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Pulm: 3/28-3/31 > Pulm- Uworld > Flashcards

Pulm- Uworld Flashcards

1
Q

70- Q 11. What is indicated for long term management of asthma (ie. first line for chronic asthma)?

A

inhaled corticosteroid

fluticasone, budesonide

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2
Q

70- Q 25. What is radial traction

A

outward pulling

= chest wall recoil

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3
Q

70- Q 25. Explain by which two mechanisms pulmonary fibrosis results in increased FEV1

A
  1. increased lung elastic recoil
  2. increased radial traction on airway => airway widening
    * fibrotic tissue around alveoli: pushes air during expiration more easily: increased lung elastic recoil
    * fibrotic tissue around airway: pulling airway (increasing radial traction) so that air can get out more easily
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4
Q

70- Q 27. Poor oral dental carries with pneumonia: what bug may cause pneumonia?

A

Actinomyces

  • Actinomyces reside in oral, colon, and vagina
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5
Q

70- Q 28. What is virulence factor of H. Infulenza?

A

PRP (PolyRibosyribotol Phosphate) in capsule

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6
Q

70- Q33. Does pulmonary embolism causes diffusion limitation?

A

NO. diffusion limitation is either changes in surface area (emphysema) or membrane thickness (fibrosis or hyaline)

*PE leads to V/Q mismatch, which can also be caused by diffusion limitation. But PE does not change diffusion

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7
Q

70- Q 39. Which pneumocosis shows bifringement particle on polarized microscopy? What is another imaging finding in this pneumocosis?

A

silicolsis

also shows “eggshell” calcification of hilar lymphnodes

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8
Q

71- Q 2. acute otitis media: what two bugs should I think?

A
  • strep.pneumo

- H. infulenza

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9
Q

71- Q 3. Is equilibration of O2 and CO2 diffusion limited?

A

NO. ONLY WHEN blood flow is not adequate to pulmonary circulation

CO2 has very great diffusion rate across membrane. So diffusion limitation will not usually occur unless there is huge blood flow limitation

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10
Q

71- Q5. What two pneumoconioses shows calcification on imaging?

A
  • abestosis
  • silicosis
  • top and bottom in FA chart
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11
Q 
# 71- Q7. (Heme question) 
Define Absolute vs. Relative erythrocytosis. What is key difference between these two?
A

Absolute: Absolute increase in RBC mass

  • primary: polycythemia vera
  • secondary: ectopic EPO synthesis (malignancy), low oxygen state (V/Q mismatch, other lung diseases)

Relative: NO CHANGE in RBC MASS
- dehydration or burns
=> RBC concentration increases due to hypovolemic state, but RBC mass stays normal

  • burns cause hypovolemia
  • It is RBC MASS that distinguish these two
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12
Q

71- Q7. At what PaO2 and SaO2 cause absolute erythrocytosis?

A

PaO2 < 65mmHg

SaO2 < 92%

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13
Q

71- Q 10. Left sided heart failure: describe pathophysiology how this leads to dypsnea

A

left side HF

  • > increased hydrostatic pressure in pulmonary circulation
  • > fluid accumulation in interstitium
  • > alveolar becomes sticky
  • > DECRESASED ALVEOLAR COMPLIANCE
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14
Q

71- Q 10. Is left to right cardiac shunting responsible for dyspnea?

A

NO

left to right CARDIAC shunting refers to shunting WITHIN heart, such as VSD or ASD

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15
Q

71- Q 15. What is responsible for green color in sputum?

A

neutrophil myeloperoxidase

MPO is blue-green heme based enzyme

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16
Q

71- Q 17. What rib levels of lung/pleura/liver @

  • anterior
  • lateral side
  • posterior
A

(6,8) (8,10) (10,12)

Anterior 6,8:

  • above 6th rib: lung
  • between 6th ant 8th rib: pleura
  • below 8th rib: liver

lateral side 8,10

posterior 10.12

  • check photo in phone
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17
Q

71- Q 21. How body mediates compensation to respiratory alkalosis? How long does it take to occur?

A
  • decrease HCO3- reabsorption (how acetazolamide helps for altitude sickness)
  • renal compenstaion occurs about 48 hours after
18
Q

71- Q 23. How can panic attack cause neurologic symptoms? Explain physiology

A

hyperventilation

  • > hypocapnea (low PaCO2)
  • > vasoconstriction -> decreased cerebral perfusion
  • > dizzness, weakness, blurred vision
  • remember CO2 is ONLY ONE metabolite that cause vasoconstriction in brain
19
Q

71- Q 29. At what CD4 T cell count does opportunistic pneumonia caused by pneumocystis jirovecii occur?

A

CD4 less than 200

  • If HIV patient has CD4 T cell count above 500, then it is considered as not severely immunocompromised status. Thus, most likely cause of pneumonia infection should be by S.pneumoniae (most common community acquired pneumonia)
20
Q

71- Q 31. What are two staining methods for cryptococcus?

A
  • india ink
  • mucicarmine: red inner capsule
  • sketchy: MUmmy in MUsicarmine red container
21
Q

71- Q 37. fatigue, chills, IV drug user present with lung infarct. Explain mechanism for lung infarct

A

endocarditis -> septic emboli -> pulmonary infraction

  • Don’t pick DVT. DVT patient will not have chills!
    If IV drug user is given, there is reason for that.
22
Q

71- Q 40. (nutrition question) Which vitamin is responsible for normal differentiation of epithelial cells into pancreatic cells or mucus secreting cells?

A

vitamin A

-> Vitamin A deficiency can cause metaplasia in pancreatic ducts

23
Q

72- Q1. gag reflex vs. cough reflex: afferent/efferent?

A
  • gag reflex
    afferent: CN9
    efferent: CN10 (soft palate elevation)
  • cough reflex
    afferent: CN 10 ( superior laryngeal nerve sensing irritants)
    efferent: CN 10 (coughing)
24
Q

72-Q 1. Which structure in pharynx runs right anteriorly with regard to superior laryngeal nerve?

A

piriform recess

  • This shit is not on FA
25
Q

72- Q 17. Pulmonary complication for obstructive sleep dyspnea?

A

pulmonary HTN

hypoxia -> pulmonary vasoconstriction

26
Q

72- Q 24. What two masses can cause SVC syndrome? How to differentiate these two different etiology?

A
  • mediastinal mass: no neurological symptoms. Just pure SVC syndrome
  • pancoast tumor: shoulder pain (axillary gets compressed), Horner
27
Q

72- Q 28. Which bug is the only one gram positive diplococci?

A

strep. pneumo

28
Q

72- Q 40. Name three anarobes that are associated with lung abscess. What are two major causes of lung abscess? how to differentiate them?

A
  • Bacteriodes
  • Peptostreptococcus
  • Fusobacterium

Two main causes are:

  1. loss of conscious that can lead to aspiration: SEZIURE, alcoholics
  2. bronchial obstruction: cancer

aspiration vs. bronchial obstrurction
: aspiration will show anarobes in abscess while bronchial obstruction is less likely to contain anarobes

29
Q

73- Q1. work of breathing is sum of what two respiratory works? How increasing breathing frequency affects these two?

A
  • work against lung recoil: opening up alveoli against inward pressure
    => increasing breathing frequency will reduce it
    : more rapid breathing, more air is trapped in alveoli (due to not full respiration) -> less work needed to open alveoli
  • work against airway: getting air out against airway resistance
    => increasing breathing frequency will increase it
    : more rapid breathing, more air is hanging out in airway -> more airway resistance
30
Q

73- Q 13. Chronic transplant rejection occurs at where in lung?

A

bronchiole, small airway

  • this process is called Bronchiolitis obliterans
31
Q

73- Q 27. Explain pathophysiology of lethargy / confusion with high flow oxygen supplementation

A

high oxygen supplementation

  • > pulmonary vasodilation
  • > increased dead space (poorly ventilated alveoli also get perfused)
  • > hypercapnea

*oxygen induced hypercapnea

32
Q

74 - Q5. Describe how eosinophils look like. What lung disease should I think when it comes to eosinophils?

A

Pink cytoplasm with purple granules

Asthma

33
Q

74- Q 9. Alveolar macrophages are located in which two segments along respiratory tract?

A

alveoli

ALSO in RESPIRATROY BRONCHIOLES
this is not clearly presented in FA

34
Q

74 - Q 18. What is the most common cause of death in systemic sclerosis?

A

pulmonary hypertension

  • It is not really associated with pulmonary fibrosis like most of other autoimmune disease. Systemic sclerosis induces INTIMAL THICKENING, leading to PULMONARY HTN
35
Q

74- Q 19. Patient comes to clinic with fever, malaise, cough and throat pain. Few days later patient is hospitalized due to progressive chest pain, dyspnea. What bug will be seen in sputum?

A

S.aureus

SECONDARY PNEUMONIA

  • starting with some viral symptoms (influenza virus in this case), and then pulmonary
    => always think about secondary pneumonia
36
Q

74- Q 20. What is the most common benign lung tumor? what is special characteristic of this tumor? (what tissue is contained in this tumor?)

A
  • pulmonary chondroma ( hamartoma)

- epithelium contains hyaline cartilage

37
Q

74- Q 23. What is initial phase of TB infection? When does helper T cell response begins?

A

bacterial proliferation is initial phase

Helper T cell response (helper T cell -> INF-gamma -> epitheloid macrophage) begins at week 2-4.

38
Q

74- Q 25. How to differentiate between allergic bronchoplumonary Aspergilios vs. asthma

A

chest x-ray

Allergic bronchopulmonary Aspergilios: infiltrate and cavity. also may show bronchiectasis

  • Asthma usually gives NORMAL chest x-ray
39
Q

74- Q32. What is direct indicator of ventilation status?

A

PaCO2

Central receptor senses CO2 -> respiratory center

  • What about PaO2? Not necessarily. It’s easy to think that hyperventilation leads to high PaO2.
    BUT THIS IS NOT TRUE. If there is V/Q mismatch, PaO2 may still stay low even with hyperventilation
40
Q

104- Q 37. How to differentiate brachiocehpalic vein compression vs. SVC syndrome

A

brachiocephalic compression: unilateral

SVC syndrome: bilateral
SVC gives rise to Left or Right brachiocephalic vein

Pulm: 3/28-3/31 (6 decks)

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