Pulm- Uworld Flashcards
70- Q 11. What is indicated for long term management of asthma (ie. first line for chronic asthma)?
inhaled corticosteroid
fluticasone, budesonide
70- Q 25. What is radial traction
outward pulling
= chest wall recoil
70- Q 25. Explain by which two mechanisms pulmonary fibrosis results in increased FEV1
- increased lung elastic recoil
- 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
70- Q 27. Poor oral dental carries with pneumonia: what bug may cause pneumonia?
Actinomyces
- Actinomyces reside in oral, colon, and vagina
70- Q 28. What is virulence factor of H. Infulenza?
PRP (PolyRibosyribotol Phosphate) in capsule
70- Q33. Does pulmonary embolism causes diffusion limitation?
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
70- Q 39. Which pneumocosis shows bifringement particle on polarized microscopy? What is another imaging finding in this pneumocosis?
silicolsis
also shows “eggshell” calcification of hilar lymphnodes
71- Q 2. acute otitis media: what two bugs should I think?
- strep.pneumo
- H. infulenza
71- Q 3. Is equilibration of O2 and CO2 diffusion limited?
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
71- Q5. What two pneumoconioses shows calcification on imaging?
- abestosis
- silicosis
- top and bottom in FA chart
# 71- Q7. (Heme question) Define Absolute vs. Relative erythrocytosis. What is key difference between these two?
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
71- Q7. At what PaO2 and SaO2 cause absolute erythrocytosis?
PaO2 < 65mmHg
SaO2 < 92%
71- Q 10. Left sided heart failure: describe pathophysiology how this leads to dypsnea
left side HF
- > increased hydrostatic pressure in pulmonary circulation
- > fluid accumulation in interstitium
- > alveolar becomes sticky
- > DECRESASED ALVEOLAR COMPLIANCE
71- Q 10. Is left to right cardiac shunting responsible for dyspnea?
NO
left to right CARDIAC shunting refers to shunting WITHIN heart, such as VSD or ASD
71- Q 15. What is responsible for green color in sputum?
neutrophil myeloperoxidase
MPO is blue-green heme based enzyme
71- Q 17. What rib levels of lung/pleura/liver @
- anterior
- lateral side
- posterior
(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
71- Q 21. How body mediates compensation to respiratory alkalosis? How long does it take to occur?
- decrease HCO3- reabsorption (how acetazolamide helps for altitude sickness)
- renal compenstaion occurs about 48 hours after
71- Q 23. How can panic attack cause neurologic symptoms? Explain physiology
hyperventilation
- > hypocapnea (low PaCO2)
- > vasoconstriction -> decreased cerebral perfusion
- > dizzness, weakness, blurred vision
- remember CO2 is ONLY ONE metabolite that cause vasoconstriction in brain
71- Q 29. At what CD4 T cell count does opportunistic pneumonia caused by pneumocystis jirovecii occur?
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)
71- Q 31. What are two staining methods for cryptococcus?
- india ink
- mucicarmine: red inner capsule
- sketchy: MUmmy in MUsicarmine red container
71- Q 37. fatigue, chills, IV drug user present with lung infarct. Explain mechanism for lung infarct
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.
71- Q 40. (nutrition question) Which vitamin is responsible for normal differentiation of epithelial cells into pancreatic cells or mucus secreting cells?
vitamin A
-> Vitamin A deficiency can cause metaplasia in pancreatic ducts
72- Q1. gag reflex vs. cough reflex: afferent/efferent?
- gag reflex
afferent: CN9
efferent: CN10 (soft palate elevation) - cough reflex
afferent: CN 10 ( superior laryngeal nerve sensing irritants)
efferent: CN 10 (coughing)
72-Q 1. Which structure in pharynx runs right anteriorly with regard to superior laryngeal nerve?
piriform recess
- This shit is not on FA
72- Q 17. Pulmonary complication for obstructive sleep dyspnea?
pulmonary HTN
hypoxia -> pulmonary vasoconstriction
72- Q 24. What two masses can cause SVC syndrome? How to differentiate these two different etiology?
- mediastinal mass: no neurological symptoms. Just pure SVC syndrome
- pancoast tumor: shoulder pain (axillary gets compressed), Horner
72- Q 28. Which bug is the only one gram positive diplococci?
strep. pneumo
72- Q 40. Name three anarobes that are associated with lung abscess. What are two major causes of lung abscess? how to differentiate them?
- Bacteriodes
- Peptostreptococcus
- Fusobacterium
Two main causes are:
- loss of conscious that can lead to aspiration: SEZIURE, alcoholics
- bronchial obstruction: cancer
aspiration vs. bronchial obstrurction
: aspiration will show anarobes in abscess while bronchial obstruction is less likely to contain anarobes
73- Q1. work of breathing is sum of what two respiratory works? How increasing breathing frequency affects these two?
- 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
73- Q 13. Chronic transplant rejection occurs at where in lung?
bronchiole, small airway
- this process is called Bronchiolitis obliterans
73- Q 27. Explain pathophysiology of lethargy / confusion with high flow oxygen supplementation
high oxygen supplementation
- > pulmonary vasodilation
- > increased dead space (poorly ventilated alveoli also get perfused)
- > hypercapnea
*oxygen induced hypercapnea
74 - Q5. Describe how eosinophils look like. What lung disease should I think when it comes to eosinophils?
Pink cytoplasm with purple granules
Asthma
74- Q 9. Alveolar macrophages are located in which two segments along respiratory tract?
alveoli
ALSO in RESPIRATROY BRONCHIOLES
this is not clearly presented in FA
74 - Q 18. What is the most common cause of death in systemic sclerosis?
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
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?
S.aureus
SECONDARY PNEUMONIA
- starting with some viral symptoms (influenza virus in this case), and then pulmonary
=> always think about secondary pneumonia
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?)
- pulmonary chondroma ( hamartoma)
- epithelium contains hyaline cartilage
74- Q 23. What is initial phase of TB infection? When does helper T cell response begins?
bacterial proliferation is initial phase
Helper T cell response (helper T cell -> INF-gamma -> epitheloid macrophage) begins at week 2-4.
74- Q 25. How to differentiate between allergic bronchoplumonary Aspergilios vs. asthma
chest x-ray
Allergic bronchopulmonary Aspergilios: infiltrate and cavity. also may show bronchiectasis
- Asthma usually gives NORMAL chest x-ray
74- Q32. What is direct indicator of ventilation status?
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
104- Q 37. How to differentiate brachiocehpalic vein compression vs. SVC syndrome
brachiocephalic compression: unilateral
SVC syndrome: bilateral
SVC gives rise to Left or Right brachiocephalic vein
