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
2
Q
How do you treat exudative effusion?
A
Drainage
3
Q
In preterm delivery, ___________ is used to stimulae surfactant production in lungs
A
Bethamethasone
4
Q
Only condition with increased fremitus is ___________.
A
Lobar pneumonia
5
Q
How is complicated community acquired pneumonia?
A
- Fluoroquinolone (levoloxacin)
- Amoxicillin pluss azithromycin
6
Q
Special COPD drugs
A
- Theophylline
- Roflumilast
7
Q
Treatment for moderate COPD
A
- As needed short acting bronchodilator
- Long-acting bronchodilator
8
Q
How do you diagnose a PE?
A
- CT angiogram- can’t be used with CKD
- VQ scan
9
Q
______________ effusion is due to high vascular permeability.
A
Exudative
10
Q
Conditons that are hyperresonant on percussion
A
Pneumothorax
Emphysema
11
Q
Which TB drug competes with uric acid for excretion in kidneys?
A
Pyrazinamide
12
Q
Prevention of RSV
A
- Palivizumab
- Monoclonal antibody against F protein
- Uses in pre-term infants
13
Q
______________ blocks synthesis of mycolic acids.
A
Isoniazid
14
Q
List one condition in which physiological shunting occurs?
A
Atelectasis (collasped airway)
15
Q
Which TB drug inhibits bacterial DNA-dependent RNA polymerase?
A
Rifampin- inhibits RNA synthesis
16
Q
Role of club cells
A
Surfactant
Detoxification
*Also known as clara cells
17
Q
Distingush between inhaled, oral, and IV steroids.
A
- Inhaled: Beclomethasone, fluticasone, budesonide
- Oral: Prednisone
- IV: Methylprenisolone (Solumedrol)
18
Q
Sarcodosis pathology
A
- Accumulation of TH1 CD4 helper cels
- Secrete IL-2 and IFN-y
- Ultimately leads to granuloma formation
19
Q
High altitude stimulates the production of _________.
A
2,3 BPG
20
Q
Most frequent non-cardiac causes of pulsus paradoxus
A
Asthma and COPD
21
Q
Oligohyramnios is caused by fetal _________ abnormalities.
A
Kidney
22
Q
Why are inspired O2 and alveolar O2 not equal?
A
Due to mixing of alveolar oxygen with CO2
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
24
Q
Restriction with normal DLCO
A
Extra-pulmonary cause
25
Classic lab values for PE
low PaO2 and low PCO2
26
Classical causes of rales
Pulmonary edema (bases)
Pneumonia
Intersitial fibrosis
27
How shoud nosocomia pneumonia be treated?
* Cefepime or Ceftazidime
* Imipenem or Meropenem
* Piperacillin-tazobactum (Zosyn)
28
In patients with COPD, ______ is the only therapy shown to improve mortality.
Oxygen
29
Lymphatic effusions have very high _________ counts.
Triglycerides
30
Result of thick mucus in GI tract due to CF
* Impaired low of bile and pancreatic secretions
* Malapsorption especially fats
* Loss of fat soluble vitamins
* Steatorrhea
31
Why is neonatal respiratory distress syndrome difficult to treat?
Due to intrapulmonary shunting, O2 goes to ealthy alveoli and the collasped alveoli remain unventilated
32
Baby needs to swollow ________ in areas that have developed to stimulate development.
Amniotic fluid
33
Classic causes of stridor
Laryngotracheitis (croup)
Epiglottitis
Retropharyngeal abscess
Diphtheria
34
Which form of restrictive disease has a normal A-a gradient?
Poor breathing mechanics
* Neuromuscular
* Structural
35
Treatment or RSV
* Ribavirin
* Inhibits synthesis of guanine nucleotides
36
Conditions that are dull on percussion
Pleural effusion
Consolidation (pneumonia)
37
Treatments for primary pulmonary hypertension
* Epoprostenol: Prostacyclin (IV)
* Bosentan: Endothelin-1 receptor antagonist (PO)
* Sildenafil: Inhibits PDE-5 in smooth muscle of lungs (PO)
38
Most common consquence of CFTR mutations
* Abnormal processing
* Abnormal protein folding
* Prevents protein trafficking to correct cellular location
39
Low DLCO conditions
* Interstitial lung disease
* Emphysema
* Abnormal vasculature
* Prior lung resection
* Anemia
40
Rhochi
Secretions in large airways
41
* Fever, malaise, chills, fatigue, and headache
* No respiratory complaints
* Chest radiograph normal
Pontiac fever
42
Treatment for Mild COPD
As needed short acting bronchodilator
43
Classic skin lesion in sarcordosis
Erythema nodosum
* Inflammation of fat cells under skin
* Tender red nodules
* Usually on both shins
44
Stridor
Wheeze that is almost entirely inspiratory
Usually loudest over neck
45
Theophylline overdose scenario
Nausea, vomiting, seizures
46
Condtions caused by RSV
Bronchiolitis
Pneumonia
Acute respiratory failure
47
Conditions in which nail clubbing seen
Bronchiectasis
CF
Lung tumors
Pulmonary fibrosis
Cyanotic congenital heart disease
48
Isoniazid is co-administed with _______ to limit neurotoxicity.
B6
49
Insterstitial lung disease has a ____________ lung appearance.
Reticulonodular "honeycomb"
50
What drug is used to stimulate sweat to test for CF?
Pilocarpine
51
Causes of cheyne-stokes breathing
* Delayed detection/ response to changes in PaCO2
52
Most common CFTR mutation
Delta F508
* Deletion of 3 DNA bases (nonframeshift delection)
* Codes for 508th AA: Phenylalanine
53
Mechanism of lobar pneumonia
* 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
54
Immunosuppresants used to treat sarcoidosis
Methotrexate
Azathioprine
Mycophenolate
55
FEV1 levels for different levels of COPD
* Mild: \>80%
* Moderate:50-70%
* Severe: 30-49%
* Very severe: \<30%
56
DLCO seen in severe disease
\<40%
57
How can pulmonary edema be distinguished from ARDS?
Pulmonary capillary wedge pressure (PCPW) is normal in ARDS
58
Do bronchioles typically have cartilage?
No
59
Restriction with low DLCO
Interstitial lung disease
60
Able to bind more CO2 to hemoglobin in a _____ (low/high) O2 environment.
Low
61
Theophylline inhibits \_\_\_\_\_\_\_\_\_\_.
Phosphodiesterase, which prevents the breakdown of cAMP and leads to increased cAMP
62
* Farmer or bird handler
* Cough, dyspnea, chest tightness
* Diffuse crackles
Hypersensitivity pneumonitis
63
Abnormal septation of the lung bud from the foregut
Tracheoesophageal fistula
64
Mutaion of _________ leads to isoniazid resistance.
katG- encoded to catalase-peroxidase, which converts INH to its active form
65
Rales
Small airways "pop" open after collapse
Early insiratory. late inspiratory or expiratory
66
Stages of lun maturation
* Pseudoglandular (5-16wk)
* Canalicular (16-26 wk)
* Saccular (26wk-birth)
* Alveolar (after birth)
67
Why is hypercapnia seen in pulmonary fibrosis and not other diffusion limited conditions?
Due to destruction of alveolar capillaries, result in a dead space
\*Not due to diffusion limitation
68
Why will CO2 remain normal in shunting?
Due to hyperventilation
69
Hypoxemia with normal A-a gradient
Hypoventialtion
High altitude
\*In these cases alveoli are working
70
Treatment for Very severe COPD
* Short acting bronchodilator
* Long-acting bronchodilator
* Inhaled corticosteroids
* Oxygen/Surgery
71
O2 content, PaO2 and % sat in presence of CO
O2 content: Decreased
PaO2 : Normal
% sat: Decreased
72
Causes of central sleep apnea
* Central nervous system disease (encephalitis)
* Neuromuscular diseases (polio, ALS)
* Severe kyphoscolosis
* Narcotics
73
O2 contenc, PaO2 and % sat in hypoxemia
All decreased
74
How does an RSV infection present?
* Runny nose (URI)
* Wheezing (Lower tract)
75
Example of condition in with V/Q is less than 1
Pulmonary edema
76
Peak Expiratory flow (PEF) falls when _______ gets worse.
Obstruction
77
IC
TV + IRV
78
Cheyne-stokes breathing is common in _________ and __________ patients.
HF and stroke
79
Sytoms of High CO2
Lethargy
Confusion
Agitation
80
At what stage to respiratory bronchioles develop?
Canalicular Period (16-26 wks)
81
How do you test for CF in patients with a negative sweat test?
Test nasal transepithelial potential difference
* Measure nasal voltage
* CF patients: More negative voltage
* Due to abnormal sodium processing
82
Calcified ghon complex is a \_\_\_\_\_\_\_.
Ranke complex
83
Blue Bloater
Chronic Bronchitis
* Cyanosis from shunting
* Air trapping
84
In bronchopulmonary dysplasia _______ does not progress normally.
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
How is uncomplicated community acquired pneumonia treated?
Azithromycin
Clarithromycin
Doxycycline
86
Congenital diaphragmatic hernia
* Defective formation of pleuroperitoneal membrane
* Hole in diaphragm
* Reduced chest circumference
87
\_\_\_\_\_\_\_\_\_\_ is a phosphodiesterase-4 inhibitor that may relax airway smooth muscle.
Roflumilast
\*Used in COPD
88
Cause of aspirin exacerbated respiratory disease
* Dysregulation of arachidonic acid metabolism
* Overproduction of leukotrienes
89
Bronchioalveolar carcinoma looks like ________ on X-Ray.
Pneumonia
90
O2 contenc, PaO2 and % sat in HF
All normal
91
Infertily in CF due to absent \_\_\_\_\_\_\_\_.
Vas deferens
* Problem is sperm transport not spermatogenesis
92
Systemic diseases with interstitial lung feautures
* Scleroderma
* RA
* Goodpasture's
* Wgener's
* Sarcoidosis
93
Wheezes
Air lows through narrowed bronchi
Usually expiratory
94
Why is patent ductus arteriousus a complication of neonatal respiratory distress syndrome?
Hypoxia keeps shut open
95
FRC
RV + ERV
96
Omalizumab
* IgG monoclonal antibody
* Inhibits IgE binding to IgE receptor on mast cells and basophils
97
Exacerbations of CF are treated with \_\_\_\_\_\_\_\_\_\_\_.
Antibiotics
98
Side effects of isoniazid
* Neurotoxicity
* Haptotoxicity
* Drug-induced lupus
99
What drug increases chloride influx? When is it used?
Ivacaftor (tablets); only for patients with G551D mutation
100
Where does an aspired foreign body go, if a person is supine?
* Right inferior lobe- superior portion (apical)
* Right upper lobe- posterior segment
101
Mechanism of Theophylline cardiotoxicity
Blocks adenosine receptors, increases heart rate
102
How should a lung abscess be treated?
Clindamycin
\*If big enough, it has to be surgically drained
103
Long acting bronchodilators
Salmeterol
Formoterol
Tiotropium
104
\_\_\_\_\_\_\_\_\_\_ won't correct with 100 % oxygen/
Shunting
105
What happens to partial pressures of O2 and CO2 in arteries and veins during exercise?
Veins: O2 falls, CO2 rises
Arteries: O2 and CO2 normal
106
Three basic mechanism that create a high A-a gradient
Fibrosis
Shunt
V/Q mismatch
107
PVR is lowest when the lungs are at the \_\_\_\_\_\_.
FRC
\*This occurs after expiration of a normal tidal volume
108
Causes of pumonary hypoplasia
* Oligohydramnios
* Congenital diaphragmatic hernia
109
O2 content, PaO2 and % sat in anemia
O2 content: Decreased
PaO2 : Normal
% sat: Normal
110
\_\_\_\_\_\_\_\_\_\_\_\_\_ is a potent cerebral vasodilator.
CO2
\*increases in CO2, increase in cerebral blood flow
111
Side effect of steroids
Oral candidiasis
112
VC
TV + IRV + ERV
113
Short acting bronchodilators
Albuterol
Ipratropium
114
Characterisrtic of Mycobacterium tuberculosis
* Obligate aerobes
* Facultative intracellular
* AFB stain
115
Drugs used for both COPD and asthma
* Short acting bronchodilators
* Long acting bronchodilators
* Steroids
116
Side of effect of ehtambutol
Optic neuropathy
117
What abnormality can result in a stroke from a DVT?
Patent foramen ovale can allow venous clot to react arterial systems
118
Classica cause of Rhonchi
COPD
119
Light's Criteria
Exudate if:
* Pleural protein/serum protein \> 0.5
* Pleural LDH/ serum LDH \>0.6
* Pleural LDH \> 2/3 upper limits normal LDH
120
Treatment for Aspirin exacerbated respiratory disease
Montelukast
Zafirlukast
121
TLC
RV + ERV + IRV +TV
122
Mechanisms of silicosis
Macrophages react to silica, resulting in inflammation, activation of fibroblasts and collagen
123
Treatment for Severe COPD
* Short acting bronchodilator
* Long acting bronchodilator
* Inhaled corticosteriod
124
Normal DLCO
75-140%
125
What drugs promote the clearance of airway secretions in CF patients?
* Inhaled DNase (doornase alfa)
* Inhaled saline
* N-acetylcysteine
126
What is used to measure %O2 saturation of blood?
Pulse Oximetry
\*Uses light and photodetector
127
Systemic side efects of B2 agonists
Hypertension, arrhyythmia
128
Components of upper respiratory tract
Nasal cavity
Pharynx
Larynx
129
How is small pneumothorax treated?
* 100% O2
* Displaces nitrogen from capillary blood
* Increases gradient for nitrogen reabsorption from pleural space
130
Classical causes of wheezes
HF (cardiac asthma)
Asthma
Chronic bronchitis
Obstruction (tumor; localized wheeze)
131
How is a DVT diagnosed?
Lower extremity ultrasound
132
How is allergic bronchopulmonary aspergillosis diagnosed? Treated?
Skin testing aspergillosis
Steroids
133
What type of pneumonia is a serious complication for ARDS?
Ventilator acquired pneumonia
134
First line treatment for aspiration pneumonia
Clindamycin
135
Which values are not meausred by spirometry?
RV
FRC
136
Long acting B2 agonist are not used as monotherapy and are always used with \_\_\_\_\_\_.
Inhaled corticosteroids
137
How are newborns tested for CF?
* Increased blood levels of immunoreactive trypsinogen
* Follow up with sweat test if positive
138
Side of effects of rifampin
Liver, GI
139
Blunting of costophrenic angle
Pleural effusion
140
Classic causes o bronchial breath sounds
Seen in pneuomonia with consolidation
141
Common causes of hypoxia
Hypoxemia
HF
Anemia
CO
142
Sleep apnea treatments
* Weight loss
* CPAP
* Upper airway surgery
143
How is hypersensitivity pneumonitits diagnoses? Treated?
Diagnosis
* Bronchoalveolar lavage
* Inhalation challenge
* Lung biopsy
Treatment
* Avoid exposure
* Steroids
144
Which interleukins are suppresed by steroids?
IN-Y, TNF-a, GM-CSF
145
How do you treat transudative effusion?
Usually treat for underlying cause (no drainage)
146
* Dyspnea, hpoxemia
* ARDS
* Confusion
* Focal deficits
* Petechiae
Fat embolism
147
Treatment for pneumocystis jiroveci
* TMP-SMX (first line)
* Dapsone
* Pentamidine
Prophylasis: TMP-SMX when CD4 \<200
148
Lung buds form as outgrowth from \_\_\_\_\_\_\_\_\_\_\_.
Foregut
149
CF presentation
* Usually diagnosed \<2yo
* Respiratory disease
* Failure to thrive
* Meconium ileus
150
Where does the pulmonary artery pass relative to bronchi?
Right- Anterior to bronchi
Left- Superior to bronchi
151
Present of pectoriloquy indicate what?
Fluid in lungs: Effusion, consolidation
152
Treatment for acute exacerbations of COPD
* Oxygen
* Nebulized albuterol +/- ipratropium
* IV or oral corticosteroids
* Antibiotics
153
\_\_\_\_\_\_\_\_\_ inhibts arabinosyl transferase.
Ethambutol. polymerizs arabinose or mycobacteria cell walls
154
CF lung disease
* Productive cough
* Hyperinflation of lungs on X ray
* Obstructive pattern
155
Inheritence patten of cystic fibrosis
Autosomal recessive
156
At what stage do type II pneumocytes form?
Canalicular (16-26 wks)
157
\_\_\_\_\_\_\_\_\_\_ does not cause hypoxemia unless accompanied by a V/Q mismarch.
Dead space
158
Virulence factors of TB. How do they work?
* 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
Bronchial breath sound
High pitched lung sounds
Longer expiratory phase than normal
160
A cut phrenic nerve cause the diaphragm to \_\_\_\_\_\_\_.
Elevate
\*Can be seen on fluoroscopy ("sniff test")
