March 30 - Pulm

Question 1

Thoracocentesis

Answer 1

Parietal pleura extends 2 ribs below visceral pleura/inferior lung border. To avoid injuring lung, do between 6th and 8th ribs at midclavicular line, between 8th and 10th ris at midaxillary line, and between 10th and 12th ribs at paravertebral line. Still risk of penetrating abdominal structures

Question 2

White out on CXR

Answer 2

Seen in both ARDS and HF. Distinguish by PCWP (normal in ARDS, increased in HF)

Question 3

Culturing legionella

Answer 3

Buffered charcoal yeast extract agar supplemented with iron, cysteine and antibioitics

Question 4

Accentuated second heart sound

Answer 4

Seen in PAH

Question 5

Scleroderma pathogenesis

Answer 5

Excess of TGF-beta results in collagen deposition in tissues

Question 6

Bosentan

Answer 6

MOA: endothelin-receptor antagonist
Use: blocks effects of endothelin

Question 7

Coccidioides

Answer 7

Causes lung disease in immunocompetant; disseminated disease in immunocompromised. Thick walled spherules packed with endospores. Occurs in SW US

Question 8

Histoplasmosis

Answer 8

Occurs in ohio and mississippi river valleys, associated with caving. Yeast is ingested by macrophages in which it multiplies so on biopsy, macrophages are filled with yeast cells

Question 9

Blastomycosis

Answer 9

Occurs in ohio and mississippi river valleys. Unlike histo, extrapulmonary disease very common, esp in skin and bone. Broad based budding yeast

Question 10

Paracoccidiomycosis

Answer 10

Seen in south and central america. On path “pilot’s wheel” with mother cell budding off multiple daughter yeast

Question 11

Allergic bronchopulmonary aspergillosis

Answer 11

Increased Th2 cells produce more IL-4 and IL-5. LEads to eosinophilia and elevated serum IgE

Question 12

Cryptococcus sulture and diagnosis

Answer 12

Cultured on Sabourad’s agar.
On india ink, clear unstained zone surrounds the yeast. Mucicarmine stains the capsule red. Latex agglutination test can be used to detect capsular antigen

Question 13

Mucormycosis

Answer 13

Seen in diabetics, esp those with DKA. Angioinvasive. Forms broad hyphae that branch irregularly with rare septations

Question 14

ESR

Answer 14

Inflammation causes release of TNF-alpha, IL-1, and IL-6 which lead to increased production of acute phase reactants. The acute phase reactant fibrinogen causes red cells to form stacks.

Question 15

Silicosis

Answer 15

Calcification of rim of hilar nodes + nodular densities on x-ray
Birefringent silica particles surrounded by fibrous tissue on biopsy.
Increased risk of TB due to impaired macropage function

Question 16

Neuroendocrine tumor markers (4)

Answer 16

NCAM (neural cell adhesion molecule, also called CD56), enolase, chromagranin, synaptophysin

Question 17

Vimentin

Answer 17

intermediate filament found in mesenchymal cells. Used in diagnosis of sarcoma

Question 18

Reid index

Answer 18

Used to determine severity of chronic bronchitis. Thickness of mucus gland layer / thickness between epithelium and cartilate (not including the cartilage). Normal is 0.4

Question 19

Bordatella pertussis on gram stain

Answer 19

Gram neg coccobacillus

Question 20

Chediak higashi presentation

Answer 20

Albinism, pyogenic infections, neurologic dysfunction

Question 21

Wiskott aldrich presentation

Answer 21

Recurrent infections, easy bleeding, eczema