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155 Cards in this Set

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What are the first generation histamine blockers.
Diphenhydramine, dimenhydrinate, chlorpheniramine, hydroxyzine.
What do histamine blockers block?
The histamine RECEPTOR
What are the second generation histamine blockers?
Loratadine, fexofenadine, desloratadine, cetirizine
What is significant about first gen. histamine blockers vs. second gen?
Second generation is far less sedating because they do no readily cross the blood brain barrier.
A nonspecific B agonist
isoproterenol
SABA that is used for for acute exacerbations plus two other SABAs
albuterol

terbutaline, metaproterenol
LABA used for long acting prophylaxis plus another LABA
Salmeterol

formoterol
what is the MOA of theophylline?
It inhibits PDE thereby increasing cAMP and this causes bronchodilation

NARROW TI though so it can easily cause neuro and cardio toxicities
what drug is not effective during an acute asthma attack and is ONLY effective for prophylaxis?
cromolyn, a mast cell stabalizer
what are two first line therapy drugs for chronic asthma?

*steroids
Beclomethasone, prednisone
what is Zileuton and what is is MOA?
a leukotriene inhibitor that inhibits lipoxygenase
what are Zafirlukast and montelukast and what is their MOA?
leukotriene inhibitors that block leukotriene receptors
I'm thinking of a drug that treats pulmonary hypertension by antagonizing endothelin-1 receptors and thus decreases pulmonary vascular resistance.
I bet your thinking of Bosentan
what are the different types of emboli?
FAT BAT

Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumors
Name the three sides of virchows triad
1. Stasis
2. hypercoagulability
3. Endothelial damage
what is the spirometry hallmark of Obstructive lung disease
A decrease in the FEV1/FVC ratio
what are the causes of centriacinar and panacinar emphysema
smoking and alpha 1-antitrypsin deficiency
what is kartageners and what lung disease is it associated with
it is a defect in the dynein arm of the cilia, associated with bronchiectasis (permanent dilation of the airways)
what is seen on biopsy of a liver in a A1AT deficient pt.
pink, PAS positive globules in the hepatocytes.
what drug is infamous for causing bouts of asthma
aspirin
what can coal miners lung result in

*associated with rheumatoid arthritis
Caplan's syndrome
what are you more susceptible to getting if you have silicosis?
TB because silica disrupts phagolysosomes and impairs macrophages.
what do you see in the hilar lymph nodes with silicosis
Eggshell calcification
what is THE clinical diagnosing factor seen with asbestosis
"ivory white" PLEURAL PLAQUES
what is more common with asbestosis...carcinoma or mesothelioma
carcinoma
what are the pathologic findings with berylliosis?
Noncaseating granulomas
what population is classically seen to have sarcoidosis?
african american females
what other disease can sarcoidosis mimic due to its involvement with salivary and lacrimal glands?
Sjogrens syndrome
what 2 clinical labs values are commonly seen with sarcoidosis?
elevated ACE and hypercalcemia
what are 2 risk factors for neonatal respiratory distress syndrome?
maternal diabetes,
c-section (reduces stress on baby leading to less steroid release which normally triggers surfactant release),
premature birth (after 34-35 weeks surfactant is at adequate levels)

....thats 3 things
what is the hallmark of ARDS?
formation of intra-alveolar hyaline membrane due to alveolar damage
what does imaging often reveal with lung cancer?
"coin-lesion"
benign lesions in young people can often appear as coin lesions on xray, what are two examples of these
Granuloma- often due to TB

Bronchial Hamartoma- benign tumor composed of lung tissue and cartilage
squamous cell carcinoma. location, characteristics, histology
Squamous = Sentral location, due to Smoking

may produce PTHrP and PT-like activity

keratin pearls and intercellular bridges
what is the most common lung cancer in women and NON-smokers?
adenocarcinoma (glands or mucin)
small cell carcinoma. location, characteristics, histology
Small cell = Sentral location

May produce paraneoplastic syndromes due to ectopic ACTH or ADH production. also Lambert-Eaton syndrome

Undifferentiated cells from neuroendocrine Kulchitsky cells
Large cell carcinoma--well or poorly differentiated?
Poorly
what do you see histologically with carcinoid syndrome?
WELL differentiated cells that are CHROMOGRANIN positive
what characterizes bronchopneumonia on an xray
scattered patchy consolidation
what characterizes interstitial pneumonia on an xray
diffuse patchy inflammation localized to interstitial areas at alveolar walls
what two organisms are associated with lobar pneumonia?
Streptococcus pneumoniae (95%) and Klebsiella pneumoniae
what bugs are associated with bronchopneumonia
Staph aureus, H. influenza, Klebsiella, S. pyogenes
what is the most common cause of atypical pneumonia
mycoplasma pneumoniae
what bugs are associated with interstitial pneumonia
Viruses, Mycoplasma, Legionella, Chlamydia
what is a Ghon complex and what is it a sign of?
a caseating necrosis in the lower lobe of the lung and hilar lymph nodes that undergoes fibrosis and calcification

sign of PRIMARY TB upon initial exposure
where does reactivation of TB generally occur?
in the apex of the lung where there is high oxygen tension.
what type of hypersensitivity reaction is TB
a type IV (delayed type)
what does pulmonary HTN often present with clinically
exertional dyspnea
if pulmonary HTN is going to be genetic, what is often the cause
BMPR2 inactivating mutations leading to proliferation of vascular smooth muscle
what type of cells extend down to the respiratory bronchioles?
pseudostratified ciliated columnar
what are the "stem" cells in the lungs? what do they secrete?
type II pneumocytes. secrete surfactant
what is the relationship of the pulmonary artery to the bronchus at each lung hilus?
RALS

Right Anterior Left Superior
what structures perforate the diaphragm and at what levels?
IVC @ T8
esophagus @ T10
Aorta @ T12

I (IVC) ate (8) ten (10) eggs (esophagus) at (aorta) 12
what keeps the diaphragm alive?
C3,4,5 keep the diaphragm alive.

One more time! C3,4,5 keep the diaphragm alive

I cant hear you! C3,4,5 keep the diaphragm alive!!!!
muscles of inSpiration during exercise
external intercostals, Scalene muscle, Sternomastoid
muscles of expiration during exercise
rectus abdominis, internal and external obliques, transversus abdominis, internal intercostals
this is the amount of air that can be breathed in after normal inspiration?
IRV
amount of the air that can be breathed out after normal expiration?
ERV
air left in lungs after maximal expiration
Residual volume
2 forms of hemoglobin

Taut and relaxed. which has high and which has low affinity for O2
taut has low affinity
relaxed has high affinity
High Cl, H+, CO2, 2,3-BPG and temperature favor what form of hemoglobin? taut or relaxed and shift the dissociation curve which way?
favor the taut form, shift the curve to the right and favor unloading of O2
why is it that fetal hemoglobin has a higher affinity for O2 than adult hemoglobin?
it has a lower affinity for 2,3-BPG and thus a higher O2 affinity
what is methemoglobin? how do you treat it?
oxidized form of hemoglobin (ferric, Fe3+) that doesnt bind O2 readily

give methylene blue to treat it
what is carboxyhemoglobin?
hemoglobin bound to CO in place of O2
describe left and right shifts in the dissociation curve
right shift promotes unloading (low affinity) of O2, left shift promotes loading (high affinity)
6 things that cause a shift in the dissociation curve?
CADET

CO2
Acid/Altitude
DPG (2,3-DPG)
Exercise
Temperature
what does perfusion limited mean and what are some gasses that are perfusion limited?
gas equilibrates early along capillary length, diffusion only increases if blood flow increases

O2, CO2, N2O
what is diffusion limited and what are some gasses?
gas does not equilibrate by the time the blood reaches the end of the capillary

O2 (when lung is fibrosed), CO
what is normal pulmonary pressure? pressure for HTN?
normal: 10-15 mmHg
HTN: >/= 25 mmHg
what is the cause of primary pulmonary HTN? what is this gene responsible for?

VERY HY!!
inactivating mutation of gene BMPR2. normally it inhibits vascular smooth muscle proliferation
anything that will lead to a decrease in the amount of O2 in the blood is termed what? hypoxemia or hypoxia
hypoxemia

hypoxia is a decrease in the delivery of O2 to the tissues
what kind of bug will thrive at high levels of O2 and thus love the apex of your lungs?
TB
both ventilation and perfusion are greatest at where in the lung?
the base
In a shunt will 100% O2 improve the PO2?
NO!!!
in what three forms does CO2 make the long, arduous journey to the lungs for the final exodus back into the atmosphere from whence it was inspired in the form of the life giving O2? which form accounts for the vast majority over the others?
Bicarb (90%)
Bound to hemoglobin (the globin....not the heme) (5%)
Dissolved (5%)
what is the Haldane effect?
in the lungs as O2 binds Hb there is a shift in the equilibrium toward CO2 formation and CO2 is released from RBCs
what is the Bohr effect?
in peripheral tissue the High H+ shifts the dissociation curve to the right unloading O2

Bohr.....deBoarding the O2
types of emboli? 6 of em
the emobolus moves like a FAT BAT
Fat
Air
Thrombus
Bacteria
Amniotic fluid
Tumor
DVTs are predisposed by Virchows triad...whats the triad?
Stasis
Hypercoagulability
Endothelial damage

SHE
what is the super high yield spirometry result for COPD?
a REDUCED FEV1/FVC ration
in chronic bronchitis there is hypertrophy of what? what is the index used to measure this?
mucus-secreting gland hypertrophy

Reid index- gland depth/total thickness of bronchial wall (not including cartilage)

Reid index is more than 50% in chronic bronchitis
Blue Bloaters have what?
cyanosis due to bronchitis
what do pink puffers have? what is the shape of their chest and fingers?
emphysema, barrel-shaped chest and clubbed fingers
patient comes in and they are breathing through pursed lips....why and what do they have?
they are trying to maintain a high airway pressure to prevent airway collapse while exhaling

they likely have emphysema
what is the underlying cause of emphysema?
decrease in lung recoil due to alveolar destruction (increase in compliance)
two types of emphysema

centriacinar and panacinar. differentiate between the two
centriacinar is due to smoking and hits the UPPER lungs

panacinar is due to alpha 1 antitrypsin deficiency (A1AT)
cause of alveolar destruction in emphysema?
excessive inflammation or a lack of A1AT can lead to protease-mediated destruction of the alveolar air sacs
biopsy of emphysema patients liver will show what?

VERY HY!!!
pink, PAS-positive globules in hepatocytes
if a pt has A1AT def. due to its misfolding what other problem do you see?
these mutant A1AT will accumulate in the ER of the hepatocytes resulting in liver damage leading to the hallmark liver Bx seen microscopically
late onset hypoxia is a sequela of emphysema? T or F
TRUE!!
three interleukins play an important role in asthma. name em
IL's 4,5, and 10

4 mediates Ig class switching to Ig E
5 attracts eosinophils
10 promotes Th2 cells and inhibits Th1
what are Charcot-Leyden Crystals and what are they seen in?

HY!!
eosinophil-derived crystals seen in asthma
what are Curschmann spirals and what are they seen in?
spiral shaped mucous plugs seen in asthma
what is bronchiectasis?
chronic necrotizing infection that leads to permanent dilation of airways
bronchiectasis is associated with Kartegeners syndrome, what the heck is that?
an inherited defect in the dynein arm, which is necessary for ciliary movement. also see sinusitis, infertility and situs inversus
what is caplans syndrome?
it is coal workers pneomoconiosis combined with rheumatoid arthritis
what lobes are hit with coal miners pneumoconiosis?
upper lobes
silicosis is assoc. with type of work? hits what area of the lung? increases your risk of what disease? the silica impairs what? see what at the hilar lymph nodes? thats a lot
associated with foundries, sandblasters and silica miners

hits the upper lobes

increases risk of TB

silica disrupts the phagolysosome of macrophages and impairs them

see "eggshell" calcification of hilar lymph nodes
asbestosis is seen in what work? hits what part of the lung?
shipbuilding, roofing and plumbing

hits lower lobe
you see these "ivory white" calcified pleural plaques (THE KEY!!!) on xray....what do they have?

what are they at an increase risk for (two things, one more than the other)
asbestosis

high risk of carcinoma and mesothelioma (carcinoma more so)
a golden brown, fusiform rods that looks like the big dumbells you lift at the gym and located in the macrophages....what is it?
asbestos bodies.
berylliosis is classically associated with what line of work? what do you see in the lung, hilary lymph nodes and system organs?
aerospace industry

see noncaseating granulomas (similar to sarcoidosis)
sarcoidosis hits what population the most? what do you see in the granulomas? what disease does it mimic due to salivary and lacrimal gland involvement?
african american women

see asteroid bodies

mimics Sjogrens syndrome
what will you see on labs for sarcoidosis?
elevated serum ACE and hypercalcemia
what is the hallmark sign of acute respiratory distress syndrome (ARDS) (see on microscope) why does it occur?
intra-alveolar hyaline membrane thickening

occurs because of damage to alveolar-capillary interface leading to protein-rich fluid edema
risk factors for Neonatal respiratory distress syndrome? 3 of em
prematurity
C-section
maternal diabetes
what are some of the complications of the lung cancer? 6 of em
SPHERE of complications

Superior vena cava syndrome
Pancoast's Tumor
Horner's Syndrome
Endocrine (paraneoplastic syndrome)
Recurrent Laryngeal Syndrome
Effusions (pleural or pericardial)
leading cancer in cancer deaths?
lung
popular site of metastases from lungs?
adrenals
xray for lung cancer often reveals what?
"coin" lesion
"coin" lesion could also be benign masses. 2 HY examples
Granuloma (due to TB)

Bronchial Hamartoma (composed of lung tissue and cartilage)
Small cell carcinoma: location, produces what 2 things, may lead to what disease? treatment
Centrally located
may produce ADH or ACTH
May cause Lambert-Eaton syndrome
Responds to CHEMO not surgery
Squamous cell carcinoma: location, may produce what, clearly linked to what, 2 things seen on histology
centrally located
may produce PTHrP (parathyroid like activity)
clearly linked to smoking
Histology shows keratin pearls and intercellular bridges
Adenocarcinoma: location, tumor histology, population hit the most (HY!!!),
peripheral
Glands and mucin
Most common lung cancer in NONSMOKERS and FEMALE SMOKERS
Large cell carcinoma: location, histo characteristics
peripheral, no keratin pearls, intercellular bridges, glands or mucin
Carcinoid Tumor: secretes what, which causes what, HY histo results
secretes serotonin which can cause carcinoid syndrome, Chromogranin positive
Bronchioalveolar carcinoma: location, linked to smoking?, presents like what
peripheral, NOT linked to smoking, presents like pneumonia
what sign does ARDS produce on XRAY?
"white out"
three types of pneumonia
Lobar
Interstitial
Bronchopneomonia

LIB
what are the two most common bugs that cause lobar pneumonia and which is the most common of those two?
Streptococcus pneumoniae (95%)
Klebsiella pneumoniae
what regenerates the lung after lobar pneumonia?
the type II pneumocytes
cause of interstitial pneumonia and what is seen on xray?
Virus (RSV, adenovirus) Mycoplasma, Legionella, Chlamydia

diffuse patchy infiltrates on xray
cause of bronchopnemonia and whats seen on xray
S. aureus, H. flu, Klebsiella, S. pyogenes

scattered patchy consolidation centered around bronchioles on xray
most common cause of community acquired pneumonia?
strep pnemoniae
malnourished guy, old people in nursing homes, alcoholics, diabetics coughing up a currant jelly sputum....what bug?
klebsiella pneumoniae
most common cause of secondary pneumonia (superimposed on a viral upper resp tract infection)
staph aureus
common cause of secondary pneumonia and pneumonia superimposed on COPD
H. influenza
bug that hits patients with cystic fibrosis
pseudomonas aeruginosa
bug transmitted via water source (gets up in your humidifier) best seen in silver stain?
legionella pneumophilia
most common cause of atypical pneumonia, usually hits young adults. other important thing about visualizing this bug??
mycoplasma pneumoniae

not visible on gram stain due to lack of cell wall
atypical pneumonia with high fever (Q fever), often seen in farmers and vets, caused by what?
coxiella burnetii
Diphenhydramine, Dimenhydrinate, Chlorpheniramine, hydroxazine

Class, use, tox
1st generation H1 blockers

allergy, motion sickness, sleep aid

tox: sedation, antimuscarinic, anti-alpha-adrenergic
loratadine, fexofenadine, desloratadine, certizine

class, use, tox
2nd generation H1 blockers

allergy

tox: FAR LESS sedating that 1st generation due to NO ENTRY into the CNS
Isoprotenerol

Class, MOA, side effect
Nonspecific Beta agonist

relaxes bronchial smooth muscle (beta 2)

nonspecific so it hits Beta 1 and causes tachy
Albuterol

class, MOA
Beta 2 agonist

relaxes bronchial smooth muscle (beta 2)
Salmeterol

class, use, tox
long acting beta2 agonist for prophylaxis

tremor and arrythmia
theophyline

class, use moa, tox

blocks action of what drug
methylxanthine

causes bronchodilation by inhibiting phosphodiesterase and this decreases cAMP hydrolysis

asthma

has a narrow TI for cardio and neuro tox

blocks adenosine
Ipratropium

class, moa, use
muscarinic antagonist

blocks muscarinic receptors and prevents bronchoconstriction

asthma and COPD
Cromolyn

moa, use
prevent release of mediators from mast cells

ONLY for prophylaxis of asthma NOT FOR ACUTE ASTHMA ATTACK
Beclomethasone, prednisone

class, moa, use
corticosteroid

inhibit synthesis of all cytokines

1ST LINE FOR CHRONIC ASTHMA
Zileuton

class, moa, use
antileukotriene

5-lipoxygenase pathway inhibitor. blocks conversion of arochidonic acid to leukotrienes

asthma
zafirlukast, montelukast

class, moa, use (one special in particular)
antileukotrienes

blocks luekotriene receptors

asthma (aspirin induced asthma in particular)
bosentan

use, moa
use to treat pulmonary HTN

antagonizes endothelin-1 receptors to decrease pulmonary vascular resistance
chest xray shows cavitations and a centrally located hilar mass and the dude smokes...whats he got?
squamous cell carcinoma
what is the chief complaint of peeps with sarcoidosis? (in here because it can lead to restrictive lung disease)
Bell's palsy
patients taking isoniazid for TB should also be given what?
pyridoxine (vitamin B6) Isoniazid drains the body of vit. B6 leading to peripheral neuropathy syndromes
what drug can cause red-green color blindness
ethambutol
nedocromil

moa
anti-inflammatory prophylaxis (similar to cromolyn

stabilizes mast cells
amino acid mutated in cystic fibrosis and what chromosome is it on?
Phenylalanine on chromosome 7
asbestos fibers get inhaled and coated with protein and iron. what are they now called and how are the visualized
ferruginous bodies and they stain positive with Prussian blue
patient is a smoker, has lung cancer and has labs showing sodium problems...whats the likely type of cancer?
small cell (paraneoplastic syndrome with excess ADH being made)
patient is a smoker and has lung cancer and has labs showing hypercalcemia...likely cancer?
squamous cell carcinoma (PTrP released with parathyroid like action)
patient presents with lung cancer along the alveolar walls WITHOUT invasion. type of cancer? it also presents with chronic cough and pneumonia like xray
broncholoalveolar carcinoma
patients without a spleen are more susceptible to what?
S. pneumoniae and N. meningitidis
young healthy male is jogging, falls and scrapes his hand...minutes later he shows signs of a tension pneumothorax. whats he got?
paraseptal emphysema