Pass Machine Questions Flashcards
What are Clara Cells / Club Cells
Also known as Bronchiolar Exocrine Cells, these cuboidal cells have microvilli, forming the ciliated simple epithelium of the airways.
What do the following yeast forms look like under the microscope?
- Mucormycosis
- Aspergillosis
- Candida
- Histoplasmosis
- Blastomycosis
- Mucor = nonseptated hyphae
- Aspergillosis = septated hyphae with acute angle branching
- Canddia = pseudohyphae
- Histoplasmosis = narrow-based, budding yeast
- Blastomycosis = broad-based, multinucleated
Disease associated with Anti-topoisomerase antibodies
Anti-topoisomerase antibodies = Anti-Scl-70
Scleroderma
Disease associated with Ro or La antibodies
Ro = SSA. La = SSB.
Sjogren’s syndrome
Disease associated with anti-mitochondrial antibodies
PBC (Primary Biliary Cholangitis)
Disease associated with anti-histamine antibodies
Drug-induced Lupus
Disease associated with cANCA
Wegner’s granulomatosis, AKA EGPA (Eosinophilic Granulomatosis with Polyangiitis)
Definition of large PTX
> 15%
Diseases associated with pANCA
Microscopic Polyangiitis Ulcerative Colitis (negative anti-Saccharomyces cerevisiae antibody)
Disease associated with anti-Saccharomyces cerevisiae antibody
Crohn’s Disease
Churg-Strauss (EGPA) can be caused by what asthma medication?
Monteleukast
Histology of bronchogenic cyst
One layer muscle tissue and adipose tissue
Histology of cystic teratoma
Tissue from each of the three germ cell lines
Histology of esophageal cyst
Two layers of muscle tissue
Stage Mesothelioma: I: II: III: IV:
- 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.
Classic tetrad of narcolepsy symptoms
Excessive daytime sleepiness
Hypnagogic hallucinations
Cataplexy
Sleep paralysis
Sleep study findings of narcolepsy
Mean sleep latency <8 minutes
2 or more sleep-onset REM
PTLD (Post-Transplant Lymphoproliferative Disroder) is associated with which virus?
EBV
Define Calplan Syndrome
Coal Worker’s Pneumoconiosis + RA
Define Flety Syndrome
RA + Neutropenia + Splenomegaly
Treatment for PJP pneumonia?
Second line?
First line - bactrim
Second line - clindamycin + primaquine
Microbiology of Nocardia?
Gram positive rods, appearing as branching chains appearing as fungal hyphae on AFB smear
What is the equation for airway resistance?
(PIP-Plat)/Flow
- PIP = Peak Inspiratory Pressure in cmH2O
- Plat = Plateau pressure in cmH2O
- Flow = inspiratory flow rate in L/s (not L/min)
What is a Rassmussen Aneurysm?
Aneurysm of pulmonary artery due to TB involvement of adventitia & media of artery.
What is the presentation of Rhodoccus equi pneumonia?
- Subacute pneumonia with horse exposure, cavitating lung nodules, lung abscesses.
- Crocidiles and birds also carry it.
How is Rhodoccus equi pneumonia diagnosed?
- Salmon-pink colonies on solid media
- PCR
How is Rhodoccus equi pneumonia treated?
2 months of combo ABx. Options:
- Rifampin-erythromycin
- Erythromycin-minocycline
- Rifampin-minocycline
- Imipenem-amikacin
What is the serum biomarker for malignant mesothelioma?
Megakarocyte potentiating factor (MPF)
What is the serum biomarker for pancreatitic cancer?
CA 19-9
What is the serum biomarker for melanoma?
S-100
What is the serum biomarker for liver cancer?
Alpha-feto-protein
What is the pathogenesis of Ovarian Hyper-Stimulation Syndrome (OHSS)? Symptoms?
VEGF causes fluid to leak extravascularly, causing ascites, pleural effusion, other fluid leaking. It causes after starting IVF (In Vitro Fertilization)
What is the triad of Meig’s Syndrome?
-Benign ovarian tumor
-Ascites
-Pleural Effusion
Develops gradually, resolves with tumor resection.
Bronchial wall biopsy in asthma shows what?
Esoinophilia, thickened basement membranes and mucous plugs
Bronchial wall biopsy in chronic bronchitis shows what?
Goblet cell hyperplasia and hyperactivity (Mucous)
Biopsy of small cell carcinoma shows what?
Keratin pearls, intercellular bridging.
What is the equation for pulmonary vascular resistance, in Woods Units?
PVR = (mPAP - PCWP) / CO
What exposure increases risk for Hantavirus?
Rodent feces aersolization
What are the pathophysiology & symptoms of hantavirus infection?
- Hantavirus CardioPulmonary Sundrome (HCPS)
- Hemorrhagic Fever with Renal Syndrome (HFRS)
- Non-cardiogenic pulmonary edema
Increased capillary leakage and vascular permeability.
What are the classic lab findings in hantavirus?
- Leukocytosis with left shift
- Thrombocytopenia
- Immunoblasts >10% of total lymphoid series
What is the diagnosis of a sleep disorder with progressively late bedtime & wake time?
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.
What is the pathophysiology of restless leg syndrome?
Dopamine transporter and D2/D3-mediated dopaminergic dysfunction
What are 3 possible underlying causes of secondary restless leg syndrome?
- Iron-deficiency
- Pregnancy
- CKD
What are the definitions of type I and type II hypoxemic respiratory failure?
- Both have PaO2 < 60, or SaO2 < 91% on room air.
- I: PaCO2 low or normal.
- II: PaCO2 high.
What is the pathophysiology of narcolepsy with cataplexy?
Loss of neurons in the lateral hypothalamus that create Orexin-1 and Orexin -2.
Criteria for apnea on PSG?
Loss of 90% of airflow for 10 seconds
Criteria for hyponea on PSG?
Loss of 30% of airflow for 10 seconds.
What are the AHI criteria for mild/moderate/severe OSAS?
- AHI < 5 is normal
- AHI 5-15 is mild
- AHI 15-30 is moderate
- AHI >30 is severe
What genetic allele is a predisposing factor for narcolepsy with cataplexy? What about environmental exposures?
- HLA-DQ B1
- H1N1 infection/vaccine, streptococcus pyogenes
What is the “Cold Freon Effect”, and what device is it seen with?
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.
What are four pleural fluid biomarkers of malignant mesothelioma?
Calretinin
Wilms Tumor 1 (WT1)
Epithelial Membrane Antigen (EMA)
Cytokeratin 5/6
What are three biomarkers of adenocarcinoma of the lung?
Thyroid Transcription Factor 1 (TTF1)
Napsin A
Carcinoembryonic Antigen (CEA)
What is a biomarker of squamous cell carcinoma of the lung?
Tumor Protein 63 (P63)
What is the treatment for methhemoglobinemia?
Methylene blue
What is the treatment for cyanide poisoining?
Hydroxocobalamin
What gene is implicated in aspirin-induced asthma?
ALOX5AP
What are some medications that can cause REM-sleep-behavior-disorder?
Beta blockers TCAs SSRIs SNRIs MAOIs Mirtazapine Caffeine
What is the treatment for REM-sleep-behavior-disorder?
Clonazepam or Melatonin
What BMI and collar size increase risk for OSAS?
BMI of 30
Collar of 17 in men and 16 in women.
Requirements for home O2
- 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%
Define Caplan syndrome
RA + pulmonary nodules.
- Hx of exposure to asbestos / coal / silica.
- Tx: DMARDs, steroids. Stop dust exposure. Exclude TB.
Buzzword: viral pneumonia in a immunocompromised patient, or with hematogenous malignancy. What virus?
Cytelomegalovirus
Treatment of CMV pneumonia in immunocompromised patient?
Ganciclovir
What is the definition of response to iNO on RHC for PAH therapy?
All of the following:
- Decrease in mPAP by at least 10
- Decrease in mPAP to 40 or less
- Unchanged or increased CO
Sweat chloride level consistient with CF?
> 60
Normal 10-35
Triad of symptoms in Young’s syndrome?
Bronchiectasis, male infertility, sinusitis.
-Ddx Primary Ciliary Dyskinesia, CF, ABPA.
Duration of symptoms required for primary insomnia?
1 month
What gene mutation causes Congenital Central Hypoventilation Syndrome?
PHOX2B
What is seen in BAL washings of sarcoidosis patients?
Elevated CD4/CD8 ratio
What is the difference between Zileuton (Zyflo) and Monteleukast (Singulair)?
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.
Differential diagnosis of a highly lymphocytic exudate?
Connective tissue diseases, TB, sarcoid, chylothorax, lymphoma.
What is the cytokine pathophysiology of ARDS?
Release of pro-inflammatory cytokines, such as IL-1β, IL-6, and IL-18 by M1 phenotype macrophages
What is the pathophysiology of Factor V Leiden deficiency?
Point mutation on Factor V (procoagulant) makes it immune to degradation by activated Protein C (anticoagulant). Chromosome 1q.
What is Sweyer-James syndrome?
Hyperlucency of one lung, due to congenital pulmonary agenesis, or early viral infection. NTD.
Goal Hct/Hgb for transfusion for Sickle Cell Disease with Acute Chest Syndrome?
Hct 30%
Hgb 11mg/dL.
How long after lung transplant does the opportunistic infection risk change from bacterial & fungal to viral?
Day 100
Other than Heart Failure, what are 7 risk factors for Cheyene-Stokes respiration?
- Stroke
- Renal failure
- Enceohalopathy
- Male
- Age over 65yo
- A Fib
- Hypocapnea
Treatment of cataplexy component of narcolepsy?
TCAs or SSRIs.
Treatment of EDS component of narcolepsy?
Wake promoting agent, such as modafinil.
Side effects of theophylline?
- palpitations / arrhythmias
- seizure
- urinary retention
Indications for using steroids in PJP pneumonia?
PaO2 less than 70
Aa gradient over 35
Kartagener’s Triad? What disease?
Primary ciliary dyskinesia.
- Sinus inversus
- Bronchiectasis
- Chronic Sinusitis
Heffner Criteria for exudates?
One of:
- Protein > 2.9
- Chol > 45
- Pleural LDH > 45% of serum ULN.
Treatment for PTLD due to EBV?
PTLD = Post-Translpant Lymphoproliferative Disorder. Tx is Rituximab.
Treatment options for post-transplant CMV infection?
Mild: PO valgancyclovir.
Tissue-invasive: IV Gancyclovir.
2nd line: Focarnet.
Symptoms of Kline-Levine Syndrome?
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.
