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RESP > MIDTERM > Flashcards

MIDTERM Flashcards

1
Q

increased airway resistance due to a narrowing or blockage at some point along the air path

A

Obstructive Lung Disease

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2
Q

Problem breathing out =

beathing = SLOW and DEEP

A

Obstructive Lung Disease

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3
Q

Decrease in respiratory compliance making the lungs more difficult to expand

A

Restrictive Lung Disease

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4
Q

Problem breating IN

breathing is rapid and shallow

A

Restrictive Lung Disease

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5
Q

Fibrotic tissue is made up of elastin fibers. When lungs undergo fibrosis, there is an increasse in elastin fibers, what happens to the recoil force?

A

Greater Recoil Force

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6
Q

4 Main Obstructive Lung Diseases

A

Asthma
Chronic Bronchititis
Emphysema
COPD

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7
Q

alveolar damage leading to hyperinflated lungs and less recoil pressure, air cannot get out = air trapping

A

Empysema

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8
Q

Obstructive Lung Disease

What happens to
PEFR
TLC
RV
FRC

A

PERF Decreases
TLC Increases
RV Increases
FRC Increases

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9
Q

PAINT mnemonic

A

Pleural
Aveolar
Interstitial
Neuromuscular
Thoracic

DEC COMPLAINCE

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10
Q

What happens to TLC, RV and PEFR in restrictive lung disease?

lungs do not want to inflate

A

TLC Decrease
RV Decrease
PEFR Decrease

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11
Q

FEV1/VC of 0.8 or greater =

A

Normal or Restrictive Disease

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12
Q

FEV1/VC of < 0.7 =

A

Obstructive Disease

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13
Q

Flow - Pressure - Resistance Formula?

A

Q = P/R

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14
Q

TPR = formula

A

TPR = MAP - CVP / CO

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15
Q

How is the left atrial pressure estimated?

A

pulmonary artery wedge pressure

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16
Q

The minimum resistance is at ____?

A

FRC = func residual capacity

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17
Q

Blood Flow Maximum is at __?

A

FRC

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18
Q

Where is the least resistance and the most blood flow in the lung?

A

BASE

q

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19
Q

Hypoxic Pulmonary Vasoconstriction

When oxygen levels drop, the lung will shunt blood to working alveoli in order to maintain the best V/Q match caused by what?

A

Local Hypoxia

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20
Q

lung capillary flow is

A

Pulsatile

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21
Q

As youre taking a deep breath, what happens to pulm. vasc. resistance?

A

INCREASES

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22
Q

You go from standing to suprine, what happens to lung base vascular resistance?

A

INC

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23
Q

Increasing transmural pressure in the pulm. artery does what to vascular resistance?

A

DEC

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24
Q

During inspiration starting at FRC what happens to vascular resistance of alveolar capillaries?

A

INC

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25
Q

Alveolar Ventilation Eqn. =

Finds CO2

A

PaCO2 = K(VCO2 / QA)

k = 0.863 VCO2 = exhaled PACo2 = in the alveoli

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26
Q

When PACO2 rises =
PACO2 falls =

A

Rises = HYPOventilation
Falls = HYPERventiliation

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27
Q

Aveolar Gas Equation

Finds O2

A

PAO2 = 150 -1.2 (PACO2)

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28
Q

CO2 = HIGH
O2 = LOW
What is V/Q ratio?

A

LOW V/Q ratio
Hypoventilation
You are retaining CO2

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29
Q

At HIGH V/Q ratio, what is your breathing pattern?

A

Hyperventiliation
Blowing off all the CO2
Low CO2, HIGH O2

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30
Q

Anatomic Dead Space vs. Aveolar Dead Space

A

Anatomic Dead Space – No Gas Exchange
Aveolar Dead Space – No perfusion

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31
Q

Blood passes through with NO gas exchange … what type of shunt?

A

Intrapulmonary Shunt

occurs when there is an airway obstruction

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32
Q

Will 100% O2 adminstration correct tetralogy of fallot?

Right to Left Shunt

A

NO

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33
Q

Will 100% O2 adminstration correct intrapulmonary shunts?

blood travels through lungs without being oxygenated

A

YES

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34
Q

A-a Gradient =

A

PAO2 - PaO2

A-a should be less than (Age + 10)/4

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35
Q

Hypoxemia vs Hypoxia

A

Hypoxemia = measured in blood LOW PaO2
Hypoxia = refers to low O2 delivery to tissues PaO2 = normal

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36
Q

flora of the oral cavity

associated with dental caries and endocarditis

A

Viridans streptococci

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37
Q

Most common cause of bacterial meningitis, pneumonia and ear infections

A

Streptococcus pneumoniae

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38
Q

What 3 are primarily responsible for rhinosinusitis?

A

Strep pneumo
Haemophilus influenzae
Moraxella catarrhalis

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39
Q

Nasal Smear

Allergic Rhinitis vs Acute Rhinosinusitis

A

Allergic – eosinophils
Acute – PMN

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40
Q

Most common cause of acute bronchitis

A

VIRUSES

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41
Q

pathophysiology of acute bronchitis

A
  1. APCs pick up antigen
  2. Present to CD4+ T Cells –> produce cytokines –> Flu Like Symptoms
  3. Cytokines activate CD8+
  4. CD8+ T cells kill infected cells (Immune mediated cellular injury – reason for long recovery)
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42
Q

In adults HRSV presents as vs. in children?

A

Adults – common cold – pneumonia
Kids – pneumonia – bronchiolitis

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43
Q

Pathogenesis of RSV

Inc vascular permeability – Influx of PMNs
Mast Cells activate and release –>
leading to the formation of

A

Release Histamine –> Syncytica = multinucleated cells

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44
Q

Parainfluenza virus can cause what in KIDS?

A

Laryngotracheobronchitis (Croup)

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45
Q

Name the virus

negative sense 8 segment ssRNA virus

A

Influenza

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46
Q

pathogenesis

What virus replicates in GI tract without lysis of respiratory epithelia?

A

Enterovirus

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47
Q

What virus is responsible for the most common cause of common cold in summer

A

Enterovirus

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48
Q

What is the most common viral agent in humans?

A

Rhinoviruses

most common cause of common cold in fall/winter

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49
Q

What are coronaviruses able to form to impair function of cilia?

A

Syncytia

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50
Q

What aids the survival of coronavirus in the GI tract?

A

Glycoprotein “Corona”
detected in stools

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51
Q

What virus?

Histology shows intranuclear inclusions without cell enlargement

A

Adenovirus

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52
Q

Name the virus

Patient was recently clearning a cabin … c/o of fever, muscle aches, cough

A

Hantavirus

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53
Q

Hantavirus attaches to what of BV?

A

endothelium of pulm BV

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54
Q

Hantavirus impairs pulm. endothelium causing what?

A

Capillary Dilation – EDEMA –> Interstital Pneumonitis

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55
Q

you see blunting of the costophrenic angle

A

pleural effusion

will move into the left lateral decubitus

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56
Q

air filled bronchioles (black) against the opacified background of the lung (white)

A

air bronchogram

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57
Q

if the right heart border is obscured where is the consodlidation?

A

Right middle lobe

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58
Q

Where will consolidations not move into?

A

Left Lateral Decubitus

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59
Q

What findings do we see with cardiogenic pulmonary edema during interstitual edema?

A

Kerley B Lines = thickening of the interlobular septa – seen on outer 1cm of ungs perpendicular to pleura
Ground Glass opacities

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60
Q

in pulmonary embolisms what defect is seen?
Is ventilation normal?

A

Segmental perfusion defects (wedge shaped)
Ventilation = normal

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61
Q

Chest XRAY shows a patchwork quilt appearance … you suspect?

A

Bronchopneumonia

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62
Q

Causes of Acute bronchitis in CF patients

5-18 years of age =
> 18 years =

A

5-18 = pseudomonas aeruginosa
>18 = burkholderia cepacia

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63
Q

microbial infection resulting in pus collection within the pleural cavity

A

EMPYEMA

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64
Q

Virus causing pneumonia in a healthy host =

A

Influenza (MC)
RSV, Adenovirus, Parainfluenza

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65
Q

Virus causing pneumonia in immunocompromised hosts

A

Herpesviruses, Influenza

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66
Q

Possible etiology of pneumonia in a NEONATE

A

GBS, Klebsiella pbeymonia, E.coli, S. pneumo, S. pyogenes, S.aureus

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67
Q

Possible etiology of pneumonia in a 1mo – 2yr

A

VIRUSES (RSV)

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68
Q

Possible etiology of pneumonia in a 2-5yr

A

VIRUSES

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69
Q

Possible etiology of pneumonia in a 5-18yr

A

S. pneumoniae

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70
Q

If you see a LOBAR pattern ….

A

S. pneumoniae

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71
Q

If you see a PATCHY pattern …

A

Atypical bacteria

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72
Q

If you see an INTERSTITAL pattern …

A

Viruses/mycoplasma

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73
Q

If you see a CAVITARY pattern ….

A

Anaerobic GNB

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74
Q

pseudomonas aeruginosa virulence factor which has blue pigment that suppresses other bacterial growth; some cytotoxicity in leukocytes

A

PYOCYANIN

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75
Q

3 virulence factors of Strep pneumo

A

Choline binding protein
Capsule
Pneumolysin

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76
Q

strep pneumo releases this upon lysis of bacteria, cytotoxic to endothelial cells for to permit dissemintation of bacteria
- suppresses neutrophila nd macrophage phagocytosis
- supresses proinflam cytokine prod.

A

PNEUMOLYSIN

impairs cilia action

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77
Q

4 phases of lobar pneumo

A

Congestion
Red Hepatization
Grey Hepatization
Resolution

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78
Q

Complication of Lobar Pneumonia

A

Bacteremia
* infective endocarditis
* cerebral abscess
* septic arthritis

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79
Q

What allows klebsiella pneumoniae to protect itself from phagocytes?

A

Polysaccharide Capsule

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80
Q

Virulence for Haemophilus influenzae type B

A

polyribitol phosphate capsule

adherence, imparis cilia, prevents phagocytosis of bacteria

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81
Q

What allows mycoplasma pneumoniae to bind directly to ciliated resp. epithelia – impairs ciliary action

VIRULENCE FACTOR

A

P1 adhesion

also toxic metabollites

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82
Q

Agents of HAP

A

Pseudomonas aeruginosa ( >4 days on vent)
Actinetobacter baumannii (prolonged vent/antibiotic resistance)
S. aureus

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83
Q

Immunocomproised Pneumonia agents

A

Pneumo jiroveci
Nocardia = gram + /acid fast
Herpesvirus

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84
Q

What allos mycobacteria to block gram staining but bind to carbofuschin in acid fast staining?

A

Mycolic Acid

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85
Q

mycobacterium tuberculosis establishes residence within what?

A

macrophages

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86
Q

If our immune system cannot clear an infection of mycobacterium tuberculosis it will form what?

A

form a granuloma to prevent expansion

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87
Q

What is the most common cause of diffuse alveolar damage and cytokine storm?

A

Viruses
Results in Hyaline Membrane Formation

88
Q

diptheria toxin can be cleaved into what 2 fragments?

laryngitis

A

A = catalytic domain
* ADP-ribosylation of elongation factor-2 inhibit ribosome function – preventing protein synthesis – cell death

B = binding

89
Q

Ghons complex/caseous granuloma is associated with

A

Primary tuberculosis

90
Q

secondary tuberculosis commonly resides where

A

apex of lung – O2 is greater here

91
Q

fungal pathogen endemic to ohio and central mississipii river valleys

A

Histoplasmosis

92
Q

fungal pathogen endemic to southwestern regions, infection is known as valley fever

nonbudding spherules

A

Coccidiomycosis

93
Q

Loffler’s syndrome is due to an accumulation of what in the lung d/t a parasitic infection?

A

Eosinophils

94
Q

Who are the culprits of lofflers syndrome or a parasitic infection of the resp tract?

A

Ascaris lumbricoides
Strongyloides stercoralis

95
Q

What is the most common clinical cause of ARDS?

A

Diffuse alveolar damage (DAD)

96
Q

What two respiratory cell groups are present in the medulla?

A

VRG = Expiratory center
DRG = Inspiratory Center
* contains nucleus tractus solitaris/recieves input from CN IX and CNX

97
Q

What 2 respiratory cell groups are in the PONS?

A

Apneustic Center – prolongs respiration
Pneumotaxi Center – inhibits apneustic center – turns off inspiration

98
Q

Both the central and peripheral receptors sense pH and CO2, which one also senses O2?

A

Peripheral Receptors

99
Q

what is the central pattern generator?

A

Medulla

100
Q

Aortic Bodies –> Aortic Nerve –> what nerve –> DRG in medulla (NTS)

A

CN X

101
Q

Carotid bodiies –> Hering nerve –> what nerve –> DRG in medulla (NTS)

A

CN IX

102
Q

Where is the carotid body located?

A

bifurcation of common carotid arteries

103
Q

What contains a collection of glomus cells surrounded by fenestrated capillaries?

A

Carotid Body

104
Q

What happens with an INFLUX of Ca
EFFLUX of K+

A

Influx Ca = DEPOLARIZATION
Efflux K+ = REPOLARIZATION

105
Q

Repolarization can be inhibited by what?, which results in the glomus cells continuously being depolarized …

A

inhibited by HIGH CO2 and Low pH

106
Q

Which fiber receptors are sensitive to changes in distension of capillaries?

A

C-Fiber Receptors = Juxtacapillary or J Receptors

DEC Distenstion – DEC Ventilation (pulm embolism obstructs flow to capillaries)

INC Distension –> INC Ventilation (pulm congestion by LV failure)

107
Q

Herring Breuer Inflation reflex is active in adults and infants if there tidal volume is >

A

> 800ml

108
Q

Rapid/Over inflation would activate what? – which sends inhibitory signals to DRG via CN X

A

activate SAR –> REDUCED Respiration, TV and RR

109
Q

Hering-Breuer DEFLATION reflex is active during what?

A

Pneumothorax, trigger for sighs, maintain infant FRC

ACTIVATES RAR – promote inspiration

110
Q

Most common cause of Pharyngitis
* Fever, Swollen anterior LN, Tonsillar exudates/swelling

A

VIRAL Infection

does not respond to antibiotics – R/O strep before calling it URI

111
Q

What lower respiratory infection must you rule out before calling it bronchitis?

A

Pneumonia

Consolidation on XRAY, dullness to percussion, INC Tact frem/tachy - SOB

112
Q

Peripheral Cyanosis indicates …

fingers/toes

A

INC O2 uptake in tissues

113
Q

Central Cyanosis indicates …

skin, mucous membranes, mouth

A

indicates lung pathology – LOW arterial O2

114
Q

Clubbing is a result of what?

Normal = Schamroths window

A

Chronic hypoxemia

115
Q

dullness on percussion would indicate?

A

Fluid present in pleural

116
Q

volume of air still in lungs after maximal forced expiration =

A

FRC
Forced Vital Capiacity

117
Q

a NORMAL FEV1/FVC ratio is a sign of what type of lung disease?

A

RESTRICTIVE

118
Q

a DECREASED FEV1/FVC ratio is a sign of what type of lung disease?

A

OBSTRUCTIVE lung disease

there is inc airway resistance in expiration – air cant get out in 1 se

119
Q

bronchoprovocation testing

A

Methacholine Test
- muscarinic agonist – constricts airway

Used to diagnose asthma

120
Q

asthma is most common in what type of demographics?

A

blacks, females and children

121
Q

disorder of bronchial airways characterized by REVERSIBLE bronchospasm

A

asthma

122
Q

as age INC asthma begins to mimic what?

A

COPD

123
Q

Astma Vs. COPD Pathophisology
Cell Markers …

A

CD4 = Asthma
CD8 = COPD

124
Q

mainstay of asthma treatment in children and adults

LONG TERM

A

Inhaled corticosteroids

125
Q

used as adjunctive asthma therapy

LONG TERM

A

Long Acting Beta Agonist (LABAs)
formoterol, salmeterol

126
Q

used in excercise induced asthma

LONG TERM

A

leukotriene modifers
monntelukast, zafirlukast

127
Q

Drug of choice for acute relief of asthma symptoms

A

Short Acting Beta Agonists
Albuterol

128
Q

Obstructive disease diagnosed based on clinical features vs. morophologic and radiologic features

A

Chronic bronchitis vs Emphysema

129
Q

pathogenesis

in larger airways – hyperplasia and hypertrophy of submucosal mucous glands
* reid index = > 0.5 (50%)

smaller airways – mucous plugging of bronchiolar lumen

A

Chronic bronchitis

130
Q

Patient comes in with a productive cough and is a cigarette smoker
He is cyanotic and has peripheral edema

A

Chronic bronchitis

progressive dx may lead to cor pulmonale / right heart failure

131
Q

INC vascular resistance or blood pressure in the lungs (Pulm HTN) due to chronic lung disease –> Hypertrophy of right ventricle

A

Cor pulmonale

132
Q

COPD characterized by permanent enlargement of airspaces distal to terminal bronchioles due to destruction of the alveolar walls and the pulm capillaries required for gas exchange

A

EMPHYSEMA

cig. smoking / inherited anti trypsin deficiency

133
Q

pathogenesis of emphysema:
there is an imbalance between what two factors in smokers?

A

elastase and elastase inhibitor a1-antitrypsin

non-smokers - homozygous inactivating mutation of a1-AT

no inhibiton of elastase

134
Q

Centriacinar vs Panacinar Emphysema

A

Centriacinar – smokers / upper lobes of lungs
Panacinar – inherited / lower lobes

135
Q

What type of emphysema is most commonly seen in young adults with spontaneous pneumothroax?

A

Distal Emphysema
- sometimes form cysts –> bullae

parencyhma is not affected

136
Q

60 yo patient presents with a barrel chest and pursed lips /
Tachypnea

A

Emphysema

Pink Puffers

137
Q

What cytokine is responsible for Ig class switching in B cells to IgE

A

IL4

IL5 = recruits eosinohphils

138
Q

in a smear of sputum of an astmatic patient, you see two hallmark features:

A

Curschmann’s spirals
Charcot-Leyden crystals

139
Q

permanent dilation of bronchi and bronchioles caused by destruction of smooth muscle and supporting elastic tissue

A

Bronchiectasis

infection/obstruction

139
Q

permanent dilation of bronchi and bronchioles caused by destruction of smooth muscle and supporting elastic tissue

A

Bronchiectasis

infection/obstruction

140
Q

what microtubule protein is essential for cillary movement?

A

Dynein

141
Q

Kartagener’s syndrome is found in some patients with ciliary dyskinesia that present with a triad of signs:

A

Situs inversus
Chronic sinusitis
Bronchiectasis

142
Q

In advanced stages, chronic diffuse restrictive pulm diseases are difficult to diferentate bc all result in diffuse scarring and gross destruction =

A

Honey Comb Lung
= end stage lung

143
Q

unknown etiology, now considered to be the result of repetitive local, micro injuries to ageing alveolar epithelium by env. factors?

A

Idiopathic pulm fibrosis

144
Q

What chronic interstital lung disease

macroscopic hallmark = cobblestoned pleural surfaces
microscopic hallmark = patchy interstital fibrosis

A

Idiopathic Pulm Fibrosis

145
Q

50 yo pt presents with dry non prod cough
on ausculation you hear “dry velcrolike” crackles at the lung bases

A

Idiopathic pulm fibrosis

146
Q

chronic bilateral interstital lung disease of unknown etiology that is freq. associated with collagen vascular disorders such as RA

A

Non-specific interstial pneumonia

147
Q

non specific interstial pneumonia has fibrosis and inflammation in varying proproptions with no temporal heteregeneity. Two major patterns can be found:

A

Cellular - lymphoid infiltration of alveolar septa
Fibrosing – collagen deposition without fibroblastic foci

148
Q

3 types of pneumoconisoses

A

Coal Workers pneumoconiosis
Silicosis
Asbestosis

149
Q

on a radiologic scan, you see the upper lober with nodules and eggshell like calcification of hilar lymph nodes

A

Silicosis Pneumoconisoses

150
Q

asbestos fibrers are coated by:

A

IRON and protein within macrophages

151
Q

clot stuck in the pulm trunk at the bifurcation

A

saddle embolus

152
Q

Patient has a pulm. embolism; what heart sound is louder and what else do you hear on ausculation?

A

2nd Heart Sound (S2) = DUB
Wheezes and Crackles

normally LUB is louder

153
Q

You sent a patient for labs … now you diagnose them with a pulm embolism because you saw an increased value of …?

A

Plasma D Dimers

154
Q

Under a microscopic you see what type of lines in a thrombus?

A

Zahn Lines

155
Q

Cardiogenic pulm congestion can cause what type of heart disease?

A

Left Heart Disease
- blood backs up in pulm vasculature –> INC pulm hydrostatic pressues
- fluid moves out of capillaries into space of lungs –> edema

156
Q

surfactant deficiency causing alveolar collapse and impaired gas exchange

disease of premature infants

A

Hyaline Membrane Disease

157
Q

What type pneumocytes produce surfactant?

A

Type 2

158
Q

pathogenesis of ARDS

injury to the walls of alveoli by inflammatory cellls, who are hearlded to the area by :

A

IL8

159
Q

50 yo male presents with slowly progressing dyspnea, nonproductive cough. End expiratory crackles and digital clubbing ….

A

Idiopathic Pulm Fibrosis

poor prognosis – survival is 3 years

160
Q

multisystem disease characterized by noncaseating epitheloid granulomas

A

Sarcoidosis

161
Q

A patient diagnosed with sarcoidosis had lab work done, you see elevated what?

A

elevated serum ACE levels

162
Q

a pulmonary function test for a patient with sarcdoidosis, you expect to see…

A

Restrictive pattern

163
Q

Upon imaging, you see bilateral hilar adenopathy/reticular opacities in the upper lung zones

A

Sarcoidosis

164
Q

Patient presents with saddle nose deformity, you suspect ….

hemoptysis, hematuria (TRIAD)

A

Granulomatosis with Polyangiitis

165
Q

diagnosis of granulomatosis with polyangiitis via what seromarker

A

C-ANCA
cytoplasmic antineutrophil cytoplasmic Abs

166
Q

P-ANCA is a seromarker for what ?

A

eosinophilic granulomatosis with polyangiitis

alergic rhinitis, severe asthma, eosinophilla

167
Q

looking at a radiologic scan you see confluent nodules in upper lung fields with egg shell hilar nodes, you suspect …

A

Silicosis [Pneumoconiosis]

168
Q

bronchial relaxation is mediated by what ?

A

cAMP

169
Q

patient no longer responds to albuterol or salmeterol for his asthma, what can you give him to restore responsiveness?

Alb = SABA / Sal = LABA

A

Corticosteroids

170
Q

these drugs activate adrenergic receptors, are helpful in relieving mucosal edema, upper airway congestion and acute bronchospasms

A

Catecholamines:
Epinephrine = rescue drug
Isoproterenol – dangergous cardaic effects

171
Q

key function of these drugs is to reduce the inflammatory/immune components of asthma

A

Inhaled corticosteroids

172
Q

What’s an adverse effect of inhaled corticosteroid?

A

Oral Candidasis

173
Q

What is the longest acting LABA with a half life of 24 hours?

A

Vilanterol = LABA

vilians have long laughs

174
Q

MOA

competitive anatgonists at muscarinic cholingergic receptors which causes a DECREASE in cGMP and therefore less bronchoconstriction –> Bronchodilation

A

Anticholinergics

175
Q

SAMA

What is the only approved anti-cholinergic for acute bronchodilation

inhalation and nasal spray for acute asthma and COPD

A

Ipratropium (SAMA)

176
Q

LAMA + LABA combo

combo maintenance treatment for COPD
for bronchodilation and bronchoprotection

Given once daily

A

Tiotropium + Olodaterol

Ola Tio

177
Q

what can inhibit phophodiesterases PDE III (bronchodilation) and PDE IV (anti inflam)

A

Theophylline
- used for control of asthma

AE = tremors and diurersis

178
Q

What group of drugs prevents histamine release, by inhibiting IgE induced calicum influx on mast cells

A

Mast Cell inhibitors

Cromolyn = OTC nasal soln for allergic rhinitis and Nedocromil

179
Q

this leukotriene anatgonist inhibits the activity of cytochrome isoenzymes CYP3A4 and CYP2C9

A

Zafirlukast
given orally for persistent astma

180
Q

this leukotriene anatgonist has minimal CYP inhibition and can cause systemic eosinophilia and vasculitis

A

Montelukast
good for aspirin induced asthmas

181
Q

this biologic binds IgE Fc receptors preventing the binding of IgE to mast cells and triggering of allergic response

A

Omalizumab
both early and late allergic response phases are prevented

182
Q

this biologic has PDE4 inhibiton (anti-inflam) – given orally for COPD and astma

A

Roflumilast

183
Q

IV medication that inhibits smooth muscle contraction, DEC histamine release from mast cells and inhibits acetycholine release

for pts with severe airflow compromise are unresponseive to std. trtmt

A

Magnesium sulfate

very useful in acute mgmt of refractory asthma in a hospital setting

184
Q

Penny brought a case of cheese to the racquetball courts

A

Cheese Washers disease
Penicillum casei/roqueforti
Cheese Mold

185
Q

Lyco the giant puffball

A

Lycoperdonosis
Lycoperdon periatum
Sport dust from mature puffballs

186
Q

Canadian crypt / maple leaf

A

Maple bark strippers disease
Cryptostroma corticale
Moldy maple bark

187
Q

The ostriches stepped on the mushroom growers mushroms

A

Mushroom growers lungs
Pleurotus ostreatus

188
Q

What type hypersensitivity reaction is hypersensitivity pneumonitis?

A

Type 3 or 4
inflammation of the interstital space

189
Q

What makees pneumocystis jirovecii an atypical fungus?

A

cell wall contains cholesterol instead of ergosterol

190
Q

pathophysiology

Pneumocystic jirovecii multiplies in lung tissue forming what and is lined with what?

A

forms granuloma lined with hyaline membrane

CYST

191
Q

What is the treatment for pneomcystosis (PCP)

A

TMP-SMX (Co trimoxazole)

only fungus that responsed to antibiotics

192
Q

Mucormycosis is caused by what opportuntistic mold?

A

Rhizopus

193
Q

Cutaneous murcormycosis presents as cellulitis –> dermal necrosis –> ??

A

Black eschars

194
Q

What morphological presentation is seen with mucormycosis?

A

Broad angled hyphae

195
Q

Invasive pulmonary aspergillosis usually invades bloodstream and has a mortality >70%?
What histology presentation can confirm diagnosis?

A

45 degree branching hyphae

196
Q

Blastomycosis has a greater incidence in areas that border what?

A

great lakes

197
Q

Broad based budding is associated to which systemic fungal pathogen?

A

Blastomyces dermatidisis

198
Q

staining of sputum revealed many yeast inside of phagocytes … you suspect which systemic fungal pathogen?

A

Histpolasmosis

lives intracellularly – can disseminate – BM involvement

199
Q

Patient presents with erythema multiforma/nodosum, he was recently in SW USA during the late summer. On microscopy you see thin walled-spherule with endospores …. you suspect?

A

Coccidiomycosis

200
Q

Sphenoidal + posterior ethmoid sinus –>

A

Superior meatus

201
Q

Maxillary, Frontal and Anterior ethmoid sinus –>

A

Middle meatus

202
Q

Nasolacrimal duct –>

A

Inferior meatus

203
Q

the osteomeateal complex is found between the maxillary sinus

A

anterior ethmoid air cells and the frontal sinus

204
Q

when you hear echinococcosis think of

A

hydatid cyst

205
Q

dog tapeworm/cestode =

A

echinoccus granulosus

206
Q

pulmonary echinococcosis [hydatid cysts] forms primarliy in what organ?

A

LIVER

20-30% in lungs

207
Q

What happens if the hydatid cyst ruptures in the lung?

Right lower lobe

A

hypersensitivity reaction – anaphylaxis

Tx: PAIR

208
Q

lung fluke/trematodes =

A

paragonimius westermanii

undercooked crustaceans

209
Q

Pt recently had undercooked crab, now presents with cough, chest pain, dyspnea/hemopytsis. CXR shows cavitated nodules.
Microscopy shows paragonimus eggs in sputum/feces
How do you treat?

A

Praziquantel

Pulm Paragonimiasis

210
Q

blood fluke trematode =

A

schistosoma mansoni

211
Q

Pulmonary Schistosomiasis

skin penetration by cercaria –> migrates to lungs then liver via what?

A

Portal blood

212
Q

Katayama fever is associated to?

A

pulm schistosomiasis

213
Q

on a CXR we see pulm nodules with ground-glass halos and ill defined borders .. you suspect

A

Pulm Schistosomias

s TX: praziquantel

214
Q

Child presents with a seal-like barking cough .. you suspect?

Autunum

A

Laryngotracheobronchietis (CROUP)

215
Q

on a CXR you see a STEEPLE sign …

A

Laryngotracheobroncheietis CROUP

RESP (3 decks)

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