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ABIM Pulmonary > Pass Machine Questions > Flashcards

Pass Machine Questions Flashcards

1
Q

What are Clara Cells / Club Cells

A

Also known as Bronchiolar Exocrine Cells, these cuboidal cells have microvilli, forming the ciliated simple epithelium of the airways.

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2
Q

What do the following yeast forms look like under the microscope?

  • Mucormycosis
  • Aspergillosis
  • Candida
  • Histoplasmosis
  • Blastomycosis
A
  • Mucor = nonseptated hyphae
  • Aspergillosis = septated hyphae with acute angle branching
  • Canddia = pseudohyphae
  • Histoplasmosis = narrow-based, budding yeast
  • Blastomycosis = broad-based, multinucleated
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3
Q

Disease associated with Anti-topoisomerase antibodies

A

Anti-topoisomerase antibodies = Anti-Scl-70

Scleroderma

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4
Q

Disease associated with Ro or La antibodies

A

Ro = SSA. La = SSB.

Sjogren’s syndrome

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5
Q

Disease associated with anti-mitochondrial antibodies

A

PBC (Primary Biliary Cholangitis)

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6
Q

Disease associated with anti-histamine antibodies

A

Drug-induced Lupus

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7
Q

Disease associated with cANCA

A

Wegner’s granulomatosis, AKA EGPA (Eosinophilic Granulomatosis with Polyangiitis)

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8
Q

Definition of large PTX

A

> 15%

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9
Q

Diseases associated with pANCA

A 
Microscopic Polyangiitis
Ulcerative Colitis (negative anti-Saccharomyces cerevisiae antibody)
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10
Q

Disease associated with anti-Saccharomyces cerevisiae antibody

A

Crohn’s Disease

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11
Q

Churg-Strauss (EGPA) can be caused by what asthma medication?

A

Monteleukast

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12
Q

Histology of bronchogenic cyst

A

One layer muscle tissue and adipose tissue

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13
Q

Histology of cystic teratoma

A

Tissue from each of the three germ cell lines

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14
Q

Histology of esophageal cyst

A

Two layers of muscle tissue

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15
Q 
Stage Mesothelioma:
I:
II:
III:
IV:
A
  • I: Mass confined within the capsule of the parietal pleura that is totally resected. There is no lymphadenopathy.
  • II: Stage I, but the margins are not clear after resection. Intrapleural lymphadenopathy could be present.
  • III: A mass invading locally into the mediastinum, pericardium, chest wall or peritoneum. Lymphadenopathy is common.
  • IV: Presence of distant metastatic disease.
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16
Q

Classic tetrad of narcolepsy symptoms

A

Excessive daytime sleepiness
Hypnagogic hallucinations
Cataplexy
Sleep paralysis

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17
Q

Sleep study findings of narcolepsy

A

Mean sleep latency <8 minutes

2 or more sleep-onset REM

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18
Q

PTLD (Post-Transplant Lymphoproliferative Disroder) is associated with which virus?

A

EBV

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19
Q

Define Calplan Syndrome

A

Coal Worker’s Pneumoconiosis + RA

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20
Q

Define Flety Syndrome

A

RA + Neutropenia + Splenomegaly

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21
Q

Treatment for PJP pneumonia?

Second line?

A

First line - bactrim

Second line - clindamycin + primaquine

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22
Q

Microbiology of Nocardia?

A

Gram positive rods, appearing as branching chains appearing as fungal hyphae on AFB smear

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23
Q

What is the equation for airway resistance?

A

(PIP-Plat)/Flow

  • PIP = Peak Inspiratory Pressure in cmH2O
  • Plat = Plateau pressure in cmH2O
  • Flow = inspiratory flow rate in L/s (not L/min)
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24
Q

What is a Rassmussen Aneurysm?

A

Aneurysm of pulmonary artery due to TB involvement of adventitia & media of artery.

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25
Q

What is the presentation of Rhodoccus equi pneumonia?

A
  • Subacute pneumonia with horse exposure, cavitating lung nodules, lung abscesses.
  • Crocidiles and birds also carry it.
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26
Q

How is Rhodoccus equi pneumonia diagnosed?

A
  • Salmon-pink colonies on solid media

- PCR

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27
Q

How is Rhodoccus equi pneumonia treated?

A

2 months of combo ABx. Options:

  • Rifampin-erythromycin
  • Erythromycin-minocycline
  • Rifampin-minocycline
  • Imipenem-amikacin
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28
Q

What is the serum biomarker for malignant mesothelioma?

A

Megakarocyte potentiating factor (MPF)

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29
Q

What is the serum biomarker for pancreatitic cancer?

A

CA 19-9

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30
Q

What is the serum biomarker for melanoma?

A

S-100

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31
Q

What is the serum biomarker for liver cancer?

A

Alpha-feto-protein

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32
Q

What is the pathogenesis of Ovarian Hyper-Stimulation Syndrome (OHSS)? Symptoms?

A

VEGF causes fluid to leak extravascularly, causing ascites, pleural effusion, other fluid leaking. It causes after starting IVF (In Vitro Fertilization)

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33
Q

What is the triad of Meig’s Syndrome?

A

-Benign ovarian tumor
-Ascites
-Pleural Effusion
Develops gradually, resolves with tumor resection.

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34
Q

Bronchial wall biopsy in asthma shows what?

A

Esoinophilia, thickened basement membranes and mucous plugs

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35
Q

Bronchial wall biopsy in chronic bronchitis shows what?

A

Goblet cell hyperplasia and hyperactivity (Mucous)

36
Q

Biopsy of small cell carcinoma shows what?

A

Keratin pearls, intercellular bridging.

37
Q

What is the equation for pulmonary vascular resistance, in Woods Units?

A

PVR = (mPAP - PCWP) / CO

38
Q

What exposure increases risk for Hantavirus?

A

Rodent feces aersolization

39
Q

What are the pathophysiology & symptoms of hantavirus infection?

A
  • Hantavirus CardioPulmonary Sundrome (HCPS)
  • Hemorrhagic Fever with Renal Syndrome (HFRS)
  • Non-cardiogenic pulmonary edema

Increased capillary leakage and vascular permeability.

40
Q

What are the classic lab findings in hantavirus?

A
  • Leukocytosis with left shift
  • Thrombocytopenia
  • Immunoblasts >10% of total lymphoid series
41
Q

What is the diagnosis of a sleep disorder with progressively late bedtime & wake time?

A

Dx is Free Running Sleep Disorder.
-Opposed to advanced or delayed phase sleep disorder, where sleep occurs earlier or later (respectively) but stays at a fixed time.

42
Q

What is the pathophysiology of restless leg syndrome?

A

Dopamine transporter and D2/D3-mediated dopaminergic dysfunction

43
Q

What are 3 possible underlying causes of secondary restless leg syndrome?

A
  • Iron-deficiency
  • Pregnancy
  • CKD
44
Q

What are the definitions of type I and type II hypoxemic respiratory failure?

A
  • Both have PaO2 < 60, or SaO2 < 91% on room air.
  • I: PaCO2 low or normal.
  • II: PaCO2 high.
45
Q

What is the pathophysiology of narcolepsy with cataplexy?

A

Loss of neurons in the lateral hypothalamus that create Orexin-1 and Orexin -2.

46
Q

Criteria for apnea on PSG?

A

Loss of 90% of airflow for 10 seconds

47
Q

Criteria for hyponea on PSG?

A

Loss of 30% of airflow for 10 seconds.

48
Q

What are the AHI criteria for mild/moderate/severe OSAS?

A
  • AHI < 5 is normal
  • AHI 5-15 is mild
  • AHI 15-30 is moderate
  • AHI >30 is severe
49
Q

What genetic allele is a predisposing factor for narcolepsy with cataplexy? What about environmental exposures?

A
  • HLA-DQ B1

- H1N1 infection/vaccine, streptococcus pyogenes

50
Q

What is the “Cold Freon Effect”, and what device is it seen with?

A

Cold Freon Effect is seen in some MDIs, where cold freon causes a cold sensation in the posterior oropharynx and paradoxical worsening of bronchospasm. It can be helped by use of a spacer device.

51
Q

What are four pleural fluid biomarkers of malignant mesothelioma?

A

Calretinin
Wilms Tumor 1 (WT1)
Epithelial Membrane Antigen (EMA)
Cytokeratin 5/6

52
Q

What are three biomarkers of adenocarcinoma of the lung?

A

Thyroid Transcription Factor 1 (TTF1)
Napsin A
Carcinoembryonic Antigen (CEA)

53
Q

What is a biomarker of squamous cell carcinoma of the lung?

A

Tumor Protein 63 (P63)

54
Q

What is the treatment for methhemoglobinemia?

A

Methylene blue

55
Q

What is the treatment for cyanide poisoining?

A

Hydroxocobalamin

56
Q

What gene is implicated in aspirin-induced asthma?

A

ALOX5AP

57
Q

What are some medications that can cause REM-sleep-behavior-disorder?

A 
Beta blockers
TCAs
SSRIs
SNRIs
MAOIs
Mirtazapine
Caffeine
58
Q

What is the treatment for REM-sleep-behavior-disorder?

A

Clonazepam or Melatonin

59
Q

What BMI and collar size increase risk for OSAS?

A

BMI of 30

Collar of 17 in men and 16 in women.

60
Q

Requirements for home O2

A
  • PaO2 55mmHg or less, SaO2 88% at rest

- Increases to 59mmHg and 89% if presence of cor pulmonale, HF, dependent edema, P-pulmonale on EKG, Hct > 56%

61
Q

Define Caplan syndrome

A

RA + pulmonary nodules.

  • Hx of exposure to asbestos / coal / silica.
  • Tx: DMARDs, steroids. Stop dust exposure. Exclude TB.
62
Q

Buzzword: viral pneumonia in a immunocompromised patient, or with hematogenous malignancy. What virus?

A

Cytelomegalovirus

63
Q

Treatment of CMV pneumonia in immunocompromised patient?

A

Ganciclovir

64
Q

What is the definition of response to iNO on RHC for PAH therapy?

A

All of the following:

  • Decrease in mPAP by at least 10
  • Decrease in mPAP to 40 or less
  • Unchanged or increased CO
65
Q

Sweat chloride level consistient with CF?

A

> 60

Normal 10-35

66
Q

Triad of symptoms in Young’s syndrome?

A

Bronchiectasis, male infertility, sinusitis.

-Ddx Primary Ciliary Dyskinesia, CF, ABPA.

67
Q

Duration of symptoms required for primary insomnia?

A

1 month

68
Q

What gene mutation causes Congenital Central Hypoventilation Syndrome?

A

PHOX2B

69
Q

What is seen in BAL washings of sarcoidosis patients?

A

Elevated CD4/CD8 ratio

70
Q

What is the difference between Zileuton (Zyflo) and Monteleukast (Singulair)?

A

Zileuton inhibits 5-lipooxygenase production, a precursor of leukotriene, and therefore blocks leukotriene production. Monteleukast is a leukotriene receptor blocker.
-Zileuton is superior to Monteleukast for asthma in terms of peak flow improvement.

71
Q

Differential diagnosis of a highly lymphocytic exudate?

A

Connective tissue diseases, TB, sarcoid, chylothorax, lymphoma.

72
Q

What is the cytokine pathophysiology of ARDS?

A

Release of pro-inflammatory cytokines, such as IL-1β, IL-6, and IL-18 by M1 phenotype macrophages

73
Q

What is the pathophysiology of Factor V Leiden deficiency?

A

Point mutation on Factor V (procoagulant) makes it immune to degradation by activated Protein C (anticoagulant). Chromosome 1q.

74
Q

What is Sweyer-James syndrome?

A

Hyperlucency of one lung, due to congenital pulmonary agenesis, or early viral infection. NTD.

75
Q

Goal Hct/Hgb for transfusion for Sickle Cell Disease with Acute Chest Syndrome?

A

Hct 30%

Hgb 11mg/dL.

76
Q

How long after lung transplant does the opportunistic infection risk change from bacterial & fungal to viral?

A

Day 100

77
Q

Other than Heart Failure, what are 7 risk factors for Cheyene-Stokes respiration?

A
  • Stroke
  • Renal failure
  • Enceohalopathy
  • Male
  • Age over 65yo
  • A Fib
  • Hypocapnea
78
Q

Treatment of cataplexy component of narcolepsy?

A

TCAs or SSRIs.

79
Q

Treatment of EDS component of narcolepsy?

A

Wake promoting agent, such as modafinil.

80
Q

Side effects of theophylline?

A
  • palpitations / arrhythmias
  • seizure
  • urinary retention
81
Q

Indications for using steroids in PJP pneumonia?

A

PaO2 less than 70

Aa gradient over 35

82
Q

Kartagener’s Triad? What disease?

A

Primary ciliary dyskinesia.

  • Sinus inversus
  • Bronchiectasis
  • Chronic Sinusitis
83
Q

Heffner Criteria for exudates?

A

One of:

  • Protein > 2.9
  • Chol > 45
  • Pleural LDH > 45% of serum ULN.
84
Q

Treatment for PTLD due to EBV?

A

PTLD = Post-Translpant Lymphoproliferative Disorder. Tx is Rituximab.

85
Q

Treatment options for post-transplant CMV infection?

A

Mild: PO valgancyclovir.
Tissue-invasive: IV Gancyclovir.
2nd line: Focarnet.

86
Q

Symptoms of Kline-Levine Syndrome?

A

AKA “Sleeping Beauty”
-Periods of hypersomnia lasting for weeks-months, where patient sleeps for 14-18 hours daily, waking only for food or bathroom, and is very irratible. Leads to obesity.

ABIM Pulmonary (37 decks)

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