Monday Wk 2 Pulm 3

Question 1

fever, hemodynamic instability, tachypnea, evidence of infection has ___
_ and pulm infections are main RF
cytokines like __, __, __, __ released, activating the pulm epithelium
inc recruitment/extravasation of __ to lungs, leading to damage

protein/fluid leaks into __, worsening condition

Answer 1

ARDS
sepsis
TNF, IL1/6/8
PMN

alveoli

Question 2

CFTR is normally present on the __ of exocrine ductal epithelial cells

L/I are CFTR modulating meds that can restore CFTR to membrane and enhance protein function

parietal pleura is found __ ribs below the visceral pleura and therefore lung

thoracentesis should be performed bw 6- __ ribs on MC line, 8-__ ribs on midaxillary line, and 10-__ rib on paravertebral line

if lower/higher, risk for __ goes up

intercostal VAN lie on the __ portion of the rib

Answer 2

apical membrane

Lumacaftor, ivacaftor

2

8, 10, 12

injury

underneath

Question 3

mothers should be evaluated at __-__ wks gestation for infections
if positive, tx GBS/meningitis/PNA w __/__ intrapartum

__ granulomas distinguish sarcoid from Tb/Mycobacterium avium

___would present w constitutional sx and palpble LN w nodular growth pattern and fibrous bands/RS cells

Answer 3

35-37
Ampicillin, PenG

noncaseating

HL

Question 4

small, oxidase pos gram neg coccobacillus is __
strains that dont produce a capsule are called ___
Hib vaccine directed against type _
capsular vaccine conjugated to _ protein for a better response

pt w recurrent sinopulm/GI infections, and autoimmune dz has ___
can have severe __ during blood transfusion due to __ directed against IgA

Answer 4

Haemophilus influenza
nontypeable
B
tetanus

IgA def
analphyactic rxn
IgE

Question 5

Pt w COPD and supplemental O2 can lead to O2 induced __ resulting in confusion and dec conciousness

major cause is __ mismatch
hypoxia causes __ in pulm arterioles, shunting blood towards well ventilated arterioles minimizing dead space

w high amounts of O2, lung regions are __ and vasodilate

blood goes from well to poorly ventilated alveoli and inc __

Hyperoxia can cause prodxn of __ species
injures airways/lung __
pt presents w __ heaviness, __ pain, and cough w in 24hrs

Answer 5

hypercapnia

VQ
vasoconstriction

reversed

physio dead space

ROS

parenchyma
substernal, pleuritic

Question 6

fibrotic focus in lower lobe and calcified ipsi LN indicates __ Tb
known as the __ complex

secondary Tb present w __ cavitary lesion

excessive daytime sleepiness, morning HA, cog impairment, depression all indicate __ as dx
upper airway blocked via relaxation of __ muscle tone
PO2 dec, PCO2 inc until __ trigger arousal

look for additional finding of __

Answer 6

primary
Ghon

apical

OSA
pharyngeal
brain

HTN

Question 7

__ is sleep apnea due to dec resp drive from a neuro do
usually have sig illness like __ and __ dz

Pt w COPD has hypoxia sensed by __ cells, leading to inc EPO prodxn

in severe PHTN, lesions can form interlacing small vasc channels called _ lesions

C__ inhibits ADP induced platelet agg in atherosclerotic iscemic dz to prevent stent thrombosis

Answer 7

CSA
CHF, CV

renal cortical

plexiform

clopidigrel

Question 8

airflow restriction in COPD results in compensatory lung __ to improve airflow
this reduces __, limiting max TV
esp during __ when expiration time is dec
process is known as __ hyperinflation and main cause of SOB

__ is common cause of pnuemonitis in lung transplant pt
enveloped __ virus part of __ family
biopsy shows large cells w __/__ inclusions surrounded by a halo

Answer 8

hyperinflation
IRV
exercise
dynamic

CMV
dsDNA, herpeviridae
intranuclear/intracytoplasmic

Question 9

I__ virus is enveloped, ssRNA
R__ is a naked, ssRNA virus
A__ is naked dsDNA virus causing resp illness

__ is pos for modified AFB, while __ is not

__ and __ and __ cells are responsible for path of COPD
release enzymes/proteases to cause __ damage, red __ motion, and inc __ secretion

Answer 9

influenza
rhinovuirus
adenovirus

Nocardia, Actinomyces

PMN, macros, CD8
alveolar, ciliary, mucus

Question 10

blood in PA is __ in O2 content than blood in the LA
due to mixing of __

comes from __ arteries, which empty in the pulm veins

and small cardiac __ veins

Answer 10

very high, deoxygenated

bronchial

thebesian

Question 11

CFTR channel opens after binding 2 __ molecules, allowing Cl to move down gradient
this potential draws __/__ across as well

mutations lead to intracellular protein degredation and prodxn of __

__ is OLD w inc DLCO due to high pulm cap blood volumes

sarcoid/pneumoconosis may produce a mixture of __/__ spiro

extrinsic restrictive dz ie / has normal DLCO

Answer 11

ATP
Na, water

thick mucus

Asthma

restrictive/obstructive

obesity, NM

Question 12

chronic SOB, obstructive findings, fibrotic destruction of small airways posttransplant indicates __ rejection
__ limitation as small brochioles are affected, producing BO__

__ inflam and destrxn of epithelium
fibropurulent exudete/granulation tissue is present in ___
leads to fibrosis, scarring, and __ of small airways

B__/D__ are CS administered to premature infants to prevent NRDS
accelerates maturation of __

Answer 12

chronic
airflow, bronchiollitis obliterans

lymphocytic
bronchioli
obliteration

Betamethasone/dexamethasone
T2 pneumocytes

Question 13

upon initial exposure, allergic response produces __ to the allergen
w exposure, allergen induces IgE to cross link to __/__ causing release of mediators
__ HS rxn

complement mediated cytotoxicity is seen w __/__ HS Rxn
__ is antibody best at activating the classical complement pathway

Answer 13

IgE
basophils/mast cells
type 1

type 2/3
IgM

Question 14

primary spontaneous PTX presents w sudden onset __/__
large change in __/__ pressure causes break in visceral pleura

superficial alveoli in the __ experience greatest pressure change, leading to formation of sublpleural blebs

spontaneous __ usually occurs in tall thin __ male

Answer 14

SOB, chest pain
alveolar/IP

apex
rupture, smoking

Question 15

large particles in trachea/bronchi/bronchioles are __ in mucus and swept to pharynx

medium sized particles are carried away via __ elevator

small particles reach resp bronchioles/alveoli and are cleared via __ via macros

engulfment activates macros, leading to the release of __ to induce inflammation
w inhalation of dust like coal, __ are stimulated to produce collagen

results in progressive __ like CWP

Answer 15

trapped

mucociliary

phagocytosis

cytokines
fibroblasts

ILD

Question 16

CGD caused by lack of NADPH oxidase, impairing killing of __ by PMN/macros
cannot transfer electron from NADPH to oxygen to form __
lack of granule __ cannot destroy pathogens

most bacteria are __ neg, this producing H2O2 allowing phagocytes to fxn

thus, CGD is susceptible to catalase pos orgs S, B, S, N, A

Answer 16

intracellular orgs
superoxide
proteases

catalase

Staph aureus, B cepacia, serratia, Nocardia, Actinomyces

Question 17

inhaled __are controlling meds used for pt w asthma not controlled w B agonist
use __ and __ to prevent cadida/irritation

Haemophilus influenza req factors X h__ and __ NAD to grow
thus, use __ blood agar
main virulence factor is antiphagocytic polysaccharide __

this allows spread, resulting in septic __/___

Answer 17

GC
spacer, mouth rinse

hematin, V
chocolate
capsule

arthritis/meningitis

Question 18

Candida is only a __ form
present in __, __ and __ flora
typically infects __ indiv
does not cause lung disease, so presence in sputum indicates that the __ is colonized

Trachea/large-small bronchi are usually ___

Answer 18

yeast
mouth, vaginal, skin
IC
oral cavity

sterile

Question 19

thickened bronchial walls, neutro/lymph infiltrates, mucus gland enlargement w inc goblet cells and squamous METAPLASIA indicates ___

similar process except w submucosal gland enlargement and eosinphils/mast cells makes __ more likely

nickel exposure can lead to __ pneumoconiosis

Answer 19

COPD

allergic asthma

silica

Question 20

acute onset neuro abnorms, hypoxemia and petechial rash in pt w severe long bone/pelvic fracture indicates __ syndrome
esp w __ fractures

trauma dislodges __ in BM, allowing them to occlude pulm microvessels
impairs __ w hypoxia

fat globules that escape lungs via precapillary AV shunt can lead to confusion and __ impairment

extravasation in dermal capillaries can lead to __

platelets may be consumed in the __

Answer 20

fat embolism
bilateral

fat globules
gas exchange

neurologic

microglobules

Question 21

septic shock results in high AGAP MA due to end organ __ leading to dec ox phos

NADH accumulates, and pyruvate is shunted to __

LA causes
enhanced met rate via S/E
reduced O2 delivery via C/P failure or I___
dec latate breakdown via __ failure

dec O2 utilization via __ poison

enzyme defects like M_ myopathy or __ storage do

Answer 21

hypoperfusion

lactate

seizure, exercise
cardio/pulm, ischemia
hepatic

cyanide

mitochondrial, glycogen

Question 22

High AGAP MA > 14

M
U
D
P
I
L
E
S

Answer 22

methanol
uremia
DKA
Propylene glycol/paraldehyde
isoniazid/Iron
LA
ethylene glycol
salicylates

Question 23

PaO2 normal, SaO2 dec, dec O2 content dx is __ poison

PaO2, SaO2, O2 content normal has __ poison

Normal PaO2/SaO2 but dec O2 content has ___

total O2 content in blood is dependent on __ conc, SaO2 and PaO2

Answer 23

CO

cyanide

HB

Question 24

__ inc from apex to base bc gravity stretches lung downward from the apex
alveoli at the apex are more __ and less compliant

zone 1 blood does not occur in _ indiv
alveolar pressure > __ > Venous
pulm capillaries are __ and there is no blood flow
can form w low pulm __ pressure or high __ pressure

zone 2 found in __ of lung
arterial > __ > Venous
pulm capillaries obstructed at __ end of capillary bed
as arterial pressure rises, capillary pressure __ and overcomes alveolar pressure
blood flow is __

Zone 3 is __ lung
arterial > __ > alveolar
blood flows __
when person lies supine, blood flow is entirely __

Answer 24

ventilation
distended

normal
arterial
collapsed
artery, alveolar

alveolar
upper region
venous, inc
pulsatile

lower
venous
continuously

Question 25

__ greatly inc from apex to base
__ inc slightly from apex to base
thus, VQ ratio __ from apex to base

intermittent resp sx in pt w normal CXR, sputum w eosinophils, reduced FEV1 suggetsts __ as dx

allergens include E, __ air, __ infection, exposure to allergen like D__, C_, pet dander, mold/__

ABPA presents w fever, malaise and expectoration of __ plgus

Answer 25

Perfusion
ventilation
dec

asthma

exercise, cold, respiratory, dust mite, cockroach, pollen

brown

Question 26

Langerhans giant cells in caseating granuloma have multiple __ organized periphrally in shape of __

__ is assc w fever, wl, intraluminal plugs of granulation tissue/inflam debris in distal airways

IPF aka \_\_
patchy involvement w dense \_\_
\_\_ cystic changes and fibroblastic foci
present in \_\_/\_\_ regions
lined by hyperplastic \_\_

Answer 26

nuclei, horshoe

COP

UIP
fibrosis
honeycomb
paraseptal/subplerual
Type 2 pneumos

Question 27

severe asthma w obstructive fts w necrotizing vasculitis and granulomatous inflamm w eosinophilic infiltration of vessels/tissues is __dx

__ presents w gradual SOB, productive cough
bilateral patchy pulm opacification w accumulation of amorphous __ and __ material

Answer 27

Eosinophilic Granulomatosis w Polyangiitis

Pulm aveolar proteinosis
protein, phospholipid