Pulmonary

Question 1

aging and its effects on pulmonary function

Answer 1

• decrease in chest wall compliance
• increase lung compliance due to loss of elastic recoil
• dilation of alveolar ducts is homogenous
• increase in residual volume
• total lung capacity= unchanged
• decrease in forced vital capacity

Question 2

what test to use to test for asthma

Answer 2

methacholine challenge test- muscarinic cholinergic agonists that acts by inducing bronchial smooth muscle contraction and increasing bronchial mucus production

Question 3

findings of idiopathic pulmonary fibrosis

Answer 3

progressive exertional dyspnea, dry cough, restrictive profile, interstitial fibrosis with cystic air space enlargement, patchy involvement with dense fibrosis , “honeycomb” changes

Question 4

why does supplemental oxygen administration in patients with COPD lead to oxygen-induced hypercapnia and thus lead to confusion and depressed consciousness?

Answer 4

reversal of hypoxic pulmonary vasoconstriction–> increases physiologic dead space as blood is shunted away from well-ventilated alveoli

Question 5

hypoxia stimulates _________ production from the renal cortex

Answer 5

erythropoietin–> to stimulate erythrocyte production

Question 6

________ deficiency is associated with reddish-pink, periodic acid-Schiff-positive granules

Answer 6

alpha-1 antitrypsin (AAT)

associated with panacinar emphysema

Question 7

signs of sarcoidosis

Answer 7

accumulation of CD4+ cells, noncaseating granulomas in parenchyma and hilar lymph nodes, dyspnea, enlarged mediastinal and hilar lymph nodes on x-ray, high ACE levels, hypercalcmia

Question 8

______ is a competitive antagonist of endothelin receptors used for pulmonary arterial hyptertension

Answer 8

Bosentan

Question 9

electrical stimulation of the ______ nerve increases the opening of the orophyngeal airway to decrease obstructive sleep apnea episodes

Answer 9

hypoglossal

Question 10

side effect of inhaled glucocorticoids/ corticosteroids (1st line for chronic asthma)

Answer 10

oral thrush/ oropharyngeal candidiasis

*use a spacer and rinse mouth after use to reduce risk

Question 11

leukotriene B4

Answer 11

stimulates neutrophil migration to sites of inflammation

Question 12

immune response to pulmonary tuberculosis infection to control it

Answer 12

CD4+ TH1 lymphocytes and macrophages

Question 13

why do lung infarction only rarely develops as a complication of pulmonary embolism?

Answer 13

lung is supplied by dual circulation from the pulmonary and bronchial systems (collateral circulation)

Question 14

how does pulmonary emboli usually appear on the lung?

Answer 14

multiple wedge-shaped hemorrhagic lesions in the periphery of the lung

Question 15

IV drug users are at risk for developing septic pulmonary emboli as a complication of __________

Answer 15

tricuspid valve endocarditis

Question 16

which has a more significant effect on cerebral blood flow: pCO2 or pO2?

Answer 16

pCO2

CO2 causes cerebral vasodilation, so decreases CO2 like with asthma, then decreased cerebral blood glow and lead to dizziness, weakness, and blurred vision

Question 17

peripheral chemoreceptors found in __________________ are the primary sites for sensing arterial PaO2 and are stimulated by hypoxemia

Answer 17

carotid and aortic bodies

Question 18

antibiotic good for lung abscess, oral infections and aspiration pneumonia

Answer 18

Clindamycin

Question 19

Vitamin ___ maintains orderly differentiation of specialized epithelia, including mucus-secreting columnar epithelia of the ocular conjuctiva, respiratory and urinary tracts, and pancreatic and other exocrine ducts

Answer 19

A

Question 20

primary cell lines that are increased in stable COPD

Answer 20

neutrophils, macrophages, and CD8+ T lymphocytes

*secrete enzymes and proteases that perpetuate both alveolar destruction of emphysema and mucus hypersecretion found in chronic brochitis

Question 21

complication of using concentrated oxygen therapy for neonatal respiratory distress syndrome

Answer 21

retinopathy of prematurity

major cause of blindness

Question 22

ventilation/perfusion scan finding for pulmonary embolism

Answer 22

perfusion defect with ventilation defect

Question 23

Cystic fibrosis is an autosomal ______ disease caused by mutations in the _________ gene

Answer 23

recessive; CF transmembrane conductance regulator (CFTR)

*CFTR protein=transmembrane ATP-gated Cl- channel

Question 24

Chyne-Stokes breacthing

Answer 24

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

• associated with advanced congestive heart failure

Question 25

what is the Reid index? like how is it measured?

Answer 25

ratio of the thickness of the mucous gland layer in the branchial wall submucosa to the thickness of the bronchial wall between the respiratory epithelum and bronchial cartilage—> does not include the cartilage part

for chronic bronchitis

Question 26

arterial blood gas changes associated with high altitudes

Answer 26

hypoxemia–> reduced PaO2–> triggers chemoreceptors in carotid bodies–> hyperventilation–> decrease PaCO2–> respiratory alkalosis–> compensation would decrease bicarb

Question 27

Pancoast tumor (key findings)

Answer 27

*key: shoulder pain and Horner’s syndrome

superior sulcus tumor arise at lung apex

Question 28

4 major causes of hypoxemia

Answer 28

alveolar hypoventilation, ventilation-perfusion mismatch, diffusion impairment, and right-to-left shunting

A-a gradient is normal with alveolar hypoventilation- distinguishes it from others

Question 29

fat embolism syndrome: the classic triad

Answer 29

acute-onset neurologic abnormalities, hypoxemia, and petechial rash

Question 30

fat embolism syndrome caused by

Answer 30

severe long bone and/or pelvic fratures

fat globules dislodges from bone marrow and travel to lung–> can cause ARDS

Question 31

normal A-a oxygen gradient

Answer 31

5-15 mm Hg, with older people having a higher gradient

Question 32

untreated obstructive sleep apnea can lead to (2 things)

Answer 32

pulmonary hypertension and right heart failure

Question 33

why is it thought that small cell carcinoma of the lung have a neuroendocrine origin?

Answer 33

tumor cells express neuroendocrine markers and have neurosecretory granules in the cytoplasm

Question 34

adverse effects of theophyline (asthma drugs that causes bronchodilation by inhibiting phosphodiesterase)

Answer 34

seizures and tachyarrhythmias (do not usually case QT prolongation)

seizures=major cause of morbidity and mortality in theophylline intoxication