Usmle Step 1 Fa Respiratory-Pathology

Front 1

Obstructive lung disease
(a) RV
(b) FVC
(c) FEV1
(d) FEV1/FVC

Back 1

Obstruction of flow results in air trapping in lungs. Airways close at prematurely high lung volumes resulting in:
(a) RV incr
(b) FVC decr
(c) FEV1 decr (--)
(d) FEV1/FVC<80%

Front 2

Restrictive lung disease
(a) lung volumes
(b) FEV1/FVC ratio

Back 2

Restricted lung expansion causes:
(a) decreased
(b) FEV1/FVC >80%

Front 3

4 major types of obstructive lung disease (COPD)

Back 3

(1) Chronic Bronchitis
(2) Emphysema
(3) Asthma
(4) Bronchiectasis

Front 4

2 general categories of restrictive lung disease

Back 4

Poor breathing mechanics (extrapulmonary, peripheral hypoventilation)
Interstitial lung disease (pulmonary, lowered diffusing capacity)

Front 5

Reid index

Back 5

Gland depth/total thickness of bronchial wall

Front 6

Chronic bronchitis
(a) definition
(b) findings
(c) pathology

Back 6

Blue Bloater
(a) productive cough for >3 months in 2+ years; disease of small airways
(b) wheezing, crackles, cyanosis (early onset hypoxemia due to shunting), late obset dyspnea
(c) hypertrophy of mucus secreting glands in bronchioles; Red index>50%

Front 7

Pink puffer

Back 7

Emphysema

Front 8

Barrel shaped chest

Back 8

Emphysema

Front 9

Emphysema (general)
(a) findings
(b) pathophys

Back 9

(a) Increased elastase activity; exhale through pursed lips to increase airway pressure and prevent airway collapse; early onset dyspnea, decr breath sounds, rachycardia, late onest hypoxemia due to eventual loss of capiallary beds (occurs with loss of alveolar walls)
(b) Enlargement of airspaces and decreased recoil resulting from destruction of alveolar tissue

Front 10

Cause of centriacinar emphysema

Back 10

Smoking

Front 11

Cause of panacinar emphysema

Back 11

Alpha 1 antitrypsin deficiency (also liver cirrhosis)

Front 12

Paraseptal emphysema associations and complications

Back 12

Assoc w/bullae; can rupture leading to spontaneous pneumothorax in young, otherwise healthy men

Front 13

Asthma
(a) pathology
(b) findings

Back 13

(a) bronchial hyperresponsiveness causes reversible bronchoconstriction; smooth muscle hypertrophy and Curschmann's spirals (shed epithelium from mucous plugs)
(b) can be triggered; cough, wheezing, dyspnea, tachypnea, hypoxemia, decr I/E ratio, pulsus paradoxus, mucus plugs

Front 14

Bronchiectasis
(a) pathology
(b) associations
(c) complication

Back 14

(a) chronic necrotizing infection of bronchi causing permanently dilated airways, purulent sputum, recurrent infection, and hemoptysis
(b) bronchial obstruction
CF
Poor ciliary motility
Kartagener's syndrome
(c) can develop aspergillosis

Front 15

Types of restrictive lung disease due to poor breathing mechanics

Back 15

Polio, myasthenia gravis (poor muscular effort)
Scoliosis, morbid obesity (poor structural apparatus)

Front 16

Types of interstitial (restrictive) lung diseases

Back 16

ARDS
Hyaline membrane disease
Pneumoconioses (coal miner's, silicosis, asbestosis)
Sarcoidosis
Idiopathic pulmonary fibrosis (repeated cycles of lung injury and wound healing with increased collagen)
Goodpasture's syndrome
Wegener's granulomatosus
Eosinophilic granuloma (histiocytosis X)
Drug toxicity (bleomycin, busulfan, amiodarone)

Front 17

Neonatal respiratory distress syndrome
(a) cause
(b) lecithin to sphinomyelin ratio
(c) possible sequelae of persistently low O2 tension
(d) risk factors
(e) treatment

Back 17

(a) surfactant deficiency
(b) <1.5 in amniotic fluid (2 is normal)
(c) PDA
(d) prematurity, maternal diabetes (elevated insulin), cesarean delivery (decr release of fetal glucocorticoids)
(e) maternal steroids before birth; artificial surfactant for infant

Front 18

Acute respiratory distress syndrome
(a) causes
(b) pathophys

Back 18

(a) trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, amniotic fluid embolism
(b) diffuse alveolar damage incr capillary permeability allowing protein rich leakage into alveoli resulting in formation of intralveolar hyaline membranes; initial damage due to neutrophilic substances, activation of coag cascade or oxygen free radicals

Front 19

Definition of sleep apnea

Back 19

Personal stops breathing for at least 10s repeatedly during sleep

Front 20

Central sleep apnea

Back 20

No sleep effort

Front 21

Obstructive sleep apnea

Back 21

Respiratory effort against airway obstruction

Front 22

Associations w/ sleep apnea (causal and result)

Back 22

Obesity, loud snoring, systemic/pulmonary HTN, arrhythmias, and possible sudden death; may result in chronic fatigue

Front 23

Treatment of sleep apnea

Back 23

Wt loss, CPAP, surgery

Front 24

Asbestosis
(a) define
(b) increased risk for?
(c) findings
(d) location in lung

Back 24

(a) diffuse pulmonary interstitial fibrosis due to inhaled asbestos fibers
(b) pleural mesothelioma and bronchogenic carcinoma
(c) long latency; ferruginous bodies in lung (asbestos coated with hemosiderin); ivory white pleural plaques
(d) mainly affects lower lobes

Front 25

What is the relationship b/w smoking and asbestosis with bronchogenic carcinoma and mesothelioma?

Back 25

No additive risk for mesothelioma
Greatly increased risk for bronchogenic carcinoma

Front 26

Where do most pneumocioses have their effect in the lung?

Back 26

Upper lobes (not asbestosis)

Front 27

Bronchial obstruction findings:
(a) breath sounds
(b) resonance
(c) fremitus
(d) tracheal deviation

Back 27

(a) absent or decr over affected area
(b) decr resonance
(c) decr fremitus
(d) tracheal deviation towards side of lesion

Front 28

Pleural effusion
(a) breath sounds
(b) resonance
(c) fremitus
(d) tracheal deviation

Back 28

(a) decr over effusion
(b) dullness
(c) decr fremitus
(d) n/a

Front 29

Pneumonia
(a) breath sounds
(b) resonance
(c) fremitus
(d) tracheal deviation

Back 29

(a) may have bronchial breath sounds over lesion
(b) dullness to percussion
(c) increased fremitus

Front 30

Tension pneumothorax
(a) breath sounds
(b) resonance
(c) fremitus
(d) tracheal deviation

Back 30

(a) decreased breath sounds
(b) hyperresonant
(c) absent fremitus
(d) away from side of lesion

Front 31

General presentation of lung cancer

Back 31

Cough, hemoptysis, bronchial obstruction, wheezing, pneumonic "coin" lesion on x ray film

Front 32

Most common tumor in lung

Back 32

Metastasis to lung most common cancer

Front 33

Primary vs Metastatic lung cancer presentation

Back 33

Met: dyspnea
Primary: cough

Front 34

SCC of lung
(a) location
(b) risk factors
(c) description
(d) histology

Back 34

(a) central
(b) smoking
(c) hilar mass from bronchus; cavitation; parathyroid like activity due to PTHrP
(d) keratin pearls and intracellular bridges

Front 35

Adenocarcinoma: bronchial
(a) location
(b) risk factors
(c) description
(d) histology

Back 35

(a) peripheral lung
(b) n/a -most common lung cancer in nonsmokers and females
(c) develops in site of prior pulmonary inflammation or injury
(d) clara cells transformed into type II pneumocytes;multiple densities on x ray of chest

Front 36

Adenocarcinoma of lung: broncioloalveolar
(a) location
(b) risk factors
(c) description
(d) histology

Back 36

(a) peripheral lung;
(b) NOT linked to smoking
(c) grows along airways; can present like pneumonia
(d) clara cells transformed into type II pneumocytes; multiple densities on CXR

Front 37

Small cell (oat cell) carcinoma
(a) location
(b) risk factors
(c) description
(d) histology
(e) treatment

Back 37

(a) central
(b) n/a
(c) Undifferentiated and very aggressive; often assoc w/ ectopic production of ACTH or ADH; may lead to Lambert Eaton syndrome.
(d) neoplasm of neuroendocrine Kulchitsky cells (small dark blue cells)
(e) responsive to chemo

Front 38

Lambert Eaton syndrome

Back 38

Autoantibodies against calcium channels

Front 39

Large cell carcinoma
(a) location
(b) description
(c) histology
(d) treatment

Back 39

(a) peripheral
(b) highly anaplastic undifferentiated tumor; poor prognosis; less responsive to chemo
(c) pleomorphic giant cells w/leukocyte frags in cytoplasm
(d) surgery (less responsive to chemo)

Front 40

Carcinoid tumor presentation

Back 40

Secretes serotonin; causes car cinoid syndrome (flushing, diarrhea, wheezing, salivation)

Front 41

Metastases to lung characteristics of most common

Back 41

Brain (epilepsy)
Bone (pathologic fracture)
Liver (jaundice, hepatomegaly)

Front 42

Pancoast's tumor
(a) description
(b) clinical presentation

Back 42

(a) occurs in apex of lung
(b) may affect cervical sympathetic plexus causing Horner's

Front 43

Lobar pneumonia
(a) most frequent organism(s)
(b) characteristics

Back 43

(a) pneumococcus
(b) intraalveolar exudate leading to consolidation; may involve entire lung

Front 44

Bronchopneumonia
(a) most frequent organism
(b) characteristics

Back 44

(a) S aureus, H flue, Klebsiella, S pyo
(b) acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving more than 1 lobe

Front 45

Interstitial/atypical pneumonia
(a) most frequent organism(s)
(b) characteristics

Back 45

(a) viruses (RSV, adeno), mycoplasma, legionella, chlamydia
(b) diffuse patchy inflammation localized to interstitial areas at alveolar wallsl generally involves more than 1 lobe; more indolent course than bronchopneumnia

Front 46

Lung abscess
(a) definition
(b) organisms

Back 46

(a) Collection of pus within parenchyma usually resulting from bronchial obstruction (e.g. cancer) or aspiration of oropharyngeal contents (esp patients predisposed to LOC -alcoholics, epileptics)
(b) S aureus or anaerobes

Front 47

Pleural effusion: transudative
(a) describe composition
(b) major causes

Back 47

(a) decr protein content
(b) CHF, nephrotic syndrome, hepatic cirrhosis

Front 48

Pleural effusion: exudate
(a) composition/description
(b) major causes
(c) course of action

Back 48

(a) increased protein content, cloudy
(b) malignancy, pneumonia, collagen vascular disease, trauma (basically anything that can increase vascular permeability)
(c) must drain in light of risk of infection

Front 49

Lymphatic pleural effusion
(a) composition/description
(b) cause

Back 49

(a) milky fluid
(b) increased triglycerides