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Boards and Beyond Flashcards

1
Q

Result on pancreatic insufficiency seen in CF

A
  • Chronic pancreatitis
  • CF-related diabetes
  • Fat malabsorption
  • Steatorrhea:
    • Frequent stools
    • Foul-smelling stools
    • Oily or greasy
    • Stools may float
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2
Q

How do you treat exudative effusion?

A

Drainage

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3
Q

In preterm delivery, ___________ is used to stimulae surfactant production in lungs

A

Bethamethasone

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4
Q

Only condition with increased fremitus is ___________.

A

Lobar pneumonia

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5
Q

How is complicated community acquired pneumonia?

A
  • Fluoroquinolone (levoloxacin)
  • Amoxicillin pluss azithromycin
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6
Q

Special COPD drugs

A
  • Theophylline
  • Roflumilast
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7
Q

Treatment for moderate COPD

A
  • As needed short acting bronchodilator
  • Long-acting bronchodilator
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8
Q

How do you diagnose a PE?

A
  • CT angiogram- can’t be used with CKD
  • VQ scan
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9
Q

______________ effusion is due to high vascular permeability.

A

Exudative

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10
Q

Conditons that are hyperresonant on percussion

A

Pneumothorax

Emphysema

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11
Q

Which TB drug competes with uric acid for excretion in kidneys?

A

Pyrazinamide

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12
Q

Prevention of RSV

A
  • Palivizumab
    • Monoclonal antibody against F protein
    • Uses in pre-term infants
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13
Q

______________ blocks synthesis of mycolic acids.

A

Isoniazid

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14
Q

List one condition in which physiological shunting occurs?

A

Atelectasis (collasped airway)

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15
Q

Which TB drug inhibits bacterial DNA-dependent RNA polymerase?

A

Rifampin- inhibits RNA synthesis

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16
Q

Role of club cells

A

Surfactant

Detoxification

*Also known as clara cells

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17
Q

Distingush between inhaled, oral, and IV steroids.

A
  • Inhaled: Beclomethasone, fluticasone, budesonide
  • Oral: Prednisone
  • IV: Methylprenisolone (Solumedrol)
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18
Q

Sarcodosis pathology

A
  • Accumulation of TH1 CD4 helper cels
  • Secrete IL-2 and IFN-y
  • Ultimately leads to granuloma formation
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19
Q

High altitude stimulates the production of _________.

A

2,3 BPG

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20
Q

Most frequent non-cardiac causes of pulsus paradoxus

A

Asthma and COPD

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21
Q

Oligohyramnios is caused by fetal _________ abnormalities.

A

Kidney

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22
Q

Why are inspired O2 and alveolar O2 not equal?

A

Due to mixing of alveolar oxygen with CO2

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23
Q

Which antibotics are given in COPD? And when?

A
  • Fluroquinolones
  • Amoxicillin/clavulanate
  • Moderate to severe COPD
    • Increased dysnea
    • Increased sputum
    • Increased sputum purelence
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24
Q

Restriction with normal DLCO

A

Extra-pulmonary cause

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25
Q

Classic lab values for PE

A

low PaO2 and low PCO2

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26
Q

Classical causes of rales

A

Pulmonary edema (bases)

Pneumonia

Intersitial fibrosis

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27
Q

How shoud nosocomia pneumonia be treated?

A
  • Cefepime or Ceftazidime
  • Imipenem or Meropenem
  • Piperacillin-tazobactum (Zosyn)
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28
Q

In patients with COPD, ______ is the only therapy shown to improve mortality.

A

Oxygen

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29
Q

Lymphatic effusions have very high _________ counts.

A

Triglycerides

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30
Q

Result of thick mucus in GI tract due to CF

A
  • Impaired low of bile and pancreatic secretions
  • Malapsorption especially fats
  • Loss of fat soluble vitamins
  • Steatorrhea
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31
Q

Why is neonatal respiratory distress syndrome difficult to treat?

A

Due to intrapulmonary shunting, O2 goes to ealthy alveoli and the collasped alveoli remain unventilated

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32
Q

Baby needs to swollow ________ in areas that have developed to stimulate development.

A

Amniotic fluid

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33
Q

Classic causes of stridor

A

Laryngotracheitis (croup)

Epiglottitis

Retropharyngeal abscess

Diphtheria

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34
Q

Which form of restrictive disease has a normal A-a gradient?

A

Poor breathing mechanics

  • Neuromuscular
  • Structural
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35
Q

Treatment or RSV

A
  • Ribavirin
    • Inhibits synthesis of guanine nucleotides
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36
Q

Conditions that are dull on percussion

A

Pleural effusion

Consolidation (pneumonia)

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37
Q

Treatments for primary pulmonary hypertension

A
  • Epoprostenol: Prostacyclin (IV)
  • Bosentan: Endothelin-1 receptor antagonist (PO)
  • Sildenafil: Inhibits PDE-5 in smooth muscle of lungs (PO)
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38
Q

Most common consquence of CFTR mutations

A
  • Abnormal processing
    • Abnormal protein folding
    • Prevents protein trafficking to correct cellular location
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39
Q

Low DLCO conditions

A
  • Interstitial lung disease
  • Emphysema
  • Abnormal vasculature
  • Prior lung resection
  • Anemia
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40
Q

Rhochi

A

Secretions in large airways

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41
Q
  • Fever, malaise, chills, fatigue, and headache
  • No respiratory complaints
  • Chest radiograph normal
A

Pontiac fever

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42
Q

Treatment for Mild COPD

A

As needed short acting bronchodilator

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43
Q

Classic skin lesion in sarcordosis

A

Erythema nodosum

  • Inflammation of fat cells under skin
  • Tender red nodules
  • Usually on both shins
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44
Q

Stridor

A

Wheeze that is almost entirely inspiratory

Usually loudest over neck

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45
Q

Theophylline overdose scenario

A

Nausea, vomiting, seizures

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46
Q

Condtions caused by RSV

A

Bronchiolitis

Pneumonia

Acute respiratory failure

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47
Q

Conditions in which nail clubbing seen

A

Bronchiectasis

CF

Lung tumors

Pulmonary fibrosis

Cyanotic congenital heart disease

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48
Q

Isoniazid is co-administed with _______ to limit neurotoxicity.

A

B6

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49
Q

Insterstitial lung disease has a ____________ lung appearance.

A

Reticulonodular “honeycomb”

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50
Q

What drug is used to stimulate sweat to test for CF?

A

Pilocarpine

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51
Q

Causes of cheyne-stokes breathing

A
  • Delayed detection/ response to changes in PaCO2
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52
Q

Most common CFTR mutation

A

Delta F508

  • Deletion of 3 DNA bases (nonframeshift delection)
  • Codes for 508th AA: Phenylalanine
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53
Q

Mechanism of lobar pneumonia

A
  • Bacteria acquired in nasopharynx
  • Aerosolized to alveolus
  • Enter alveolar type II cells
  • Pneumococci multiply in alveolus
  • Invade alveolar epithelium
  • Pass from one alveolus to next
  • Inflammation/ consolidation of lobes
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54
Q

Immunosuppresants used to treat sarcoidosis

A

Methotrexate

Azathioprine

Mycophenolate

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55
Q

FEV1 levels for different levels of COPD

A
  • Mild: >80%
  • Moderate:50-70%
  • Severe: 30-49%
  • Very severe: <30%
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56
Q

DLCO seen in severe disease

A

<40%

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57
Q

How can pulmonary edema be distinguished from ARDS?

A

Pulmonary capillary wedge pressure (PCPW) is normal in ARDS

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58
Q

Do bronchioles typically have cartilage?

A

No

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59
Q

Restriction with low DLCO

A

Interstitial lung disease

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60
Q

Able to bind more CO2 to hemoglobin in a _____ (low/high) O2 environment.

A

Low

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61
Q

Theophylline inhibits __________.

A

Phosphodiesterase, which prevents the breakdown of cAMP and leads to increased cAMP

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62
Q
  • Farmer or bird handler
  • Cough, dyspnea, chest tightness
  • Diffuse crackles
A

Hypersensitivity pneumonitis

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63
Q

Abnormal septation of the lung bud from the foregut

A

Tracheoesophageal fistula

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64
Q

Mutaion of _________ leads to isoniazid resistance.

A

katG- encoded to catalase-peroxidase, which converts INH to its active form

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65
Q

Rales

A

Small airways “pop” open after collapse

Early insiratory. late inspiratory or expiratory

66
Q

Stages of lun maturation

A
  • Pseudoglandular (5-16wk)
  • Canalicular (16-26 wk)
  • Saccular (26wk-birth)
  • Alveolar (after birth)
67
Q

Why is hypercapnia seen in pulmonary fibrosis and not other diffusion limited conditions?

A

Due to destruction of alveolar capillaries, result in a dead space

*Not due to diffusion limitation

68
Q

Why will CO2 remain normal in shunting?

A

Due to hyperventilation

69
Q

Hypoxemia with normal A-a gradient

A

Hypoventialtion

High altitude

*In these cases alveoli are working

70
Q

Treatment for Very severe COPD

A
  • Short acting bronchodilator
  • Long-acting bronchodilator
  • Inhaled corticosteroids
  • Oxygen/Surgery
71
Q

O2 content, PaO2 and % sat in presence of CO

A

O2 content: Decreased

PaO2 : Normal

% sat: Decreased

72
Q

Causes of central sleep apnea

A
  • Central nervous system disease (encephalitis)
  • Neuromuscular diseases (polio, ALS)
  • Severe kyphoscolosis
  • Narcotics
73
Q

O2 contenc, PaO2 and % sat in hypoxemia

A

All decreased

74
Q

How does an RSV infection present?

A
  • Runny nose (URI)
  • Wheezing (Lower tract)
75
Q

Example of condition in with V/Q is less than 1

A

Pulmonary edema

76
Q

Peak Expiratory flow (PEF) falls when _______ gets worse.

A

Obstruction

77
Q

IC

A

TV + IRV

78
Q

Cheyne-stokes breathing is common in _________ and __________ patients.

A

HF and stroke

79
Q

Sytoms of High CO2

A

Lethargy

Confusion

Agitation

80
Q

At what stage to respiratory bronchioles develop?

A

Canalicular Period (16-26 wks)

81
Q

How do you test for CF in patients with a negative sweat test?

A

Test nasal transepithelial potential difference

  • Measure nasal voltage
  • CF patients: More negative voltage
  • Due to abnormal sodium processing
82
Q

Calcified ghon complex is a _______.

A

Ranke complex

83
Q

Blue Bloater

A

Chronic Bronchitis

  • Cyanosis from shunting
  • Air trapping
84
Q

In bronchopulmonary dysplasia _______ does not progress normally.

A

Alveolarization

NOTE: Babies that develop bronchopulmonary dysplasia have poor gas exhange due to abnormal secondary septation. These babies have fewer and larger alveoli compared to normal children

85
Q

How is uncomplicated community acquired pneumonia treated?

A

Azithromycin

Clarithromycin

Doxycycline

86
Q

Congenital diaphragmatic hernia

A
  • Defective formation of pleuroperitoneal membrane
  • Hole in diaphragm
  • Reduced chest circumference
87
Q

__________ is a phosphodiesterase-4 inhibitor that may relax airway smooth muscle.

A

Roflumilast

*Used in COPD

88
Q

Cause of aspirin exacerbated respiratory disease

A
  • Dysregulation of arachidonic acid metabolism
    • Overproduction of leukotrienes
89
Q

Bronchioalveolar carcinoma looks like ________ on X-Ray.

A

Pneumonia

90
Q

O2 contenc, PaO2 and % sat in HF

A

All normal

91
Q

Infertily in CF due to absent ________.

A

Vas deferens

  • Problem is sperm transport not spermatogenesis
92
Q

Systemic diseases with interstitial lung feautures

A
  • Scleroderma
  • RA
  • Goodpasture’s
  • Wgener’s
  • Sarcoidosis
93
Q

Wheezes

A

Air lows through narrowed bronchi

Usually expiratory

94
Q

Why is patent ductus arteriousus a complication of neonatal respiratory distress syndrome?

A

Hypoxia keeps shut open

95
Q

FRC

A

RV + ERV

96
Q

Omalizumab

A
  • IgG monoclonal antibody
  • Inhibits IgE binding to IgE receptor on mast cells and basophils
97
Q

Exacerbations of CF are treated with ___________.

A

Antibiotics

98
Q

Side effects of isoniazid

A
  • Neurotoxicity
  • Haptotoxicity
  • Drug-induced lupus
99
Q

What drug increases chloride influx? When is it used?

A

Ivacaftor (tablets); only for patients with G551D mutation

100
Q

Where does an aspired foreign body go, if a person is supine?

A
  • Right inferior lobe- superior portion (apical)
  • Right upper lobe- posterior segment
101
Q

Mechanism of Theophylline cardiotoxicity

A

Blocks adenosine receptors, increases heart rate

102
Q

How should a lung abscess be treated?

A

Clindamycin

*If big enough, it has to be surgically drained

103
Q

Long acting bronchodilators

A

Salmeterol

Formoterol

Tiotropium

104
Q

__________ won’t correct with 100 % oxygen/

A

Shunting

105
Q

What happens to partial pressures of O2 and CO2 in arteries and veins during exercise?

A

Veins: O2 falls, CO2 rises

Arteries: O2 and CO2 normal

106
Q

Three basic mechanism that create a high A-a gradient

A

Fibrosis

Shunt

V/Q mismatch

107
Q

PVR is lowest when the lungs are at the ______.

A

FRC

*This occurs after expiration of a normal tidal volume

108
Q

Causes of pumonary hypoplasia

A
  • Oligohydramnios
  • Congenital diaphragmatic hernia
109
Q

O2 content, PaO2 and % sat in anemia

A

O2 content: Decreased

PaO2 : Normal

% sat: Normal

110
Q

_____________ is a potent cerebral vasodilator.

A

CO2

*increases in CO2, increase in cerebral blood flow

111
Q

Side effect of steroids

A

Oral candidiasis

112
Q

VC

A

TV + IRV + ERV

113
Q

Short acting bronchodilators

A

Albuterol

Ipratropium

114
Q

Characterisrtic of Mycobacterium tuberculosis

A
  • Obligate aerobes
  • Facultative intracellular
  • AFB stain
115
Q

Drugs used for both COPD and asthma

A
  • Short acting bronchodilators
  • Long acting bronchodilators
  • Steroids
116
Q

Side of effect of ehtambutol

A

Optic neuropathy

117
Q

What abnormality can result in a stroke from a DVT?

A

Patent foramen ovale can allow venous clot to react arterial systems

118
Q

Classica cause of Rhonchi

A

COPD

119
Q

Light’s Criteria

A

Exudate if:

  • Pleural protein/serum protein > 0.5
  • Pleural LDH/ serum LDH >0.6
  • Pleural LDH > 2/3 upper limits normal LDH
120
Q

Treatment for Aspirin exacerbated respiratory disease

A

Montelukast

Zafirlukast

121
Q

TLC

A

RV + ERV + IRV +TV

122
Q

Mechanisms of silicosis

A

Macrophages react to silica, resulting in inflammation, activation of fibroblasts and collagen

123
Q

Treatment for Severe COPD

A
  • Short acting bronchodilator
  • Long acting bronchodilator
  • Inhaled corticosteriod
124
Q

Normal DLCO

A

75-140%

125
Q

What drugs promote the clearance of airway secretions in CF patients?

A
  • Inhaled DNase (doornase alfa)
  • Inhaled saline
  • N-acetylcysteine
126
Q

What is used to measure %O2 saturation of blood?

A

Pulse Oximetry

*Uses light and photodetector

127
Q

Systemic side efects of B2 agonists

A

Hypertension, arrhyythmia

128
Q

Components of upper respiratory tract

A

Nasal cavity

Pharynx

Larynx

129
Q

How is small pneumothorax treated?

A
  • 100% O2
    • Displaces nitrogen from capillary blood
    • Increases gradient for nitrogen reabsorption from pleural space
130
Q

Classical causes of wheezes

A

HF (cardiac asthma)

Asthma

Chronic bronchitis

Obstruction (tumor; localized wheeze)

131
Q

How is a DVT diagnosed?

A

Lower extremity ultrasound

132
Q

How is allergic bronchopulmonary aspergillosis diagnosed? Treated?

A

Skin testing aspergillosis

Steroids

133
Q

What type of pneumonia is a serious complication for ARDS?

A

Ventilator acquired pneumonia

134
Q

First line treatment for aspiration pneumonia

A

Clindamycin

135
Q

Which values are not meausred by spirometry?

A

RV

FRC

136
Q

Long acting B2 agonist are not used as monotherapy and are always used with ______.

A

Inhaled corticosteroids

137
Q

How are newborns tested for CF?

A
  • Increased blood levels of immunoreactive trypsinogen
  • Follow up with sweat test if positive
138
Q

Side of effects of rifampin

A

Liver, GI

139
Q

Blunting of costophrenic angle

A

Pleural effusion

140
Q

Classic causes o bronchial breath sounds

A

Seen in pneuomonia with consolidation

141
Q

Common causes of hypoxia

A

Hypoxemia

HF

Anemia

CO

142
Q

Sleep apnea treatments

A
  • Weight loss
  • CPAP
  • Upper airway surgery
143
Q

How is hypersensitivity pneumonitits diagnoses? Treated?

A

Diagnosis

  • Bronchoalveolar lavage
  • Inhalation challenge
  • Lung biopsy

Treatment

  • Avoid exposure
  • Steroids
144
Q

Which interleukins are suppresed by steroids?

A

IN-Y, TNF-a, GM-CSF

145
Q

How do you treat transudative effusion?

A

Usually treat for underlying cause (no drainage)

146
Q
  • Dyspnea, hpoxemia
  • ARDS
  • Confusion
  • Focal deficits
  • Petechiae
A

Fat embolism

147
Q

Treatment for pneumocystis jiroveci

A
  • TMP-SMX (first line)
  • Dapsone
  • Pentamidine

Prophylasis: TMP-SMX when CD4 <200

148
Q

Lung buds form as outgrowth from ___________.

A

Foregut

149
Q

CF presentation

A
  • Usually diagnosed <2yo
  • Respiratory disease
  • Failure to thrive
  • Meconium ileus
150
Q

Where does the pulmonary artery pass relative to bronchi?

A

Right- Anterior to bronchi

Left- Superior to bronchi

151
Q

Present of pectoriloquy indicate what?

A

Fluid in lungs: Effusion, consolidation

152
Q

Treatment for acute exacerbations of COPD

A
  • Oxygen
  • Nebulized albuterol +/- ipratropium
  • IV or oral corticosteroids
  • Antibiotics
153
Q

_________ inhibts arabinosyl transferase.

A

Ethambutol. polymerizs arabinose or mycobacteria cell walls

154
Q

CF lung disease

A
  • Productive cough
  • Hyperinflation of lungs on X ray
  • Obstructive pattern
155
Q

Inheritence patten of cystic fibrosis

A

Autosomal recessive

156
Q

At what stage do type II pneumocytes form?

A

Canalicular (16-26 wks)

157
Q

__________ does not cause hypoxemia unless accompanied by a V/Q mismarch.

A

Dead space

158
Q

Virulence factors of TB. How do they work?

A
  • Trehalose dimycolare (cord factor)
    • Heps evade immune response
    • Causes granuloma formation
    • Triggers cytokine release
  • Sulfatides
    • Inhibits fusion of pagosomes/lysosomes
  • Catalase-peroxidase
    • Resists host cell oxidation
159
Q

Bronchial breath sound

A

High pitched lung sounds

Longer expiratory phase than normal

160
Q

A cut phrenic nerve cause the diaphragm to _______.

A

Elevate

*Can be seen on fluoroscopy (“sniff test”)

OS3 (10 decks)

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