Pulm- FA

Question 1

classic three symptoms of PE

Answer 1

• sudden onset of chest pain
• dyspnea
• tachypnea

Question 2

hemoptysis, cough, wheezing. Diagnosis?

Answer 2

lung cancer

*buzzword: hemoptysis (highly vascularized tumor)

Although it sounds like COPD (wheezing), COPD does NOT present with hemoptysis

Question 3

Equation for calculating alveolar O2? (thus Aa gradient)

Answer 3

PAO2= Air O2 (PIO2) - PaCO2/R
= 150- PaCO2/0.8

150= (760-PH2O)*0.21
* R: respiratory quotient, question may give different number

Question 4

Describe mechanism regarding how Acetazolamide can be used for high altitude sickness

Answer 4

high altitude -> respiratory alkalosis

acetazolamide induces acidosis by inhibiting carbonic anhydrase -> less HCO3- reabsorption/ H+ secretion
-> promotes renal compensatory mechanism of HCO3- excretion

Question 5

Lab findings of pulmonary consolidation.

• breath sounds
• percussion
• fremitus
• tracheal deviation

What are two examples of pulmonary consolidation? How to differentiate these two?

Answer 5

• decreased breath sounds
• dullness to percussion
• INCREASED fremitus (consolidation is ONLY thing that increases fremitus)
• no tracheal deviation

1. lobar pneumonia
2. pulmonary edema

pulmonary edema usually has preceding HF, while lobar pneumonia shows signs of bacterial infection
( Strep.pneumo, Klebsiella, legionella)

Question 6

1st line for chronic asthma

Answer 6

inhaled corticosteroids

Question 7

What is pulmonary shunt? V/Q value? Will 100% O2 be helpful?

Answer 7

• obstruction
• V/Q equals to 0
• 100% O2 will NOT be helpful

Question 8

Silicosis: what is impaired? Increased risk for what two?

histologic finding?

Answer 8

Silica is deposited in MACROPHAGE, disrupting phagolysosome -> increased risk for TB

Also increased risk for bronchogenic carcinoma

histologic finding: “eggshell” calcification of hilar lymph node

Question 9

Abscess

• what is it?
• chest x-ray finding of lung abscess?
• What bugs (3) should I think about?
• treatment?

Answer 9

• pus (neutrophil infiltrate) within parenchyma
• air-fluid level cavity (black hole) on chest x-ray
• Klebsiella (TV on sketchy), S.aureus (camel back on sketchy), anerobes (bacteriodes, fusobacterium, peptostreptococcus)
• clindamycin (antibiotics for above diaphragm)

Question 10

List three histologic markers for small cell lung cancer

Answer 10

• chromogranin
• enolase
• neural cell adhesion molecule (NCAM)

Question 11

How to calculate dead space with given

• arterial pCO2
• expired pCO2
• tidal volume

Answer 11

dead space = tidal volume * [PaCO2-PeCO2]/PaCO2

• this makes sense: with zero expired pCO2 (which means no gas exchange occurs), dead space= tidal volume

Question 12

Which asthmatic drug can result in immediate relief?

Answer 12

beta 2 agonist

beta 2 -> Gs -> increased cAMP ->PKA

• > inhibition of PLCK (smooth muscle)
• > bronchodilation

Question 13

Phrenic nerve root?

Answer 13

C3-C5

Question 14

Rib location of right middle lobe?

Answer 14

between 4th and 6th rib

Question 15

Emphysema: etiology of each type? affected region?

• panacinar
• centriacinar

Answer 15

• panacinar: alpha1 antitrypsin deficiency
  ENTIRE acini from respiratory bronchiole to alveoli is uniformly messed up
• centriacinar: smoking
  only central region is messed up

Question 16

Where is respiratory center located in CNS?

Answer 16

medulla

Question 17

What week does surfactant begins to synthesize? What weeks are needed to achieve mature surfactant level?

Answer 17

surfactant synthesis starts at week 26

> 35 weeks are required to achieve mature surfactant level

Question 18

female, non-smoker: what lung cancer? central or peripheral?

Answer 18

adenocarcinoma

peripheral

Question 19

what is atelectasis? X-ray finding?

Answer 19

bronchial airway collapse

tracheal deviation toward lesion on x-ray
* this is the only pathology that shows tracheal deviation toward lesion on x-ray