Chapter 9: High Yield Respiratory

Question 1

Most common cause of Rhinitis

Answer 1

Adenovirus

Question 2

Biopsy - pleomorphic keratin-positive epithelial cells in a background of lymphocytes. Associated with EBV.

Answer 2

Nasopharyngeal carcinoma

Question 3

Hoarse, “barking” cough and inspiratory stridor. Inflammation of the upper airway. Most common cause = parainfluenza virus

Answer 3

Laryngotracheobronchitis (Croup)

Question 4

Consolidation of an entire lobe of the lung. Usually bacterial (S. pneumoniae 95%; Klebsiella pneumoniae) Red hepatization –> Gray hepatization

Answer 4

Lobar pneumonia

Question 5

Scattered patchy consolidation centered around bronchioles. Multifocal and bilateral.

Answer 5

Bronchopneumonia

Question 6

Diffuse interstitial infiltrates. Mild upper respiratory symptoms.

Answer 6

Interstitial (atypical) pneumonia

Question 7

Most common cause of Community-acquired poneumonia

Answer 7

S pneumoniae. - lobar pneumonia

Question 8

Pneumonia in cystic fibrosis patients

Answer 8

P. aeruginosa (Bronchopneumo)

Question 9

Most common cause of atypical pneumonia. Military recruits

Answer 9

Mycoplasma pneumoniae

Question 10

Most common cause of atypical penumia in infants

Answer 10

RSV

Question 11

Farmers and vets - cattle.

Answer 11

Coxiella burnetii

Question 12

Pneumonia in malnourished, alcoholics, diabetics. currant jelly sputum

Answer 12

Klebsiella pneumonia (lobar)

Question 13

Gohn complex

Answer 13

Primary TB ( mycobacterium tuberculosis)

Question 14

Caseating granulomas; AFB bacilli. Apex of lung

Answer 14

Secondary TB

Question 15

Caseating granulomas; AFB bacilli. Apex of lung

Answer 15

Secondary TB

Question 16

Decreased FVC; Greatly decreased FEV1; Increased TLC

Answer 16

COPD

Question 17

Most common cause of centriacinar emphysema

Answer 17

smoking

Question 18

You see a barrel chested ‘pink puffer’ in ___

Answer 18

Emphysema

Question 19

Productive cough with spiral-shaped mucus plugs (curschmann spirals) and eosinophil-derived crystals (Charcot-Leyden cyrstals)

Answer 19

Asthma

Question 20

The 4 COPDs are:

Answer 20

1. Chronic bronchitis 2. Emphysema 3. Asthma 4. Bronchiectasis

Question 21

Permanent dilation of bronchioles and bronchi due to necrotizing inflammation [Cystic fibrosis; Kartagener syndrome]. Couch, dyspnea and foul-smelling sputum. Can get secondary (AA) amyloidosis!

Answer 21

Bronchiectasis

Question 22

Decreased TLC and greatly decreased FVC; FEV1: FVC ratio is increased (FVC reduced more than FEV1)

Answer 22

Restrictive diseases:

Idiopathic pulmonary fibrosis; Pneumoconioses; Sarcoidosis; Hypersensitivity pneumonitis)

Question 23

Fibrosis of lung interstitium due to TGF-Beta. Subpleural patches initially, leading to diffuse fibrosis and end-stage “HONEYCOMB” Lung

Answer 23

Idiopathic pulmonary fibrosis

Question 24

Fibrosis of lung interstitium due to TGF-Beta. Subpleural patches initially, leading to diffuse fibrosis and end-stage “HONEYCOMB” Lung

Answer 24

Idiopathic pulmonary fibrosis

Question 25

Stellate inclusions (asteroid bodies) seen within giant cells of non-caseating granulomas. systemic disease. Granulomas of hilar lymph nodes and lungs leading to restrictive lung disease. CD4+ helper T-cell response. Elevated serum ACE and hypercalcemia.

Answer 25

Sarcoidosis

Question 26

Plexiform lesions

Answer 26

Seen in severe, long standing pulmonary HTN ( MAP > 25 mmHg)

Question 27

Plexiform lesions

Answer 27

Seen in severe, long standing pulmonary HTN ( MAP > 25 mmHg)

Question 28

BMPR2

Answer 28

Inactivation mutation leads to proliferation of vascular smooth muscle --> primary pulmonary HTN

Question 29

Tx of ARDS

Answer 29

ventilation with positive end-expiratory pressure (PEEP)

Question 30

Tx of ARDS

Answer 30

ventilation with positive end-expiratory pressure (PEEP)

Question 31

Surfactant production begins ____ and reaches adequate levels _____

Answer 31

Begins at 28 weeks; | Adequate levels at 34 weeks

Question 32

What condition in the mother decreases surfactant production

Answer 32

Diabetes. Insulin decreases surfactant production

Question 33

What condition in the mother decreases surfactant production

Answer 33

Diabetes. Insulin decreases surfactant production

Question 34

Key risk factors for lung cancer [3]

Answer 34

Cigarette smoke [polycyclic aromatic hydrocarbons and arsenic]; radon; and asbestos

Question 35

Lung Cancer usually metastasis to ___

Answer 35

adrenal gland

Question 36

Male smoker. Central tumore from neuroendocrine cells. May produce ADH or ACTH or cause Eaton-Lambert syndrome [pre-synaptic Ca channel antibody - paraneoplastic syndrome]

Answer 36

Small cell carcinoma

Question 37

Keratin pears or intercellular bridges. Most common tumore in male smokers. Central; may produce PTHrP (can get hypercalciemia)

Answer 37

Squamous cell carcinoma

Question 38

Metastasis TO lung

Answer 38

Breast and colon carcinoma. Presents like multiple 'cannon-ball' nodules

Question 39

Metastasis TO lung

Answer 39

Breast and colon carcinoma. Presents like multiple 'cannon-ball' nodules

Question 40

Penetrating chest wall injury. Trachea is pushed OPPOSITE to the side of injury

Answer 40

Tension pneumothorax - Chest tube = medical emergency..

Question 41

Equation for physiologic dead space Vd

Answer 41

``` Vd= Vt * [ (PaCO2 - PECO2) / PaCO2 ] Vt = tidal volume. PECO2 = expired air PC02 Pa = arterial ```

Question 42

Equation for physiologic dead space Vd

Answer 42

``` Vd= Vt * [ (PaCO2 - PECO2) / PaCO2 ] Vt = tidal volume. PECO2 = expired air PC02 Pa = arterial ```

Question 43

Normal Hb amount in blood

Answer 43

15 g/dL | cyanosis results when deoxygenated Hb > 5g/dL

Question 44

O2 binding capacity =

Answer 44

20.1 mL02/dL

Question 45

Bohr effect

Answer 45

In peripheral tissue, inc H+ from tissue metabolism shifts curve to right, unloading O2.

Question 46

Haldane effect

Answer 46

In lungs, oxygenation of Hb promotes dissociation of H+ from hb. This shifts equilibrium toward CO2 formation; therefore CO2 is released from RBC

Question 47

Dorsiflexion of foot causes calf pain

Answer 47

+ Homan's sign. indicate DVT

Question 48

DVT tx

Answer 48

heparin for prevention and acute management; | Warfarin for long-term prevention of DVT recurrence

Question 49

Classic triad: hypoxemia, neurologic abnormalities and petechial rash

Answer 49

Fat emboli