4. Pulmonary Path. -2

Question 1

A 3 year old boy is rushed to the hospital due to cyanosis during examination it is found that their are absent breath sounds and x-ray shows that there is a toy car blocking the right upper bronchi. What else would you expect to see on examination?

A. Fluid accumulation in pleural cavity
B.  Fibrotic changes in the lung 
C. Trachea shifted towards left 
D. Diaphragmatic elevation to the right 
E. Low Lecithin

RFA

RFA

Answer 1

ANS. D The patient history points towards resorption Atelectasis (foreign object in the lung and absent breath sound). Examination should also show diaphragmatic and trachea shift towards site of blockage.

A. & C- Would describe compression atelectasis, thick mor tension pneumothorax ( so stab wound)

E. Would describe neonatal atelectasis, kid is to old for this

Question 2

A 12 year old boy is playing on ice on a lake and the ice cracks. And the boy falls in and almost drowns. He is rushed to the hospital. Would would you except to find during examination 2 weeks after the incident?

A. Intra-alveolar hemorrhage 
B. Heavy Firm lungs
C. Hyaline membranes 
D.Necrosis of alveolar epithelial cells  
E. Proliferation of type II cells

RFA

Answer 2

ANS. E. Proliferation of type II cells would happen from 4 day to 3 weeks after incident. other things that happen are

• Fibrosis
• Alveolar septal thickening

A-D describe things that happen in the acute phase (0-4 days)

Question 3

A hypoxic baby boy is born and diagnosed with neonatal atelectasis due to decreased surfacant levels. Which of the following could be the cause of the decreased surfacant?

A. Born at 29 weeks 
B. Born by vaginal delivery
C. Born by Cesarian Section
D. Maternal diabetes
E. Decreased surface tension in lungs 

SZ

Answer 3

Ans. C & D

C. Stress during vaginal delivery, increases cortisol which increases surfacant. If the baby is born via C-section there is not stress to increase cortisol levels.
D. Maternal diabetes causes hyperglycemia, the body will compensate by increasing insulin production which will decrease surfacant levels.

A. Anything less than 28 wks is premature and surfacant has not had time to be produced.

E. Decreasing the surface tension of the lung to prevent alveolar collapse is the purpose of surfacant

Question 4

A 65 y/o male with hx smoking for 30 pack years presents with c/o SOB, productive cough beginning 2 wks ago. He has had similar episodes of a persistent cough over the last 3 years. Which of the following characteristics would be present in his type of lung disease?

A. Decreased TLC
B. Increased FEV1/FVC 
C. Decreased FEV1/FVC
D. Decreased  lung compliance
E. Decrease O2 diffusing compacity

SZ

Answer 4

Ans. C. Decreased FEV1/FVC

The remaining answers are characteristics of Restrictive Lung Diseases such as ARD, interstitial fibrosis. chest wall deformities etc.

The man’s history of smoking and chronic bronchitis suggest he has Obstructive Lung Disease

Question 5

A 35 year old male presents to the ED in severe respiratory distress. CXR shows mediastinal shift away from the affected lung. What type of atelectasis does the patient have? (MG)

A. Contraction
B. Compression
C. Resorption
D. Fibrotic

Answer 5

B. Compression

Question 6

A 40 year old male presents with severe respiratory distress. Examination and testing shows severe hypoxemia and bilateral pulmonary infiltrates. He is diagnosed with ARDS. Which of the following is a possible etiology based on direct pulmonary insult? (MG)

A. Sepsis
B. Trauma with shock
C. Oxygen toxicity
D. Transfusion of blood products
E. Uremia

Answer 6

C. Oxygen toxicity

all others are indirect etiologies for ARDS