Pulmonary and Critical Care Flashcards
1
Q
pleuritic chest pain arising from the mediastinal or diaphragmatic pleura will be carried by the _____ nerve
A
phrenic
2
Q
amniotic fluid lecithin (phosphatidylcholine) to sphinomyelin ration (L/S) is measured to assess ______
considered mature when ration is greater than
A
fetal lung maturity
2
3
Q
probability of a child from two parent populations with different mutant allele carrier frequencies will inherit and AR disease is =
A
25% multiplied by the carrier frequencies
4
Q
_______ pneumocytes regenerate alveolar lining following injury and produce surfactant
A
Type II
5
Q
COPD encompasses _______ and _______. _________ causes destruction of interalveolar walls and decreased ____________, leading to increased ________, ___________, _______________
patients present with hyperinflated lungs, flattened diaphragm, barrel shaped chest
A
chronic bronchitis and emphysema
emphysema
lung elastic recoil
residual volume, functional reserve capacity, total lung capacity
6
Q
smaller spheres w/o surfactant will ______ compared to larger ones due to laplace’s law and the difference in _____
A
collapse
surface tension
7
Q
ill school children spread to older adult, abrupt onset fever, HA, myalgia, and malaise, symptoms gradually improve =
predisposes to secondary infection bacterial pneumonia from (3)
A
influenza A
streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae
8
Q
cromoglycates such as ______ block mast cell degranulation independent of the triggering stimulus
A
cromolyn and nedocromil
9
Q
the F508 mutation in the _____ protein is the most common mutation in patients with ____. These patients produce eccrine sweat with higher than normal concentrations of sodium and chloride, thus exposure to high temperatures and exercise can lead to ______
A
CFTR
CF
hyponatremia
10
Q
early onset, no smoking history of emphysema is likely due to ______ and shows as lower lobe predominant
due to breakdown of _____
properties of this protein are due to extensive crosslinking between monomers, facilitated by
A
alpha 1 antitrypsin deficiency
elastin
lysyl oxidase
11
Q
_________ and aceetylcholine have pharmacologic receptor antagonists that offer clear therapeutic benefit in allergic asthma, while _______ plays a minor role
A
Leukotrienes (LTC4, D4, E4)
Histamine
12
Q
anaphylactic shock is due to _____ hypersensitivity which occurs when cell surface bound ____ bridge by ______. This is mediated by basophils, mast cells and ____
A
Type I
Antibody
Antigen
IgE
13
Q
pulmonary vascular resistance is lowest at the _____
A
functional residual capacity
14
Q
Each MHC class I molecule consists of a heavy chain and a _______. These molecules interact with
A
Beta 2 microglobulin
CD8 CTL
15
Q
minute ventilation includes _______ while alveolar ventilation does not
A
dead space volume
16
Q
antiretroviral therapy prenattaly will decrease
A
HIV transmission to infant
17
Q
F508 mutation in CF leads to protein _____ and failure of ______ followed by proteasome mediated degradation of CFTR proteins
A
misfolding and failure of glycosylation
18
Q
the most highly oxygenated blood in the fetus is carried by the _______ which empties directly into the _____ via the ________
A
umbilical vein
inferior vena cava
ductus venosus
19
Q
alveolar fluid contains natural proteases like elastase that are derived from infiltrating ________ and alveolar _______
A
neutrophils
macrophages
20
Q
hyperinflated lungs, airway mucus plugging, cellular infiltrate of the bronchial wall =
cellular infiltrate due to =
controlled most strongly by
A
chronic bronchial asthma
leukotrienes
glucocorticoids like fluticasone (inhaled)
21
Q
HIV pneumonia with CD4+ count 400-1400 =
less than 200 =
A
Strep pneumo
P jiroveci
22
Q
the most common cause of lung abscesses in alcoholics is a __________ infection of ________ that should be treated with _________
another common cause of aspiration pneumonia in alcoholics is ______ that should be treated with _______
A
polymicrobial
anaerobes
clindamycin
Klebsiella
cephalosporins
23
Q
recurrent respiratory infections, dextrocardia, infertility = which is a form of primary ciliary dyskinesia. This disorder is characterized by situs inversus, chronic sinusitis, and bronchiectasis and is due to the failure of _________ to develop normally
A
Kartagener syndrome
dynein arms
24
Q
immunosuppressed, lung infection with infiltrates, unresponsive to antibiotics, stains red on ________ is indicative of ______________ infection. The polysaccharide capsule appears clear and unstained on india ink
A
mucicarmine
Cryptococus neoformans
25
immunosuppressed, fever, weight loss, HSM, painful oral ulcers, cough, bone marrow aspirate shows intracellular ovoid bodies in macrophages =
Histoplasma capsulatum
26
________ is the most aggressive type of lung cancer and can present with paraneoplastic SIADH and hyponatremia. These have neuroendocrine origin and will stain for markers such as _______ or CD56, enolase, chromogranin, and synaptophysin
Small cell carcinoma of the lung
Neural cell adhesion molecule (NCAM)
27
chest tube placement for pleural effusion is placed into the 4th or 5th intercostal space in the anterior axillary or midaxillary line and traverses through ________, _________, and the parietal pleura
serratus anterior
intercostals
28
IL-12 stimulates the differentiation of naive Thelper cells into the ______ cell. Patients with IL 12-R deficiency suffer from severe mycobacterial infections due to the inability to mount a strong cell mediated ______immune response. They are treated with ______
IL2, IFNy, lymphotoxin B secreted by
IL4, 5, 10, 13 secreted by
Th1
granulomatous
IFN-y
Th1
Th2
29
obstructive lung disease due to _______ or _______ shows as a left shift and shrinkage on a volume flow loop, where as restrictive lung disease due to _______ will show as a right shift and shrinkage on a volume flow loop
chronic bronchitis or emphysematous destruction of interalveolar walls
pulmonary fibrosis
30
________ is a fast acting, depolarizing neuromuscular blocking agent used for rapid sequence intubation that has two phases of blockade
Succinylcholine
31
sudden onset dyspnea in a setting of calf swelling is strongly suggestive of _____. This leads to the development of a ______ mismatch, hypoxemia, hyperventilation, and ________
pulmonary embolism
V/Q
respiratory alkalosis
32
________ has an inactivating mutation affecting _____ that results in recurrent infections with catalase positive bacteria and fungi affecting the lungs, skkin, lymph nodes and shows diffuse granuloma formation. These patients lack neutrophil superoxide production.
inheritance =
chronic granulomatous disease
NADPH oxidase
X linked
33
sensitized ___ cells secrete ____ and _____ which promote B lymphocyte classing switching for IgE synthesis
Th2
IL4
IL13
34
_________, _________, _________ are able to disrupt the peptidoglycan cell wall of G+ and G- organisms: after treatment, these organisms lose their ability to tolerate ______ stress
penicillins
cephalosporins
vancomycin
osmotic
35
worsening shortness of breath, normal PaO2, normal SaO2, low oxygen content =
chronic blood loss
36
daytime somnolence, non restorative sleep with frequent awakenings, morning headaches, obese, systemic HTN =
obstructive sleep apnea
37
during aerobic exericse, increased skeletal muscle ______ production increases the ______ of ______
CO2
PCO2
Mixed venous blood
38
patient with chronic fatigue, dyspnea, difficulty concentrating, and increased PaCO2 in the setting of obesity likely has _________, which is an important causes of hypoxemia with a normal alveolar to arterial oxygen gradient
obesity hypoventilation syndrome
39
aging is associated with steady decreases in chest wall compliance, but increases in lung compliance due to loss of ______ recoil. THis causes an _______ in residual volume, a _________ in forced vital capacity, and an unchanged total lung capacity
elastic
increase
decrease
40
older adult with incidental pleural thickening with calcification of the posterolateral midlung zones and diaphragm likley has
full blow _______ presents with slowly progressive diffuse pulmonary fibrosis
asbestos related pleural disease
asbestosis
41
pulmonary _______ resembles sarcoidosis with nodular infiltrates, enlarged lymph nodes, noncaseating granulomas
berylliosis
42
nodular densities and eggshell calcifcations of the hilar nodes are seen in
pulmonary silicosis
43
radiographic multiple discrete nodules most prominent in the upper lung zones
coal workers pneumoconiosis
44
in left ventricular failure, fluid accumulation in the lung interstitium leads to
decreased compliance
45
polyribosylribitol phosphate, or PRP is a capsule component and major virulence factor for ______. This is the most common cause of _____, and presents with fever, stridor, and dyspnea in unvaccinated children
Haemophilus influenzae type b
epiglottitis
46
most inhaled particles that lodge in the bronchial tree are removed via proximal transport by ________ epithelial cell
ciliated
47
adult with long lasting cough, with bursts of coughing so severe that they vomit, that is around kids often =
this a _______ coccobacillus
pertussis (whooping cough)
Gram -
48
acute respiratory distress syndrome develops results in formation of interstitial and alveolar edema and exudate resulting from increased _______. This leads to _____ lung compliance, _______ work of breathing, ________ V/Q mismatching, and a _________ pulmonary capillary wedge pressure
pulmonary capillary permeability
decrease
increase
worsening
normal
49
immunosuppressed due to lung tranplant, pneumonitis, enlarged cells with intranuclear and intracytoplasmic inclusions (owls eyes) =
type of virus
CMV
enveloped, dsDNA virus
50
candida albicans is a normal inhabitant of the _______ including ______, thus it is a common contaminant of sputum culture
looks like
GI tract
oral cavity
budding yeast
51
sepsis is one of the most common risk factors for ______. As cytokines circulate in response to infection, they activate the pulmonary epithelium and provoke and neutrophil inflammatory response that leads to capillary damage and the leakage of protein and fluid into the alveolar space
acute respiratory distress syndrome
52
FEV1 <80% =
FEV1/FVC <70%? >70%?
FVC normal? or decreased? less than 80%?
obstructive or restrictive
obstructive, restrictive
obstructive, obstructive, restrictive
53
emphysema will cause an ______ in total lung capacity, a _______ in diffusing capacity for carbon monoxide, and a _______ in FEV1/FVC ratio
increase
decrease
decrease
54
cruise travel or hotel visit, headache, confusion, watery diarrhea, fever, bradycardia =
lab findings =
culture on
Legionella pneumonia
hyponatremia
BCYE
55
COPD can cause hypoxia suffiicient enough to stimulate _____ production
EPO
56
the ____________ mediates the afferent limb of the cough reflex above the vocal cords. Foreign bodies lodged in the piriform recess can cause damaged to this nerve
internal laryngeal nerve
57
progressive exertional dyspnea and dry cough, restrictive profile on PFT, and interstitial fibrosis with cystic air space enlargement are characteristic of _______, with honeycomb changes and fibroblastic foci more prominent in the subpleural and paraseptal spaces. This is in the absence of any other indicating symptoms
idiopathic pulmonary fibrosis
58
_______ infection by M tuberculosis occurs after inhaling the organism. This infection is characterized by a Ghon complex, which consists of lower lobe lung lesion (Ghon focus) and ipsilateral hilar adenopathy with calcification
Primary
59
________ commonly contaminates hospital _______. The culture is performed on BCYE with L cysteine and iron, and the organism is best visualized with silver stains
Legionella
water systems
60
young adult african american women with progressive dyspnea on exertion, nonproductive cough, and fatigue with a family history of RA. Non caseating granulomas with aggregates of epitheloid macrophages and multinucleated giant cells
Sarcoidosis
61
the inflammatory cells that mediate COPD are _____, _____, and ____
neutrophils
macrophages
CD8+ CTL
62
chronic cough and progressive weight loss with positive acid fast bacilli =
samples of granulomas will yield ______ giant cells with multiple nuclei on the periphery in a horsehoe pattern. The macrophages that form these giant cells are activated by _______
pulmonary tuberculosis
Langerhans
CD4+ Th1 lymphocytes
63
F508 mutation in CF impairs ____ of CFTR
post translational processing
64
the intercostal vein, artery, and nerve lie in the subcostal groove on the ______ of the rib.
Thoracentesis should be performed above the 8th rib at the midclavicular line, the 10th rib along the mixaxillary line, and the 12th rib along the posterior scapular and paravertebral line. At the 10th rib, you risk injuring the ____
inferior border
right hepatic lobe
65
stab wound above the clavicle between the mid clavicular line and the lateral sternal line risks injuring the ______
lung pleura
66
thickened bronchial walls, lymphocytic infiltrate, mucous gland enlargement, and patchy squamous metaplasia of the bronchial mucosa indicates =
_______ is the leading cause of chronic bronchitis
chronic bronchitis
cigarette smoking
67
drug that reduces nicotine cravings while decreasing pleasurable effects of cigarettes and other tobacco products =
MOA?
varenicline
parital agonist of NAChR
68
_______ is the antifungal of choice for oropharyngeal candidiasis in patients without advanced immunodeficiency
Nystatin
69
Arterial PaCO2 is a direct indicator of ________ status. Hypocapnia implies alveolar _______.
hypercapnia implies ________
upper airway obstruction, reduced ventilatory drive, respiratory muscle fatigue, and decreased chest wall compliance are possible causes of _______
alveolar ventilation status
hyperventilation
hypoventilation
hypoventilation
70
Th1 cells, IL2, IFN-y, and macrophages contribute to the noncaseating granulomas seen in
african american female with pulmonary infiltrates and hilar adenopathy
sarcoidosis
71
the work of breathing is minimized in patients with _______ when their respiratory rate is high and tidal volume is low (fast shallow breaths). in contrast, patients with ______ breathe at a lower rate/higher tidal volume (slow deep breaths) in order to minimize work of breathing
pulmonary fibrosis
asthma/COPD
72
_______ is an anticholinergic agent and derivative of atropine that blocks the action of ACh at MAChR, preventing ________ and reducing parasympathetic stimulation of tracheobronchial submucosal glands in the lungs
Ipratropium
bronchoconstriction
73
most common site for MRSA colonization is the
anterior nares
74
in patients with alpha-1 antitrypsin deficiency, _______ dramatically increases the risk of developing panacinar emphysema
smoking
75
immunocompromised patient with fever, HA, ring enhancing lesion on brain MRI, respiratory symptoms with pulmonary nodules, and sputum studies revealing branching G+ organisms that look like thin fungal hypahe
Nocardia asteroides
76
the center of the airway pressure volume curve is the ______, where the airway pressure equals zero. The intrapleural pressure at this point is _____
FRC
-5
77
CD19 and CD20 cells =
B lymphocytes
78
erythrocytosis is defined as a hematocrit level > ____ in men and _____ in women.
hypoxic erythrocytosis occurs when SaO2 < ____
a normal red blood cell mass with apparent polycythemia is ______
52%, 48%
92%
relative erythrocytosis
79
older man presents with heavy hemoptysis, blood tinged sputum over the past few months, with a PMH significant for TB that was treated, round mass in an old left upper lobe cavity =
looks like
aspergillus fumigatus infection
septate hyphae at 45 degree angles
80
tall thin young individual can have _______ blebs that result in a ________
apical subpleural
primary spontaneous pneumothorax
81
CFTR protein is a transmembrane ______ chloride channel
ATP gated
82
PE post operative results in hypoxemia due to
V/Q mismatch
83
Chronic granulomatous disease results from a genetic defect in _______
5 catalase positive organism they're susceptible to
NADPH oxidase
Staph aureus, Burkholderia cepacia, Serratia marcescens, Nocardia, Aspergillus
84
killed virus vaccine stimulate
live vaccines stimulate
humoral immunity
cell mediated immunity
85
lots of neutrophils but no bacteria on gram stain sputum =
legionella
86
__________ is a dimorphic fungus endemic to the ______ US. Forms endo spores and turn into spherules in lungs
IC patient and pigeon droppings =
Mississippi and Ohio River basins, caving or cleaning bird droppings =
Coccidioides immitis
SW
Cryptococcus neoformans
Histoplasma capsulatum
87
____ is released by eosinophils to kill ______ and contributes to bronchial epithelial damage in atopic asthma
MBP
helminths
88
dimorphic fungus located intracellularly within _________ indicative of
macrophages
histoplasma capsulatum
89
G+, alpha hemolytic, optochinin sensitive, bile soluble diplococci
strep pneumo
90
perfusion increases from the ____ of the lung to the _____. ventilation increases slightly from the ______ to the _________. The V/P ratio decreases from _______ to _________
apex
base
apex
base
apex
base
91
ether and other organic solvents can inactivate ________ viruses
enveloped
92
gray -brown firm lonbe with fragmented RBCs, alveolar exudate w/ neutrophils and fibrin =
red, full RBCs, neutrophils, fibrin =
exudate w/ mostly bacteria =
enzymatic degradation of exudate =
gray hepatization
red hepatization
congestion
resolution
93
abnormal premature baby retinal neovascularization is a result of ____ for neonatal respiratory distress syndrome. major cause of ______ in developed nations
concentrated oxygen therapy
blindness
94
apical cavitary lesions and hemoptysis is indicative of
reactivation tuberculosis
95
long bone and pelvic fracture with neurologic abnormalities, hypoxemia, and petechial rash post trauma =
fat embolism syndrome in pulmonary arterioles
96
the ___ is the lung volume that remains after maximal expiration and is increased in COPD
Residual volume, RV
97
eggshell calcification of the rim of hilar nodes (eggshell) and birefringent particles surrounded by dense collagen fibers
Silicosis
98
great lakes trip, large yeast cell with a single bud, incupated at 24C, multicellular structure with branching tubular cells grows =
blastomyces dermatitidis
99
smoking or chronic irritation in the lungs can lead to ______
this also occurs in ______ (GI)
squamous metaplasia
Barrett esophagus
100
neuromuscular weakness of the _____ is involved in obstructive sleep apnea. Electrical stimulation of the ________ nerve increases the diameter of the oropharyngeal airway and decreases the frequency of apneic events
oropharynx
hypoglossal
101
______ are present throughout the respiratory bronchioles but are not present in the alveoli or alveolar ducts
Bronchi have ________ epithelium with goblet cells and submucosal glands and cartilage.
bronchioles, terminal bronchioles, respiratory bronchioles lack ______, glands, and cartilage
terminal bronchioles have ________ epithelium
cilia
pseudostratified columnar ciliated
goblet cells
simple ciliated cuboidal
102
theophylline is an _______ antagonist and an indirect adrenergic agent with a narrow ______. Inhibition of hepatic cytochrome oxidases by ___________, cimetidine, macrolides, or verapamil can raise serum concentration to a toxic level
adenosine receptor
therapeutic index
ciprofloxacin
103
rapidly progressive fever, sore throat, drooling, stridor, cherry red epiglottis =
most like missed =
H Influenzae type b
vaccine
104
medial hypertrophy, intimal fibrosis, luminal narrowing of pulmonary vessels with family history of similar symptoms (dyspnea and weakness), young =
treatment during waiting period before transplant
mechanism
idiopathic pulmonary HTN
Bosentan
endothelin receptor antagonist
105
active tuberculosis = biopsy shows
macrophages secrete _____ to induce Th1 differentiation. Th1 cells produce ______ to activate macrophages. Activated macrophages produce _____ to recruit additional monocytes and macrophages to the area
epitheloid macrophages and multinucleated giant cells
IL12
IFNy
TNFa
106
TB granulomas form as _______ of activated ________
aggregations
leukocytes
107
The ____________ of type II pneumocytes store and release ________. A surfactant deficiency can cause alveolar _________, or collapsed alveoli, as seen in _______
lamellar bodies
surfactant
atelectasis
neonatal respiratory distress syndrome
108
African American presenting with constitutional symptoms, bilateral hilar adenopathy, and pulmonary complains with non caseating granulomas on biopsy =
same case with a caseating granuloma and hemoptysis =
Sarcoidosis
TB
109
The pO2 in the left atrium and ventricle is lower than that in the ______________ due to mixing of oxygenated blood and deoxygenated blood
pulmonary capillaries
110
prolonged, untreated obstructive sleep apnea can cause _________ and ______ heart failure
pulmonary hypertension
Right sided
111
normal tracheal pO2 is
normal alveolar pO2 is
normal alveolar PCO2 is
with poor alveolar perfusion PO2 goes ____ and alveolar PCO2 goes
150
104
40
up
down
112
apnea followed by gradually increasing then decreasing tidal volumes until the next apneic period =
commonly seen in
Cheyne Strokes breathing
CHF
113
Pancreatitis is a major risk factor for ________ as it results in a release of large amounts of inflammatory cytokines and pancreatic enzymes, which leads to activation of ________ in the alveolar tissue. The alveoli become lined with _________
ARDS
neutrophils
hyaline membranes
114
alveolar hypoventilation, ventilation perfusion mismatch, diffusion impairment, and right to left shunting are the 4 major causes of _______. The A-a gradient is normal with ___________, which helps distinguish it
hypoxemia, low PaO2
alveolar hypoventilation
115
6 month history of cough, fatigue, malaise, weight loss, carpenter (________), HIV negative, lower lobe infiltrate, large yeast with single broad based bud =
rotten organic material
Blastomyces dermatitidis
116
In the pulmonary vascular bed, tissue ______ results in a vasoconstrictive response
hypoxia
117
The twisted serpetine ropes of TB are consistent with ________ a virulence factor.
cord factor
118
airway resistance from the trachea to terminal bronchioles increses to the_______ generation of segmented bronchi, then drops of shaprly
5th
119
S Pneumo is able to undergo transformation via ________ in order to gain virulence
direct extracellular DNA uptake
120
which bacteria is found in soil and capable of surviving past the boiling point of water ?
Bacillus anthracis
121
in pulmonary sarcoidosis, bronchoalveolar lavage fluid will dominate with ______ lymphocytes. Patients will also have elevated _____
CD4+
ACE
122
nagging, nonproductive couhg, low grade fever, many people who work and live together with similar symptoms, CXR looks worse then symptoms let on =
Mycoplasma species require _____ to grow on artificial medium
Walking Pneumonia: Mycoplasma pneumoniae
cholesterol
123
infant with brassy, barking cough, dyspnea and recent history of URTI =
caused by
croup
paramyxovirus (parainfluenza)
124
inhaled glucocorticoids long acting can cause oropharyngeal _______ and require ringing the mouth after use to reduce the risk
Candidiasis
125
________, an anti IgE antibody is an effective add on therapy for patients with severe allergic asthma
Omalizumab
126
no evidence of pulmonary infarction acutely after PE, why?
collateral circulation from pulmonary and bronchial arteries
127
Superior vena cava syndrome will present with a ______ and ________ swelling due to a mediastinal mass pressing on the SVC. It will also show ______distention around the neck and chest
dry cough
facial
128
The most common asbestos related cancer is _______, not malignant mesothelioma
bronchogenic carcinoma
129
all Mycoplasma, including ureaplasma, lack ___________ and are resistant to agents that attack it such as penicillins, cephalosporins, carbapenems, and vancomycin. They can be treated with anti ribosomal agents like ________ and ________
peptidoglycan cell wall
tetracycline, macrolides
130
Chronic granulomatous disease: neutrophils unable to kill _______ + organisms
catalase
131
alpha 1 antitrypsin deficient leads to young onset
panacinar emphysema in lower lobes
132
acutely after MI, ______ accumulates in the ______ lumen
transudate
alveolar
133
_____________ presents with nagging cough and cold agglutinins that coagulate blood in cold temperatures
Mycoplasma pneumoniae
134
_______ are the most common benign lung tumors, present with a _____ lesion and are composed of ________
hamartomas
coin
cartilage, fat, fibrous tissue
135
high chloride content in venous blood compared to arterial blood due _______ and is driven by _______
chloride shift
carbonic anhydrase
136
supine vomiting, most likely lung lobe affected
posterior segment up right upper lobe
137
heavy smoking history and CT indicative of centriacinar emphysema due to activated
macrophages and neutropohils
138
____________ due to aspergillus fumigatus may complicate asthma and can result in recurrent pulmonary infiltrates and eventual proximal _________
allergic bronchopulmonary aspergillosis
bronchiectasis
139
decreased breath sounds, hemithorax opacification, deviation of the trachea to the opacified side on CXR are suggestive of _______ due to _______
trachea deviated away from affected lung =
collapsed lung
bronchial obstruction
tension pneumothorax or large pleural effusion
140
_____ stimulates neutrophil migration to sites of inflammation, along with 5 HETE, C5a, and IL8
LTB4
141
during the first week of TB exposure in non exposed patient, ___________________ occurs in alveolar macrophages
intracellular bacterial proliferation
142
infant, thymic aplasia, severe bacterial and viral infections, chronic diarrhea, mucocutaneous candidiasis =
presents with absent T cells and _____
SCID
hypogammaglobulinemia
143
______ overdose can present with acute respiratory acidosis
Heroin
144
encapsulated, lactose fermenting, gram negative bacillus appears mucoid in culutre, pink colonies on MacConkey agar with alcoholic history =
Klebsiella pneumoniae
145
high altitude exposure results in _____ with respiratory ________. Over the course of a few days, chronic respiratory ________ sets in with a decrease in serum HCO3 as renal compensation
hypoxemia
alkalosis
alkalosis
146
shoulder pain, long smoking history, numbness in fingers and hemoptysis =
arise in the =
Pancoast tumor at apex
superior sulcus
147
administration of excessively high O2 concentrations to patients with COPD can lead to increased ______, resulting in confusion and lethargy. This is due to the increased _______________ as the poorly venitlated alveoli are perfused
CO2 retention
physiologic dead space
148
pulmonary abscesses in unresolved pneumonia are primarily caused by __________ from neutrophils and ________
lysosomal enzyme release
Macrophages
149
patient with intermittent SOB, unable to link it to _______, which is the most common cause of ______. The most useful excluding test would be a __________
allergies
asthma
negative methacholine challenge
150
finding of squamous metaplasia in the pancreatic ducts in a patient with CF due to deficiency of ______
Vitamin A
151
In patients with COPD, response to PaCO2 has been blunted, and ______ becomes the important contributor to respiratory drive, which is monitored at the ______ chemoreceptors. PaCO2 is monitored at the ______ chemoreceptors
example of a peripheral chemo receptor
PaO2
peripheral
central
carotid or aortic body
152
CFTR reduces luminal chloride secretion, which increases _______ and ______ absorption and results in _______ and a more negative __________.
sodium and water
dehydrated mucus
transepithelial potential difference
153
hemorrhagic pleural effusions, pleural thickening, tumor cells with long slender microvilli and abundant tonofilaments =
mesothelioma
154
pathogenicity of H influenza depends on the presence of an antiphagocytic _________
polysaccharide capsule
155
budding yeast with thick halo capsules in HIV patient with pneumonia and Mucicarmine staining =
usually manifest as
cryptococcos neoformans
meningoencephalitis
156
pulmonary embolism leads to an area of ______ defect without ______ defect
perfusion
ventilation
157
peptostreptococcus, prevotella, bacteroides, ad fusobacterium grown on culture. These are _______ bacteria found in the _______ and the most frequent cause of lung abscess. Risk factors include aspiration risk due to ______, ______ , drug abuse, stroke, and dementia
anaerobic
oral cavity
alcoholism
seizure disorders
158
carbolfuchsin is part of the _______ stain in order to ID _______ in Mycobacterium and some Nocardia species
acid fast
mycolic acid
159
bowel obstruction, green insipissated mass in distal ileum of a newborn is indicative of _______ which is found in _______. These patients will ultimately succumb to ________
meconium ileus
CF
Pneumonia
160
gradually progressive dyspnea and bilateral honeycomb reticulonodular opacities on CXR
pulmonary fibrosis
161
CD4 count < 50, risk for? Prophylaxis
CD4< 100?
CD4< 150?
CD4<200
Mycobacterium avium complex: azithromycin
Toxoplasma gondi: TMP-SMX
Histoplasma capsulatum: Itraconazole
Pneumocystis jirovecii: TMP-SMX
162
_______ is a slowly progressive disease caused by gram + anaerobic bacteria in people at risk for aspiration pneumonia (alcoholics). Bacteria have unique __________ and characteristic ______ granules. Treat with ______
Actinomycosis
filamentous branching patterns
sulfur
penicillin
163
fibrous bronchiolitis obliterans in lung transplant patient due to
chronic rejection
164
patients having panic attacks who _______ventilate will experience dizziness, weakness, and blurred vision due to _______ which causes cerebral ________
hyper
decreased pCO2
vasoconstriction
165
strep pneumo vaccine that encompasses 23 serotypes contains _____
outer polysaccharide covering
166
RBC fall rate is =
cytokines that inc this via stimulation of hepatic acute phase proteins
ESR
IL1, 6, TNFa
167
progressive exertional dyspnea and fatigue, pain and bluish discoloration of fingers and toes when cold, tightening of skin over fingers =
can lead to intimal thickening of _____
systemic sclerosis
pulmonary arteries
168
delayed hypersensitivity tests are due to the action of
T lymphocytes
169
_______ of H influenza can still infect after vaccination because they do not form an ___________
nontypable forms
antiphagocytic capsule
170
paroxysmal breathlessness and wheeing in a young patient without obvious trigger =
findings include eosinophils and ______ crystals
Eosinophils are recruited and activated by ____ secreted by Th2 cells
extrinsic allergic asthma
Charcot Leyden
IL5
171
celiac disease, young, recurrent pulmonary infections, given blood transfuison and develops anaphylaxis due to ________
selective IgA deficiency
172
young patient presenting with respiratory symptoms and central obesity without a history of pulmonary disease likely has ______
most common indicator is a ______ in ERV and functional residual capacity
obesity related restricted lung disease
reduction
173
a virus that is naked, purified RNA infectious molecule that can induce protein synthesis and and viral genome replication must be
most likely virus in a young man with fever, cough, sore throat and runny nose
ssRNA positive sense
Rhinovirus
174
interstitial lung disease leads to ____ elastic recoil that results in ____________ on the airways, leading to increased expiratory flow rates when corrected for low lung volume
increased
increased radial traction
175
________ is the most common lung cancer in the general population and in nonsmoking women. tumor cells form papillary or glandular structures
Adenocarcinoma
176
cough and fever, desert areas of US and mexico, thick walled spherules packed with many endospores =
coccidoides immitis
177
strep pneumo infection, green mucous color caused by neutrophil ____
myeloperoxidase
178
Reid index to measure severity of chronic bronchitis due to smoking is the ratio of the thickness of the _____ to the thickness of the _____ between the respiratory epithelium and the bronchial cartilage
mucous gland layer
bronchial wall
179
chronic rejection of lung transplant affects the
small airways
180
defense mechanism most directly responsible for clearing particles from the respiratory bronchioles and alveolar ducts -
phagocytosis
181
animal dander, dust mites, cockroaches, pollen, smoke, aspirin or NSAIDs, exercise, cold dry air, all triggers for
asthma
182
pulmonary infiltrate with columnar mucin secreting cells that line the alveolar spaces without invading stroma or vessels, copious amounts of pale/tan colored sputum =
benign or malignant
Adenocarcinoma in situ
malignant
183
Risks of smoke in a newborn
sudden infant death syndrome
184
beta hemolytic gram positive cocci in chains that are bacitracin resistant =
what would prevented a newborn infection
S. agalactiae
intrapartum ampicillin
185
IV drug users are at risk for _______ and developing
tricuspid valve endocarditis
septic pulmonary emboli
186
primary virulence factor of S pneumo is
polysaccharide capsule
