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56 Cards in this Set
- Front
- Back
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A young woman has infertility, recurrent URIs, and dextrocardia. Which of her proteins is deficient?
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This is Kartagener's syndrome. The problem is immotile cilia due to a dynein arm defect. Results in male and female infertility, bronchiectasis, and recurrent sinusitis. Also associated with situs inversus (dextracardia here).
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A woman with fibroids is chronically tierd. What is the most likely diagnosis and what changes have occurred in her oxygen content and saturation?
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The diagnosis is hypochromic microcytic anemia due to fibroids (iron deficiency from bleeding).
There is no change in O2 content or O2 saturdation. There is a decrease in hemoglobin due to bleeding however. |
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What gene is abnormal is primary pulmonary HTN?
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BMPR2 - Bone Morphogenetic Protein Receptor type II
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What infections can primary pulmonary hypertension be associated with?
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HIV and Kaposi's sarcoma (HHV-8)
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What substances are known for causing methemoglobinemia?
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Nitrates, sulfonamides, dapsone, chloroquine, primaquine, metoclopramide, and local anesthetics
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What amniotic fluid measurement is indicative of fetal lung maturity?
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Lecithin to sphingomyelin ration > 2.0
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What histological change takes place in the trachea of a smoker?
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Metaplasia; ciliated pseudostratified columnar becomes squamous
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A patient in the ER is having anaphylaxis. You make an incision beneath the thyroid cartilage to establish airway. What structure was cut?
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Cricothyroid membrane
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What cell type proliferates during lung damage?
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Type II pneumocytes
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What are other names for surfactant?
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Dipalmitoyl phosphatidylcholine and lecithin
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Where do the IVC, aorta, and esophagus perforate the diaphragm?
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T8 - inferior vena cava
T10 - esophagus (and vagus) T12 - aorta (red), thoracic duct (white), azygous vein (blue) I (IVC) ate (8) ten (10) eggs (esophagus) at (aorta) twelve (12). |
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What activates bradykinin? What inactivates bradykinin?
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ACE activates bradykinin
Kallikrein activates bradykinin |
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What is the different between the T and R forms of hemoglobin?
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T has low affinity for 02. R has higher affinity (300x) for O2.
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What conditions favor the T form of hemoglobin over the R form?
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T form is favored by increased Cl-, H+, CO2, 2,3-BPG, and temperature.
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What is the treatment for cyanide poisoning?
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Use nitrates to oxidize hemoglobin to methemoglobin, which has an increased affinity for cyanide, allowing cytochrome oxidase to function. Use thiosulfate to bind this cyanide, forming thiocyanate, which is renally excreted.
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How would carbon monoxide poisoning affect a pulse ox reading?
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It wouldn't, since saturation would still read as normal.
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What is the normal value for pulmonary artery pressure? What is the value for pulmonary hypertension?
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Normal pulmonary artery pressure is 10-14 mmHg
Pulmonary HTN is > 25 mmHg or > 35 mmHg when exercising |
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What pathological events take place during pulmonary HTN?
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Atherosclerosis, medial hypertrophy, and intimal fibrosis of pulmonary arteries
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What can you mix with oxygen in order to get O2 into the lung when a tumor is causing constriction and increasing viscosity?
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Helium
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What is the alveolar gas equation?
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PAO2 = 150 - (PACO2/0.8)
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What is the V/Q of the lung apex?
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V/Q = 3 (wasted ventilation)
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What is the V/Q of the lung base?
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V/Q = 0.6 (wasted perfusion)
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Where are ventilation and perfusion greatest?
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Both ventilation and perfusion are greatest at the base of the lung than at the apex of the lung.
There is a higher percentage of 02 in the apex due to decreased perfusion, which is why TB likes it up there. |
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In what forms is CO2 transported from tissues to the lungs?
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Bicarbonate (90%), bound at the N-terminus of globin (not heme) as carbaminohemoglobin (5%), and dissolved CO2 (5%).
CO2 binding of the N terminus of globin favors the taut form of hemoglobin. |
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What enzyme converts CO2 into bicarb for transport in blood cells?
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Carbonic anhydrase
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Haldane effect
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In lungs, oxygenation of Hb promotes dissociation of H+ from Hb. This shifts equilibrium toward CO2 formation; therefore, CO2 is released from RBCs.
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Bohr effect
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In peripheral tissues, increased H+ shifts O2 dissociation curve to the right, favoring unloading of O2.
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What can you give to treat the respiratory alkalosis found with altitude sickness?
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Acetazolamide - causes self limited NaHCO3 diuresis and reduction in total-body HCO3- stores.
Toxicity includes hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, and sulfa allergy. |
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How does exercise afffect PaO2, PaCO2, and venous CO2 content?
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PaO2 and PaCO2 do not change, but venous CO2 content increases.
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What are the three most common symptoms associated with pulmonary embolus?
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Chest pain, tachypnea, and dyspnea
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Where do 95% of pulmonary emboli arise?
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Deep leg veins
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What is Virchow's triad?
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It is a predisposition to deep venous thrombosis: Stasis (post-op, cast, pregnancy), hypercoagulability (sickle cell, polycythemia, CHF, estrogen excess, smoking), and endothelial damage (fracture, post-op, and post-partum)
Post-partum has all three risk factors, but that is good because you don't want the mother to hemorrahge. |
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What structure would allow a DVT to cause a stroke?
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Patent foramen ovale
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What is Homans' sign?
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In the case of DVT, dorsiflexion of the foot can cause a tender calf muscle.
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A patient suffers a stroke after incurring multiple long bone fractures in a skiing accident. What caused the infarct?
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Fat embolus traveling through a patent foramen ovale.
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What scan is done for DVTs?
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Ultrasound compression scan or lower extremity duplex scan
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What is the gold standard test for pulmonary embolism?
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Pulmonary angiogram
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What are some lab values associated with pulmonary embolism?
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Elevated d-dimer, maybe DVT on lower extremity ultrasound, large Aa gradient, possible ECG changes (S1Q3T3)
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What scan is done for DVTs?
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Ultrasound compression scan or lower extremity duplex scan
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A patient presents with an asthma attack. What immunological reaction is taking place that is responsible for anaphylaxis in this patient?
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Antigen cross-linking IgE on presensatized mast cells.
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What is the gold standard test for pulmonary embolism?
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Pulmonary angiogram
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What are some lab values associated with pulmonary embolism?
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Elevated d-dimer, maybe DVT on lower extremity ultrasound, large Aa gradient, possible ECG changes (S1Q3T3)
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A patient presents with an asthma attack. What immunological reaction is taking place that is responsible for anaphylaxis in this patient?
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Antigen cross-linking IgE on presensatized mast cells.
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What are some histological findings in asthma?
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Smooth muscle hypertrophy, Curschmann's spirals (shed epithelium from muscous plug), and Charcot-Leyden crystals.
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Which of these increases your risk of lung cancer: Coal, silicon, and/or asbestos?
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Asbestos
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What are the symptoms of silicosis?
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Associated with foundries, sandblasting, and mines. Macrophages respond to silica and release fibrogenic factors, leading to fibrosis. It is thought that silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB. Affects upper lobes. "Eggshell" calcification of hilar lymph nodes.
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Why do type II pneumocytes make surfactant?
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35th week of gestation
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What causes retinopathy of prematurity?
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Therapeutic supplemental O2
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What are the risk factors for neonatal respiratory distress syndrome?
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Prematurity, maternal diabetes (due to elevated insulin), cesarean delivery (decreased release of fetal glucocorticoids)
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What are treatment options for neonatal respiratory distress syndrome?
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Maternal steroids before birth (no benefit after week 35), artificial surfactant for infant, thyroxine
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What is the difference between central sleep apnea and obstructive sleep apnea?
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Central sleep apnea occurs with no respiratory effort (premature infants) while obstructive sleep apnea occurs with respiratory effort against airway obstruction (no movement of air due to soft palate or swollen tonsils; associated with obesity, loud snoring, HTN, arrhythmias, and possible sudden death).
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What is the common presenting symptoms with primary lung cancer? metastases to the lung?
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Primary lung cancer - presents with cough
Metastases to the lung - presents with dyspnea |
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What are some of the characteristics of squamous cell carcinoma of the lung?
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Central location; hilar mass arising from bronchus. Associated with smoking. Parathyroid-like activity - PTHrP.
Histology shows keratin pearls and intercellular bridges. |
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What can be produced ectopically from small cell lung cancer?
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ACTH or ADH; may lead to Lambert-Eaton syndrome (autoantibodies against calcium channels; weakness responds with use).
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Where are carcinoid tumors most likely found? What are the symptoms?
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Most commonly found in the lung or GI; symptoms include (B FDR): bronchospasm (wheezing), flushing, diarrhea, and right sided heart lesion, murmur, or etc.
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What is Pancoast's tumor?
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Carcinoma that occurs in the apex of lung and may affect cervical sympathetic plexus, causing Horner's syndrome (ptosis, miosis, and anhidrosis).
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