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Pulmonology > Anatomy TA Questions (Pulm) > Flashcards

Anatomy TA Questions (Pulm) Flashcards

1
Q

What nerve innervates the diaphragm?

A

Phrenic nerve

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2
Q

What are the three levels of openings within the diaphragm?

A

T8 (IVC), T10 (esophagus), and T12 (aorta)

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3
Q

Which bronchi is more likely to contain a foreign body?

A

Right – it is wider, shorter, and more vertical

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4
Q

How many secondary bronchi exist on the right side?

A

Answer: 3
- Additional Information: 2 exist on the left side. Each supplies a lobe.

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5
Q

What is the name for the area of lung aerated by a tertiary bronchus?

A

Bronchopulmonary segment

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6
Q

What are the three layers that compose the wall of the trachea?

A

Mucosa, submucosa, adventitia

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7
Q

In order to expel mucus when coughing, which muscle must contract?

A

Trachealis muscle

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8
Q

Where in the bronchial tree does cartilage disappear?

A

Bronchioles

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9
Q

What are three functions of the conducting zone?

A

Warm air, trap foreign matter from entering the alveoli, and conduct air to the respiratory zone.

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10
Q

What cell type makes up the alveolar walls?

A

Single layer of squamous epithelium / type I pneumocytes, Type II pneumocytes, and Alveolar phagocytes

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11
Q

Patency of the alveoli is determined by what substance?

A

Surfactants (it reduces surface tension)

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12
Q

Surfactant is produced by what type of cells within the alveoli?

A

Type II

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13
Q

Which lung is smaller?

A

Answer: Left
- Additional Information: The left lung has 2 lobes, separated by an oblique fissure. The right lung has 3 lobes separated by oblique and horizontal fissures.

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14
Q

How many bronchopulmonary segments are present in each lung?

A

10

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15
Q

Due to the trachea being in closer proximity to it, breath sounds are louder in which lung?

A

right

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16
Q

A patient presents with hemoptysis after visiting Mozambique. You suspect
tuberculosis. Which lobe is likely involved and why?

A

Upper lobe, due to presence of more O2 in the upper lobe.

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17
Q

What is the purpose of the pleurae?

A

Provide lubrication and surface tension

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18
Q

The costo-phrenic (cost-diaphragmatic) angle may appear blunted on a CXR when
a patient has a pleural effusion. This angle is a space between what?

A

The lower limit of the pleural sac and the lower border of the lung

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19
Q

What is the name of the condition where there is a collection of pus in the pleural
space?

A

Empyema

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20
Q

What are the contents of the posterior mediastinum?

A

Esophagus, descending aorta, azygos with hemi-azygos veins, thoracic duct, vagus
nerve, thoracic splanchnic nerves, and posterior mediastinal lymph nodes

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21
Q

What are the four processes of respiration?

A

Pulmonary ventilation, external respiration, transport, and internal respiration

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22
Q

What is atmospheric pressure at sea level?

A

Answer: 760 mmHg
- Additional Information: CPAP machines, used for patients with sleep apnea, provide continuous positive airway pressure, meaning that the pressure of the air provided is greater than
that at sea level.

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23
Q

Intrapulmonary pressure is the pressure within the alveoli. What is its relationship
to atmospheric pressure?

A

it always eventually equalizes

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24
Q

Intrapleural pressure is the pressure in the pleural cavity. What is its relationship
to atmospheric pressure?

A

It is always negative, less than both atmospheric pressure and intrapulmonary pressure.
This is due to TWO inward forces, which promote lung collapse, and ONE outward force, which enlarges the lungs.

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25
Q

According to Boyle’s Law, what is the relationship between pressure and volume?

A

inverse

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26
Q

A patient completes pulmonary function tests. Results indicate increased TLC,
FRC, and RV. Is this an obstructive or restrictive process?

A

obstructive

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27
Q

A patient completes PFTs. Results indicate FEV1/FVC at 65%. Is this an
obstructive of restrictive pattern?

A

obstructive

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28
Q

What is the term for an area with no perfusion and normal ventilation?

A

dead space

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29
Q

Ventilation is regulated by changes in what?

A

partial pressure of CO2

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30
Q

Central chemoreceptors, which respond to changes in serum pH via changes to
PaCO2 in the CSF, are housed where?

A

Medulla

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31
Q

What does the VQ ratio represent

A

ventilation to perfusion

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32
Q

In patients with chronic bronchitis, their V:Q ratio is low (ventilation decreased).
How does this explain the resulting right heart failure seen in patients with chronic bronchitis?

A
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33
Q
A

asthma

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34
Q

What is the classic triad of clinical manifestations seen in patients with asthma?

A

dyspnea, wheezing, cough especially at night

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35
Q

What is the gold standard used to diagnose asthma?

A

PFTs, observing for an increase in FEV1 of 12% or more, accompanied by an absolute increase in FEV1 of at least 200mL

36
Q

Asthma exacerbations lead to respiratory acidosis or alkalosis?

A

Alkalosis – hyperventilation results in decreased PaCO2

37
Q

What is the best objective way to assess the severity and patient response of
asthmatic patients in the ED?

A
38
Q

Which of the following drug classes is NOT used as quick relief for acute
asthmatic exacerbations?

Short-acting beta-2 agonists, anticholinergics, systemic corticosteroids, or inhaled corticosteroids

A

Inhaled corticosteroids – these are the drug of choice for long term, persistent chronic maintenance

39
Q

A patient’s asthma was not well controlled on an inhaled corticosteroid alone. Therefore, a long-acting beta-2 agonist was added to the regimen. Once the patient’s asthma has been well controlled for > 3 months with the ICS and LABA, how should the patient’s medications be adjusted?

A

The patient should be stepped-down off of the LABA

40
Q

A patient with asthma also has allergic rhinitis and aspirin induced asthma. Their
current regiment of ICS and LABA is not effective for controlling their symptoms. Which drug
class may be useful for this patient, given their asthma triggers?

A

Answer: Leukotriene Modifiers (Montelukast)
- Additional Information: Leukotriene modifiers are useful in asthmatics with allergic
rhinitis/aspirin induced asthma

41
Q

A patient with nighttime symptoms > 1/week, but not nightly, has what
classification of asthma severity?

A

Answer: Moderate persistent
- Additional Information: Moderate persistent asthma also denotes symptoms that are
experienced daily, the use of SABAs daily, and some limitation with normal activity.

42
Q

What is the most important risk factor for COPD?

A

Answer: Smoking
- Additional Information: It is also the most important step in management of COPD.

43
Q

There is only one genetic disease linked to COPD in younger patients (< 40 years
old). What is this genetic disease?

A

Answer: Alpha 1-antitrypsin deficiency – Alpha 1 antitrypsin protects elastin in the lungs from damage by WBCs.
- Additional Information: Smoking also decreases this protective enzyme, while also increasing damaging enzymes such as elastase from macrophages and neutrophils.

44
Q

What is the hallmark symptom of emphysema?

A

Answer: Dyspnea on exertion
- Additional Information: “Pink puffers”. CXR reveals enlarged lung fields, flattened
diaphragms, trapped air, decreased vascular markings, and bullae. Barrel chest and increased AP
diameter is also seen in emphysema.

45
Q

What is the hallmark symptom of chronic bronchitis?

A

Answer: Productive cough
- Additional Information: “Blue bloaters”. CXR reveals increased vascular markings and normal diaphragms.

46
Q

what is the gold standard for diagnosing COPD

A

PFTs/Spirometry

47
Q

Combination of what two drug classes has shown greater response when used
together vs. alone in the management of COPD?

A

Beta-2 agonists and anticholinergics

48
Q

What is the mechanism of action of anticholinergic medications such as
Ipatroprium that help manage COPD?

A

Answer: Anticholinergic medications block acetylcholine-mediated bronchoconstriction, thus causing bronchodilation.
- Additional Information: Recall that anticholinergics are contraindicated in glaucoma (dilates pupils) and BPH (increases urinary retention).

49
Q

are inhaled corticosteroids an option for monotherapy of COPD

A

no they may be added to a LABA

50
Q

What is the only medical therapy proven to decrease mortality of patients with
COPD? It decreases pulmonary HTN/cor pulmonale by decreasing hypoxia-mediated pulmonary
vasoconstriction.

A

oxygen

51
Q

A 15 year old patient presents complaining of a daily chronic cough with thick, mucopurulent, foul smelling sputum. Physical exam reveals persistence crackles at the bases of
his lungs. In collecting his past medical history, you learn that he has Cystic Fibrosis. What organism is the most likely cause of his bronchiectasis?

A
52
Q

Sacroidosis results in noncaseating granulomas seen on tissue biopsy. Describe a granuloma.

A
53
Q

What two skin conditions may also present in patients with sarcoidosis?

A

Answer: Lupus pernio and erythema nodosum
- Additional Information: 70% of patients will also have cutaneous anergy, a diminished skin test reactivity to common skin allergens due to peripheral immune suppression

54
Q

What is the classic finding on CXR in a patient with sarcoidosis?

A

bilateral hilar LAD

55
Q

A 40 year old male presents with gradual onset of dyspnea and a nonproductive
cough. Physical exam reveals fine basilar inspiratory crackles and mild clubbing of his fingers. CXR shows diffuse reticular opacities, or “honeycombing”. What is the most likely diagnosis?

A

Idiopathic pulmonary fibrosis

56
Q

Coal workers inhale coal and carbon mine dust. This results in small upper lobe
nodules and hyperinflation of the lower lobes. This is known as coal workers pneumoconiosis.
What is another name for this disease?

A

The black lung

57
Q

This disease is caused by inhalation of mineral dust used in the creation of tool
and dye manufacturing, ceramics, electronics, and florescent light bulbs. Similar to sarcoidosis,
it causes noncaseating granulomas. What is the name of this disease?

A

berylliosis

58
Q

what is the most common anterior mediastinal tumor

A

thymoma

59
Q

what cell type are most lung carcinomas?

A

Non-small cell carcinoma, more specifically – adenocarcinoma (most common type in smokers, women, and non-smokers).

60
Q

Eighty percent of mesotheliomas are due to chronic asbestos exposure. Where
does this disease most commonly originate from?

A

The pleura (peritoneum is 2nd most common)

61
Q

Infectious processes lead to an increase in local factors which increase vascular
permeability. Light’s criteria is used to describe this exudative material. What are Light’s criteria?

A

Pleural fluid protein – serum protein > 0.5; Pleural fluid LDH – serum LDH > 0.6 or Pleural Fluid LDH > 2/3 upper limit of normal LDH

62
Q

What is A) the most common symptom, and B) the most common sign, of a
pulmonary embolism?

A

Dyspnea is most common symptom, tachypnea is most common sign

63
Q

What is the gold standard test for diagnosing a pulmonary embolism?

A
64
Q

Which drug works through the intrinsic coagulation pathway? Heparin or
warfarin?

A

Heparin – inactivates thrombin and other clotting factors of the intrinsic pathway such as Xa, XI, and XII.

65
Q

what is the antidote for heparin

A

protamine sulfate

66
Q

What is the most common pathogen responsible for community acquired
pneumonia?

A
67
Q

What are the two most common pathogens responsible for viral pneumonia in infants and small children?

A

Answer: RSV and parainfluenza
- Additional Information: Influenza in adults

68
Q

True or false - redness is considered a positive PPD test for TB?

A

false - induration is considered positive

69
Q

In someone with no known risk factors for TB, what reaction size is considered a
positive PPD?

A

greater than or equal to 15 mm

70
Q

What is the gold standard for diagnosis of tuberculosis?

A

Answer: Acid-fast smear and sputum cultures for 3 days (AFB)
- Additional Information: Treatment includes 4 drug regimen for 6 months (RIPE – Rifampin, INH, Pyrazinamide, and Ethambutol). Patients are no longer considered infectious after 2 weeks
of therapy.

71
Q

In order to prevent the peripheral neuropathy caused by Isoniazid (INH), what is given to patients?

A

Pyridoxine (B6)

72
Q

Which of the four major drugs used to treat TB causes thrombocytopenia and
orange colored secretions?

A

Rifampin (RIF)

73
Q

Red-green visual changes and optic neuritis are a side effect of which TB drug?

A

Ethambutol (EMB)

74
Q

BOOP (Bronchiolitis Obliterans with Organizing Pneumonia) has been renamed to Cryptogenic Organizing Pneumonia (COP). In this disease, persistent alveolar exudates cause
fibrosis of the bronchioles and alveoli. What is the treatment for this disease?

A

Corticosteroids

75
Q

Acute bronchiolitis is a lower respiratory tract infection that leads to peripheral
airway narrowing and variable obstruction. It is most commonly caused by RSV. What age group does this disease most commonly affect?

A

Infants < 2 years old

76
Q

What pathogen causes croup?

A

Parainfluenza - treatment is cool, humidified air

77
Q

What is the most common cause of acute epiglottitis/supraglottitis?

A
78
Q

What antibiotics are given to patients with acute epiglottitis?

A

2nd or 3rd generation cephalosporins

79
Q

During what phase of pertussis does the classic whoop appear?

A

Answer: Paroxysmal phase
- Additional Information: Erythromycin is given to patients with pertussis. This is to decrease the contagiousness of the affected patient. However, antibiotics do not alter the duration or severity of pertussis.

80
Q

What is the hallmark of Acute Respiratory Distress Syndrome (ARDS)?

A

Severe refractory hypoxemia (not responsive to 100% O2)

81
Q

Which strain of Influenza, A or B, is associated with more severe and extensive outbreaks?

A

influenza A

82
Q

Briefly explain why acidosis results in an increase in respiration.

A

To blow off excess CO2

83
Q

What pattern is this

A

obstructive (air quickly leaves large airways and is then trapped in smaller airways)

84
Q

What pattern is this

A

Restrictive

85
Q

What pattern is this

A

mixed obstruction & restriction

Pulmonology (19 decks)

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