Lung and Pleura

Question 1

Type of pulmonary edema:
Imbalance of starling forces in pulmonary circulation
Increased hydrostatic pressure, decreased oncotic pressure
Transudate
Hemosiderin laden macrophages
Thickening of alveolar wall

Answer 1

Cardiogenic pulmonary edema

Question 2

Most common causes of acute lung injury

Answer 2

Sepsis
Diffuse pulmonary infections
Gastric aspiration

Question 3

What phase of ARDS?
Day 0-7
Alveolar edema, neutrophilic infiltrates, hyaline membranes
Usually mech vent dependent

Answer 3

Exudative

Question 4

What phase of ARDS?
Day 7-21
Lymphocytic infiltrates, type 2 pneumocyte proliferation
Clinical improvement

Answer 4

Proliferative

Question 5

What phase of ARDS?
>21 days
Alveolar duct and interstitial fibrosis
Long term O2 support

Answer 5

Fibrotic

Question 6

FEV1/FVC ratio in restrictive lung disease

Answer 6

Normal to increased

Question 7

FEV1/FVC ratio in obstructive lung disease

Answer 7

Decreased (<0.7)

Question 8

COPD
Irreversible destruction of air spaces distal to terminal bronchioles
Due to smoking, a1 antitrypsin deficiency
Centriacinar fibrosis

Answer 8

Emphysema

Question 9

COPD
Cough with sputum for at least 3 months for at least 2 consecutive years
Smoking, particles from dust etc
Hyperemia, swelling and edema of mucous membranes
Goblet cell hyperplasia
Squamous metaplasia

Answer 9

Chronic bronchitis

Question 10

Emphysema type that is due to antiprotease deficiency

Involves respiratory bronchioles to alveoli

Answer 10

Panacinar emphysema

Question 11

Most common type of emphysema
Involves respiratory bronchiole
Due to smoking
Inflammation and increase in proteases

Answer 11

Centriacinar

Question 12

Chronic disorder of the conducting airways, usually caused by an immunologic reaction, marked by episodic bronchoconstriction due to increased airway sensitivity to a variety of stimuli, inflammation of bronchial walls and increased mucus secretion

Answer 12

Bronchial asthma

Question 13

Whorls of shed epithelium in status asthmaticus

Answer 13

Curschmann spirals

Question 14

Eosinophilic crystals in asthma

Answer 14

Charcot-Leyden crystals

Question 15

Destruction of smooth muscle and elastic tissue by chronic necrotizing infections leading to permanent dilation of bronchi and bronchioles

Answer 15

Bronchiectasis

Question 16

Bronchiectasis associated conditions

Answer 16

Kartagener syndrome (primary ciliary dyskinesia)
Recurrent infection
Bronchial obstruction

Question 17

Dilated airways filled with mucopurulent secretions
Acute and chronic inflammatory exudates within the walls of bronchi and bronchioles
Squamous metaplasia

Fibrosis in chronic

Answer 17

Bronchiectasis

Question 18

Patchy interstitial fibrosis with varying age
Honeycomb fibrosis
Fibroblastic focus

Answer 18

Usual interstitial pneumonia

Question 19

Non neoplastic lung reaction to inhalation of mineral dusts encountered in the workplace

Answer 19

Pneumoconiosis

Question 20

What mineral dust is involved:

Coal mining

Answer 20

Coal dust

Question 21

What mineral dust is involved:

Metal casting work, sandblasting, hard rock mining, stone cutting

Answer 21

Silica

Question 22

What mineral dust is involved:

Mining, milling, manufacturing, and installation and removal of insulation

Answer 22

Asbestos

Question 23

Innocuous

Inhaled carbon pigments in alveolar macrophages

Answer 23

Anthracosis

Question 24

Coal macules and nodules that contain carbon laden macrophages

Answer 24

Simple coal workers pneumoconiosis

Question 25

Most common form implicated in silicosis is due to

Answer 25

Quartz and cement dust

Question 26

Increased susceptibility to tuberculosis Fine nodularities in upper lung zones Eggshell calcification in lymph nodes

Answer 26

Silicosis

Question 27

Localized fibrous plaques Recurrent pleural effusions Lung CA Mesothelioma

Answer 27

Asbestos

Question 28

Systemic granulomatous disease of unknown etiology Noncaseating granulomas Common organs affected: lymph node, lungs, spleen Epitheloid giant cells

Answer 28

Sarcoidosis

Question 29

Medial hypertrophy of pulmonary muscular and elastic arteries Pulmonary arterial atherosclerosis RVH

Answer 29

Pulmonary hypertension

Question 30

Most common cause of CAP

Answer 30

S. pneumoniae

Question 31

Most common bacterial cause of acute exacerbations of COPD

Answer 31

H.influenzae | M. catarrhalis

Question 32

Cause of post viral pneumonia, lung abscess, empyema, pneumonia in IV drug users, HCAP

Answer 32

S.aureus

Question 33

Most common cause of gram negative bacterial pneumonia Chronic alcoholics Currant jelly sputum

Answer 33

Klebsiella pneumoniae

Question 34

Pneumonia in immunocompromised, HCAP | Propensity to invade blood vessels

Answer 34

P. aeruginosa

Question 35

Pneumonia that flourishes in artificial aquatic environment

Answer 35

Legionella

Question 36

Common cause of pneumonia in children and young adults

Answer 36

Mycoplasma pneumoniae

Question 37

Local suppurative process that produces necrosis of lung tissue Suppurative destruction of parenchyma within the central area of cavitation

Answer 37

Lung abscess

Question 38

Most common type of Lung CA in never smokers

Answer 38

AdenoCA

Question 39

Butterflies on a fence appearance

Answer 39

Bronchoalveolar CA

Question 40

``` Associated with tobacco smoke lung CA Males Hypercalcemia Squamous dysplasia P53 mutations ```

Answer 40

Squamous Lung CA

Question 41

Highest smoking association with Lung CA SIADH, Cushing RB gene loss

Answer 41

Small cell lung CA

Question 42

Keratin pearls Abundant pink cytoplasm Distinct cell borders

Answer 42

Squamous cell lung CA

Question 43

``` Small round blue cells Scant cytoplasm Increased NC ratio Nuclear molding Azzopardi effect- basophilic staining of vascular walls ```

Answer 43

Small cell lung CA

Question 44

Salt and pepper nuclei

Answer 44

Neuroendocrine nature

Question 45

Light criteria

Answer 45

EXUDATE Pleural fluid/serum protein >0.5 Pleural fluid/ serum LDH >0.6 Pleural fluid LDH more than 2/3 the normal upper limit for serum