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USMLE Step 1 pulmonary
DIT-pulmonary
58
Medical
Graduate
05/27/2010

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Cards

Term
What histiological change takes place in the trachea of a smoker?
Definition
Ciliated columnar epithelium--> squamous
Term
Where do you perform an emergency tracheotomy?
Definition
Cricothyroid membrane (right below the thyroid cartilage)
Term
Which structures pierce the diaphragm and at what vertebral levels?
Definition
"I (IVC) ate (8) ten (10) Eggs (esophagus) At (aorta) twelve (12)"...
T8: IVC
T10: Esophagus, vagus
T12: (red, white, blue)... aorta, thoracic duct, azygous v
Term
What cell type proliferates during lung damage?
Definition
Type II pneumocytes
Term
Where is pain from diaphragm referred to?
Definition
shoulder
Term
What two lung volumes can give you total lung capacity?
Definition
TLC = FRC + IC
Term
What are the 3 components of virchow's triad?
Definition
1. Stasis
2. hypercoagulability
3. endothelial damage
Term
A patient suffers a stroke after incurring multiple long bone fractures in a skiing accident. What caused the infarct?
Definition
fat embolus
Term
What is the differential dx for eospinophilia?
Definition
D-NAAACP...Drugs, Neoplasm, Allergy/asthma (Churg-strauss), Addison's dz, Acute interstitial nephritis, Collagen Vascular dz, Parasites (Loffler's eosinophilia)
Term
Which asthmas medication? inhaled DOC for chronic asthma
Definition
steroids
Term
Which asthmas medication? inhaled treatment of choice for acute exacerbations
Definition
albuterol (and lev-albuterol)
Term
Which asthmas medication? Narrow TI, drug of last resort
Definition
theophylline
Term
Which asthmas medication? blocks conversion of arachidonic acid to leukotrienes
Definition
zileuton (MAKE ZILCH)
Term
Which asthmas medication? inhibits mast cell release of mediators, used for prophylaxis only
Definition
cromylyn
Term
Which asthmas medication? inhaled treatment that blocks muscarinic receptors
Definition
ipratropium
Term
Which asthmas medication? long-acting beta-2 agonist
Definition
salmeterol
Term
Which asthmas medication? blocks leukotriene receptors
Definition
zafilukast, montelukast
Term
Patient has an extended expiratory phase, what dz?
Definition
obstructive dz... COPD
Term
What anti-leukotriene do you use in kids?
Definition
montelukast
Term
What is the most common cause of pneumonia in pts w/ other health problems?
Definition
klebsiella
Term
Most common cause of viral pneumonia
Definition
RSV
Term
A 55 yo man who is a smoker and heavy drinker presents w/ a new cough and flu-like symptoms...gram stain shows no organisms but silver stain shows gram(-) rods. Dx?
Definition
Legionella
Term
Which has high protein content: exudate or transudate?
Definition
exudate
Term
What is the V/Q at the apex of the lung?
Definition
~3
Term
What is the V/Q at the base of the lung?
Definition
~0.6
Term
In exercise, what does V/Q approach?
Definition
1
Term
What is the HALLMARK sign of COPD?
Definition
decreased FEV1/FVC
Term
What is the HALLMARK sign of restrictive lung dz?
Definition
decreased total lung capacity
Term
What is pulsus paradoxis and what causes it?
Definition
Systolic bp decreases by >10mmHg in inspiration, often caused by cardiac tamponade
Term
What lecithin:sphingomyelin ratio indicates fetal lung maturity?
Definition
2...if not mature, give mom steroids
Term
What is pulmonary surfactant composed of?
Definition
dipalmitoyl phosphatidylcholine
Term
Which lung are inhaled foreign bodies more likely to lodge?
Definition
RIGHT bronchus bc it is wider and more vertical
Term
What lung volume? air in lung after maximal expiration, cannot be measured on spirometry
Definition
residual volume
Term
What lung volume? Are that can still be breathed out after normal expiration
Definition
(ERV)...Expiratory Reserve Volume
Term
What lung volume? Air that moves into lung with each quiet inspiration. What is a normal volume?
Definition
tidal volume, usually ~500mL
Term
What lung volume? air in excess of tidal volume that moves into lung on maximum inspiration
Definition
(IRV) Inspiratory reserve volume
Term
What is the lung capacity? TV + IRV + ERV
Definition
VC-- Vital Capacity (everything except reserve volume)
Term
What is the lung capacity? RV + ERV
Definition
FRC...functional residual capacity (volume in lung after normal expiration)
Term
What is the lung capacity? IRV + TV
Definition
IC...Inspiratory Capacity
Term
What is the lung capacity? IRV + TV + ERV + RV
Definition
TLC...Total Lung Capacity
Term
Taut form of hemoglobin...high or low affinity for O2?
Definition
Low affinity...oxygen to tissues
Term
What 5 conditions favor the Taut form of hemoglobin?
Definition
1. increased Cl
2. increased H+ (low pH)
3. increased CO2
4. 2,3 BPG
5. increased temp
....leads to O2 unloading
Term
What do you treat methemoglobinemia with?
Definition
Methylene blue and Vit C
Term
What do things do you use to treat cyanide poisoning?
Definition
1. Nitrates to cause methemoglobinemia to bind the CN
2. Then thiosulfate to bind CN and it is renally excreted
Term
In what form is the majority of carbon dioxide transported in the body?
Definition
90% as bicarbonate
Term
What is the alveolar gas exchange equation?
Definition
PAO2-PaO2 ~~ 10-15mmHg (higher in elderly)
A--Alveolar, a--Arterial (arteries are smaller, so small "a")
Term
At what part of the lung is ventilation and perfusion the highest?
Definition
Base of lung (although V/Q is higher at apex)
Term
What is your metabolic and respiratory condition at high altitude?
Definition
Respiratory alkalosis w/ metabolic compensation (kidney getting rid of bicarb)
Term
What 3 professions are associated w/ asbestosis?
Definition
shipbuilding, roofing, plumbing
Term
What is the difference in the location which silicosis versus asbestosis affects the lungs?
Definition
Silicosis: upper lobe
Asbestosis: lower lobe
Term
What composes artificial surfactant that can be given to premature neonates?
Definition
thyroxine
Term
Pt develops hypoxia and bilateral infiltrates several days after being admitted to Intensive Care Unit. What do you suspect?
Definition
ARDS (Acute Respiratory Distress Syndrome)
Term
What is the hallmark histiological finding with ARDS?
Definition
formation of thick hyaline membranes consisting of proteinaceous material and epithelial necrotic debris
Term
Between pleural edema and pleural effusions, which has fluid that follows gravity (ie. dependent on pt position)
Definition
pleural effusion (fluid in fluid space, not parenchyma like in edema)
Term
Which lung cancer is not necessarily associated w/ smoking?
Definition
Adenocarcinomas
Term
What do you treat atypical pneumonias with?
Definition
macrolides
Term
Rupture of what causes a chylothorax?
Definition
thoracic duct (milky lymphatic fluid, lots of TG's)
Term
What drug? Used to treat pulmonary HTN...Competitively antagonizes endothelin-1 receptors, decreasing pulmonary vascular resistance
Definition
BoSETRON
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