsiella pneumonia |
| What is common in klebsiella pneumonia | lobar consolidation and abscess formation |
| Gram-negative rod that requires IF stain or Dieterle silver stain to identify in tissue? | legionella pneumophila |
| What may legionella produce as a consequence? | tubulointerstitial disease w/ destruction of JG app leading to hyporeninemic hypoaldosteronism (type 4 RTA - hyponatremia, hyperkalemia, metabolic acidosis) |
| Budding yeast with narrow-based buds surrounded by a thick capsule? | cryptococcus neoformans |
| MC opportunistic fungal infection? | cryptococcus neoformans |
| Fruiting body and narrow-angles (45 degrees), branching septate hyphae? | aspergilllus fumigatus |
| Cause of massive hemoptysis? | aspergillus fumigatus |
| Vessel invader with hemorrhagic infarctions and a necrotizing bronchopneumonia? | aspergillus fugimatus |
| Wide-angled hyphae (>45 degrees) without septa? | mucor species |
| Vessel invader and produces hemorrhagic infarcts in lung? | mucor species |
| Spherules with endospores in tissues contracted by inhaling arthrospores in dust? | coccidioides immitis |
| Flu-like symptoms and erythema nodosa and increased after earthquakes? | coccidioides immitis |
| MC systemic fungal infection? | histoplasma capsulatum |
| Fungal infection endemic in Ohio and central Mississippi River valleys? | histoplasma capsulatum |
| Inhalation of microconidia in dust contaminated with excreta from bats or chickens? | histoplasma capsulatum |
| What are yeast forms of histoplasma capsulatum? | macrophages |
| What is the MCC of multiple calcification in the spleen? | histoplasma capsulatum |
| Yeasts have broad-based buds and nuclei? | Blastomyces dermatitidis |
| Occurs in Great Lakes and central and SE US and skin lesions stimulate squamous cell carcinoma? | blastomyces dermatitidis |
| Cysts and trophozoites present and cysts attach to type I pneumocytes? | pneumocystis jiroveci |
| Where are the lung abscesses due to aspiration primarily located? | right side |
| What has spiking fever with productive cough and chest radiograph shows cavitation with air-fluid level? | lung abscess |
| MC site for aspiration? | superior segment of right lower lobe |
| Where do majority of pulmonary thromboemboli originate? | femoral vein |
| What protects the lungs from infarction? | bronchial arteries |
| What are potential consequences of pulmonary artery occlusion? | increase in pulmonary artery pressure, decrease blood flow to pulmonary parenchyma which may lead to hemorrhagic infarction |
| What produces a pleural friction rub? | pleural surface with fibrinous exudate |
| What causes sudden increase in pulmonary artery pressure and produces acute right ventricular strain and sudden death? | saddle embolus |
| What's MC symptom and sign are dyspnea and tachypnea? | pulmonary infarction |
| What causes pleuritic chest pain (pain on inspiration), friction rub, and effusion? | pulmonary infarction |
| What are the lab findings with pulmonary infarction? | respiratory alkalosis (arterial pCO2 <33 mmHg), paO2 <80 mmHg, inc A-a gradient, abnormal perfusion radionuclide scan, and positive D-dimers |
| What is the gold standard confirmatory test in pulmonary infarction? | pulmonary angiogram |
| What is the V and Q in pulmonary infarction? | ventilation scan = N, perfusion scan = abnormal |
| What is the main cause of secondary PH? | respiratory acidosis and/or hypoxemia |
| How are restrictive lung diseases characterized? | reduced TLC in presence of normal or reduced expiratory flow rate |
| What chest wall disorders in the presence of normal lungs cause restrictive lung disease? | kyphoscoliosis, pleural disease (e.g. mesothelioma), obesity |
| 2 examples of chronic interstitial disease? | fibrosing disorders (e.g. pneumoconiosis) and granulomatous disease (e.g. sarcoidosis) |
| What is the earliest manifestation of interstitial fibrosis? | alveolitis |
| What causes alveolitis? | leukocytes release cytokines which stimulate fibrosis |
| What happens with compliance and elasticity in restrictive lung disease? | decreased compliance and increased elasticity |
| What do the chest radiographs show in interstitial fibrosis? | diffuse bilateral reticulonodular infiltrates |
| What is the FEV1/FVC ratio in restrictive lung disease? | increased |
| What is inhalation of mineral dust? | pneumoconioses |
| What does mineral dust include? | coal dust, silica, asbestos, and beryllium |
| What particle size reach the bifurcation of the respiratory bronchioles and alveolar ducts? | 1-5-um particles |
| What particle size reach the alveoli and are phagocytosed by alveolar MPs? | <0.5-um particles |
| What is the least fibrogenic particle? | coal dust |
| What are very fibrogenic particles? | silica, asbestos, and beryllium |
| What are alveolar MPs with anthracotic pigment called? | dust cells |
| Black lung disease? | complicated CWP (coal worker's pneumonia) |
| What syndrome may occur with complicated CWP? | caplan syndrome - CWP + large cavitating rheumatoid nodules in lung |
| MC occupational disease in world? | silicosis |
| What is highly fibrogenic and deposits in the upper lungs? | quartz (crystalline silicone dioxide) |
| Where is quartz found? | foundaries (casting metal), sandblasting, working in mines |
| Nodular opacities contain collagen and quartz describes what? | silicosis |
| What has "egg-shell" calcification in the hilar nodes (rim of dystrophic calcification in the nodes)? | silicosis |
| What complications occur in silicosis? | cor pulmonale, caplan syndrome, and increased risk for lung cancer and TB |
| Where do asbestos fibers deposit? | respiratory unit (respiratory bronchioles, alveolar ducts, alveoli) |
| What are the sources of asbestos? | insulation around pipes in old naval ships, roofing material used >20 yrs ago, demolition of old buildings |
| Nuclear and aerospace industry? | berylliosis |
| MC noninfectious granulomatous disease of the lungs? | sarcoidosis |
| In sarcoidosis, where are the granulomas located? | interstitium and mediastinal and hilar nodes |
| In sarcoidosis, what do the granulomas contain? | multinucleated giant cells which contain laminated calcium concretions (Schaumann bodies) and stellate inclusions (asteroid bodies) |
| What produces erythema nodosum? | coccidioides immitis and sarcoidosis |
| Violaceous rash on the nose and cheeks (called lupus pernio) occurs in what disease? | sarcoidosis |
| In sarcoidosis what endocrine disorder is associated? | diabetes insipidus |
| What other findings besides increased ACE and hypercalcemia are found in sarcoidosis? | polyclonal gammopathy and cutaneous anergy (consumption of CD4 Th cells in granulomas and loss of cells in alveolar secretions) |
| What is the chest radiograph of sarcoidosis? | enlarged hilar and mediastinal lymph nodes ("potato nodes") and reticulonodular densities throughout lung parenchyma |
| Lung has a honeycomb appearance describes which disease? | idiopathic pulmonary fibrosis |
| Any unexplained pleural effusion in a young woman is what until proven otherwise? | SLE |
| What is one of the key criteria for diagnosing SLE? | presence of serositis (pleuritis w/ pleural effusion) |
| What is the antigen in farmer's lung? | thermophilic actinomyces in moldy hay |
| Inhalation of wheat weevil protein describes what disease? | silo filler's disease |
| Contact with cotton, linen and hemp products and occurs in textile workers? | byssinosis |
| Workers develop "Monday morning blues"? | byssinosis |
| Drugs associated with interstitial fibrosis? | amiodarone, bleomycin and busulfan, cyclophosphamide, MTX and mehtysergide, nitrosurea and nitrofurantoin |
| What targets the respiratory unit? | emphysema |
| What is the MCC of emphysema? | cigarette smoking |
| Destruction of the tistal terminal bronchioles and RBs describe what? | centriacinar (centrilobular) emphysema |
| What is the genetic phenotype that causes AAT deficiency in panacinar emphysema? | ZZ phenotype |
| What lobes are affected in centriacinar emphysema? | upper lobes |
| What lobes are affected in panacinar emphysema? | lower lobes |
| Pink puffers describes what disease? | emphysema |
| Localized disease in subpleural location that has increased incidence of spontaneous pneumothorax? | paraseptal emphysema |
| Localized disease is associated with scar tissue describes which emphysema? | irregular emphysema |
| Productive cough for at least 3 mos for 2 consecutive years describes what? | chronic bronchitis |
| What is the MCC of chronic bronchitis? | smoking cigarettes |
| Blue bloaters describes what disease? | chronic bronchitis |
| What is the acid/base in chronic bronchitis? | chronic resiratory acidosis and hypoxemia |
| What is the episodic and reversible airway disease? | asthma |
| What do eosinophils release? | major basic protein and cationic protein that damage epithelial cells and produce airway constriction |
| What does acetylcholine do in extrinsic asthma? | causes airway muscle contraction |
| What histologic changes occur in the terminal bronchioles that form spiral-shaped mucus plugs? | shed epithelial cells called curschmann spirals |
| Curschmann spirals are a pathologic effect of? | major basic protein and cationic protein |
| In asthma, what do crystalline granules in eosinophils coalesce to form? | charcot-leyden crystals |
| Treatment of mild asthma? | metered-dose inhaler with B2-agonist (e.g. albuterol) |
| Treatment of advanced asthma? | metered low-dose inhaler with corticosteroids and use of leukotriene inhibitors |
| Intrinsic asthma is due to what? | virus-induced respiratory infection, air pollutants, ASA or NSAID, stress, exercise, cigarette smoke |
| Patient has productive cough of copious sputum (often cupfuls), with digital clubbing and cor pulmonale? | bronchiectasis |
| What is the MCC of metastatic lung CA? | primary breast cancer |
| What is the MC site of mediastinal masses? | anterior compartment |
| MC primary mediastinal masses? | neurogenic tumors |
| What is most often associated with myasthenia gravis? | thymomas |
| What are other thymoma associations? | hypogammaglobulinemia, pure RBC aplasia, increased incidence of autoimmune disease (e.g. Graves' disease) |
| What can develop with bronchiectasis? | aspergillosis |
| What hemoglobin form has low affinity for O2? | taut |
| What lung product activates bradykinin? | kallikrein |
| What do pulmonary arteries carry? | deoxygenated blood from the right side of the heart |
| Black discoloration in the lungs indicates what? | carbon |
| Treatment of H. influenzae? | macrolide - bind p site of the 50S ribosomal subunit interfering with bacterial protein synthesis |
| Causes of right shift oxygen dissociation curve? | decrease pH, increase lactic acid, increase temp, increase pCO2, increase 2,3-BPG |
| Minute alveolar ventilation equation? | (tidal volume - dead space) x RR |
| Hyperventilation leads to what lab values? | decreased arterial pCO2 and increased pH |
| What happens to cerebral flow during hyperventilation? | decreased flow and increased resistance |
| Treatment of strep pneumo? | azithromycin or cefuroxime |
| Anemic patient has decreased levels of what? | mixed venous O2 |
| In emphysema what levels are changed with supplemental oxygen? | increase paO2, increase pAo2, increase A-a gradient and no change in diffusion |
| Acute aspirin poisoning develops what? | respiratory alkalosis: increased pH and decreased HCO3- |
| Tumors that are peripheral and cause coin lesions are what? | adenocarcinoma, bronchioalveolar CA, and large cell CA |
| Treatment of CAP Strep pneumonia? | azithromycin |
| Nasal mucosa supply? | sphenopalatine artery - terminal branch of maxillary artery which branches off external carotid artery |
| If alveolar ventilation is doubled, what happens to alveolar pCO2? | decreased by 2 |
Created by:
eandres1
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