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UWorld > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

In the lungs, the binding of O2 to hemoglobin drives the release of ___ and ___ from hemoglobin

A

H+

CO2

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2
Q

Strep pneumoniae is gram _____, ___-hemolytic, optochin-______, and bile-______

A

positive
alpha
sensitive
soluble

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3
Q

Prolonged neuromuscular paralysis after succinylcholine administration is due to what autosomal recessive disorder

A

pseudocholinesterase deficiency

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4
Q

What cells function to regenerate the alveolar lining following injury

A

type II pneumocytes

also produce surfactant

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5
Q

The ____ carries lymph from most of the body and drains into the junction between the left subclavian and jugular veins

A

thoracic duct

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6
Q

In an anemic patient, what changes occur to the oxygen content of blood, oxygen saturation, and PaO2

A

oxygen content: low (bc low hemoglobin)
oxygen saturation: normal
PaO2: normal

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7
Q

How are phosphatidylcholine and sphingomyelin used to determine lung maturity in utero

A

fetal lung lectin (phosphatidylcholine) production increases sharply afer 30 weeks gestation and sphingomyelin levels should remain constant
a lectin/sphingomyelin ratio of 2 or more indicates adequate surfactant production

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8
Q

What are the two mechanisms that cause a malignant pleural effusion

A

inflammation induced increase in vascular permeability

malignant cells can occlude the pleural lymphatic stromal and prevent pleural fluid reabsorption

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9
Q

Cystic fibrosis is most commonly due to a 3 base pair deletion in the CF transmembrane conductance regulator gene leading to impairment of what

A

impaired post-translational processing of CTFR –> shunting of CTFR towards the proteasome with complete absence of the protein in the cell surface

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10
Q

What amino acid content/structure contributes to elastin’s rubber-like properties

A

high content of nonpolar amino acids and extensive cross-linking between elastin monomers facilitated by lysyl oxidase (oxidatively deaminates lysine residues –> desmosine cross links)

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11
Q

How are the following affected during physical exercise: venous CO2 and O2, arterial CO2 and O2

A

venous CO2: increased
venous O2: constant or decreased
arterial CO2 and O2: remain constant (increases in alveolar ventilation and gas exchange efficiency)

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12
Q

How does congenital diaphragmatic hernia cause respiratory distress in a neonate

A

herniation of the abdominal contents into the thorax causes pulmonary hypoplasia from compression of the lungs

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13
Q

Where in the airway does pseudostratified epithelium become simple cuboidal epithelium

A

terminal bronchioles

gradually transitions up until there

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14
Q

Ciliated cells are present in the airway from the trachea through where?

A

proximal portions of the respiratory bronchioles

not present in alveolar ducts or alveoli themselves

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15
Q

which have glands and cartillage: bronchi or bronchioles?

A

bronchi

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16
Q

What drugs interact with sextromethorphan

A

serotonergic drugs (can cause serotonin syndrome due to its ability to increase serotonin activity in the CNS)

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17
Q

Airway resistance is highest at ____ and lowest at what point in the airway

A

highest: medium sized bronchi
lowest: alveoli

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18
Q

Nocardia most commonly causes what manifestations in immunocompromised patients

A

pneumonia and brain abscesses

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19
Q

How is Legionella pneumophila most often spread

A

contaminates water –> organism is inhaled in aerosolized water and establishes infection via the pulmonary route

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20
Q

_____ is the most common mutation in the CFTR protein in patients with cystic fibrosis

A

delta F508

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21
Q

What is administered to pregnant women at risk of premature delivery to prevent neonatal respiratory distress syndrome

A

betamethasone or dexamethasone

cortisol –> accelerate fetal lung maturation by stimulating surfactant production

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22
Q

What neoplasm has sheets of small blue cells with scant cytoplasm and is positive for chromogranin and synaptophysin

A

small cell carcinoma of the lung

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23
Q

Primary TB causes the formation of Ghon foci in what region of the lungs? Where does secondayr/reactivated tuberculosis often localize?

A

primary: lower lung lobes
secondary: upper lungs

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24
Q

Cryptococcus neoformans is the only fungus that has a ____ which appears ___ on mucicarmine stain and ____ on india ink

A

polysaccharide capsule
red
clear

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25
Q

what is the equation for minute ventilation? alveolar ventilation?

A

minute ventilation = tidal volume * breaths/min

alveolar ventilation = (tidal volume - dead space volume) * breaths/min

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26
Q

The CFTR protein is a transmembrane ___ gated chloride channel

A

ATP

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27
Q

Aspirated material is more likely to travel down the main bronchus on what side?

A

right

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28
Q

Supine patients typically aspirate into what lobes as opposed to patients who are upright

A

supine: posterior segments of upper lobes and superior segments of the lower lobes
upright: basilar segments of lower lobes

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29
Q

Thickened bronchial walls, lymphocytic infiltration, mucous gland enlargement, and patchy squamous metaplasia of the bronchial mucosa are features of what?

A

chronic bronchitis

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30
Q

Pulmonary arterial hypertension is often caused by inactivating mutations involving the ____ gene resulting in ___ and ____ cell proliferation –> vascular remodeling –> vascular resistance

A

BMPR2
endothelial
smooth muscle

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31
Q

Bosentan MOA

A

endothelin receptor antagonist

endothelin is a potent vasoconstrictor that also stimulates endothelial proliferation

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32
Q

what medication improves symptoms in pulmonary arteriole hypertrophy by decreasing pulmonary arterial pressure and lessening the progression of vascular remodeling

A

Bosentan

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33
Q

Infants with secondhand smoke exposure are at increased risk for pneumonia becuase cigarette smoke affects _____ and ____ function

A

alveolar macrophage

mucocilliary

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34
Q

Pulmonary embolism causes increased _____ which leads to hypoxemia due to consequent ventilation/perfusion mismatch

A

dead space

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35
Q

When being weaned from mechanical ventilation, patients typically breath at ___ (high/low) tidal volumes and ____ (increased/decreased) respiratory rate which leads to increase in wasted ventilation (increased dead space)

A

low tidal volumes

increased respiratory rate

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36
Q

With chronic irritation, such as smoking, normal columnar epithelium of the bronchi are replaced with ______ which is more resistant to irritation but has reduced mucociliary clearance

A

squamous epithelium

this is reversible

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37
Q

Histologic findings of what disease include patchy lymphoplasmacytic infiltrates, focal fibroblastic proliferation with dense fibrosis, honeycombing, and hyperplasia of type 2 pneumocytes

A

idiopathic pulmonary fibrosis

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38
Q

Pirfenidone is used to treat idiopathic pulmonary fibrosis. What is its MOA

A

antifibrotic agent that inhibits TGF-beta

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39
Q

Nintedanib is used to treat idiopathic pulmonary fibrosis, what is its MOA

A

tyrosine kinase inhibitor that inhibits PDGF, FGF, and VEGF

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40
Q

Therapies for idiopathic pulmonary fibrosis are directed at slowing the progression of fibrosis by inhibiting what fibrogenic growth factors

A

TGF beta
PDGF
fibroblastic growth factor
VEGF

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41
Q

In a transplant patient, pneumonia with intranuclear and cytoplasmic inclusion bodies histologically points to opportunistic infection with what organism?

A

cytomegalovirus

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42
Q

Cytomegalovirus is a (enveloped or not?) virus that contains (double or single) stranded (RNA or DNA)

A

enveloped

double stranded DNA

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43
Q

Thoracentesis should be performed below the __ rib in midclavicular line, __ rib along midaxillary line, or ___ rib along paravertebral line in order to minimize risk of lung injury

A

6
8
10

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44
Q

Insertion of a needle for throacentesis lower than the 9th rib increases risk of penetrating _____

A

abdominal structures (ie. liver)

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45
Q

During thoracentesis, the needle should be inserted along the (upper or lower) border of the rib to prevent injury to the intercostal vessels

A

upper

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46
Q

How are total lung capacity, residual volume, and expiratory flow rate affected in COPD

A

total lung capacity: increased
residual volume: increased
expiratory flow rate: decreased

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47
Q

what leads to expiratory airflow obstruction in COPD

A

anatomic narrowing of bronchi (chronic bronchitis)
decreased lung elasticity from destruction of interalveolar walls (emphysema) promotes dynamic compression of airways during expiration

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48
Q

When inserting a chest tube at the 4th or 5th intercostal space at the midaxillary line, the tube traverses through what muscle?

A 
serratus anterior
(and intercostals)
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49
Q

What is the causative agent of walking pneumonia

A

mycoplasma pneumoniae

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50
Q

Mycoplasma pneumoniae requires ___ supplementation to grow on artificial media

A

cholesterol

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51
Q

In severe emphysema, what is the typical acid base status and how are the following affected: PaCO2, bicarb, pH, PaO2

A

respiratory acidosis with metabolic compensation
PaCO2: high (cause of resp acidosis is CO2 retention)
bicarb: high (compensation)
pH: slightly acidic
PaO2: low

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52
Q

Blood in the left atrium and ventricle has a slightly lower pO2 than blood in pulmonary capillaries due to mixing of deoxygenated blood from the _____ and ___ veins emptying into the left heart

A

bronchial veins (which empty into pulmonary veins which empty into left heart) and thebesian veins which are small cardiac veins

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53
Q

After a few weeks of primary TB, ____ lymphocytes are stimulated to release ____ which activates macrophages and leads to control of the infection

A

CD4

interferon gamma

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54
Q

What lung neoplasm has neural cell adhesion molecule

A

small cell carcinoma

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55
Q

What is the characteristic histopathologic feature of sarcoidosis

A

noncaseating granulomas

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56
Q

How does hyperventilation cause dizziness

A

hypocapnia –> reduced cerebral blood flow

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57
Q

What is seen on lung imaging of sarcoidosis

A

bilateral hilar adenopathy

pulmonary reticular infiltrates

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58
Q

What lab values are elevated in sarcoidosis?

A

calcium

ACE

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59
Q

Sarcoidosis has large number of ____ lymphocytes which release ___ and ___ to drive ___ activation and granuloma formation

A

CD4
interferon gamma
tumor necrosis factor alpha
macrophage

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60
Q

What is the most common cause of clubbing in adults

A

lung adenocarcinoma (tumor secretes VEGF)

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61
Q

Theophylline MOA

A

adenosine receptor antagonist and phosphodiesterase inhibitor (sometimes used as an alternate therapy for asthma and COPD)

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62
Q

What antibiotics are CYP450 inhibitors

A

isoniazid
macrolides (except azithromycin)
quinolones

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63
Q

During hypoxia, such as at high elevations, how is aldosterone effected

A

hypoxia –> aldosterone suppression –> diuresis and reduced plasma volume

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64
Q

How is diffusing capacity for carbon monoxide effected in emphysema

A

decreased

due to destruction of alveoli and adjoining capillary beds

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65
Q

What is the primary virulence factor of strep pneumoniae

A

polysaccharide capsule that inhibits opsonization and phagocytosis

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66
Q

What organism can be seen on microscopic examination of lung tissue as spherules packed with endospores

A

coccidioides immitis

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67
Q

_____ is characterized by bilateral pulmonary infiltrates and hypoxemia in the absence of heart failure

A

acute respiratory distress syndrome

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68
Q

In acute respiratory distress syndrome, inflammatory cytokines recruit ___ resulting in endothelial damage, capillary permeability and leakage of protein rich fluid into alveolar spave

A

neutrophils

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69
Q

at high altitude for 2 days, how are pH, PaO2, PaCO2, and bicarb affected

A

pH: increased (respiratory alkalosis)
PaO2: decreased
PaCO2: decreased (hyperventilation)
bicarb: increase

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70
Q

Acid fast staining is due to what being present in the organism walls

A

mycolic acid

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71
Q

Electrical stimulation of what nerve increases the diameter of the oropharyngeal airway and decreases the frequency of apneic events

A

hypoglossal (causes the tongue to move forwards slightly)

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72
Q

How does pneumocystis jirovecii appear on methenamine silver stain

A

the cell wall appears as a crescent, crushed ping pong ball, or a circular ring around a clear center

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73
Q

what is first line treatment for pneumocystis pneumonia (pneumocystis jirovecii)

A

trimethoprim-sulfamethoxazole

TMX

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74
Q

Lobar pneumonia is marked by cytokine-mediated accumulation of ___ and ____ material in the alveoli

A

neutrophils

proteinaceous

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75
Q

When saline is applied to the nasal mucosa of a patient with CF, increased ____ causes a more negative nasal transepithelial potential difference which can be used to diagnose cystic fibrosis

A

sodium absorption

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76
Q

Pneumoconioses are disease from the inhalation of fine dust particles that reach the respiratory bronchioles and alveoli. Particles that lodge in this region are usually cleared by what mechanism

A

macrophages

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77
Q

what effect does normal aging have on chest wall compliance, lung compliance, residual volume, forced vital capacity and total lung capacity

A 
chest wall compliance: decrease
lung compliance: increase
residual volume: increase
forced vital capacity: decreased
total lung capacity: relatively unchanged
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78
Q

What are the 3 leading pathogens that cause bacterial pneumonia

A

streptococcus pneumoniae
staphylococcus aureus
haemophilus influenza

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79
Q

Compare the FEV1, FVC, and FEV1/FVC in restrictive (fibrosis) vs obstructive (COPD) lung diseases

A

Restrictive: FVC reduced, FEV1 reduced, FEV1/FVC normal or sometimes increased
obstructive: FVC normal or reduced, FEV1 reduced, FEV1/FVC decreased

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80
Q

The superficial alveoli in the apices experience greater pressure changes due to weight of the lungs pulling down on the apical tissue, predisposing them to formation of ___ which can spontaneously rupture causing a primary spontaneous pneumothorax

A

subpleural blebs

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81
Q

What CD4 counts are required for a aspergillus pneumonia infection? Pneumocystis pneumonia?

A

aspergillus <50

pnueumocystis pneumonia: <200

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82
Q

During the initial phase of respiratory distress, interstitial and intraalveolar edema, inflammation, and fibrin depostion cause the alveoli to become line with _____ membranes

A

waxy hyaline

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83
Q

Pleural plaques (focal or band-like pleural thickening) are a hallmark of ____ exposure

A

asbestos (chronic inflammation and collagen deposition within the pleura)

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84
Q

Haemophilus influenza is a gram negative coccobacillus that requires what 2 things to grow

A

X factor: hematin

V factor: NAD+

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85
Q

What virulence factor allows H. flu type B to spread hematogenously and cause invasive disease such a septic arthritis and meningitis

A

antiphagocytic polysaccharide capsule

86
Q

Ketamine can be used for anesthesia induction. Why is it particularly useful in patients with bronchospasm

A

increased catecholamine release –> bronchodilation

87
Q

What lung changes are seen in chronic rejection of a lung transplant

A

bronchiolitis obliterans: lymphocytic inflammation, fibrosis, and ultimately destruction of the bronchioles

88
Q

During aerobic exercise, what changes happen to minute ventilation, ventilation/perfusion ratio, and mixed venous oxygen content

A

minute ventilation: increased (increased respiratory rate and tidal volume –> increased oxygen uptake and carbon dioxide removal)
ventilation/perfusion ratio: increased (increased ventilation –> decreased pulmonary vascular resistance –> reduced dead space)
mixed venous oxygen content: decreased (lactic acid in blood –> oxygen unloading from hemoglobin)

89
Q

Left sided heart failure has what effect on lung compliance

A

decreases lung compliance dur to accumulation of edema in the pulmonary interstitium that makes the lungs heavy and stiff, restricting expansion and decreasing compliance

90
Q

Arterial pressure of ____ is the major stimulator for central chemoreceptors to trigger increased ventilation. ____ is the major chemoreceptor for peripheral chemoreceptors (carotid body).

A

CO2

O2

91
Q

How are PaO2, PaCO2 and A-a gradient effected by normal aging

A

PaO2: decreased (via basilar microatelectasis from decreased muscle and chest wall stiffening –> intrapulmonary shunting: perfusion of blood through non ventilated alveoli)
PaCO2: unchanged (resting hypoventilation at any age is always pathologic)
A-a: increased (alveolar-arterial oxygen gradient; due to ventilation perfusion mismatch)

92
Q

What medications can be used to treat pulmonary arterial hypertension by lowering pulmonary arterial pressure and improving dyspnea

A

endothelin receptor antagonists: bosentan and ambrisentan

93
Q

Legionella pneumophila has what clinical presentation and elicits what abnormal blood test

A 
high fever
cough
confusion
diarrhea
hyponatremia
94
Q

The Reid index determines the severity of bronchitis by comparing the thickeness of the ____ divided by the thickness of what

A

submucosal bronchial glands
bronchial wall between the epithelial basement membrane and the bronchial cartilage (do not include the epithelium or cartilage)

95
Q

Pulmonary alveolar proteinosis is a rate condition characterized by progressive respiratory dysfunction due to the accumulation of _____ within the alveolar space which most often occurs due to impaired clearance by the ____

A

surfactant

alveolar macrophages

96
Q

Substance found in the alveoli that is periodic acid-Schiff positive and forms lamellar bodies is what

A

surfactant

97
Q

Peptosteptococcus and fusobacterium are anaerobic bacteria that are part of normal mouth flora. Presence of these organsims in the lung is highly suggestive of what lung pathology

A

lung abscess

98
Q

what are symptoms of lung abscess

A 
fever
night sweats
weight loss
cough
foul smelling sputum
99
Q

Malignant mesothelioma is a rare neoplasm typically arising from the _____. Histopathology reveals tumor cells with numerous _____ and abundant _____

A

long, slender microvili

tonofilaments

100
Q

How are the following effected by pneumothorax: tactile fremitus, breath sounds, resonance to percusion

A

tactile fremitus: decreased
breath sounds: decreased
hyperresonance to percussion

101
Q

How does septic shock cause an anion gap acidosis

A

tissue hypoxia –> impaired oxidative phosphorylation –> shunting of pyruvate to lactate –> lactic acidosis

102
Q

How does corticosteroid treatment improve response to albuterol

A

in addition to their anti-inflammatory effect, they upregulate B2 receptors and increased cellular responsiveness to adrenergic stimuli and potentiate the bronchodilatory response to B2 agonists

103
Q

____ is an encapsulated, lactose-fermenting (appears pink on macconkey agar), gram negative bacillus

A

Klebsiella

104
Q

What treatment for asthma are used chronically and can prevent inflammatory cellular reactions in the airways

A

inhaled corticosteroids (fluticasone)

105
Q

What acid base disorder is caused by pulmonary embolism

A

acute respiratory alkalosis

due to hyperventilation –> low CO2

106
Q

in a 19 yr old, small airways filled with mucin plugs containing abundant inflammatory cells and a dilated bronchial tree are findings in what condition

A

cystic fibrosis

107
Q

What cause of granulomas in the lungs can spread lymphatically and collect in the reticuloendothelial system (spleen and liver) and may appear on radiographic imaging as they calcify overtime

A

histoplasma capsultaum

108
Q

Why are patients with silicosis at an increased risk for TB

A

internalized silica particles impair macrophage function disrupting phagocytosis and promoting apoptosis

109
Q

How is putting a patient with acute respiratory distress syndrome in the prone position able to improve arterial oxygenatoin

A

reduced compression of posterior lung segments (location of majority of alveoli) –> more evenly distributed ventilation –> reduced shunting –? improved vent-perfusion matching

110
Q

_____ can cause pulmonary disease in immunocompetent host resulting in granuloma formation and is endemic to states adjacent to and east of the mississippi and ohio river valleys

A

blastomyces dermatitidis

111
Q

The leading bacterial cause of upper respiratory infections that exacerbate COPD is____

A

H flu

112
Q

Why is there an elevated central venous oxygen saturation in a patient with sepsis?

A

bacterial components and acute phase cytokines trigger production of free radicals –> damage mitochondria –> decreased oxidative phosphorylation –> decreased oxygen use

113
Q

Work of breathing is the energy expended during respiration and comprises the work required to over come ___ and ____

A

elastic resistance

airflow resistance

114
Q

What is elastic resistance and what type of lung diseases have increased elastic resistance

A

opposition to lung expansion
restrictive lung diseases
(interstitial fibrosis, severe obesity)

115
Q

what is airflow resistance and what type of lung diseases have increased airflow resistanct

A

opposition to airflow created by limited airway diameter and turbulent airflow
obstructive lung diseases
(asthma, COPD; due to bronchoconstriction or airway collapse)

116
Q

In patients with restrictive lung diseases, work of breathing is minimized in what relative tidal volume and respiratory rate

A

tidal volume: low

to compensate for low lung volumes, rapid, shallow breathing is favored

117
Q

in patients with obstructive lung disease, the work of breathing is minimized at what relative tidal volumes and respiratory rates

A

respiratory rate: low

tidal volume: high

118
Q

The inflammatory immune response to radiation induced lung damage, for example, can have what acute and what delayed histological effects

A

acute: exudative alveolitis and hyaline membrane formation
delayed: dense fibrosis

119
Q

infection with ______ can cause a brassy, barking cough, dyspnea following a recent upper respiratory infection in children

A

croup (parainfluenza, a member of paramyxoviridae family)

120
Q

What medication can be used to reduce withdrawal cravings and attenuate the rewarding effects of nicotine

A

varenicline (partial nicotinic agonist)

121
Q

What pulmonary disease can be caused directly by rheumatoid arthritis as well as its treatment including methotrexate, cyclophosphamide, and sulfasalazine)

A

interstitial lung disease

122
Q

A green inspissated mass (dehydrated meconium) in the distal ileum points to the diagnosis of meconium ileus as a source of obstruction which is a very specific finding in what disease

A

cystic fibrosis

123
Q

Nearly all cases of mesothelioma will stain positive for ___ and many will also typically stain positive for ____

A

cytokeratins
calretinin
(EM shows polygonal tumor cells with numerous long, slender microvilli and abundant tonofilaments)

124
Q

In a patient with cystic fibrosis presenting with acute onset shortness of breath and subcutaneous crepitus, what is the cause of the acute shortness of breath

A

spontaneous pneumothorax

common in CF

125
Q

A patient with bilateral hilar adenopathy, elevated serum ACE levels, skin lesions, and hepatomegaly likely have what diagnosis

A

sarcoidosis

126
Q

What malignancies are patients with a long history of asbestos exposure at risk for developing

A 
bronchogenic carcinoma (more common)
mesothelioma (only caused by asbestos but less common)
127
Q

histology of what condition shows lymphocytic infiltrate, poorly formed noncaseating granulomas, and septal fibrosis on biopsy

A

hypersensitivity pneumonitis

128
Q

ferruginous bodies (translucent fibers coated with a golden iron containing material) are histopathologic signs on lung biopsy of what

A

asbestosis exposure

129
Q

Etomidate is a ____ agonist that is often used for anesthesia induction

A

GABA

130
Q

Which anesthesia has the advantage of being the most hemodynamically neutral

A

Etomidate

131
Q

What anesthesia has the advantage of reducing airway resistance but causes vasodilation –> hypotension

A

propofol

132
Q

What anesthesia has the benefit of an analgesic effect

A

ketamine

133
Q

Describe the strep pneumoniae vaccination for infants vs the elderly

A

infants: polysaccharide vaccine, contains 23 serotypes, T cell independent response driven largely by B cell activation
elderly: conjugate vaccine, capsular polysaccharides from 13 serotypes covalently attached to recombinant, inactivated diptheria toxin. protein allows histocompatibility complex to display –> Tcell mediated B cell lymphocyte activation

134
Q

An aspergilloma (mycetoma) represents Aspergillus colonization which may develop in old lung cavities from what?

A

TB
emphysema
sarcoidosis

135
Q

Intermittent respiratory symptoms in a patient with a normal chest xray, sputum eosinophils, and reduced FEV1 suggests what diagnosis

A

asthma

136
Q

describe the histological changes that cause emphysema

A

interalveolar septal destruction with bronchial wall inflammation

137
Q

What type of embolism should be strongly suspected in a patient with severe longbone and/or pelvic fractures who develops acute onset neuro abdnormalities, hypoxemia, and petechial rash

A

fat

138
Q

Abscess formation is largely driven by ____ recruitment and activation

A

neutrophil

139
Q

Inhibition of glycosyltransferase has what effect on bacteria

A

gaps in bacterial cell wall –> cell lysis from osmotic stress

140
Q

why are organisms from the mycoplasma genus immune to the follow agents: penicillins, cephalosporins, carbapenems, vanco

A

they lack a cell wall

141
Q

Montelukast MOA

A

leukotriene receptor antagonist (treats asthma by preventing leukotrienes to bind their receptors which causes bronchoconstriction, mucus secretion and edema)

142
Q

define cor pulmonale

A

hypertrophy and/or dilation of the right ventricle due to disease of the lungs or pulmonary blood vessels

143
Q

How does sarcoidosis cause hypercalcemia

A

activated macrophages produce 1,25 dihydroxyvitamin D which leads to increased intestinal absorption of calcium

144
Q

What complication of asthma can result in transient recurrent pulmonary infiltrates and eventual proximal bronchiectasis

A

allergic bronchopulmonary aspergillosis

145
Q

exudative effusions are typically due to what?

A

inflammation and consequent increased vascular membrane permeability

146
Q

What dimorphic fungus is a large round yeast with doubly refreactile wall and single broad based bud on biopsy (37 C)

A

blastomyces dermatitidis

147
Q

what dimorphic fungus appears as oval yeast cells within macrophages on biopsy (37 C)

A

histoplasma capsulatum

148
Q

What dimorphic fungus appears as cells covered in budding blastoconidia on biopsy (37 C)

A

paracoccidioides brasiliensis

149
Q

what dimorphic fungus appears as thick walled spherules filled with endospores on biopsy (37 C)

A

coccidioides immitis

150
Q

what dimorphic fungus appears as round or cigar shaped budding yeasts on biopsy (37 C)

A

sporothrix schenckii

151
Q

What fluid type should be administered for volume resuscitation as seen in septic shock

A

isotonic: .9% normal saline or lactated ringer solution

isotonic is similar tonicity to blood

152
Q

Generally, the most important protection from influenza A includes a humoral response with antibodies directed against ____.

A

hemagglutinin
(neutralize the virus and primarily block its binding to host cells)
(neuraminidase antibodies have some protective effect by decreasing extent of viral invasion and shedding but not the main source of protection against reinfection)

153
Q

Eosinophils are recruited and activated by what cytokine secreted by what cells?

A

IL-5

TH2 type T cells

154
Q

Positive end-expiratory pressure helps treat ARDS by opening collapsed alveoli to reduce intrapulmonary shunting and increase functional residual capacity. Increased FRC has what benefits

A

decreased ventilation perfusion mismatching

increased oxygen reserve

155
Q

How do advanced hypoxic lung diseases such as COPD cause pulmonary hypertension

A

mainly from diffuse hypoxic vasoconstriction and to a lesser degree from vascular remodeling

156
Q

Hamartomas are common, slow-growing, benign lung neoplasm microscopically characterized by nodules of disorganized, mature _____ and entrapped respiratory epithelium

A

connective tissue

157
Q

MOA of cromoglycates/cromolyn/nedocromil

A

inhibit mast cell degranulation and prevent release of preformed chemical mediators

158
Q

Staph aureus strains that express _____, a protease that kills leukocytes and causes necrosis, are most likely to cause skin or soft-tissue abscess and invasive disease

A

Panton-Valentine leukocidin (PVL)

159
Q

Particles in or proximal to the terminal bronchioles are cleared by what mechanism? How are particles distal to the terminal bronchioles mainly cleared?

A

terminal bronchioles: cilia

distal to terminal bronchioles: macrophages

160
Q

Describe the changes that occur in the following with a pneumothorax: intrapleural negative pressue, volume of effected hemithroax, inspiratory compliance

A

negative pressure: decreased
volume of hemithorax: increased
inspiratory compliance: decreased

161
Q

_____ results from an exaggerated immunologic response to an inhaled antigen. Bronchoalveolar lavage typically shows high relative lymphocyte count which helps support the diagnosis

A

hypersensitivity pneumonitis

162
Q

What causes central sleep apnea

A

diminished respiratory drive from a neurologic disorder

163
Q

Does cystic fibrosis cause a obstructive or restrictive lung disease

A

obstructive

164
Q

What cause of pneumoconiosis appears histologically as birefringent silicate particles within dense, whorled collagenous nodules durrounded by dust-laden macrophages

A

silica

165
Q

In community acquired pneumonia, a patient may have improved oxygenation shortly after treatment initiation despite no changes in alveolar debris or edema. What mechanism is responsible for this initial clinical improvement?

A

in inflammatory states, hypoxic pulmonary vasoconstriction is impaired –> vasodilation in regions that are not ventilated.
treatment decreases vasoactive inflammatory mediators which restores hypoxic pulmonary vasoconstriction and decreases perfusion to unventilated areas

166
Q

How is A-a gradient effected in low respiratory drive such as benzo overdose

A

A-a is not effected because efficiency of gas transfer between the lungs and the circulation is intact

167
Q

Will a pneumothorax produce hyper, hypo or normal resonance on percussion

A

hyper

168
Q

What does a lung biopsy showing engorged alveolar capillaries with acellular pink material represent

A

acute pulmonary edema

169
Q

What complication of ascites may cause a transudative right-sided pleural effusion

A

hepatic hydrothorax: passage of intraabdominal fluid into chest cavity through small fenestrations in the diaphragm

170
Q

What 3 cell types are the primary mediators of disease in COPD

A

neutrophils
macrophages
CD8 T cells
(secrete enzymes and proteases that cause and perpetuate alveolar destruction and mucus hypersecretion)

171
Q

What is empyema

A

bacterial invasion of intrapleural space -> progressive inflammation, pus accumulation, and organized fibrosis

172
Q

In empyema, drainage with a chest tube is often difficult due to loculations and high fluid viscosity, but it can be aided by the intrapleural administration of ____ in combination with ____

A 
fibrinolytic agent (TPA)
nucleic acid cleaving enzyme (deoxyribonuclease (DNase))
(these help break down organized fibrin and cleave nucleic acids that increase fluid viscosity after being deposited by lysed leukocytes)
173
Q

how is group B strep in a newborn prevented

A

intrapartum (during birth) administration of penicillin or ampicillin

174
Q

what is the cause of exudative pulmonary edema in acute respiratory distress syndrome

A

neutrophilic lung inflammation with widespread alveolar damage due to proteases and reactive oxygen species, leading to failure of the vascular barrier and exudative pulmonary edema

175
Q

Mucicarmine staining of lung tissue and bronchoalveolar washings revealing budding yeast forms with thick capsules indicates what diagnosis

A

cryptococcus neofromans

176
Q

what is the most common presentation of a cryptococcus neoformans infection

A

meningoencephalitis

lung infection occurs first but is usually asymptomatic

177
Q

Patients with alcohol use disorder are at increased risk for lung abscess due to aspiration of bacteria from where? what type of pathogens should be covered in emperic treatment

A

oral flora

strict and facultative anaerobic oral flora (bacteroides, prevotella, fusobacterium, peptostreptococcus)

178
Q

What is CREST syndrome

A 
calcinosis
Raynaud phenomenon
esophageal dysmotility
sclerodactyly
telangiectasia
179
Q

What is the initial treatment of choice in sarcoidosis

A

oral glucocorticoids

180
Q

What is atelectasis

A

diffuse alveolar collapse (as seen in neonatal respiratory distress syndrome)

181
Q

Normal aging as what effect on the following: total respiratory compliance , lung compliance, dead space

A

total respiratory system compliance: decreased
lung compliance: increased (but chest wall is stiffer so decreased total compliance)
dead space: increased (loss of alveolar surface area)

182
Q

What electrolyte imbalance is caused directly by cystic fibrosis

A

hyponatremia and hypochloremia due to excessive sodium chloride loss through sweat

183
Q

What fungus replicates within macrophages and spreads throughout the reticuloendothelial system as small, ovoid yeasts

A

histoplasma capsulatum

184
Q

What would cause unilateral lower lobe dullness on percussion, breath sounds that are loud hollow and high pitched, and higher clarity when the patient says “ninety nine” in a normal voice

A

alveolar consolidation due to being filled with fluid, ie bacterial pneumonia

185
Q

Massive life-threatening hemoptysis is typically due to hemorrhage from _____ . How is bronchiectasis a common etiology

A

high pressure bronchial circulation

chronic airway inflammation –> hypertrophied bronchial arteries which are prone to rupture with coughing

186
Q

Intrapleural negative pressure peaks at maximal inspiration at a value of approximately ____ cm H2O. During passive expiration the chest wall relaxes and the respiratory system returns to its equilibrium position, in which intrapleural pressure is approximately ___ cm H2O

A
  • 8

- 5

187
Q

The ____ of type II pneumocytes store and release pulmonary surfactant into the fluid layer lining the inner surface of alveoli

A

lamellar bodies

188
Q

What shunting is present due to neonatal respiratory distress syndrome caused by surfactant deficiency

A

intrapulmonary right-to-left shunt due to decreased ventillation/perfusion ration
extrapulmonary right-to-left shunt within the heart or patent ductus arteriosus due to compensatory pulmonary vasoconstriction

189
Q

What shunting is present due to neonatal respiratory distress syndrome caused by surfactant deficiency

A

intrapulmonary right-to-left shunt due to decreased ventillation/perfusion ration
extrapulmonary right-to-left shunt within the heart (foramen ovale) or patent ductus arteriosus due to compensatory pulmonary vasoconstriction

190
Q

Why does a tension pneumothorax cause hypotension

A

increased intrapleural pressure –> vena cava collapse –> decreased venous return –> hypotension, tachycardia, obstructive sock

191
Q

A child presenting with high fever and shortness of breath who is leaning forward, with their neck extended and mouth open to breath likely has what diagnosis

A

H. flu with epiglottitis

posture described is the tripod position

192
Q

What will be seen on a chest x ray of a collapsed lung due to bronchial obstruction

A

trachea deviated toward affected side (other organs such as the heart and esophagus may also shift in the same direction)
completely opacified hemithorax due to loss of radiolucent air

193
Q

A patient with interstitial lung disease will have a significant drop in arterial partial pressure of oxygen during exercise due to what normal physiologic change during exercise

A

increased pulmonary blood flow

decreases time that for oxygen extraction in a person who already has a limited oxygen diffusion across the membrane

194
Q

What causes high RBC chloride content in venous blood compared to arterial blood

A

CO2 from tissues is converted to bicarb by carbonic anhydrase in RBC, bicarb is then transferred into the plasma via exchange with chloride ions

195
Q

Explain how high altitude can cause pulmonary edema

A

reduced oxygen –> hypoxic pulmonary vasoconstriction and pulmonary arterial hypertension
if pulmonary vasoconstriction is uneven areas of high capillary perfusion pressure can disrupt the alveolar-capillary membrane leading to patchy, bilateral pulmonary edema

196
Q

Under normal conditions, pleural fluid enters the pleural space via ____ and exit via ____

A 
intercostal microvessels
lymphatic stomata (holes in the pleura) that drain into parietal pleura lymphatics
197
Q 
How are the following affected in idiopathic pulmonary fibrosis: 
type 1 pneumocytes
type 2 pneumocytes
basement membrane
fibroblasts
A

type 1: decreased (due to repetitive injury)
type 2: increased (due to proliferation in order to repair damage)
basement membrane: abnormal
fibroblasts: increased (produces honeycomb appearance and dilation of terminal bronchioles)

198
Q

Pertussis is what kind of organism

A

gram negative coccobacillus

199
Q

What should be suspected in a patient presenting with facial weakness and hypoventilation causing respiratory failure

A

myasthenia gravis

200
Q 
Which of the following cause increased breath sound intensity and increased tactile fremitus: 
lobar consolidation
pericardial effusion
pneumothorax
pleural effusion
pulmonary edema
A

pulmonary edema
lobar consolidation
(vibration travels faster and more efficiently through liquids than gases)
(fluid in the pleural space acts to insulate sound vibrations so pleural effusion causes decreased sounds)

201
Q

What protects the lungs from infarction during a pulmonary artery occlusion (ie pulmonary embolism)

A

collateral circulation from the bronchial arteries

202
Q

How does Histoplasma capsulatum appear on lung biopsy

A

ovoid/round yeast predominantly within the intracellular space of macrophages

203
Q

In interstitial lung disease, what 2 changes cause an increased expiratory flow rate when corrected for the low lung volume

A

increased elastic recoil

increased radial traction (outward pulling on the airways)

204
Q

According to Light criteria, pleural fluid/serum lactate dehydrogenase ratio > ____ is an exudative effusion

A

.6

205
Q

The green discoloration of pus or sputum seen during common bacterial infections is due to the presence of ______, a blue-green heme-based enzyme that is released from ___ azurophilic granules

A

myeloperoxidase

neutrophil

206
Q

In neonate respiratory distress syndrome, how are the following affected before treatment/intervention:
alveolar compliance
functional residual capacity
airway resistance

A

alveolar compliance: decreased

functional residual capacity: decreased

207
Q

Prolonged, untreated obstructive sleep apnea can cause what complication

A

pulmonary hypertension and right heart failure

208
Q

Describe why hereditary hemorrhagic telangiectasia causes pulmonary hypertension

A

systemic arteriovenous malformations –> high output heart failure

209
Q 
How will pulmonary arterial levels of the following be affected in pulmonary arterial hypertension: 
endothelin
thromboxane
nitric oxide
prostacyclin
A

endothelin and thromboxane: increased
nitric oxide and prostacyclin: decreased
(endothelial dysfunction –> increased releases of vasoconstrictive, proproliferative mediators and decreased vasodilative, antiprolferative mediators)

210
Q

What is the most common primary lung cancer in the general population

A

adenocarcinoma

211
Q

Albuterol is a ___ receptor agonist which increases ____ levels in bronchial smooth muscle to induce bronchodilation

A

beta 2

cyclic AMP

212
Q

How does excessively high oxygen supplementation cause confusion and lethargy in patients with COPD

A

oxygen induced hypercapnia

high PaO2 –> reversal of pulmonary vasoconstriction in underventilated areas –> inability to excrete CO2

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