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Respi_Kaplan

QuestionAnswer
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