Pulm

Question 1

A-a gradient

Answer 1

Greater if you have primary lung disease. Ventilation defect, perfusion defect, diffusion defect.

Question 2

Nasal polyps

Answer 2

Allergic is most common. In a KID, NEVER. Allergic polyps develop in adults that have chronic. In child, THINK CYSTIC FIBROSIS. Triad asthma - ASA or NSAID –> asthma + nasal polyps. Middle-aged woman with chronic pain syndrome develops asthma = NSAID. Mech - blockage of cyclooxygenase -> shunting to the lipoxygenase pathway LTC, D, E4 are BRONCHOconstrictors -> asthma. NOT a HS-1.

Question 3

Laryngeal carcinoma

Answer 3

True - pseudo stratified columnar; False - squamous. Etios - smoking, alcohol. Synergistic RF’s. True for ANY squamous cancer (mouth, upper esophagus).

Question 4

Epiglottitis

Answer 4

Inspiratory stridor. Haemophilus influenzae.

Question 5

Croup

Answer 5

Parainfluenza. TRACHEAL inflammation.

Question 6

Hyaline membrane disease = RDS

Answer 6

COLLAPSED alveoli. MASSIVE atelectasis. WHY? Surfactants (lecithins, phosphatidylcholine, phosphatidylglycerol) are deficient b/c collapsing pressure = Surface tension / radius. On expiration, airways get smaller, increased collapsing pressure -> atelectasis unless surfactants DECREASE surface tension. Etios = Prematurity (surfactant synthesis poor; tx = glucorticocoids to mom to stimulate synthesis; THYROXINE is another, Prolactin does too). Etios = Diabetes (mom) -> hyperglycemia -> baby increased insulin -> DEC. surfactant. Etios = C-Section -> stress is MISSING -> NO ACTH and cortisol -> LESS surfactant.

Question 7

Why macrosomia in babies of gestational diabetics?

Answer 7

Baby’s insulin is increased. Insulin INCREASES fat storage (TG synthesis and deposition). Most adipose is central. Insulin leads to uptake of aa’s in muscle. Hypoglycemia when they’re born.

Question 8

RDS commonly have PDA?

Answer 8

Hypoxemia

Question 9

Hyaline membrane

Answer 9

Degeneration of type 2 pneumocytes. Leakage of fibrinogen.

Question 10

ARDS

Answer 10

PEEP therapy in order to uncollapse the alveoli + surfactant.

Question 11

Lamellar bodies

Answer 11

CONTAIN surfactant. EM picture. Type II pneumocytes.

Question 12

ARDS

Answer 12

Same as RDS in pathophysiology. But usually a NEUTROPHIL-related injury. Etio = septic shock (most common is E. coli 2/2 indwelling). Neutrophils in the lung -> destroying type I/ii pneumocytes -> MASSIVE atelectasis. Leaky capillary syndrome 2/2 neutrophils -> protein and fibrinogen -> hyaline membranes in ARDS.

Question 13

Spontaneous pneumothorax

Answer 13

Etio - most common is ruptured sub pleural bleb -> collapse of that part of the lung b/c lose negative intrapleural pressure. Trachea deviation toward side + up diaphragm

Question 14

Tension pneumothorax

Answer 14

Most commonly due to knife injuries, gunshot wound. Tear of pleura that is a FLAP. Air goes in but can’t LEAVE out. Pushes lung and mediastinum to the other side. Compression atelectasis. Pushes on VC, RV -> compromised blood flow. Diaphragm pushed DOWN.

Question 15

Pneumonia

Answer 15

Typical and atypical. Typical - sudden onset. Atypical - slow and insidious onset. Community acquired and nosocomial.

Question 16

CA-PNA vs. HA-PNA

Answer 16

Strep (tx = Pen G) and Mycoplasma pneumoniae, Chlamydia pneumoniae (atypical) vs. E.coli/Pseudomonas/staph

Question 17

Typical pna

Answer 17

Productive cough - signs of consolidation and exudate/pus in the alveoli. Increased percussion, increased tactile fremitus, E->A = egophany, whisper pectoriloquy. Pleural effusion would lead to decreased percussion.

Question 18

Atypical PNA

Answer 18

DONT have productive cough. Not as high of temperature. INTERSTITIAL pneumonias. No exudate in the alveoli.

Question 19

Rhinovirus

Answer 19

Acid-labile = Won’t get gastroenteritis b/c is destroyed by acid. No vaccine b/c > 100 serotypes.

Question 20

Bronchiolitis

Answer 20

RSV. Inflamed small airways = wheezing.

Question 21

Influenza

Answer 21

Hemagluttinins are the attachments to the nasal mucosa. Antigenic drift = minor. Antigenic shift = NEW vaccine; mut in neuroaminidase and hemagluttinin. Vaccine just against A.

Question 22

Chlamydia psittica

Answer 22

Parrots, turkeys

Question 23

Chlamydia trachomatis

Answer 23

Newborn. Increased A-P diameter. Tympanic. Wheezing. NO FEVER. Crusty eyes b/l. Staccato cough. Transmitted via infected cervix.

Question 24

Pseudomonas

Answer 24

Water-loving bacteria. ICU’s on a RESPIRATOR. GREEN-discoloration.

Question 25

Klebsiella

Answer 25

Alcoholics w/ MUCOID-appearing sputum. THICK capsule of organism. Cavitate in upper lobes.

Question 26

Legionella

Answer 26

Atypical PNA. Non-productive cough. Water-loving bacteria. Mists, industrial water. Hyponatremia? Legionella infects liver and interstitial nephritis (JGA damage -> LOW renin, LOW aldo -> lose salt). Tx = azithro?

Question 27

Candida

Answer 27

Indwelling catheters…

Question 28

Midwest + Ohio/Tennesse

Answer 28

Histoplasmosis. Starlings (birds), BATS (caves). Yeast phagocytosed by macrophages.

Question 29

Pigeon fungi

Answer 29

Cryptococcus. Narrow-based bud. Mickey-Mouse. (1) NYC executive w/ pigeon on AC. (2) Painters on Brooklyn Bridge.

Question 30

Southeast America

Answer 30

Blastomycosis. Skin and LUNG infections.

Question 31

Southwest U.S.

Answer 31

Coccidiomycoses = NM, Arizona, S. California. Spherule w/ endospore. (1) L.A. earthquake (2) Cave explorer in the desert in SW.