Pulmonology

Question 1

Cyanide poisoning tx

Answer 1

Hydroxycobalamin
Na thiosulphate
Amyl nitrate// na nitrate

Question 2

Cyanide posioning presentation

Answer 2

Cvs collapse
Tachy tachpnea headache nausea vomit
Almond odor

Question 3

Co poisoning tx

Answer 3

Hyperbaric o2

100% o2

Question 4

Co poisoning presentation

Answer 4

Headache dizziness
Convulsions
Resp arrest

Question 5

Co poisoning cerebral effect

Answer 5

Globus pallidus lesions on MRI

Question 6

Methemoglobin tx

Answer 6

Methylene blue and vitamin C

Question 7

Perfusion limited causes

Answer 7

Normal
Co2
N2o

Question 8

Diffusion limited

Answer 8

Emphysema
Fibrosis
Exercise 
ARDS
RDS

Question 9

Normal A-a gradient hypoxemia

Answer 9

High altitude

Hypo ventilation

Question 10

HNSCC HX

Answer 10

Sheets of Polygonal cells with abundant eosinophilic cytoplasm invade mucosa and surrounding structures intracellular bridges and keratin pearl’s

Question 11

Squamous papilloma

Answer 11

Fibrovascular core surrounding by sq epithelium

Question 12

Emphysema types smoking

Answer 12

Centriacinar

Question 13

Emphysema in panacinar

Answer 13

Alpha anti trypsin def

Question 14

Asthma cells involved?

Answer 14

Eosinophilic mast cells and helper t cells cause
Bronchial wall thickening
Inc smooth muscle

Question 15

CD IN ASTHMA

Answer 15

Cd4

Question 16

COPD cd type?

Answer 16

CD8

Question 17

Chronic bronchitis hx

Answer 17

Hypertrophy and hyperplasia of mucous secreting glands

Question 18

Emphysema hx

Answer 18

Leucocyte infiltraion
Cd8+ t cells
Inc protease activity
Oxidative stress

Question 19

Asthma hx

Answer 19

Hyper responsive bronchi
Reversible bronchi constriction
Smooth muscle hypertrophy
Crushmann spirals(shed epithelium from whorled mucous plugs)
Charcot laden crystals 🦯 (eosinophilic, hexagonal
DLCO normal or increased

Question 20

Bronchoectasis

Answer 20

Chronic necrotising inf and inflammation of bronchi and obstruction
Permanently dilated airways
Bronchial artery hypertropy and easily rupture cause hemoptysis

Question 21

Sarcodiosis hx

Answer 21

Non caseating granuloma (epithelioid containing microscopic schamann and asteriods bodies)
Inc CD4/CD8 ratio
Inc ACE AND CAlcium
Mild LFTS deranged
Abn ALP» amino transferases
To differentiate from other ILD CD RATIO CD4/CD8+ > 2:1

Question 22

Sarcoidosis radio

Answer 22

B/l hilar lymphadenopathy Reticular opacities, infiltrates nodules

Question 23

Sarcoidosis skin

Mnemonic UGLIER

Answer 23

Lupus pernio

Erythema nodusum

Question 24

Asbestosis hx

Answer 24

Ivory white calcified supra diaphragmatic and pleural plaque( diffuse pleural thickening)
Inc risk bronchogenic cancer

Furruginous bodies golden brown (iron containing) fusiform rods dumbbells like in sputum by perssian blue stain in BAL

Question 25

Berylliosis hx

Answer 25

``` Granulomatous non caseating Inc cancer risk And cor pulmonale Enlarge nodules with pleural plaques Nodular infiltrates ```

Question 26

Coal worker pneumoconiosis hx

Answer 26

Macrophages laden with carbon | Small rounded nodular opacities

Question 27

Silicosis hx

Answer 27

Egg shell calcification of hilar lymph nodes in xray Nodular opacities round coalesce to form mass in upper lobe Patchy pink interstitial fibrosis Excess collagen cause fibrosis

Question 28

Mesothelioma hx

Answer 28

Cuboidal/spindle cells stain for cytokeratin flattened epithelium Polygonal tumor cells e long slender microvilli and abundant tono filaments

Question 29

Lobar pneumonia

Answer 29

Intra alveolar exudate can involve whole lobe

Question 30

Broncho pneumonia

Answer 30

Acute inflammatory infiltrate from bronchioles into adjacent alveoli Patchy >1 lobe

Question 31

Interstitial (atypical) pneumonia

Answer 31

Diffuse patchy inflammation localised to interstitial areas at alveolar walls with minimum or no alveolar infiltrates. Walking pneumonia indolent course

Question 32

Cryptogenic organising pneumonia

Answer 32

Fibroblast plugs in alveolar sacs and ducts often extend into adjacent alveoli in butterfly pattern

Question 33

Small cell lung CA

Answer 33

``` Small cell with scant cytoplasm granular nuclear chromatin (salt and pepper pattern) indistinct nucleoli Neuroendocrine Kulchitsky cells Chromogranin A + Neuron specific enolase + Synaptophysin positive Neuronal cell adhesion molecules + CD 56 Amplification of myc ```

Question 34

AdenoCA lung CA types

Answer 34

Glandular Brochoalveolar Tall glands mucin positive Papillary

Question 35

Sq cell ca lung hx

Answer 35

Sheets of. Malignant cells Keratin pearls Intracellular bridges Polygonal cells e eosinophilic cytoplasm

Question 36

Sq cell ca paraneoplastic type

Answer 36

Inc PTHrP

Question 37

AdenoCA ass e

Answer 37

hypertrophic osteoarthropathy

Question 38

Small cell ca ass e

Answer 38

``` ACTH SIADH MYELITIS ENCEPHALITIS SUBACUTE CEREBRAL DEGENERATION LAMBERT EATEN SYNDROME ```

Question 39

Lung abcess radio

Answer 39

Air fluid level cavitation

Question 40

Lung abcess bacteria

Answer 40

``` Bacteriods Fusobacterium Peptostreptococcus S aureus Prevotella All are anaerobes Shows by foul smelling ```

Question 41

Lung abcess necrosis type

Answer 41

Liquefactive necrosis d/t cytokines release by neutrophils in attempt to kill bacteria

Question 42

Guaifenesin

Answer 42

Thin respiratory secretion | Expectorant

Question 43

Dextromethorphane

Answer 43

NMDA glutamate receptors antagonist

Question 44

Loffler syndrome hx

Answer 44

Larger cells e bilobed nucleus eosinophilic cytoplasm

Question 45

Pulmonary edema color froth?

Answer 45

Pink material due to intra alveolar transudate

Question 46

Goodpasteur lung hx

Answer 46

Focal necrosis of alveolar walls e hemorrhage

Question 47

BAL IN CARDIOGENIC PULM EDEMA

Answer 47

hemosiderin laden macrophages by intra alveolar RBC into alveoli

Question 48

Hypersensitivity pneumonia hx

Answer 48

``` Restrictive dx Non caseating granuloma Lymphocytic infiltrate Interstitial fibrosis 10% lymphocytes in alveolar fluid 85% macrophages Small %age of neutrophils eosinophils But in BAL high lymphocytes count 50% ```

Question 49

Hypersensitivity pneumonia xray

Answer 49

Diffuse reticular interstitial opacities