PULMO

Question 1

How can viruses use eukaryotic ribosomes for protein synthesis?

Answer 1

They must convert their polycistronic genome into monocis mRNA

Question 2

How to convert poly genome into monocis mRNA?

Answer 2

1. viral genome is already segmented 2. a transcription promotor can precede each gene 3. precursor RNA strands can undergo alternative splicing 4. viral genome can serve as a single mRNA that’s cleaved into sep proteins

Question 3

Elastin’s ability to stretch during inspiration then recoil to original shape- explained by

Answer 3

interchain crosslinks involving lysine

Question 4

Explain resistance to streptomycin

Answer 4

altered structure of bacterial ribosomal proteins

Question 5

Inhibits fungal DNA and RNA synthesis

Answer 5

Flucytosine

Question 6

Inhibits fungal cell wall

Answer 6

Caspofungin

Question 7

Inhibits fungal cell membrane

Answer 7

ampho B and Nystatin bind ergosterol; azoles inhibit ergosterol synthesis

Question 8

The high susceptibility of patients with silicosis to TB is best explained by

Answer 8

impaired macrophage killing

Question 9

at peak exercise, what parameters are the same in systemic and pulmonary circulation?

Answer 9

blood flow per minute

Question 10

Suggests diagnoses of cystic fibrosis

Answer 10

hx recurrent respi infections with Ps aeruginosa, chronic diarrhea, weight loss, death of a 9 y/o sibling d/t respi infection

Question 11

Explain diarrhea and weight loss in CF

Answer 11

malabsorption due to obstructive fibrosis and progressive insufficiency of the exocrine pancreas

Question 12

Improve condition of CF

Answer 12

pancreatic lipase

Question 13

Why does the V/Q ratio decrease from the lung apex to the base?

Answer 13

bc perfusion increases significantly from the apex to the base

Question 14

Explain antibodies involved in M pneumoniae

Answer 14

share antigens with human erythrocytes and cause RBC destruction; Ab referred to as cold agglutinins

Question 15

at what point is total pulmonary vascular resistance lowest?

Answer 15

functional residual capacity

Question 16

likely to cause chronic pneumonia in an immunocompetent host

Answer 16

Blastomyces dermatitidis

Question 17

Highest O2 sat in fetal circulation is in the

Answer 17

umbilical vein, which empties directly into the IVC via the ductus venosus

Question 18

pH lower than 7.35 signifies

Answer 18

acidosis

Question 19

respi acidosis occurs due to

Answer 19

the retention of CO2 in the lungs; presents with low pH and high pCO2

Question 20

chronic respi acidosis

Answer 20

is compensated, with a HCO3 level >30

Question 21

Centriacinar emphysema

Answer 21

heavy smoker with exertional dyspnea and airspace enlargement on CT

Question 22

Pathogenesis of centriacinar emphysema

Answer 22

involves intraalveolar release of proteases, especially elastase, from infiltratin NEUTROPHILS and from alveolar MACROPHAGES

Question 23

In the setting of lung volume loss, the trachea deviates…

Answer 23

toward the opacified lung (atelectasis)

Question 24

In the setting of a large pleural effusion, the trachea deviates…

Answer 24

away from the opacified lung

Question 25

Rx Mycoplasma infections

Answer 25

anti-ribosomal agents like tetracyline and erythromycin

Question 26

Frameshift mutation

Answer 26

deletion or addition of a number of base pairs which are not a multiple of three

Question 27

Most frictional airway resistance is found in the

Answer 27

large bronchi

Question 28

MCC of meconium ileus

Answer 28

cystic fibrosis

Question 29

Most likely cause of death, CF

Answer 29

pneumonia

Question 30

Three day hx of dysuria and back pain. Fever, hypotensive, tachypneic, tachycardic. Becomes hypoxic. LUNG FINDINGS?

Answer 30

fluid accumulation in alveolar spaces (ARDS; sepsis and shock are two major risk factors)

Question 31

long history of asbestos exposure

Answer 31

bronchogenic carcinoma

Question 32

Decreased FVC, lower lobe involvement, a1- antitrypsin deficiency

Answer 32

chronic panacinar emphysema

Question 33

intermittent respi sx in a patient with normal CXR, occasional sputum eosinophils, and reduced FEV1

Answer 33

asthma

Question 34

what would an elevated PCWP in a patient with pulmonary edema be suggestive for?

Answer 34

a cardiogenic cause, such as pulmonary venous hypertension

Question 35

Increased pulm capillary permeability in ARDS results in...

Answer 35

decrease in lung compliance, an increase in the work of breathing, and worsened V/Q mismatching

Question 36

non caseating granulomas in an African American

Answer 36

sarcoidosis

Question 37

Accentuated second heart sound over the upper left sternal border, pitting lower extremity edema, and hepatomegaly in a patient with atrophic skin changes and cold-induced digital vasospasm. Cause of condition

Answer 37

intimal thickening of pulmonary arterioles (scleroderma and PH)

Question 38

interstitial pneumonia in a transplant patient with intranuclear and cytoplasmic inclusion bodies. Organism is described as....

Answer 38

enveloped ds DNAV (CMV)

Question 39

Clinical features of Legionella pneum

Answer 39

high fever with relative bradycardia, headache and confusion, watery diarrhea

Question 40

lab findings in Legionella

Answer 40

hyponatremia, sputum GS showing many neutrophils but few or no organisms

Question 41

Rx Legionella

Answer 41

respi FQ or newer macrolides

Question 42

Legionella is described as a

Answer 42

G- rod

Question 43

18 y/o male w/ sudden onset right-sided chest pain and dyspnea. Tall, thin patient in acute distress. Right side of chest is hyperresonant to percussion and lack BS. MLC of condition?

Answer 43

apical subpleural blebs

Question 44

High fever, chills, and cough productive of green sputum. Crackles over right lower lung lobe. What accounts for color of sputum?

Answer 44

myeloperoxidase

Question 45

MPO

Answer 45

released from neutrophil azurophilic granules; heme-containing pigmented molecule

Question 46

MCC of SVC syndrome

Answer 46

bronchogenic carcinoma

Question 47

nkaed rna molecules induce viral protein sythesis and viral genome replication. The patient is ML infected with

Answer 47

rhinovirus (SS, positive sense RNA molecule)

Question 48

many of amphotericin b's toxic effects are due to its binding of

Answer 48

cell membrane cholesterol

Question 49

ethambutol affects bacterial

Answer 49

carbohydrate polymerization

Question 50

diagnose CF by

Answer 50

chloride level in sweat

Question 51

columnar mucin-secreting cells that fill the alveolar spaces without invading the stroma or vessels

Answer 51

bronchioalveolar Ca

Question 52

Cheyne-Stokes describes

Answer 52

cyclic breathing in which apnea is followed by gradually increasing tidal volumes, and then gradually decreasing tidal volumes until the next apneic period

Question 53

Cheyne stokes breathing seen in

Answer 53

advanced CHF

Question 54

stimulates neutrophil migration to the site of inflammation

Answer 54

leukotriene B4

Question 55

small fibrotic focus in lower lobe of right lung, calcified LN in right lung hilus..

Answer 55

primary exposure to MTB

Question 56

several episodes of H flu OM despite immunizations.. why?

Answer 56

the strains responsible for the pt's dse do not produce a capsule

Question 57

Pneumonia, histo: alveoli filled with exudate containing neutrophils, fibrin, and some fragmented red blood cells. Pt died during..

Answer 57

gray hepatization

Question 58

V/Q ratio highest at the

Answer 58

Apex

Question 59

Perfusion highest in the

Answer 59

Base