M2 Pulmonary Week 3 - Key Facts

Question 1

TB Microbiology Key Points (4)

Answer 1

1) Aerobic (Like’s Top of Lungs) Mycobacteria
2) Bacillus
3) Non-Spore Forming
4) Cell Wall has Mycolic Acid (Acid Fast Stain)

Question 2

Outcomes Following Infection (3) + %

Answer 2

1) Primary TB - 5% - Lower Lobe + Serious
2) Latent TB - 80% - Never Symptomatic Again
3) Reactivation TB - 10% - Get it again later

Question 3

Risk Factors for TB Reactivation (5)

Answer 3

1) HIV
2) Immunocompromised
3) Renal Failure
4) Diabetes - Exam Key
5) Silicosis

Question 4

Gross Imaging Findings (2) + Histology Findings (2)

Answer 4

Gross 
Ghon Complex (Lower Lobe) - Calficifcations + Fibrosis - Gray/White Lesion

Histology

1) Caseating Granulomas
2) Epithelial Histocytes - High Calcium

Question 5

PPD - Test Basics (3)

Answer 5

1) 48-72 Period then reexamine + only measure the bump not the redness
2) Triggers Type III (IgG) Hypersensitivity Reaction
3) Positive PPD = TB at some point (but may be latent)

Question 6

PPD - 3 Cut Off Points

Answer 6

1) < 5 mm - Immuncompromised (Lose ability to respond to Type III so any response is note worthy) - HIV/Transplant
2) < 10 mm - Risk Factors - Immigrants + IV Drugs + Kids + Healthcare Workers
3) < 15 mm - Everyone else

Question 7

Interferon Gamma Release Assay - Key Points

Answer 7

1) Draw blood and put it into a vile with TB Antigens - Look to see if patient’s blood makes IFN-Gamma
2) Less interpretation + no follow-up
3) No impact of BCG (TB Vaccine)

Question 8

Differentiation of Caseating Granuloma (2)

Answer 8

1) Fungi

2) TB - AFB (Acid Fast) = Red = Positive

Question 9

Signs of Active TB (5)

Answer 9

1) Fever
2) Night Sweats
3) Cough
4) Hemoptysis
5) Weight Loss
6) Gradual
7) No Abx Response

Question 10

Extra-Pulmonary TB (4)

Answer 10

1) Cervical Lymph Nodes
2) Joints - Potts + Spine
3) Kidney (Sterile Pyuria)
4) TB Meningitis

Question 11

Miliary TB - Key Points (3)

Answer 11

1) Hematogenous Dissemination of TB
2) Occurs with Primary and Secondary TB
3) Diffuse Nodules on CXR

Question 12

TB CXR - 3 Types

Answer 12

1) Primary = Lower/Middle Lobe Infilitrates
2) Reactivation = Apical Cavitation
3) Miliary = Diffuse Nodules

Question 13

HIV TB - 2 Keys

Answer 13

1) Can Have Normal CXR

2) Extra Pulmonary Symptoms More Common

Question 14

Children TB - 2 Keys

Answer 14

1) Less likely to have cavitation

2) More likely to have intrathoracic adenopathy

Question 15

CF - Gene Knock-Out + Results

Answer 15

1) F508 = Complete Knockout
2) G551D = Partial = Kalydeco Tx

1) Inflammation + Bronical Obstruction + Bronchiestasis

Question 16

CF - Diagnosis Criteria (6)

Answer 16

Need 1 In Each Category

1) >1 Phenotypical CF Feature
2) Sibling with CF
3) Positive Newborn Screening Test

1) High Salt Sweat Test
2) IDed CTFR Mutation
3) Abnormal Nasal Potential Different

Question 17

CF - 4 Major Pulmonary Symptoms

Answer 17

1) Recurrent Pneumonia
2) Atypical Asthma
3) Nasal Polyps
4) Pseudomonas

CF Asthma has clubbing - Normal does not

Question 18

CF Infection - 3 Key Points

Answer 18

1) Can’t Keep Kids Together
2) Psuedomonas before Age 6 = Bad Prognosis
3) Psudomonas loves the mucous

Question 19

ARDS Pathophysiology

Answer 19

Diffuse Alveolar Damage –> Due to protein rich fluid leakage + formation of hyaline membranes - Actication of neutrophils causes free radical destruction of Type I and II Pneumocytes

Question 20

Major ARDS Clinical Features (5)

Answer 20

1) Hypoxdemia
2) Cyanosis
3) Respiratory Distress
4) Dyspnea (Alveoli Collapse
5) White Out CXR

Question 21

Typical ARDS Causes (8)

Answer 21

1) Sepsis
2) Pulm. Infection (Pneumonia)
3) Shock
4) Trauma
5) Aspiration
6) Pancreatitis
7) DIC
8) Hypersentivity Reactions

Question 22

Major Stages of ARDS (3)

Answer 22

1) Exudative Phase 1-7 Days
2) Organizing Phase 7-14
3) Resolution Phase

Question 23

Exudative Phase - Pathophysiology Steps (5)

Answer 23

1) Insult Triggers Inflammation
2) Endothelial + Alveolar Injury
3) Increased Permeability (Protein rich interstitial and alveolar edema)
4) Atelectiasis/DAD

Question 24

Exudative Phase - Results (5)

Answer 24

DAD

1) Edema
2) Hyaline Membranes
3) Hemorrhage
4) Neurtophil Invasion

Also Type 1 Pneumocyte Destruction

Question 25

Organizing Phase - Key Points (4)

Answer 25

1) Type II Pneumocyte Proliferation
2) Granulation and fibroblast proliferation
3) Still Reversible
4) Less Hemorrhage on Histology

Question 26

Resolution Phase - 3 Outcomes

Answer 26

1) Full Resolution
2) Stable Fibrosis
3) Progressive Fibrosis

Collagen deposition = irreversible step

Question 27

ARDS Rule Outs (3)

Answer 27

1) Localized to 1 Lobe
2) Death within 1 week (underlying cause)
3) Sepsis = Big Cause

Question 28

Major Pathophysiology Changes in ARDS (4)

Answer 28

1) Impaired Ventilation (loss of alveoli)
2) Surfactant Inactivation
3) Decreased Compliance (Restrictive Lung Disease)
4) V/Q Mismatch - Blood passes through without gas exchange (atelectasis + thick diffusion barrier) - Physiological Shunting = Not responsive to O2

Question 29

Ventilation Injury Types (4)

Answer 29

1) Barotrauma - Macroscopic
2) Volutrauma - End Inspiratory Volume Over distension
3) Atelectotrauma - Not enough PEEP
4) Biotrauma - Biochemical Injury

Question 30

Ventilator Injury - Barotrauma + Causes (2)

Answer 30

Macroscopic compression

1) Pneumothorax
2) Subcutaneous Emphysema

Question 31

Ventilator Injury - Volutrauma + Causes (1)

Answer 31

Large tidal volumes - Causes over extension of the alveoli after inspiration (increases wall stress)

Question 32

Methods to Avoid Ventilator Induced Injury (3)

Answer 32

1) Optimal PEEP
2) Low Tidal Volume
3) Prone Position