2012 end of module exam Flashcards
What is the main cell infiltrate in Arthur reaction (type III hypersensitivity)?
- Neutrophils
What action of inhaled corticosteroid?
- Inhibit IgE synthesis
Asthmatic lady with bout of coughing, she develops chest pain what best diagnostic method for pain?
- Urgent CT scan
Table with low PaCO2 and at pure oxygen PaO2 is low?
- Abnormal shunt
What’s influence static compliance?
- Lung volume
- Ppl
- Frequencyofbreath
- Lung volume
What Decreases dynamic compliance?
- deep breath
- Exercise
- Increase of Raw
- Increase of Raw
Tb Drug not given to female on oral contraceptives? -
Rifampin
*Rifampin is a strong inducer of cyt P450, hence rapid inactivation of oral contraceptives, warfarin, and oral antidiabetics.
Ifshuntedbloodexceeds30%thiswillcauserisein: - PaO2
- PAO2
- PaCO2
- AaDO2
- AaDO2
In which condition the DLCO will increase?
Lefttorightshunt
What increases DLCO?
Pulmonary hemorrhage
Concentric layers of hyalinized fibrotic?
- Foci in the lung
What is the mechanism in the smooth muscles of the pulmonary vessels that links hypoxia and vasoconstriction?
- Reduced uptake of Ca+ in the sarcoplasmic reticulum
- Hypoxia –> increased AMP –> activation ofAMPK –> phosphorylation of K+ channels and partial depolarization –> opening of Ca2+ channels. AMPK also phosphorylates cADPR which allow mobilization of Ca2+ into cytoplasm through RyR receptors
What Ig is involved in allergic Reaction?
IgE
What is the most common cause of URTIs in Kuwait?
- Viral
A child presented with fever, dyspnea, tachypnea, she didn’t have all her childhood vaccination?
- Epiglottitis
What joint is associated with bucket handle movement?
- Costovertebral joint (stiff with little space –> slight gliding)
- Costotransverse joint (at ribs 7-10)
- Costotransverse joint (at ribs 7-10)
What is the cause of damage in AAT deficiency when a pathogen is introduced?
- Increased protease activity
What is the mechanism of alpha1anti-trypsin?
- Suicide substrate
What would happen if SP-D was deficient?
- Impaired innate immunity
What is effect of polyhydrocarbons?
- Formation of DNA adducts
How do nitrogen base analogs cause mutations?
- Mismatch pair
- Mismatch pair
What is the hyaline membrane of ARDS patient composed of?
Fibrin and necrotic epithelial cells
Immediate effector cells in allergic reaction?
- mast cells
Late effector cells in allergic reactions?
Eosinophils
What is the effect of 2,3BGP?
Decrease affinity of hemoglobin to O2
How does RBC’s react in hypoxia?
Release of ATP
A woman had interstitial lung disease, bilateral lung involvement, subcutaneous nodules, & salivary gland involvement. Skin biopsy showed non-caesating granuloma & asteroid bodies. Diagnosis?
Sarcoidosis
What can directly affect cough receptors in airway epithelium?
- Substance P
It was about diagnosis of obstructive diseases or something like that?
- FEV1 & FVC & their ratios
female non-smoker, fever, cough with rusty sputum, normal lung expansion, dullness in infra-scuplar area, bronchial breathing, fine crackles during inspiration & expiration?
- Pneumonia
What decreases significantly in anemic patients?
- O2 arterial content
Pathophysiology of emphysema?
Loss of elastic recoil
What increases Hb affinity to O2?
- Increase intracellular pH
A case w/ rusty sputum?
- S. Pneumonia
A question about calculating CaO2
The equation is (0.03 x PaO2) + (Hb x Saturation x 1.34)
What is the most common viral infection in Kuwait?
- Adenovirus
- Influenza virus
- Corona virus
- Rhinovirus
- Rhinovirus
Deficiency in which cell predispose patient to recurrent bacterial infection?
- B cells
- Neutrophils
- Neutrophils
In which structure does the nasolacrimal duct open?
- Inferior nasal meatus
Which structure most commonly infected?
- Maxillary sinus
Tooth ache?
- Maxillary sinus
Main muscle to increase thoracic cage volume?
Diaphragm
Which cell develops protection for terminal bronchiole?
- Clara cells
- Clara cells are nonciliated cells that detoxify noxious inhaled substances (e.g. nitric oxide) and secrete surfactant-like protective material and leukocyte protease inhibitor (anti-inflammatory to protect epithelium).
Origin of visceral pleura?
- Splanchnic mesoderm
- Lateral plate mesoderm divides into somatopleuric mesoderm (forms parietal pleura) and splanchnopleuric mesoderm (forms visceral pleura)
Structure pain insensitive?
Visceral pleura
What structure paralyze when dorsal rami of thoracic spinal nerve is cut?
- Levator costarum
Blood-air barrier in alveoli?
Type 1 pnemocyte
From which structure epithelium of LRT develops?
- Neural crest
- Laryngotracheal groove/diverticulum ( –> lung buds)
- Laryngotracheal groove/diverticulum ( –> lung buds)
* Endoderm not mentioned in the choices
A life long smoker had a pulmonary function test. What is the
result to confirm that he is COPD?
- Reduced FEV1/FVC ratio
A 25 year old man presented with cough and chest pain, initial chest x-ray reveled small plural effusion at the right side, after 3 months follow up while he’s asymptomatic, a chest x-ray showed small opacity on the right apex?
- Secondary TB
Anti Tb drug that caused nephrotoxicity and ototoxicity?
Streptomycin
What is the percentage of smokers that will die from smoking- related disease?
- 50%
Which condition has the triad of bronchiectasis, sinusitis, sinus inverses seen in approximately 50% of primary ciliary dyskinesia patients?
- ARDS
- Ive(something) syndrome
- Kartagner syndrome
Kartagner syndrome
What makes influenza vaccine? - Two A, one B
- Two B, one A
- One A, one B, one C
- TwoA, oneB
Most common cause of sore throat?
- Diphtheria
- H.influenza
- Pyogenes
- Pyogenes
Most common cause of allergies in Kuwait?
- Cat dander
- Dog hair
- Moulds
- Cockroaches
- Pollen
- Pollen
Arrangement of cilia in respiratory tract?
- 9+2
Table with low CO2 , low O2 and high Hb - V/Q mismatch
- Hypoventilation
- Anemia
- Diffusion limitation
- High altitude for two months
- High altitude for two months
What is essential to surfactant in children?
*Synthesis of dipalmitoylphosphatidylcholine (DPPC) requires glucose, choline, and palmitic acid, which occurs in type II pneumocytes; amino acids are needed for surfactant proteins.
Increase of what causes surfactant to be disrupted in adults?
Cholesterol
Lack of which SP would cause a decrease in innate immunity?
- SP-A
- Although the major role of SP-D is to be part of innate immunity, SP-A is the “most abundant surfactant protein” and it has both lipid roles and innate immunity roles, i.e. amount of SP- A is more than 5 times that of SP-D (see pie chart in lecture)
Treatment of a 1 year old with otitis media?
Amoxicillin
Treatment of a child with strep throat who’s allergic to penicillin?
- Erythromycin (for Corynebacterium)
- Clindamycin
Clindamycin
What enzymes do steroids block?
Phospholipase A2
Causes destructive pulmonary disease?
- M.kanasi
Which of these regarding the genotype of AAT deficiency is true?
PIss genotype results in formation of a protein with a short half-life that is easily degraded outside the liver
If recurrent laryngeal nerve is cut, which muscle is spared?
Cricothyriod muscle (innervated by external branch of superior laryngeal nerve which is from CNX)
What is the result of mutation of the gene responsible for cystic fibrosis?
- Calcium channels
- Sodium channels
- Chloride channels
- Potassium channels
- Chloride channels
Severe asthma (static asmaticus) for long term control
LABA + inhaled steroids
Which of the following combination in a patient who is recently infected with TB?
Refampcin / isonzaid / pyrazinamide / ethambutol
What structure has to be identified and carefully isolated in the separation of 2 bronchopulmonary segments from each other?
- Pulmonary arteries
- Pulmonary veins
- Pulmonary lymph nodes
- Pulmonary lymphatics
- Pulmonary ligaments
- Pulmonary veins
What muscle tenses the vocal folds in high-pitched voice?
Cricothyroid
What contributes to the development of posterolateral part of the diagram?
Pleuriperitoneal membrane
What nerve is responsible for sensory innervation of peripheral part of the diaphragm?
- Intercostal nerve
A 67 year old man developed ventilator associated pneumonia in the ICU after a colorectal surgery. His tracheoaspirate showed green colonies. What is the causative agent?
Pseudomonas aeruginosa
What is most affected in ciliary dyskinesia?
Trachea
What joint has bucket handle movement?
- Costochondral
- Costovertebral
- Costotransverse
- Costovertebral
What besides smoking is the most important risk factor for COPD in developing countries?
- Poor diet
- Genetics
- Poor diet
Old female had nocturnal wheezing. She was asthmatic before puberty. Her doctor changed her diabetes medications one month ago. What causes her wheezing?
- NSAIDs(shifts arachidonic acid into LTs instead of PGs)
- ACEI
?
Patient with cough and confusion. Chest x-ray shows interstitial infiltrates. What is the causative agent?
- Chlamydia pneumonia
- Streptococcus pneumonia
- Chlamydia pneumonia
A 61 year old had hip replacement surgery then she had hemoptysis. What is the cause?
- PE
- Bronchogenic carcinoma
- Bronchiectasis
- PE
What is the effect of 2, 3-BPG?
Reduce O2 affinity
What causes an increase in AaDO2?
?
