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Respiratory
Overall by section
| Question | Answer |
|---|---|
| What conditions during fetal development may increase the risk for NRDS? | Prematurity and Gestational diabetes mellitus |
| What physical feature may be expected of a neonate or fetus, with a mother with Gestational DM with hyperglycemia? | Neonate may be larger than expected for their gestational age |
| What is the equation for Alveolar gas pressure? | PAO2 = [FiO2 x (Patm - P water)] - (PCO2/RespQ) |
| What are physical features or clinical manifestations of NRDS? | Tachypnea, increased work of breathing, and grunting during expiration |
| What condition in neonates is often seen with grunting during expiration? | NRDS |
| What is the histological description of Type II pneumocytes? | Cuboidal cells that are inter-spread within the wall of the alveoli |
| What substance is produced by Type II pneumocyte? | Surfactant |
| Which type, I or II, pneumocytes produce surfactant? | Type II pneumocytes |
| Surfactant is produced by --> | Type II pneumocytes |
| Are type II pneumocytes cuboidal or columnar cells? | Cuboidal cells |
| What enzyme is inhibited by Zileuton? | 5-lipoxygenase |
| What conversion process is blocked by Zileuton? | Conversion of arachidonic acid to leukotrienes |
| Do leukotrienes cause bronchoconstriction or bronchodilation? | Bronchoconstriction |
| Which chronic condition is often treated with Zileuton? | Asthma |
| Air in pleural space? | Pneumothorax |
| What is Pneumothorax? | Air in the pleural space |
| What are the classic clinical findings of Pneumothorax? | Sudden onset of chest pain, SOB, and hyperresonance on percussion |
| What is the classic auscultation finding of Pneumothorax? | Hyperresonance on percussion |
| What condition is often presented with SOB, sudden chest pain, rapid breathing, and hyperresonance on percussion of the chest? | Pneumothorax |
| What direction does air flow in pneumothorax lead to crushing chest pain and dyspnea? | Aire enter the pleura from the outside, causing a rise in intrapleural pressure to atmospheric levels |
| What condition is known to cause intrapleural pressure to rise to the level of atmospheric pressure? | Pneumothorax |
| Which pulmonary (thorax) pressure is decreased in Pneumothorax? | Transpulmonary pressure |
| What is the result of the decreased transpulmonary pressure in Pneumothorax? | Collapse of lungs |
| How does the body adapt to high altitude? | RBCs increase production of 2,3-BPG |
| How does the increase in 2, 3-BPG help in adapting to high altitude? | Shifts the oxygen-hemoglobin dissociation curve to the right and releases more oxygen to the tissues |
| What condition may be developed in a person travelling from Houston to Aspen, to spend the weekend skiing? | Acute Mountain sickness |
| Does an increase or decrease in 2, 3-BPG lead to a right shift and increase release of oxygen to tissues? | Increase in 2, 3-BPG |
| Which form of hemoglobin will be increased or prominent in a setting of increased levels of 2,3-BPG? | T(deoxy) hemoglobin |
| What kind of poisoning may be seen in household fire? | Cyanide poisoning |
| How does CN poisoning cause inhibition of the ETC? | CN strongly binds to iron in the complex IV of the ETC |
| What are the main clinical features of CN poisoning? | Headache, vomiting, flushing, bright red vessels on fundoscopy, and acrid, almond-like breath |
| What condition is often associated with acrid, almond-like poisoning? | Cyanide poisoning |
| Which adrenergic receptor agonists are used in treating ACUTE asthma attacks? | Beta-2 agonists |
| What is a quite common Beta-2 agonist used to treat acute asthmatic attacks? | Albuterol |
| Which "G-protein pathway" is stimulated by Beta-2 agonists? | Gs pathway |
| In normal respiration, are intrapleural pressures positive or negative? | Negative |
| Having a positive intrapleural pressure, is it considered normal or abnormal? | Abnormal |
| When in "ok" or normal to have a positive intrapleural pressure? | Forced expiration, due to compression of airways |
| Which arterial body may be compressed in conditions of increased intra-abdominal pressure? | Inferior Vena Cava |
| At what point does the IVC cross the diaphragm? | T8 |
| Which vein is known to traverse the diaphragm at the T8 level? | Inferior Vena Cava |
| The _________ traverses the diaphragm at T8, directly passing through the central tendon of the diaphragm. | Inferior Vena Cava |
| What is the MCC of death in neonate with a congenital diaphragmatic hernia? | Pulmonary hypoplasia |
| What causes Pulmonary hypoplasia in neonates with Congenital Diaphragmic hernia? | Impaired growth and inflation of the newborn's lungs as result of compression for herniated bowel |
| Which type of acid-base disorder is caused by COPD? | Respiratory acidosis |
| What causes respiratory acidosis in COPD? | Build-up of CO2 in the lungs, as it then is converted into bicarbonate |
| Which respiratory cells are affected by COVID-19 infection? | Type II pneumocytes |
| How does COVID-19 enter cells and infect them? | By interaction with ACE-II, and interferon-induced gene expressed on type 2 pneumocytes |
| What is secreted by type II pneumocytes? | Surfactant |
| How is the diagnosis of Asthma confirmed histologically? | Evidence of epithelia shedding and double-pointed needlelike crystals in the sputum |
| What is the classic finding in the sputum of an asthmatic person? | Double-pointed needle-like crystals |
| Are short- or long-acting B2-agonists the first line of treatment of acute asthma? | Short acting B2 agonists |
| How do Short-acting B2-agonists help treat acute exacerbation of asthma? | Relaxation of bronchial smooth muscle |
| What is the cascade of events resulting from B2 receptor activation of the Gs pathway? | Activation of adenylyl cyclase, leading to cAMP formation, and subsequent PKA activation. |
| What is the most effective treatment for acute asthma exacerbation, if B2-agonists are not enough? | Glucocorticoids (steroids) |
| Which pathway is inhibited by Glucocorticoids? | Phospholipase A2 formation |
| How is Methemoglobinemia clinically manifested? | Cyanosis, chocolate-colored blood, and decreased oxygen saturation |
| What is the cause of Methemoglobinemia? | Nitroglycerin |
| What condition is characterized by the increase concentration of Fe3+ instead of Fe2+ in the blood? | Methemoglobinemia |
| A state of acidosis, will cause a __________ -shift to the Oxygen-Hemoglobulin dissociation curve? | Right |
| What is the main controller for respiratory drive? | Low arterial pressure of oxygen (PaO2) |
| PaO2 is the main controller/indicator for: | Respiratory drive |
| What are some common causes of ARDS? | Sepsis, pneumonia, aspiration, trauma, acute pancreatitis, and blood transfusion |
| Which changes in blood oxygen/CO2 levels are experienced due to vigorous exercise? | Drop in mixed venous oxygen saturation |
| Why is there a fall or drop in the venous oxygen saturation in a person during vigorous exercise? | Increase oxygen is extracted from blood by the muscles |
| What is the direct effect of Chronic anemia, especially in young menstruating women? | Increase production of 2, 3-BPG |
| To which side is the Oxygen-Hemoglobulin dissociation curve shifts in cases of chronic anemia? | Rightward shift |
| Why is aspiration by a foreign object more likely in the right bronchus? | Right main bronchus is more vertical and wider than the left |
| Where is the place to find an aspirated object in a kid while standing or sitting down? | Right middle of inferior lobe |
| What is PNH? | Acquired clonal stem cell disorder characterized with anemia and "cola-colored" urine in the morning |
| What proteins and receptors are unable to bind in PNH? | GPI cannot bind to CD55 and CD59 |
| What is the result of the failed binding of GPI to CD55 and CD59 in PNH? | Failure to protect the RBCs from complement-mediated lysis |
| What is a potential oral complication of inhaled corticosteroid use? | Oral candidiasis |
| How can oral candidiasis, from inhaled corticosteroid use, be prevented? | Rinsing the mouth after inhalation |
| Inhibition of NF-kB, is often part of the MOA of which type of medication? | Corticosteroids |
| Which transcription factor is known to be inhibited by corticosteroids? | NF-kB |
| What are two important complications of Acute Mountain Sickness? | HACE (High Altitude Cerebral Edema) and HAPE (High Altitude Pulmonary Edema) |
| How is HACE from AMS clinically presented? | Ataxia, confusion, and coma |
| Which hypersensitivity reaction(s) is "hypersensitivity pneumonitis"? | Combination to type III and type IV hypersensitivity reactions |
| Obstructive or Restrictive lung disease: Hypersensitivity pneumonitis? | Restrictive lung disease |
| What is the pathogenesis of ARDS? | Capillary damage from neutrophil cytokine and protease release, which leads to fluid extravasating from capillaries into the alveoli |
| What kind of hypertrophy is seen in Primary hypertension? | Concentric hypertrophy, causing thickening of the ventricle which reduces chamber volume |
| What are two of the most common causes of Concentric hypertrophy of the left ventricle? | Aortic stenosis and long-standing hypertension |
| What type of hypertrophy is expected in states in which there is a high afterload? | Concentric LV hypertrophy |
| Is Lambert-Eaton Muscular syndrome associated with increased weakness or strength with use? | Increased muscle strength with use |
| If a patient with muscular dystrophy experiences an increase in muscle strength with use, is it more likely to LEMS or MG? | Lambert-Easton Muscular dystrophy |
| What is affected or attached by antibodies in LEMS? | Antibodies that inhibit the presynaptic calcium channels at the NMJ |
| LEMS or MG: affect presynaptic Ca2+ channels at the NMJ? | Lambert-Eaton Muscular dystrophy |
| Which parts of the body is lymph fluid NOT drained by the Thoracic duct? | Right arm, the right side of the thorax, and the right head and neck region |
| The right arm lymph is drained by which structure? | Right lymphatic duct |
| What type (composition) of kind stones are due to lung cancers? | Calcium kidney stones |
| What is the most common cause of malignant hypercalcemia in lung cancer? | PTHrP secretion |
| What are the cells associated with Small Cell lung cancer? | Neuroendocrine Kulchitsky cells |
| What are the most common paraneoplastic syndromes associated with Small Cell lung carcinoma? | ACTH, ADH, and LES |
| IS Small Cell Lung cancer associated with Squamous cell cancer of the lung or small cell lung cancer? | Small cell lung carcinoma |
| What are the 3 main symptoms of Horner syndrome? | Ptosis, anhidrosis, and miosis |
| What is a vascular complication that may occur due to Apical lung tumors? | Compress SVC, causing facial welling and JVD |
| What AR disorder is strongly associated with Bronchiectasis? | Cystic Fibrosis |
| How is Bronchiectasis clinically presented? | Children with recurrent pneumonia, purulent cough, and hemoptysis |
| Wath are the most common signs and symptoms of acute pulmonary embolism? | 1. Acute onset of pleuritic chest pain 2. Dyspnea and tachycardia 3. Hypoxemia 4. (+) d-dimer test |
| What condition is often associated with the production of Pulmonary Embolisms? | Protein C/S deficiency |
| What is the result of air trapping in COPD? | Chronic inflammation and destruction of alveolar tissue, which increase alveolar dead space, preventing Oxygen-Carbon dioxide exchange |
| What is a possible cause of COPD in a patient with a negative history of smoking? | Alpha 1-antitrypsin deficiency |
| What COPD condition is associated with alpha 1-antitrypsin deficiency? | Panacinar emphysema |
| What deficiency is associated with Panacinar emphysema and cirrhosis? | Alpha 1-antitrypsin deficiency |
| What is the associated pulmonary condition of Scleroderma? | Pulmonary arterial hypertension |
| What causes Pulmonary arterial hypertension (PAH) in cases such as Scleroderma? | Arteriolar destruction fibrotic narrowing due to immune activation, vascular destruction, and fibrosis |
| What are common associations and complications of chronic hypoxia? | 1. Increased EPO production 2. Secondary Erythrocytosis |
| What are some clinical consequences of tension pneumothorax? | Hypotension, tachycardia, and mediastinal shift away from the loss of breath sounds on the affected side |
| What is a distinctive cardiologic feature of ARDS? | Cardiogenic pulmonary edema is absent in ARDS, and the hypoxia is entire due to lung pathology |
| What is distinctive of the developed hypoxemia in ARDS? | It is entirety due to lung pathology, and does not have a cardiogenic component |
| What are the clinical features of Psittacosis? | Abrupt onset of symptoms and an unliteral lower lobe infiltrate |
| Which sinuses are palpated inferior to the eye and lateral to the nose? | Maxillary sinuses |
| Which sinuses, anatomically, are immediately lateral to the eyes? | Ethmoidal sinuses |
| Which bacterium is associated with surface protein A virulence factor? | S. aureus |
| How does the Protein A virulence factor work? | Binds to Fc portion of antibodies, blocking opsonization. |
| What is the 1st-line of therapy for a Pulmonary Embolism? | Low-Molecular Weight-Heparin |
| MOA of LMWH | Potentiates antithrombin III, which is done by inhibition of factor Xa |
| Which anticoagulant is known to be administered subcutaneously and does not require monitoring? | Low-Molecular Weight-Heparin |
| Which enzyme is inhibited by Etoposide? | Topoisomerase II |
| What are common adverse effects of Etoposide? | Alopecia, myelosuppression, and diarrhea |
| Which is the distinctive adverse effect of Etoposide? | Alopecia |
| Which thyroid cancer is associated with RAS oncogene? | Follicular thyroid cancer |
| Which organs systems are affected by Eosinophilic granulomatosis with polyangiitis? | Upper respiratory, neurologic, renal, and skin diseases |
| To which autoantibody is Eosinophilic granulomatosis with polyangiitis positive to? | p-ANCA |
| How is unstable angina presented? | New onset chest pain at result with increased frequency or inhibits limits activity |
| What is an added risk of patients with underlying malignancies? | Higher risk of developing acute pulmonary embolism |
| What is the pathology of a pulmonary embolism? | Absent perfusion |
| Which paraneoplastic syndrome is associated with small cell lung carcinoma, that often relates to development of abdominal streae? | Cushing syndrome |
| Histological description of Smal cell lung carcinoma? | Small, dark blue cells with epithelial and neuroendocrine markers |
| What is an important associated with chronic severe asthma? | Airway remodeling, which leads to fibrotic airway changes that no longer responds to B2-agonists |
Created by:
rakomi
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