Usmle Step 1 Dit: Respiratory

Front 1

How does FEV/FVC ratio differ in obstructive and resistrictive lung disease?

Back 1

In both diseases there is a decrease in the ratio but in obstructive, FEV is more dramatically reduced compared to FVC whereas in restrictive they are reduced proportionetly and the ratio doesnt get very affected.

Front 2

COPD with hyperplasia of mucus secreting glands in the bonchi and reid index >50%

Back 2

Chronic bronchitis

Front 3

Productive cough for >3 months per year for >2 years

Back 3

Chronic bronchitis

Front 4

COPD of small airways

Back 4

Chronic bronchitis

Front 5

Wheezing, crackles, cyanosis, late onset dyspnea with history or smoking

Back 5

Chronic bronquitis

Front 6

COPD with enlargement of airways

Back 6

Emphysema

Front 7

Exhalation through pursed lips to increase airway pressure.

Has decreased recoil, increased compliance.

Back 7

Emphysema

Front 8

Seen in smokers in upper lobes and superior segments of lower lobes

Back 8

Centroacinar emphysema

Front 9

Associated with a1-antitripsin deficiency, early onset, affect all lobes but mostly lowerm associated to early onset cirrhosis

Back 9

Panacinar

Front 10

Bronchial hyperresponsiveness that causes reversible bronchoconstrictiona

Back 10

Asthma

Front 11

Curshmann spirals, charcot leyden crystals, smooth muscle hypertrophy

Back 11

Asthma

Front 12

Formed from breakdown of eosinphils in sputum

Back 12

Charcot-leyden crystals

Front 13

Shed epithelium that forms mucus plugs

Back 13

Curshmann spirals

Front 14

Cough, wheezing, tachypnea, dyspnea, decreased I/E ratio, pulsus parodoxus, mucus plugging

Back 14

Asthma

Front 15

Chronic necrotizing infection of large bronchi that cause permanently dilated airways, purulent sputum, recurrent infections, hemoptysis

Back 15

Bronchioectasis

Front 16

Associated with bronchial obstruction, pooe ciliary motility (smoking, kartagener sx, cystic fibrosis), allergic bronchopulmonary aspergillosis

Back 16

Bronchiectasis

Front 17

Main causes of eosinophilia

Back 17

NACA D PUTA

Neoplasia, asthma, allergic processes, connective tissue diseases, parasites, drugs, addisson

Front 18

Drug used for treatment in mild intermittent asthma

Back 18

B2-agonist

Albuterol and levalbuterol are used during exacerbation and salmeterol and formoterol are used as prophylaxis

Front 19

What B2 agonists are used to treat asthma?

Back 19

Albuterol, levalbuterol, salmeterol, formoterol

Front 20

When is salmeterol & formoterol used?

Back 20

They are long acting agents for prophylaxis of asthma attacks.

Front 21

How is mild persistant asthma (use of albuterol more than 2x per week) treated?

Back 21

B2+ corticoid

Front 22

What inhaled corticosteroids are used in the treatment of asthma?

Back 22

Beclomethasone, fluticasone

Front 23

By which mechanism are corticoids useful in treating asthma?

Back 23

Inhibit the synthesis of all cytokines. Inactivate NF-kB and other inflammatory agents.

Front 24

What does NF-kB normally do?

Back 24

Induces the production of TNF-a

Front 25

1st lines therapy for chronic asthma

Back 25

Corticosteroids; beclomethasone, fluticasone

Front 26

In what cases are systemic steroids used in asthma patients?

Back 26

Severe chronic asthma and acute asthma excacerbation with inhaled B2

Front 27

What systemic steroid is most commonly used in asmtha?

Back 27

Methoprednisolone

Front 28

Good for treating aspirin-induced asthma

Back 28

Antileukotriens

Front 29

What drugs pertain to "antileukotrienes"

Back 29

Montelukast, zafirlukast, Zileuton

Front 30

5-lipooxygenase pathway inhibitor that blocks conversion of arachidonic acid to leukotrienes

Back 30

Zileuton

Front 31

Block leukotriene D4 receptors

Back 31

Montelukast, zafirlukast

Front 32

Main effect of antileukotrienes?

Back 32

Block neutrophil chemotaxis and increase bronchial tone

Front 33

Prevents mast cell release and bronchoconstriction

Back 33

Cromolyn

Front 34

Inhibits antigen and IgE on mast cells

Back 34

Omalizumab

Front 35

Muscarinic agonist used in asthma treatment

Back 35

Ipatropium and tiopropium

Front 36

By which mechanism does ipatropium and tiotropium work?

Back 36

Competitively block of muscarin receptors, preventing bronchoconstriction. Decrease overall vagal or parasympathetic tone in the lungs and decrease mucus production

Front 37

By which mechanism do methylxantines treat asthma?

Back 37

Cause bronchodilation by inhibiting phosphodiesterase and increasing cAMP levels due to decreased cAMP hydrolysis . Blocks actions of adenosine. Metabolized by cytochrome p450

Front 38

What is the methylxantines most commonly used to treat asthma?

Back 38

Theophylline

Front 39

Why is the use of methyxantines limited?

Back 39

Narrow therapeutic index (induces cardiotoxicity, neurotoxicity and seizures.

Front 40

What are the 1st generation H1 blockers?

Back 40

Diphenhydramine, dmenhydrinate, chlorpheniramine, hydoxyzine

Front 41

What are the clinical uses of 1st generation H1 blockers?

Back 41

Allergy, motion sickness, sleep aid (but poor quality)

Front 42

What are the 2nd generation H1 blockers?

Back 42

Loratadine, fexofenadine, desloratadine, cetirizine

Front 43

What are the clinical uses of 2nd generation H1 blockers?

Back 43

Allergy, rinitis

Front 44

How do the toxicities between 1st generation and 2nd generation H1 blockers differ?

Back 44

1st generation causes a lot of sedation, antimuscarinic effect, anti-a-adrenergic

Whereas 2nd generation are far less sedating because of decreased entry into CNS

Front 45

Guaifenesin and N-acetlycysteine are examples of:

Back 45

Expectorants

Front 46

Expectorant that does not suppress cough reflex

Back 46

Guaifenesin

Front 47

Expectorant that can loosen mucous plugs in CF patients by cleaving disulfide bonds within mucous glycoproteins. Also used as antidote for acetaminophen and contrast-induced renal nephropathy

Back 47

N-acetylcysteine

Front 48

Antitussive which is a synthetic derivative of morphine, which no analgesic effect.

Back 48

Dextromethorphan

Front 49

B2 agonist with less B1 effect (less taquicardia)

Back 49

Levalbuterol

Front 50

Constrict dilated arterioles in nasal mucosa and act by being sympathomimetic a-agonist

Back 50

Nasal decongestants; Pseudoephedrine, phenylephrine

Front 51

Antihistamine used as an apetite stimulant

Back 51

Cyproheptadine

Front 52

Antihistamine used to treat nausea and vomiting

Back 52

Promethazine

Front 53

Antihistamine used to treat OTC allergy/ cold

Back 53

Chlorpheniramine

Front 54

Antihistamine used to treat sedation and itching

Back 54

Hydroxyzine

Front 55

Antihistamine used to treat vertigo

Back 55

Meclizine

Front 56

The two types of restrictive lung disease

Back 56

- Poor breathing mechanics

- Interstitial lung disease

Front 57

What conditions can be classified as restrictive lung diseases caused by poor breathing mechanics?

Back 57

Polio, mystaenia gravis, guillan barre , scoliosis, morbid obesity, chest wall deformity, diaphragmatic hernia, kyphosis

Front 58

What conditions can be classified as restrictive lung diseases due to interstitial lung diseases?

Back 58

pneumoconiosis, sarcoidosis, idiopathic pulmonary fibrosis, goodpasture syndrome, langerhans cell histiocytosis, hypersensitivity pneumonitis

Front 59

List the most common types of pneumoconiosis

Back 59

Anthracosis, silicosis, asbestosis, coal workers lung, berylliosis

Front 60

Due to inorganic dust inhalation

Back 60

Pneumoconiosis

Front 61

Most common types of sarcoidosis

Back 61

Bilateral hilar lymphadenopathy, noncaseating granuloma

You can see increased ACE and Ca2+

Front 62

What is idiopathic pulmonary fibrosis?

Back 62

Repeated cycles of lung injury and wound healing with increased collagen deposition.

Honeycomb lung on imaging.

Fatal after a few years of diagnosis

Front 63

Anti-basement membrane antibodies seen in lung, kidney (as glomerulonephritis)

Back 63

Goodpasture syndrome

Front 64

Eosinophilic granuloma

Back 64

Langerhans cell histiocytosis

Front 65

Due to organic dust exposition

Back 65

Hypersensitivity pneumonitis

Front 66

Farmers lung and pigeon breeders lung

Back 66

Hypersensitivity pneumonitis

Front 67

A GRUELING Disease

Back 67

Sarcoidosis;

(ACE inhibitor, granulomas, rheumatoid arthritis, uveitis, erythema nodosum in the tibia, lymphadenopathy, idiopathic, noncaseating granuloma, gammaglobulinemia, vit D increase)

Front 68

Pneumoconioses increases the risk of:

Back 68

COR pulmonale and caplan syndrome

Front 69

Associated to shipbuilding, roofing and plumbing

Back 69

Asbestosis

Front 70

Ivory white calcified pleural plaques

Back 70

Asbestosis

Front 71

Asbestosis predisposes to what kinds of lung cancer?

Back 71

bronchogenic carcinoma and mesothelioma

Front 72

What areas of the lung does asbestosis affect?

Back 72

Lower lobes

Front 73

Golden brown fusiform rods resembling dumbells

Back 73

Asbestosis

Front 74

Aerospace manufactors

Back 74

Berylliosis

Front 75

Cell mediated immunity with noncaseating granulomas, very similar to sarcoidosis and increased risk of lung CA

Back 75

Berylliosis

Front 76

Due to prolonged coal dust exposure, consists of inflammation and fibrosis of the upper lobes. Not associated to smoking OR lung Ca

Back 76

Coal workers pneumoconiosis

Front 77

Associated with foundries, sand blasting and mines.

Back 77

Silicosis

Front 78

Eggshell calcification of hilar lymph nodes

Back 78

Silicosis

Front 79

Increased risk of TB and bronchogenic carcinoma, affects upper lobes

Back 79

Silicosis

Front 80

How does neonatal respiratory distress syndrome look on CXR?

Back 80

Diffuse airspace, interstitial opacities, air bronchograms, ground glass appearance

Front 81

What factors increase the risk for neonatal respiratory distress syndrome?

Back 81

Prematurity, maternal diabetes, C-section delivery

Front 82

When does surfactant synthesis begin?

Back 82

Week 26

Front 83

When does surfactant synthesis complete?

Back 83

Week 35

Front 84

What are the main causes of acute respiratory distress syndrome?

Back 84

Trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, amniotic fluid embolism

Front 85

How is the wedge pressure in acute respiratory distress syndrome?

Back 85

PCWP is normal

Front 86

What disease has formation of hyaline membrane inside alveoli?

Back 86

Acute respiratory distress syndrome

Front 87

Decreased lung compliance, increased permeability, worstening V/Q, increased worth breathing, normal PCWP

Back 87

Acute respiratory distress syndrome

Front 88

Diffuse alveolar damage, increased capillary permeability, protein rich leakage into alveoli

Back 88

Acute respiratory distress syndrome

Front 89

No repiratory effort while sleeping. Seen in premature infants due to decreased drive

Back 89

Central sleep apnea

Front 90

Respiratory effort against airway obstruction during sleep. Due to enlarged palate or tonsils. Associated to obesity, loud snoring.

Back 90

Obstructive sleep apnea

Front 91

What is the tx for central sleep apnea?

Back 91

Caffeine

Front 92

What is the treatment for obstructive sleep apnea?

Back 92

Weight loss, CPAP, surgery (adenoidectomy), modafinil (for daytime sleepiness)

Front 93

How is Pa02 during the day of a person with sleep apnea?

Back 93

Normal