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74 Cards in this Set
- Front
- Back
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what histo change takes place in the trachea of a smoker?
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metaplasia = columnar→squamous
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A pt in the ER is having anaphylaxis→ you make an incision beneath the thyroid cartilage to establish airway→ what structure is cut?
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cricothyroid membrane
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what structures traverse the diaphragm & at what vertebral level do they pass through?
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"I 8 10 Eggs At 12" & "red, while & blue"
- T8 = IVC - T10 = esoph, vagus - T12 = aorta, thoracic duct, azygous |
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what cell type proliferates during lung damage?
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clara
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what amniotic fluid measurement is indicative of fetal lung maturity?
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lecithin-to-sphingomyelin ratio >2.0
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a young woman has infertility, recurrent URI's & dextrocardia→ which of her proteins is defective?
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Kartagner's → dynein arm defect of cilia
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what substances are known for causing methemoglobiinemia?
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- nitros
- local anesthetics (ie, lidocaine) - dapsone - sulfonamides - chloraquine, primaquine - metoclopromide |
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a 42 y/o woman w/fibroids is chronically tired→ What is the most likely dx & what changes have occured in the oxygen content & saturation?
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bleeding from fibroids→ l/t ↓Hgb (hypochromic, microcytic anemia)
no change in O2 content or saturation |
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patient is shown to have hypoxia & CXR reveals an enlarged heart→ what is the most likely cause of hypoxia?
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CHF→ not perfusing lungs well enough
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a pt suffers a stroke after incurring multiple long bone fxs in a skiing accident→ what caused the infarct?
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fat embolus from fx going thru patent foramen ovale
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a pt w/recent tibia fx & no hx of COPD or asthma is shown to have hypoxia, CXR is normal→ what is the cause of hypoxia & what dz process does it mimic?
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probably PE from a DVT (from stasis...)
mimics MI |
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DDx for eosinophilia
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- Drugs
- Neoplasms - Atopic (?) - Allergy, Asthma, Churg-Strauss - Addison's dz - Acute Interstitial Nephritis (AIN) - Collagen vascular dz - Parasites |
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a pt presents w/asthma attack→ what immunological rxn is taking place that is responsible for anaphylaxis in this pt?
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mast cell mediated→ antigen cross-linking IgE on sensitized mast cells
(type I hypersensitivity) |
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inhaled DOC for chronic asthma
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steroids
(beclomethasone, prednisone) |
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inhaled DOC for acute asthma exacerbations
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albuterol/levabuterol
(b2-agonists; usu +ipratropium) |
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narrow therapeutic index, drug of last resort for asthma
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theophylline
(methylxanthines) |
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asthma med that blocks conversion of arachidonic acid to leukotriene
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zileuton
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asthma drug that inhibits mast cell release of mediators, used for prophylaxis only
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cromolyn
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inhaled asthma tx that blocks muscarinic receptors
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ipratropium
(muscarinic antagonist) |
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inhaled asthma tx that's a long-acting b2-agonist
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salmeterol
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asthma med that blocks leukotriene receptors
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zafirlukast & montelukast
(zafir = 5+; monte = 1+) |
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pt has extended expiratory phase→ what's the dz process?
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obstructive lung disease
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H&E of lung biopsy from a plumber shows elongated structures w/clubbed ends in tissue→ what is the dz & what is he @↑ risk for?
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asbestosis
@↑ risk for bronchogenic CA & mesothelioma |
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a preterm baby has difficulty breathing→ xray shows diffuse ground glass appearance w/air bronchograms→ what is the dx & what could have prevented this?
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dx = hyaline membrane dz / respiratory distress syndrome
- giving mom GC before birth - artificial surfactant |
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pt develops ARDS from an occupational inhalation of nitrogen dioxide→ what histo changes are seen in the recovering pt?
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↑ type II pneumocytes
(take over for type I ??) |
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CXR shows pleural effusions→ what are the clinical findings?
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- ↓ breath sounds
- ↓ resonance - ↑ fremitus |
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a tall, thin male teenager has abrupt onset dyspnea & L-sided chest pain; percussion on affected side is hyperresonant & breath sounds are diminished→ what's the dx?
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spontaneous pheumothorax
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CXR shows collapse of middle lobe of right lung & mass in right bronchus; pt has hx of recurrent pneumonias→ what's the dx?
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bronchogenic CA
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pt develops lung cancer but has never smoked; he is a coal miner→ exposure to what has put him at risk for developing lung cancer?
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radon
(collects in coal mines & basements) |
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what complications can arise from lung cancer?
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SPHERE
- SVC syndrome - Pancoast tumor - Horner's syndrome - Endocrine (paraneoplastic) - Recurrent laryngeal sxs (hoarse) - Effusions (pleural/pericardial) (& also esoph invasion (dysphagia) & laryngeal invasion (death)) |
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common cause of pneumo in immunocomp pts
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PCP
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MCC atypical / walking pneumo
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Mycoplasma pneumo
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common cause of pneumo in alcoholics
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Klebsiella
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can cause interstitial pneumo in bird handlers
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chlamydia psittaci
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often the cause of pneumo in pt w/hx of exposure to bats/bat droppings
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histoplasma
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often cause of pneumo in pt who has recently visited Southern California, New Mexico, or West Texas
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coccidioides
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pneumo a/w "currant jelly" sputum
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Klebsiella
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pneumo a/w Q fever
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coxiella burnetii
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pneumo a/w air conditioners
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legionella
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MCC pneumo in kids 1 y/o or younger
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RSV
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MCC pneumo in the neonate
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- E. coli
- GBS - Listeria |
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MCC pneumo in kids & young adults (incl college students, military recruits, & prisoners)
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mycoplasma
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common cause of pneumo in pts w/other health probs
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Klebsiella
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MCC of viral pneumonia
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RSV
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causes wool sorter's disease (a life-threatening pneumonia)
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bacillus anthracis
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pneumo causing endogenous flora in 20% of adults
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S. pneumo
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common bacterial cause of COPD exacerbation
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H. influenzae
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common pneumo in ventilator pts & those w/cystic fibrosis
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pseudomonas
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pontiac fever
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legionella pneumo
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exam of a lung @autopsy reveals a periph lesion w/caseous necrosis→ dx?
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TB
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30 y/o comatose man on ventilatory support in ICU develops an infx & dies; autopsy reveals pus-filled cavity in right lung→ likely etiology?
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aspiration (causing a lung abscess)
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55 y/o man who is a smoker & heavy drinker presents w/new cough & flu-like sxs→ gram stain shows no organisms; silver stain shows gram-ned rods→ dx?
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Legionella
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causes of transudate pleural effusion
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- CHF
- cirrhosis - nephrotic syndrome - PE - fluid overload |
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causes of exudate pleural effusion
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- pneumonia, infections, TB
- cancer - uremia - CT disease |
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3 MC locations of lung cancer mets?
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- brain
- bones - liver |
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what is the V/Q at the apex of the lung?
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3
(approaches 1 w/exercise) |
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what is the V/Q at the base of the lung?
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0.6
(approaches 1 w/exercise) |
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what is the V/Q during airway obstruction?
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0
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what is the V/Q during blood flow obstruction?
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infinity
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emphysema d/t smoking
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centriacinar
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emphysema d/t a-1-antitrypsin deficiency
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panacinar
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hallmark sign of COPD
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↓ FEV1/FVC
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hallmark sign of restrictive lung disease
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nl FEV1/FVC & ↓TLC
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which tumors arise centrally in the lung & are linked to smoking?
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SCC & small (oat) cell carcinoma of the lung
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which tumors arise peripherally in the lung & are less linked to smoking (if at all)?
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- adenocarcinoma
- large cell carcinoma |
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how does the body compensate for hypoxia at high altitude?
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- ↑ ventilation
- (& thus) ↑ renal excr of bicarb - ↑2,3-DPG - ↑ mitochondria (↑O2 utilization) - ↑ RBC's (from ↑erythropoietin) (R-shift of curve→ ↓ O2 affinity → favors unloading of O2) |
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pneumo w/ gram(+) cocci in clusters
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S. aureus
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pneumo w/ gram(+) cocci in pairs
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S. pneumo
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pneumo w/ gram(-) rods in 80 y/o
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E. coli
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pneumo w/ gram(+) cocci in neonate
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GBS
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pneumo w/ gram(-) rods in neonate
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E. coli
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75 y/o pt w/60 pack yr hx, complains of difficulty standing up from bed in morning & difficulty raising arms in morning to wash hair→ you might suspect?
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Lambert-Eaton syndrome→ small cell (oat) carcinoma
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what is pulsus paradoxis
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↓SBP >10 mmHg w/inspiration
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what causes pulsus paradoxis?
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- asthma
- COPD - croup - cardiac tamponade |
