pulm

Question 1

MC location and pathogen of rhinosinusitis?

Answer 1

maxillary sinus in adults

viral URI MCC (can get superimposed bacterial infection (S pneumo, H flu, M cat))

Question 2

MC location of epistaxis?

Answer 2

anterior segment of nostril = Kiesselbach plexus

Question 3

location of life-threatening epistaxis?

Answer 3

posterior segment - sphenopalatine artery (branch of maxillary artery)

Question 4

what are lines of Zahn?

Answer 4

alternating areas of pink (platelets, fibrin) and red (RBCs)

found in thrombi formed PRE-mortem only

Question 5

Reid index?

Answer 5

thickness of gland layer / total thickness of bronchial wall

** chronic bronchitis: Reid index > 50%

Question 6

centriacinar vs panacinar emphysema?

Answer 6

centriacinar: smoking
panacinar: alpha1 antitrypsin

Question 7

what are Curschmann spirals?

Answer 7

shed epithelium –> whorled mucus plugs

happens in ASTHMA

Question 8

what are Charcot Leyden crystals?

Answer 8

eosinophilic hexagonal double-pointed needle-like crystals
formed from breakdown of eos in sputum
happens in ASTHMA

Question 9

drugs that cause restrictive lung disease?

Answer 9

bleomycin
busulfan
amiodarone
methotrexate

Question 10

rheumatoid arthritis and pneumoconioses with intrapulmonary nodules?

Answer 10

Caplan syndrome

Question 11

shipbuilding/roofing/plumbing, ivory white calcified supradiaphragmatic/pleural plaques?

Answer 11

asbestosis
increased incidence of lung ca (bronchogenic > mesothelioma)
LOWER lobes

** asbestos bodies = golden-brown fusiform rods that look like dumbbells

Question 12

aerospace and manufacturing industries, granulomas?

Answer 12

berylliosis
UPPER lobes
occasionally responsive to steroids

Question 13

prolonged coal dust exposure?

Answer 13

coal workers’ pneumoconiosis
macrophages laden with carbon –> inflammation and fibrosis
UPPER lobes

Question 14

anthracosis?

Answer 14

asymptomatic condition found in many urban dwellers exposed to sooty air

Question 15

foundries/sandblasting/mines, lung fibrosis?

Answer 15

silicosis
silica disrupts phagolysosomes and impairs macrophages –> increased susceptibility to TB
increased risk of bronchogenic carcinoma
UPPER lobes

** eggshell calcification

Question 16

neonatal respiratory distress syndrome?

Answer 16

surfactant deficiency –> increased surface tension –> alveolar collapse - ground glass
lecithin:sphingomyelin < 1.5
persistently low O2 –> risk of PDA

Question 17

risks with therapeutic supplemental O2 in NRDS?

Answer 17

retinopathy of prematurity
intraventricular hemorrhage
bronchopulmonary dysplasia

Question 18

risk factors for NRDS?

Answer 18

prematurity
maternal diabetes (increased fetal insulin
C-section delivery (decreased fetal glucocorticoid release)

Question 19

tx of NRDS?

Answer 19

give mom steroids before birth

artificial surfactant after birth

Question 20

ARDS histologic findings?

Answer 20

intra-alveolar hyaline membranes

Question 21

mechanism of damage in ARDS?

Answer 21

release of neutrophilic substances toxic to alveolar wall
activation of coag cascade
O2-derived free radicals

Question 22

histologic findings in pulmonary HTN?

Answer 22

arteriosclerosis
medial hypertrophy
intimal fibrosis

Question 23

heritable cause of PAH?

Answer 23

inactivating mutation in BMPR2 gene - normally inhibits vascular smooth mm proliferation

Question 24

categories of pulm HTN?

Answer 24

PAH
2/2 L heart dz
2/2 lung dz/hypoxia
2/2 chronic thromboembolism
multifactorial

Question 25

when does trachea deviate toward lesion?

Answer 25

atelectasis/bronchial obstruction

Question 26

MCC of lobar PNA?

Answer 26

S pneumoniae
Legionella
Klebsiella

Question 27

MCC of bronchopneumonia

Answer 27

S pneumo
S aureus
H flu
Klebsiella

Question 28

MCC of atypical PNA?

Answer 28

viruses
Mycoplasma
Legionella
Chlamydia

Question 29

MCC of lung abscesses?

Answer 29

anaerobes (Bacteroides, Fusobacterium, Peptostreptococcus)

S aureus

Question 30

tx of lung abscesses?

Answer 30

clinda

Question 31

hemorrhagic pleural effusion, pleural thickening, psammoma bodies?

Answer 31

mesothelioma

Question 32

effects of Pancoast tumor?

Answer 32

Horner’s
SVC syndrome
sensorimotor deficits
hoarseness

Question 33

facial plethora, neck and upper extremity edema?

Answer 33

SVC syndrome
causes: malignancy (Pancoast), thrombosis from indwelling catheters

** if severe, can raise ICP

Question 34

paraneoplastic syndrome of small cell lung ca?

Answer 34

ACTH
SIADH
Lambert Eaton
myelitis/encephalitis

Question 35

gene changes in small cell?

Answer 35

amplification of myc

Question 36

histology of small cell?

Answer 36

neuroendocrine Kulchitsky cells
small dark blue cells
Chromograinin A +

Question 37

gene changes of adenocarcinoma of lung?

Answer 37

KRAS
EGFR
ALK

Question 38

histology of adenocarcinoma of lung?

Answer 38

glandular pattern
mucin +

bronchioalveolar subtype: growth along alveolar septa - look thickened

Question 39

paraneoplastic syndrome of squamous cell lung ca?

Answer 39

PTHrP –> hypercalcemia

Question 40

findings in squamous cell lung ca?

Answer 40

hilar mass - arising from bronchus
cavitation
kertain pearls and intercellular bridges

Question 41

large cell carcinoma of lung can secrete what?

Answer 41

b-HCG

Question 42

histology of large cell carcinoma of lung?

Answer 42

pleomorphic giant cells

Question 43

bronchial carcinoid tumor?

Answer 43

sx due to mass effect, occasional carcinoid syndrome

** histo: nests of neuroendocrine cells, chromogranin A +

Question 44

which lung ca are central?

Answer 44

small cell

squamous cell

Question 45

which lung ca is inoperable?

Answer 45

small cell

Question 46

which lung ca is unresponsive to chemo?

Answer 46

large cell ca