Step1-Respiratory

Front 1

what type of cell lines respiratory tree?

Back 1

pseudostratified ciliated columnar cells (to respiratory bronchioles)

Front 2

what type of cells line alveoli?

Back 2

type I pneumocytes (97% of surface area); squamous

Front 3

stem cells of pneumocytes?

Back 3

type II pneumocytes

Front 4

which cells secrete surfactant?

Back 4

type II pneumocytes; cuboidal

Front 5

chemical name of surfactant?

Back 5

dipalmitoyl phosphatidylcholine

Front 6

nonciliated columnar cells that degrade toxins in alvioli?

Back 6

Clara cells

Front 7

what amniotic finding indicates fetal lung maturity?

Back 7

lecithin-to-sphingomyelin ratio of >2.0

Front 8

what is in the center (anatomically) of each bronchopulmonary segment?

Back 8

tertiary bronchus and two arteries (bronchial and pulmonary)

Front 9

what vessels are at the border of each bronchopulmonary segment?

Back 9

veins and lymphatics

Front 10

how many lobes in each lung?

Back 10

Right: three lobes
Left: two plus lingula

Front 11

if you aspirate a small object, where does it go?

Back 11

while upright: lower portion of right inferior lobe
while supine: superior portion of right inferior lobe

Front 12

anatomic relation of pulmonary artery to the bronchus at each lung hilus?

Back 12

RALS:
Right Anterior
Left Superior

Front 13

at what level do various important structures perforate diaphragm?

Back 13

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

Front 14

what cranial nerves innervate the diaphragm?

Back 14

C3, 4, 5

Front 15

what muscles are used in forceful inspiration?

Back 15

diaphragm + external intercostals, scalenes, sternomastoids

Front 16

what muscles are used in forceful expiration?

Back 16

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

Front 17

five compounds secreted by lung?

Back 17

1. surfactant
2. prostaglandins
3. histamine
4. angiotensis-converting enzyme
5. kallikrein (activates bradykinin)

Front 18

which form of hemoglobin (taut vs. relaxed) has high affinity for O2?

Back 18

Relaxed

Front 19

fetal hemoglobin has higher/lower affinity for oxygen than adult hemoglobin?

Back 19

HIGHER (due to lower affinity for 2,3-BPG)

Front 20

how do you treat cyanide poisoning?

Back 20

1. use nitrates to oxidize hemoglobin to methemoglobin (binds cyanide)
2. use thiosulfate to bind cyanide for renal excretion

Front 21

normal pulmonary artery pressure?

Back 21

10-14 mmHg

Front 22

definition of pulmonary hypertension?

Back 22

pulmonary artery pressure > 25 mmHg or >35 during exercise

Front 23

cause of primary pulmonary hypertension?

Back 23

inactivating mutation in BMPR2 gene

Front 24

formula for pulmonary vascular resistance (PVR)?

Back 24

P(PA) - P(LA)
-----------------------
cardiac output

Front 25

what causes cyanosis?

Back 25

more than 5 g/dL of deoxygenated Hb

Front 26

approximation of alveolar gas equation?

Back 26

PA(O2) = 150 - PA(CO2)/0.8
(150 is PO2 in inspired air, 0.8 is normal respiratory quotient)

Front 27

normal A-a gradient?

Back 27

10-15 mmHg

Front 28

three things that cause increased A-a gradient?

Back 28

1. V/Q mismatch
2. right-to-left shunting
3. diffusion limitation/fibrosis

Front 29

where is V/Q normally >1?

Back 29

at apex of lungs (wasted ventilation)

Front 30

where is V/Q normally <1?

Back 30

at base of lungs (wasted perfusion)

Front 31

why is reactivation TB typically found in apices of lungs?

Back 31

thrives in high O2 found at apex (due to V/Q > 1)

Front 32

how is most carbon dioxide transported in the blood?

Back 32

as bicarbonate (90%); result of carbonic anydrase activity in rbcs

Front 33

what other condition is seen along with amniotic fluid emboli?

Back 33

DIC

Front 34

imaging test of choice for PE?

Back 34

CT angiography

Front 35

Virchow's triad?

Back 35

1. stasis
. Hypercoagulability
3. endothelial damage

Front 36

Homan's sign?

Back 36

pain in calf with dorsiflexion of foot (sign of DVT)

Front 37

cause of centriacinar emphysema?

Back 37

smoking

Front 38

cause of panacinar emphysema?

Back 38

alpha-1-antitrypsin deficiency

Front 39

what type of emphysema causes spontaneous pneumothorax in young, healthy males?

Back 39

paraseptal emphysema (associated with bullae)

Front 40

in what condition do you see a decreased FEV1/FVC ratio?

Back 40

obstructive lung disease

Front 41

what pattern of PFTs do you see in restrictive lung disease?

Back 41

decreased FVC and TLC with FEV1/FVC ratio > 80%

Front 42

what meds cause restrictive long disease?

Back 42

bleomycin, busulfan, amiodarone

Front 43

ivory white calcified pleural plaques?

Back 43

asbestosis

Front 44

what causes "eggshell" calcification of hilar lymph nodes?

Back 44

silicosis

Front 45

golden-brown dumbbell shaped rods inside macrophages in lungs?

Back 45

asbestos bodies

Front 46

what neoplastic conditions are associated with asbestosis?

Back 46

bronchogenic carcinoma and mesothelioma

Front 47

at what point in gestation is surfactant produced?

Back 47

mostly after 35th week

Front 48

supplemental O2 given in neonatal respiratory distress syndrome can cause what pathology?

Back 48

retinopathy

Front 49

what are risk factors for neonatal respiratory distress syndrome?

Back 49

prematurity, maternal diabetes, cesarean delivery

Front 50

mechanism of ARDS?

Back 50

diffuse alveolar damage causes increased capillary permeability and protein-rich leakage into alveoli. Results in formation of intra-laveolar hyaline membrane

Front 51

normal FEV1/FVC ratio?

Back 51

80%

Front 52

"coin" lesion on chest x-ray?

Back 52

lung cancer

Front 53

where in lung does squamous cell carcinoma occur?

Back 53

central (hilar mass)

Front 54

histology of squamous cell carcinoma (of lung)?

Back 54

keratin pearls and intracellular bridges

Front 55

where in lung does adenocarcinoma occur?

Back 55

peripherally, at site of prior pulmonary inflammation or injury

Front 56

in what type of lung cancer do Clara cells differentiate into type II pneumocytes?

Back 56

adenocarcinoma

Front 57

type of lung cancer most often associated with ectopic ACTH or ADH production?

Back 57

small cell carcinoma

Front 58

Lambert-Eaton syndrome?

Back 58

autoantibodies against neuromuscular junction calcium channels produced by lung small cell carcinoma; results in decreased ACh being released

Front 59

peripherally located, highly anaplastic undifferentiated lung tumor with poor prognosis?

Back 59

Large cell carcinoma

Front 60

lung cancer with histology showing pleomorphic giant cells with leukocyte ragments in cytoplasm?

Back 60

large cell carcinoma

Front 61

lung cancer with Psammoma bodies in histology?

Back 61

mesothelioma

Front 62

types of lung cancer most likely causing Pancoast's tumor?

Back 62

squamous cell or small cell carcinomas (peripherally located)

Front 63

most common cause of lobar pneumonia?

Back 63

pneumococcus, then klebsiella

Front 64

most common causes of interstitial (atypical) pneumonias?

Back 64

Viruses (RSV, adenoviruses), Mycoplasma, Legionella, Chlamydia

Front 65

Most common organisms causing lung abscesses?

Back 65

S. aureus, anaerobes

Front 66

first generation H1 blockers?

Back 66

diphenhydramine, dimenhydrinate, chlorpheniramine

Front 67

second generation H1 blockers?

Back 67

loratadine, fexofenadine, desloratadine, cetirizine

Front 68

MOA of isoproternol?

Back 68

non-specific beta-agonist; relaxes bronchial smooth muscle, but also causes tachycardia

Front 69

clinical use of albuterol vs. salmeterol?

Back 69

albuterol: short acting B2 agonist, use during acute asthma exacerbation
salmeterol: long-acting agent for prophylaxis

Front 70

MOA of theophylline?

Back 70

causes bronchodilation by inhibiting phosphodiesterase (decreases cAMP hydrolysis); metabolized by P450

Front 71

MOA of ipratropium?

Back 71

competitive block of muscarinic receptors; prevents bronchoconstriction

Front 72

MOA of cromolyn

Back 72

prevents release of mediators from mast cells; used for ppx against asthma

Front 73

first line therapy for chronic asthma?

Back 73

inhared corticosteroids

Front 74

medication especially used for aspirine-induced asthma?

Back 74

montelukast and other leukotriene inhibitors

Front 75

bosentan?

Back 75

medication used ot treat pulmonary hypertension; competitively antagonizes endothelin-1 receptors and decreases pulmonary vascular resistance

Front 76

mechanism by which smoking causes COPD?

Back 76

smoking increases neutrophil elastase activity which over time causes destruction to alveolar walls and decreased diffusion of oxygen into alveolar walls

Front 77

in COPD, what is limiting factor to oxygenation of pulmonary circulation?

Back 77

diffusion (unlike healthy lungs, which are perfusion limited)

Front 78

PPX for PCP pneumonia?

Back 78

TMP-SMX (second line is aerosolized pentamidine in case of sulfa allergy)

Front 79

what organism causes strep throat?

Back 79

streptococcus pyogenes

Front 80

treatment for strep throat?

Back 80

penicillin

Front 81

mechanism of infertility associated with cystic fibrosis?

Back 81

congenital absence of vas deferens

Front 82

what happens to TLC in COPD?

Back 82

increased due to lung hyperinflation

Front 83

vitamin abnormality seen in sarcoidosis?

Back 83

elevated vitamin D due to increased conversion from inactive form by macrophages