5/13 Mixed, Pulm

Question 1

Respiratory papillomatosis (6,11)

Answer 1

HPV infects basal epithelial cells, predilection for stratified squamous epithelium
Found in the TRUE VOCAL CORDS (undergo frequent friction/ abrasion)
Infants acquire respiratory papillomatosis via passage thru the birth canal of mothers infected with the virus
Warty growths on the true vocal cords lead to weak cry, hoarseness and stridor

Question 2

Immunocompetent patient with a heterophile antibody-negative mononucleosis-like syndrome

Answer 2

CMV infection
Can be acquired during transfuion of leukocyte-laden blood products
Heterophil antibody negative = Monospot test- serum fails to agglutinate horse erythrocytes
Fever, myalgias, malaise, progressive fatigue, splenomegaly
Atypical lymphocytes

Question 3

Wiskott Aldrich Syndrome

Answer 3

Eczema, recurrent infections, thrombocytopenia
Mutation on X chromosome (combined B and T cell disorder)
Increased risk for infection with capsular organisms
Rx: HLA matched bone marrow
Onset is early

Question 4

Charcot-Bouchard Aneurysms

Answer 4

Associated with HTN

Location: basal ganglia, cerebrellum, thalamus, pons

Question 5

Candida Albicans

Answer 5

On light microscopy: budding yeasts with pseudohyphae
Germ tube is diagnostic candida albicans
37 C > true hyphae

Question 6

Para-aminohippuric acid (PAH) and the kidney

Answer 6

Freely filtered by glomerulus
Majority is secreted by the proximal tubule via carrier mediated active transport
NOT reabsorbed by any portion of the nephron

Question 7

Elevated pressure in left renal vein

Answer 7

Due to compression where the vein crosses the aorta beneath the superior mesenteric artery
“Nutcracker effect” can cause hematuria and flank pain
Pressure can elevated in left gonadal vein, leading to formation of a varicocele

Question 8

Where is the majority of water absorbed in the kidney?

Answer 8

Proximal tubules reabsorb >60% of water filtered by the glomeruli

Question 9

Tricyclic Antidepressant (TCA) Overdose

Answer 9

Delirium, seizures, cardiac abnormalities (arrhythmias, conduction delays, QT prolongation), severe hypotension, anticholinergic toxicity (hyperthermia, flushing, dry mouth, urinary retention

Caused by blockage of cardiac fast Na channels and other receptors

Sodium bicarbonate treats a widened QRS interval or ventricular arrthythmias- increases serum pH and extracelluar sodium (alleviating fast sodium channel blockade)

Question 10

Hereditary orotic aciduria

Answer 10

Rare AR disorder of de novo pyrimidine synthesis
Physical and mental retardation, megaloblastic anemia, elevated urinary orotic acid
Defect in Uridine 5’-monophosphate (UMP) synthase
Rx: uridine supplementation (Uridine is converted to UMP via nucleoside kinases)

Question 11

Accessory nipples

Answer 11

Due to failure of involution of the mammary ridge
Usually asymptomatic, may swell or become tender during menses, prenancy, lactation
Hyperpigmentation, epidermal thickening
Most common congenital breast anomaly

Question 12

Relative erythrocytosis

Answer 12

Normal RBC mass indicates a relative erythrocytosis
Due to a decrease in plasma volume
Can be due to aggressive diuretic therapy for heart failure exacerbation

Question 13

Overflow incontinence

Answer 13

Due to impaired detrusor contractility or bladder outlet obstruction
Involuntary and continuous urinary leakage when bladder is full and incomplete emptying
Most likely due to diabetic autonomic neuropathy affecting detrusor muscle innervation (common in T1 DM)
Postvoid residual (PVR) testing to confirm

Question 14

Enterococcus

Answer 14

Important cause of UTIs
Gram positive cocci in pairs and chains
Grown on blood agar, do not cause hemolysis (gamma-hemolytic)

Question 15

Asthma Dx in a patient with a history consistent with asthma but normal spirometry value

Answer 15

Bronchoprovocation techniques = methacholine
Elicit asthma symptoms and confirm the diagnosis
Causes bronchoconstriction and increased airway secretions
A decrease in FEV1 after a methacholine challenge indicates bronchial asthma

Question 16

Wernicke-Korsakoff syndrome

Answer 16

Oculomotor dysfunction, ataxia, confusion
Most symptoms resolve after thiamine administration
Korsakoff syndrome is a complication of Wernicke encephalopathy, and involves permanent memory loss and confabulation

Question 17

Malignant hyperthermia

Answer 17

Due to hypersensitivity of skeletal muscle to inhalation anesthetics (especially halothane) and muscle relaxant succinylcholine
Genetically susceptible: defect on ryanodine receptors of SR
Tachycardia, hypertension, hyperkalemia, myoglobinemia
Rx: Dantrolene (prevents further release of Ca in the cytoplasm of muscle fibers)

Question 18

Ipratropium

Answer 18

Anticholinergic agent
derivative of atropine
Blocks the action of Ach at muscarinic receptors, preventing bronchocontriction and reducing the parasympathetic stimulation of tracheobronchial submucosal glands in the lungs

Question 19

Azoles

Answer 19

Antifungal medications
Inhibit demethylation of lanosterol into ergosterol in fungal cells, suppress synthesis of ergosterol (essential component of fungal cell membrane)
Inhibit human P450 cytochrome enzymes, resulting in many drug-drug interactions

Question 20

Carbamazepine

Answer 20

Used to treat simple partial, complex partial, generalized tonic-clonic seizures
Blocks voltage-gated Ba channels in cortical neurons
SE: bone marrow suppression, hepatotoxic, SIADH

Question 21

Polymyositis

Answer 21

Symmetrical proximal muscle weakness
Increasing difficulty climbing stairs, getting up from a chair, carrying heavy objects
Elevated muscle enzymes
Autoantibodies (ANA, anti-Jo1
Biopsy: endomysial mononuclear infiltrate, patchy necrosis
Increased expresison of major histocompatibility complex class I antigens on the sarcolemma (with CD8 lymph infiltrate)
Complications: interstitial lung disease, myocarditis

Question 22

Properties of elastin

Answer 22

Rubber-like properties due to extensive cross linking between elastin monomers, which is facilitated by lysyl oxidase (interchain cross-links involving lysine)

Question 23

Alveolar hyperventilation

Answer 23

Acute onset dyspnea, hypoxemia, hypocapnia
Arterial PaCO2 is inversely related to and considered the main indicator of total alveolar ventilation (hypocapnia implies alveolar hyperventilation)
Results from V/Q mismatch (pneumonia or PE)
Persistent tachypnea will lead to eventual respiratory muscle fatigue, hypoventilation, hypercapnia

Question 24

Bosentan

Answer 24

Competitive antagonist of endothelin receptors used for treatment of idiopathic pulmonary arterial hypertension

Question 25

Sarcoidosis

Answer 25

African Americans, cough, dyspnea, bilateral hilar adenopathy, pulmonary reticular infiltrates, hypercalcemia, elevated ACE, biopsy shows noncaseating granuolmas
CD4+ T helper cells are the predominant type of lymphocyte found in sarcoid granulomas

Question 26

Lung Abscesses

Answer 26

Due to lysosomal enzyme release by neutrophils and macrophages

Question 27

Vertical transmission of HIV-1

Answer 27

Oral thrush, interstitial pneumonia, severe lymphopenia during first year of life
All pregnant women with HIV should take ART
2 NRTIs + protease inhibiotr or NNRTIs
Antiretroviral therapy during pregnancy reduces the risk of perinatal transmission of HIV to 1%-2%

Question 28

Pulmonary tuberculosis

Answer 28

Passed person to person through transmission of aerosolized respiratory secretions that contain M. tuberculosis organisms
Smaller droplets deposit organisms in the alveoli of lower lung fields
These organisms are engulfed by alveolar macrophages that allow for intracellular bacterial proliferation

Question 29

As the radius of a sphere with constant surface tension decreases, the distending pressure increases

Answer 29

Smaller spheres collapse before larger ones

Surfactant counteracts alveolar collapse by decreasing surface tension as alveolar radius decreases

Question 30

Cryptococcus neoformans

Answer 30

Only pathogenic fungus that has a polysaccharide capusle

Capsule appears read on mucicarmine stain and as a clear unstained zone with India ink