Pulmonology

Question 1

List four types of cells in the lungs?

Answer 1

Goblet: mucus production
Type I Pneumocyte: macrophages (95%)
Type II Pneumocyte: surfactant production
Clara/Dust (Macrophages): ingest dust particles

Question 2

What is the histology of the trachea?

Answer 2

Top 1/3: stratified squamous epithelium – protect against abrasion
Middle 1/3: mixture
Lower 1/3: tall columnar pseudostratified ciliated epithelium

Question 3

What muscles are needed to breathe IN?

Answer 3

Innermost intercostals – contralateral chest wall
External intercostals – ipsilateral chest wall
Diaphragm

Question 4

What muscles are needed to force air IN?

Answer 4

Scalenes
Sternocleidomastoid (SCM)
Trapezius
Pectoralis Major and Minor

Question 5

What muscles are needed to breathe OUT?

Answer 5

Passive – recoil

Question 6

What muscles are needed to force air OUT?

Answer 6

Internal and External Oblique
Recurs Abdominus
Transverse Abdominus
Quadratus Lumborum

Question 7

What is the difference between the carotid body and the carotid?

Answer 7

Carotid body: chemoreceptor

Carotid sinus: baroreceptor

Question 8

What color is air on X-ray?

Answer 8

Black “radiolucent”

Question 9

What color is fluid/solids on X-ray?

Answer 9

White “radiopaque”

Question 10

What disease has steeple sign on neck film?

Answer 10

Croup

Question 11

What disease has thumb sign on neck film?

Answer 11

Epiglottitis

Question 12

What is a “blue bloater”?

Answer 12

Bronchitis (chronic)

Question 13

What is a “pink puffer”?

Answer 13

Emphysema

Question 14

What diseases have pulmonary eosinophilia?

Answer 14

Aspergillosis, strongyloides

Question 15

What drugs cause pulmonary eosinophilia?

Answer 15

Nitrofurantoin, sulfonamides

Question 16

What are the risk factors for lung cancer?

Answer 16

Smoking, radon, 2nd hand smoke, pneumoconiosis (except anthracosis)

Question 17

What diseases have hemoptysis?

Answer 17

Bronchiectasis, bronchitis, pneumonia, TB, lung cancer

Question 18

Where is a Bokdalek hernia?

Answer 18

Back of diaphragm

Question 19

Where is a Morgagni hernia?

Answer 19

Middle of diaphragm

Question 20

What diseases have respiratory alkalosis?

Answer 20

Restrictive lung diseases – anxiety, pregnancy, Gram - sepsis, PE

Question 21

What diseases have respiratory acidosis?

Answer 21

Obstructive lung diseases

Question 22

What diseases have metabolic alkalosis?

Answer 22

Low volume state – vomiting, diuretics, GI blood loss

Question 23

What diseases have metabolic acidosis?

Answer 23

Acid production – MUDPILES , RTA II, diarrhea

Question 24

What is the obstructive pattern of blood gasses?

Answer 24

Inc pCO2 —> dec pH, inc RR —> inc pO2

Question 25

What is the restrictive pattern of blood gasses?

Answer 25

Dec pO2 —> in RR —> dec pCO2 —> inc pH

Question 26

What does stridor tell you?

Answer 26

Extrathoracic narrowing —> narrows when breathing in —> neck X-ray

Question 27

What does wheezing tell you?

Answer 27

Intrathoracic narrowing —> narrows when breathing out —> chest X-ray

Question 28

What does rhonchi tell you?

Answer 28

Mucus in airway —> obstructive lung disease

Question 29

What does grunting tell you?

Answer 29

Blows collapsed alveoli open —> restrictive lung disease

Question 30

What does dull percussion tell you?

Answer 30

Something between airspace and chest wall absorbing sound (fluid or solid)

Question 31

What does hyperresonance tell you?

Answer 31

Lungs hyperinflated with air

Question 32

What does tracheal deviation tell you?

Answer 32

Away from pneumothorax OR toward atelectasis “air phobic”

Question 33

What does fremitus, egophony, and .. tell you?

Answer 33

Consolidation —> pathognomonic for pneumonia

Question 34

What is Restrictive Lung Disease?

Answer 34

Small stuff lungs, trouble breathing in

Question 35

What is Obstructive Lung Disease?

Answer 35

Big mucus filled lungs, trouble breathing out

Question 36

Epiglottitis

Answer 36

X-ray thumb sign, drooling

Question 37

Croup

Answer 37

X-ray steeple sign, barking cough

Question 38

Tracheitis

Answer 38

Look toxic, grey pseudo membrane, leukocytosis

Question 39

Asthma

Answer 39

Wheeze on expiration, IgE, eosinophils

Question 40

Bronchiolitis

Answer 40

Asthma in kids < 2yo

Question 41

Maxillary Sinusitis

Answer 41

Teeth pain worse with bending forward

Question 42

Bronchiectasis

Answer 42

Bad breath, purulent sputum, hemoptysis

Question 43

Chronic Bronchitis

Answer 43

Lots of sputum, “blue bloater”

Question 44

Emphysema

Answer 44

Restrictive to obstructive pattern, “pink puffer”

Question 45

Laryngomalacia

Answer 45

Epiglottis roll in from side to side

Question 46

Pneumonia

Answer 46

Consolidation of airway

Question 47

Pneumothorax

Answer 47

Air outside of lungs, hyperresonance on same side

Question 48

How do you detect a Pulmonary Embolism?

Answer 48

Tachypnea, increased V/Q scan, EKG: S1Q3T3

Question 49

Tamponade

Answer 49

Decreased breath sounds and BP, increased JVD, fluid in pericardial sac

Question 50

Tracheomalacia

Answer 50

Soft cartilage, stridor since birth

Question 51

Cystic Fibrosis

Answer 51

Meconium ileus, steatorrhea, bronchiectasis

Question 52

Aspergillosis

Answer 52

Allergy to mold, dead plants, compost piles

Question 53

Who gets Asbestosis?

Answer 53

Shipyard workers, pipe fitters, brake mechanics, insulation installers

Question 54

Who gets Silicosis?

Answer 54

Sandblasters, glassblowers

Question 55

Who gets Byssinosis?

Answer 55

Cotton workers

Question 56

Who gets Beryliosis?

Answer 56

Radio, TV welders, this working with bulbs

Question 57

Anthracosis

Answer 57

Coal workers, massive fibrosis

Question 58

Carcinoid Syndrome

Answer 58

Flushing, wheezing, diarrhea

Question 59

Small Cell Cancer

Answer 59

At carina, malignant, Cushing’s, SIADH, SVC Syndrome

Question 60

Large Cell Cancer

Answer 60

Large stuff

Question 61

Squamous Cell Cancer

Answer 61

Smoker, high PTH, high Ca2+

Question 62

Bronchealveolar Cancer

Answer 62

Looks like pneumonia, due to pneumoconiosis