Comlex/usmle Step 1 Review: Pulmonary

Front 1

what makes up the conducting zone of the respiratory tree

Back 1

nose, pharynx, trachea, bronchi, bronchioles, terminal bronchioles

Front 2

what makes up the respiratory zone of the respiratory tree

Back 2

respiratory bronchioles, alveolar ducts, and alveoli

Front 3

where does gas exchange take place in the respiratory tree

Back 3

in the respiratory zone (respiratory bronchioles, alveolar ducts, and alveoli)

Front 4

how do the trachea/bronchi differ histologically from the bronchioles

Back 4

No cartilage in the bronchioles

Front 5

pneumocytes are made of what epithelium

Back 5

pseudostratified ciliated columnar epithelium

Front 6

goblet cells extend to what part of the respiratory tree

Back 6

bronchi

Front 7

function of type I pneumocytes

Back 7

gas diffusion

Front 8

function of type II pneumocytes

Back 8

makes surfactant

Front 9

function of surfactant

Back 9

decrease alveolar surface tension

Front 10

these special cells in the lung are nonciliated, contain secretory granules, secrete a component for making the surfactant, and help degrade toxins

Back 10

Clara cells

Front 11

what ratio is examined during amniocentesis to assess the fetal lung maturity levels

Back 11

lecithin/sphingomyelin ratio (should be >2)

Front 12

which pulmonary vessel contains deoxygenated blood and originates from the R ventricle

Back 12

pulmonary artery

Front 13

which pulmonary vessel contains oxygenated blood and travels to the L atrium

Back 13

pulmonary vein

Front 14

which lung more commonly traps inhaled foreign objects and why

Back 14

the R lung because it's wider, shorter, and more vertical than in the L lung

Front 15

aspirating a peanut while standing will most likely become lodged where in the lung

Back 15

lower portion of the R inferior lobe

Front 16

aspirating a peanut while supine will most likely become lodged where in the lung

Back 16

superior portion of the R inferior lobe

Front 17

what is the relationship to the R and L pulmonary artery to the R and L main bronchi

Back 17

the R pulmonary artery is anterior to the R bronchus, and the L pulmonary artery is superior to the L main bronchus (pneumonic: RALS)

Front 18

what structure perforate the diaphragm at what levels

Back 18

T8: IVC
T10: esophagus and vagus n.
T12: aorta, thoracic duct, azygous vein

(pneumonic: I 8 10 Eggs At 12)

Front 19

innervation to the diaphragm

Back 19

phrenic nerve (C3-C5)

Front 20

what's the main muscle of inspiration during quiet breathing

Back 20

diaphragm

Front 21

what's the main muscle of expiration during quiet breathing

Back 21

there is no specific muscle- just passive motion

Front 22

what are the main muscles of inspiration during exercise

Back 22

diaphragm, external intercostals, scalenes, SCM

Front 23

what are the main muscles of expiration during exercise

Back 23

rectus abdominus, internal/external obliques, transversus abdominis, and internal intercostals

Front 24

main component of surfactant

Back 24

dipalmitoyl phosphatidylcholine (lecithin)

Front 25

surfactant is deficient in what neonatal respiratory condition

Back 25

neonatal respiratory distress syndrome (RDS)

Front 26

the tendency for the lung to collapse on expiration as radius decreases is known as what

Back 26

Law of Laplace

Front 27

what is histamine's effect on the lung

Back 27

bronchoconstriction

Front 28

what endogenous hormone activates bradykinin

Back 28

kallikrein

Front 29

air in the lung after maximal exhalation

Back 29

residual volume

Front 30

what lung volume can NEVER be DIRECTLY measured

Back 30

residual volume

Front 31

TLC - VC = ?

Back 31

residual volume

Front 32

lung volume that moves into and out of the lung with normal respiration

Back 32

tidal volume

Front 33

what is the normal tidal volume

Back 33

500mL

Front 34

total amount of air possible for inspiration

Back 34

inspiratory capacity

Front 35

excess air on top of the tidal volume that can be inspirated

Back 35

inspiratory reserve volume

Front 36

TV + IRV = ?

Back 36

IC

Front 37

lung volume left in the lung after normal respiration

Back 37

functional residual capacity (FRC)

Front 38

excess air that can still be breathed out after normal expiration

Back 38

expiratory reserve volume (ERV)

Front 39

RV + ERV = ?

Back 39

FRC

Front 40

volume of inspired air that does not take place in gas exchange

Back 40

dead space

Front 41

does the taut or relaxed form of hemoglobin has a high affinity for oxygen

Back 41

relaxed form has a high affinity

Front 42

why does fetal hemoglobin have a higher affinity for oxygen than adult hemoglobin

Back 42

because it has a lower affinity for 2,3-BPG than adult hemoglobin does

Front 43

what shifts the oxygen/hemoglobin dissociation curve to the R (thus increases the unloading of oxygen)

Back 43

increased hydrogen, increased chloride, increased CO2, increased 2,3-BPG, increased temperature, exercise, high altitudes, and decreased pH

Front 44

normal adult hemoglobin is made of what subunits

Back 44

2 alpha and 2 beta subunits

Front 45

normal fetal hemoglobin is made of what subunits

Back 45

2 alpha and 2 gamma subunits

Front 46

methemoglobin has an increased affinity for what ion

Back 46

cyanide (CN-)

Front 47

does carbon dioxide or oxygen have a higher binding affinity for hemoglobin

Back 47

CO2 has a 200x higher affinity than oxygen

Front 48

hemoglobin can bind how many oxygen molecules

Back 48

4 oxygen per hemoglobin

Front 49

is the fetal hemoglobin/oxygen dissociation curve shifted to the left or right of the normal adult hemoglobin/oxygen dissociation curve

Back 49

shifted to the L because it has a higher affinity

Front 50

how does hypoxemia and cyanosis affect the oxygen/hemoglobin dissociation curve

Back 50

it doesn't

Front 51

what is the response of the lungs to a decrease in oxygen

Back 51

vasoconstriction

(**note that the lungs are the only part of the body that vasoconstrict in response to decreased oxygen- everywhere else in the body vasodilates in response to decreased oxygen)

Front 52

normal pressure in the pulmonary arteries

Back 52

10-14

Front 53

pressure in the pulmonary arteries during exercise

Back 53

>35 mmHg

Front 54

pressure of the pulmonary arteries in pulmonary HTN

Back 54

>25 mmHg (note this is at rest)

Front 55

primary pulmonary HTN is linked to what gene mutation

Back 55

BMPR2

Front 56

causes of secondary pulmonary HTN

Back 56

COPD, mitral stenosis, recurrent thromboemboli, autoimmune disease, L->R heart shunts, sleep apnea, and living at a high altitude

Front 57

only treatment for pulmonary HTN

Back 57

lung transplant

Front 58

during vasoconstriction, reducing the radius of a blood vessel 50% increases the resistance by how much

Back 58

16x

Front 59

1g of Hb can bind how much oxygen

Back 59

1.34mL

Front 60

cyanosis develops at what level of deoxygenated Hb in the blood

Back 60

>5 g/dL

Front 61

does the apex of the lungs have high or low blood flow

Back 61

low blood flow

Front 62

what part of the lung has the highest levels of oxygen

Back 62

apex

Front 63

what does a V/Q ratio of zero suggest

Back 63

airway obstruction (shunts)

Front 64

what does a V/Q ratio of infinity suggest

Back 64

blood flow obstruction (physiologic dead space)

Front 65

in what 3 forms in CO2 transported from tissue into the lung

Back 65

1. bicarbonate (90%)
2. bound to hemoglobin
3. dissolved CO2

Front 66

oxygenation of hemoglobin in the lungs promotes dissociation of hydrogen from the Hb-- this shifts the equilibrium towards CO2 formation, thus CO2 is released from RBCs; this mechanism is known as what

Back 66

Haldane effect

Front 67

what is the Bohr effect

Back 67

in the peripheral tissues, increased H+ shifts curve to the R which unloads oxygen

Front 68

effects of high altitude on respiration

Back 68

1. causes hyperventilation which leads to respiratory alkalosis-- the kidneys compensate by increasing excretion of HCO3 (augmented by acetazolamide)
2. 2,3-BPG increases to shift curve to the R to unload more oxygen
3. adverse effect is chronic pulmonary vasoconstriction results in RVH
4. erythropoietin increases

Front 69

what happens to the arterial concentrations of oxygen and CO2 during exercise

Back 69

remain the same

Front 70

what type of emboli are associated with bone fractures and liposuction

Back 70

fat emboli

Front 71

MOST pulmonary emboli arise from where

Back 71

deep leg veins

Front 72

what is the best imaging choice to assess for a PE

Back 72

CT angiography

Front 73

risk factors for a DVT

Back 73

stasis/immobility, hypercoagulability, endothelial damage, pregnancy, and drugs (birth control, hormone replacement therapy)

Front 74

DOC to prevent DVTs

Back 74

heparin

Front 75

what is Homans sign and what is it associated with

Back 75

Homans sign: dorsiflexion of the foot causes pain in the calf-- seen in DVTs

Front 76

how is the FEV1 / FVC ratio affected in obstructive lung disease

Back 76

the FEV1 / FVC ratio is decreased (<80%)

Front 77

how is the FEV1 / FVC ratio affected in restrictive lung disease

Back 77

the FEV1 / FVC ratio is increased (>80%)

Front 78

what's the normal FEV1 / FVC ratio

Back 78

80%

Front 79

how is TLC affected in obstructive vs. restrictive lung disease

Back 79

TLC is increased in obstructive lung disease and decreased in restrictive lung disease

Front 80

condition characterized by enlargement of the alveolar air spaces and decreased elastic recoil secondary to destruction of the alveolar walls

Back 80

emphysema

Front 81

barrel-chest is a major symptom of what disease

Back 81

emphysema

Front 82

people referred to as "pink puffers" have what disease

Back 82

emphysema

Front 83

people referred to as "blue bloaters" have what disease

Back 83

chronic bronchitis

Front 84

someone who has both emphysema and chronic bronchitis is said to have what condition

Back 84

COPD

Front 85

which form of emphysema is caused mainly by smoking

Back 85

centriacinar

Front 86

which form of emphysema is linked to alpha-1-antitrypsin deficiency

Back 86

panacinar

Front 87

which form of emphysema is linked to bullae which can spontaneously rupture and cause pneumothorax

Back 87

paraseptal

Front 88

how is compliance affected in emphysema

Back 88

increased (due to loss of elastic fibers)

Front 89

why do patients with COPD often breath through pursed lips

Back 89

to increase airway pressure and prevent airway collapse during exhalation

Front 90

what enzyme will be increased in emphysema

Back 90

elastase

Front 91

condition characterized by hypertrophy of the mucus secreting glands in the bronchioles

Back 91

chronic bronchitis

Front 92

what grading system is used to asses the extent of hypertrophy in chronic bronchitis

Back 92

Reid index (>50% in chronic bronchitis)

Front 93

definition of bronchitis

Back 93

productive cough for >3 consecutive months for at least 2 years

Front 94

condition characterized by reversible severe bronchoconstriction leading to bronchospasms

Back 94

asthma

Front 95

morphologic feature of asthma

Back 95

Curschmann's spirals

Front 96

common triggers of asthma

Back 96

viral URIs, allergens, drugs (aspirin), exercise, and stress/anxiety

Front 97

what do you use to test for asthma

Back 97

methacholine challenge

Front 98

in what respiratory condition will you see pulsus paradoxus and mucus plugging

Back 98

asthma

Front 99

condition characterized as a chronic necrotizing infection of the bronchi causing permanently dilated airways, purulent sputum, recurrent infection, and hemoptysis

Back 99

bronchiectasis

Front 100

conditions associated with bronchiectasis

Back 100

cystic fibrosis, kartagener's syndrome, and aspergillosis

Front 101

drugs that have a SE of pulmonary fibrosis (restrictive lung disease)

Back 101

amiodarone, bleomycin, busulfan

Front 102

cause of restrictive lung disease characterized by bilateral hilar lymphadenopathy, noncaseating granulomas, and increased levels of ACE, vitamin D, and calcium

Back 102

sarcoidosis

Front 103

Do ARDS and neonatal RDS cause obstructive or restrictive lung disease

Back 103

restrictive lung disease

Front 104

morphologic feature of silicosis

Back 104

eggshell calcifications in the hilar lymph nodes

Front 105

morphologic features of asbestosis

Back 105

asbestos bodies (golden brown fusiform rods that look like dumbbells) found in the macrophages; there is also "ivory white" calcified pleural plaques

Front 106

pneumoconiosis associated with shipbuilding, roofing, and plumbing

Back 106

asbestos

Front 107

pneumoconiosis associated with foundries, sandblasting, and mines

Back 107

silicosis

Front 108

silicosis increases risk for what disease

Back 108

TB

Front 109

what week is surfactant initially made during gestation

Back 109

week 24

Front 110

what week is surfactant production MOST abundant during embryogenesis

Back 110

week 35

Front 111

therapeutic supplementation of oxygen in a premature neonate can induce what condition

Back 111

blindness secondary to increased vascularization (retrolental fibroplasia)

Front 112

the persistently low oxygen tension seen in neonatal RDS can increase the risk for what congenital heart defect

Back 112

PDA

Front 113

DOC to close a PDA

Back 113

indomethacin

Front 114

risk factors for neonatal respiratory distress syndrome

Back 114

prematurity, maternal diabetes (due to elevated insulin), and C-section

Front 115

prophylaxis treatment to prevent neonatal RDS in premature births

Back 115

steroids for mother
synthetic surfactant and thyroxine in infant

Front 116

condition characterized by sudden respiratory insufficiency linked to an increases in alveolar capillary permeability causing protein leakage into the alveoli (forms intra-alveolar hyaline membranes)

Back 116

ARDS

Front 117

MAJOR risk factor for obstructive sleep apnea

Back 117

obesity

Front 118

MOST common symptom of sleep apnea

Back 118

persistent loud snoring

Front 119

patients has decreased breath sounds, hyperresonance, absent fremitus, and tracheal deviation away from the lesion

Back 119

tension pneumothorax

Front 120

during physical, patients has bronchial breath sounds over the lesion, dullness to percussion, increased fremitus, and no tracheal deviation

Back 120

pneumonia

Front 121

during physical, patients has decreased breath sounds over the lesion, dullness to percussion, decreased fremitus, and no tracheal deviation

Back 121

pleural effusion

Front 122

during physical, patients has absent breath sounds over lesion, decreased resonance, decreased fremitus, and tracheal deviation toward the lesion

Back 122

bronchial obstruction

Front 123

what is fremitus

Back 123

palpable vibration over an area of the lung

Front 124

how would pneumothorax show up on imaging

Back 124

radiolucent area

Front 125

lung cancer has the highest fatality rate of all cancer, true or false?

Back 125

true, lung cancer kills more people than any other cancer (although it's not the most common in either sex)

Front 126

4 common cancers that metastasize to the lung

Back 126

breast, colon, prostate, and bladder

Front 127

where does lung cancer usually metastasize to

Back 127

adrenals, brain, bone, liver

Front 128

type of lung cancer MOST commonly linked to smoking

Back 128

squamous cell carcinoma

Front 129

hormone expressed by squamous cell carcinoma of the lung

Back 129

parathyroid-like hormone

Front 130

major morphologic features (2) of squamous cell carcinoma of the lung

Back 130

keratin pearls and intercellular bridges

Front 131

which lung cancers are located more centrally

Back 131

squamous cell and small cell

Front 132

which lung cancers are located more peripherally

Back 132

adenocarcinoma and large cell carcinoma

Front 133

major morphologic feature of adenocarcinoma of the lung

Back 133

clara cells

Front 134

which type of lung cancer is NOT linked at all to smoking

Back 134

adenocarcinoma of the lung

Front 135

most aggressive type of lung cancer; usually the worst prognosis too

Back 135

small cell carcinoma

Front 136

hormones expressed by small cell carcinoma

Back 136

ACTH and ADH

Front 137

autoimmune disease linked to small cell carcinoma

Back 137

Lamber-Eaton myasthenic syndrome (autoantibodies against calcium channels)

Front 138

major morphologic feature of small cell carcinoma

Back 138

Kulchitsky cells

Front 139

type of lung cancer that secretes massive quantities of serotonin leading to flushing, diarrhea, wheezing, and salivation

Back 139

carcinoid lung tumor

Front 140

lung cancer linked to asbestos exposure

Back 140

malignant mesothelioma

Front 141

morphologic feature of mesothelioma

Back 141

psammoma bodies

Front 142

carcinoma that occurs in the apex of the lung affecting the cervical lymphatic plexus causing Horner's syndrome

Back 142

Pancoast tumor

Front 143

MOST common cause of lobar pneumonia

Back 143

S. pneumoniae

Front 144

4 common causes of bronchopneumonia

Back 144

S. aureus, H. influenzae, Klebsiella, and S. pyogenes

Front 145

5 common causes of interstitial pneumonia

Back 145

RSV, adenovirus, mycoplasma, legionella, chlamydia

Front 146

common causes of lung abscesses

Back 146

S. aureus and the anaerobes

Front 147

differences between transudate and exudate

Back 147

transudate: no protein; seen in CHF, nephrotic syndrome, cirrhosis

exudate: increased protein; seen in malignancy, pneumonia, collagen vascular disease, trauma; MUST be drained to prevent infection

Front 148

beta agonists used to treat asthma

Back 148

isoproterenol (nonspecific)
albuterol (specific for beta2- short acting)
salmeterol (specific for beta2- long acting)

Front 149

DOC for acute exacerbation of asthma

Back 149

albuterol

Front 150

MOA of theophylline in treating asthma

Back 150

causes bronchodilation by inhibiting phosphodiesterase thus decreasing cAMP

Front 151

why is theophylline used very sparingly

Back 151

it has a very narrow therapeutic index (cardiotoxicity and neurotoxicity); it also affects P450 enzymes

Front 152

drug that can treat COPD and act as prophylaxis against asthma

Back 152

ipratropium

Front 153

MOA of cromolyn

Back 153

prevents release of cytokines from mast cells; only used as prophylaxis

Front 154

1st line therapy for chronic asthma

Back 154

corticosteroids (beclamethasone and prednisone)

Front 155

MOA of Zileuton

Back 155

inhibits 5-lipoxygenase which blocks the conversion of arachidonic acid to leukotrienes

Front 156

MOA of zafirlukast and montelukast

Back 156

blocks leukotriene receptors

Front 157

DOC for aspirin-induced asthma

Back 157

zafirlukast/montelukast

Front 158

drug that removes excess sputum, but doesn't suppress the cough reflex

Back 158

Guaifenesin

Front 159

drug that loosens mucus plugs in CF patients, and is also used as an antidote for acetaminophen overdose

Back 159

N-acetylcysteine

Front 160

drug that can help slow the progression of pulmonary HTN by competitively antagonizing endothelin-1 receptors thus decreasing pulmonary vascular resistance

Back 160

bosentan

Front 161

DOC for prophylaxis of asthma

Back 161

cromolyn or nedocromil

Front 162

Where does the L lung drain to

Back 162

L upper lobe drains into the thoracic duct
L lower lobe drains into the R lymphatic duct

Front 163

difference between anatomic, alveolar, and physiologic dead space

Back 163

anatomic dead space: air in the conducting pathway that doesn't engage in gas exchange
alveolar dead space: air in the alveoli of the respiratory pathway that doesn't engage in gas exchange
physiologic dead space: sum of anatomic and alveolar dead spaces

Front 164

significance of the "wedge" pressure

Back 164

only reliable way to measure L atrial pressure

Front 165

what safety mechanism does the lung utilize to try and prevent pulmonary edema

Back 165

constant pumping of the lymphatics

Front 166

what happens to pleural pressure during inspiration and exhalation

Back 166

pleural pressure decreases during inspiration (gets more negative) and increases during exhalation (gets less negative)

Front 167

MOST common cause of restrictive lung disease

Back 167

silicosis

(*asbestos is 2nd most common)

Front 168

ferruginous bodies are associated with what lung condition

Back 168

asbestosis

Front 169

lung pathology linked to Sjogren's

Back 169

lymphocytic interstitial pneumonia

Front 170

characterized by pulmonary eosinophilic granulomas

Back 170

Langerhans cell histiocytosis

Front 171

"honeycombing" of the lung is linked to what pathology

Back 171

interstitial pneumonia

Front 172

benign lung tumor composed of cartilage and pulmonary epithelium and characterized by a "popcorn" pattern of calcification

Back 172

pulmonary harmatoma

Front 173

cancer in the lung with a positive CEA tumor marker

Back 173

metastatic cancer

Front 174

which type of atelectasis is caused by an airway obstruction

Back 174

resorption atelectasis

Front 175

does the trachea shift towards or away from the affected lung in resorption atelectasis? what about in compression atelectasis

Back 175

trachea shifts towards the affected lung in resorption atelectasis and away from the lung in compression atelectasis

Front 176

pulmonary disease linked to acellular surfactant

Back 176

PAP

Front 177

anti-GM-CSF antibodies

Back 177

acquired (genetic) PAP

Front 178

autoantibodies against the alpha3 domain of type IV collagen in the GBM and alveoli

Back 178

Goodpasture's

Front 179

initial presenting symptoms of Goodpasture's syndrome? and what other disease commonly presents with the same 2 symptoms

Back 179

presenting symptoms are hemoptysis and hematuria

Wegener's granulomatosis usually presents with the same 2 symptoms (serology is used to differentiate the 2)

Front 180

cause of pneumonia in IV drug users

Back 180

S. aureus

Front 181

pneumonia associated with current jelly sputum

Back 181

Klebsiella

Front 182

pneumonia associated with alcoholics and homeless people

Back 182

Klebsiella

Front 183

cause of pneumonia in CF patients

Back 183

pseudomonas

Front 184

pneumonia in organ transplant recipients

Back 184

legionella

Front 185

pneumonia characterized by lack of sputum, lack of consolidation, and lack of exudate

Back 185

atypical pneumina ("walking pneumonia")

Front 186

MOST common cause of atypical pneumonia

Back 186

mycoplasma

Front 187

this cause of pneumonia will have a high titer of cold agglutinins (IgM)

Back 187

mycoplasma

Front 188

cause of SARS

Back 188

coranovirus

Front 189

massive amounts of foul-smelling, sputum with clubbing-- tumor markers for cancer are negative

Back 189

lung abscess

Front 190

common fungal causes of pneumonia

Back 190

Histoplasmosis
Blastomycosis
Coccidioidomycosis

Front 191

what are the different geographical distributions of histoplasmosis, blastomycosis, and coccidioidomycosis

Back 191

Histoplasmosis: Mississippi and Ohio river valleys

Blastomycosis: east of the Mississippi and central america

Coccidioidomycosis: SW US and west coast

Front 192

MOST common cause of pneumonia in AIDS patients

Back 192

P. jiroveci

Front 193

MOST common cause of pneumonia in neonate

Back 193

CMV (via TORCH infection)

Front 194

cause of pneumonia linked to bat droppings

Back 194

histoplasmosis

Front 195

cause of pneumonia in AIDS patient when CD4 is <50

Back 195

M. avium-intracellulare

Front 196

morphologic features unique to primary TB

Back 196

hilar nodes and the ghon focus (together they are known as the ghon complex)

Front 197

morphologic features unique to secondary (reactivation) TB

Back 197

cavitation

Front 198

Farmer's lung is linked to exposures to the spores of what organism

Back 198

actinomyces

Front 199

lung cancer associated with kidney stones

Back 199

squamous cell carcinoma

Front 200

morphologic features seen in BOTH primary and secondary TB

Back 200

caseating granulomas, calcifications