1 Pulm T

Question 1

What is the progression of Idiopathic Pulmonary HTN

Answer 1

muscularization -> medial hypertrophy -> intimal fibrosis -> plexiform lesions

Question 2

What is Bosentan?

Answer 2

endothelian-receptor antagonist; decreases pulmonary HTN

Question 3

What is occurring within the nucleolus?

Answer 3

Primary site of rRNA transcription (RNA Poly I) and ribosomal subunit assembly

Question 4

What does RNA Poly II synthesize?

Answer 4

mRNA

Question 5

What does RNA Poly III synthesize?

Answer 5

tRNA

Question 6

What gives elastin it elastic property?

Answer 6

lysine cross linking via lysol hydroxylase; very little hydroxylation compared to collagen

Question 7

What is Varenicline?

Answer 7

A partial nicotine agonist to help withdrawal

Question 8

What two things does H inf. require to grow?

Answer 8

Factor X (hematin) and Factor V (NAD+)

Question 9

What are the two tests for NADPH oxidase?

Answer 9

Nitroblue Tetrazolium (NBT) & Dihydrorhodamine (DHR)

Question 10

What does missense, silent, frameshift, and nonsense mutations mean?

Answer 10

missense - change aa used
silent - change third codon doesn’t matter
frameshift - change sets of three
nonsense - early stop codon

Question 11

What controls RR in healthy people vs COPD pts?

Answer 11

Healthy - PaCO2 - central chemoreceptors

COPD - PaO2 - peripheral chemoreceptors

Question 12

What is the V/Q at the apex vs the base?

Answer 12

Roughly 2.5 at the apex and 0.6 at the base assuming non-exertional upright status

Question 13

What are some risks of uncorrected sleep apnea?

Answer 13

Pulm HTN w/ cor pulmonale

Question 14

What type of tissue do hamartomas have?

Answer 14

cartilage; they are the most common benign lung tumors

Question 15

What is a common prophylaxis for lung transplant patients?

Answer 15

valganciclovir for CMV

Question 16

What mediates the cough reflex?

Answer 16

CN X; internal laryngeal nerve, a branch of the superior laryngeal nerve

Question 17

What is atopic asthma controlled by?

Answer 17

LTC/D/E4 antagonists

Question 18

What do small cell carcinomas often show evidence of?

Answer 18

neuroendocrine markers

Question 19

Aspirgillus branches at what angle?

Answer 19

45 degrees

Question 20

What does HCO3- exchange with in RBCs to maintain electroneutrality in tissues as they take on CO2?

Answer 20

Cl-

Question 21

What are the dimorphic fungi?

Answer 21

1) sporothrix 2) coccidioides 3) histoplasma 4) blastomyces 5) paracoccidioides

Question 22

Where does S. aureus typically colonize?

Answer 22

Ant. Nares

Question 23

Name the anti-IgE antibody

Answer 23

Omalizumab

Question 24

What is Cheyenne-Stokes breathing?

Answer 24

CHF patients who alternate between hypocapnic/hypercapnic episodes resulting in apnic-to-hyperventalatory responses.

Question 25

What are some common features of SCID?

Answer 25

no thymic shadow; mucocutaneous candida; failure to thrive; hypogammaglobulinemia: B and T cell dysfunction

Question 26

Why is sputum green?

Answer 26

myeloperoxidase; contains a blue-green heme pigment

Question 27

Why do people with panic attacks pass out?

Answer 27

hypocapnia can decrease cerebral blood flow

Question 28

What is lead-time bias?

Answer 28

An apparent increase in survival time with better screening tools when the prognosis is exactly the same

Question 29

Which bacteria has the glutamic acid capsule?

Answer 29

bacillus anthracis

Question 30

What mm is at the 5th intercostal space in the midaxillary line?

Answer 30

serratus anterior

Question 31

In what bacteria are sulfitides and what purpose does it serve?

Answer 31

TB/mycobacteria; it is a virulence factor allowing survival in macrophages

Question 32

What type of cells cover the true vocal cords?

Answer 32

stratified squamous epithelium; HPV can cause warty growths

Question 33

Where is stratified squamous epithelium found?

Answer 33

oropharynx; laryngopharynx; ant epiglottis; upper half of post epiglottis; true vocal cords

Question 34

What does nocardia often present with?

Answer 34

cavitary lung lesions, often misdiagnosed as TB: Tx w/ TMP-SMX

Question 35

When is the work of breathing minimized in restrictive Dx? Obstructive Dx?

Answer 35

Restrictive - low TV high RR | Obstructive - high TV low RR

Question 36

How long does it take the Th1 cells to begin to produce IFN-g after TB infection?

Answer 36

2-4weeks

Question 37

What are the signs of 1* and 2* TB infection?

Answer 37

1* - Ghon complex | 2* - Fibrocaseous lesion in the upper pole

Question 38

What particles deposit in the base of the lung? The apex?

Answer 38

coal/silica in the apex | asbestos in the base

Question 39

Species with budding yeast and thick capsule

Answer 39

Cryptococcus

Question 40

Species with pseudohyphae and blastoconida

Answer 40

Candida

Question 41

Species with septal hyphae and dichotomous V-shaped branching

Answer 41

Aspirgillis

Question 42

What are some functions of Club/Clara cells?

Answer 42

They help detox inhaled substances with P450; secrete surfactant components

Question 43

Where do 10-15um particles get trapped in the lungs?

Answer 43

URT

Question 44

Where do 2.5-10um particles get trapped in the lungs?

Answer 44

trachea/bronchi

Question 45

What happens to inhaled

Answer 45

phagocytosed in terminal respiratory bronchioles

Question 46

What are the signs of fat embolism?

Answer 46

Triad 1) hypoxemia 2) petechial rash 3) fractured long bone | occurs 24-72h post fracture

Question 47

Explain the two types of pneumonia vaccines and their respective responses

Answer 47

PPV23 is just polysaccharide and induces T-independent B-cell response PPV13 is conjugated to diptheria toxin and induces a T-dependent B-cell response

Question 48

What type of drug is theophylline?

Answer 48

PDE inhibitor - increases cAMP (similar to B-agonists)

Question 49

What is a typical ABG of a PE patient?

Answer 49

PCO2 is decreased as you hyperventilate. This causes a resp. alkalosis. PaO2 is decreased as well as you have V/Q mismatch and a shunt

Question 50

What is a potential complication to a selective Ig deficiency?

Answer 50

Pt will make antibodies to the missing Ab and you can have reactions to transfusions

Question 51

What are H1 antagonists useful/not useful for?

Answer 51

They are useful for hives and allergic symptoms but NOT asthama

Question 52

CFTR proteins serve what functions?

Answer 52

They block the ENaC channel and promote Cl- secretion which adds salt and water to the mucus. If lacking, the mucus becomes dehydrated and viscous

Question 53

What are some signs of MAC?

Answer 53

pallor, hepatosplenomegaly, clear CXR, elevated alk phosphate: grow optimally at 41*C

Question 54

What is azithromycin used to prophylactically treat in HIV with a CD

Answer 54

Azithromycin is used to prophylactically treat MAC

Question 55

Bronchioloalveolar carcinoma is what cell type and where is it located?

Answer 55

It is columnar cells and it lines alveoli so it is in the periphery. It spreads aerogenously.

Question 56

What are lamellar bodies?

Answer 56

They are within TII pneumocytes and store the surfactant

Question 57

What does IL-4/IL-5 do?

Answer 57

``` IL-4 causes IgE class switching IL-5 causes IgA class switching and eosinophil activation ```

Question 58

What are the signs of sarcoidosis?

Answer 58

Hilar LAD, elevated ACE, skin nodules, arthralgia. Causes scattered granulomas

Question 59

Explain what happens after a bronchus obstruction

Answer 59

Trapped air will get reabsorbed and lead to atalectasis

Question 60

What are the signs of cystic fibrosis?

Answer 60

recurrent sinopulmonary infections, pancreatic insufficiency, GI malabsorption,

Question 61

What is the mutation leading to CFTR?

Answer 61

A 3 bp deletion which leads to abnormal post translational processing

Question 62

What are some side effects of using methotrexate?

Answer 62

interstitial pneumonitis and fibrosis

Question 63

Where does the aspirate go 1) upright and 2) laying down?

Answer 63

1) Upright - basilar segments of lower lobe 2) Laying down - posterior segments of the upper lobe

Question 64

MCC of spontaneous pneumo in young patients?

Answer 64

apical subpleural blebs

Question 65

Which bacteria is bile soluble and optochin sensitive?

Answer 65

S. pneumo

Question 66

What give germ tubes (true hyphae) when grown at 37C?

Answer 66

Candida

Question 67

What is the first signs of CREST?

Answer 67

Intimal thickening of the Pulmonary arteries

Question 68

What are the four phases of pneumonia and their characteristics?

Answer 68

Congestions - bacteria Red - RBCs, Neutrophils, Fibrin Grey - RBC disintegration, Neutrophils, Fibrin Resolution - clear

Question 69

Acute pancreatitis can cause what resp. issue?

Answer 69

ARDS