Respiratory

Question 1

Sarcoidosis

Answer 1

-non-caseat granuloma (macrophage) -Elevated ACE level and CD4/CD8 -unknown cause -Black -Finding : 20-40 yr old , black female presented with dry cough and shortness of breath, nodules on shin ( erythema nodosum) -Lungs: mediastinal Lymphadenopathy Pulmonary fibrosis Pulmonary nodule -etc ; liver nodules, cirrhosis, cholestasis uveitis conjuntivitis Skin : erythema nodosum , Lupus pernios Heart: heart block -Tx : Steroids

Question 2

TACTILE FREMITUS

Answer 2

ใช้มือวางทาบแล้ว say ninety nine -Increase tactile fremitus Pneumonia -Decrease tactile fremitus Pleural effusion Pneumothorax

Question 3

Familial Pulmonary Hypertension (PAH)

Answer 3

-Autosomal dominance with variable penetrance -inactivated BMPR 2 >> smooth muscle cell proliferation >> epithelial dysfunction RESULT : Vasoconstriction with increase pulmonary vascular resistence leads to pulmonary HT

Question 4

Light’s Criteria

Answer 4

Exudate Vs Transudate Exudate -Pleural Protein/Serum Protein > 0.5 -Pleural LDH/Serum LDH > 0.6 -Serum LDH >2/3 UNL Pathophysio Exudate : inflammatory increase in mb permeability Transudate: change in hydrostatic and oncotic pressure Common causes Exudate : infection , malignancy, rheumatologic Transudate: heart failure, cirrhosis, nephrotic syndrome

Question 5

Lung abscess What is the most contributor ?

Answer 5

-Lysosomal content release by neutrophil cuz neutrophil is key player role in lung abscess >> recruited มาจาก cytokine ที่มาจาก microbial molecule and obsonizing factors -Activated neutrophil จะ release cytotoxic granules (lysosome) ที่มี myeloperoxidase ซึ่ง enz พวกนี้จะ damage parenchyma and cause liquefying necrosis

Question 6

pt with pulmonary TB Showing Lung specimen >> Langerhans cell Which processes is contribute to finding

Answer 6

Ans. Cytokine secretion by CD4 T lymp >> secrete interferon gamma >> activate macrophage >> macrophage differentiate into epitheliod histiocytes >> multinucleated Langhans giant cells มา wall off mycobacteria with granuloma

Question 7

Green discoloration of sputum come from

Answer 7

it s due to the presence of myeloperoxidase , blue green heme-based enzyme that released from neutrophil azurophilic granules and forms hypochlorous acid

Question 8

Pt presented with leg edema and sudden dyspnea Ask what is most likely increase in pt

Answer 8

Ans. Physiologic dead space In Pulmonary embolism ,obstruction of pulmonary circulation increase “dead space ventilation” ( volume of inspired air does not participate in gas exchange) Blood that continue to flow not fully oxygenated >> hypoxemia

Question 9

Pt with pulmonary embolism plan to wean off ETT Breathing pattern แบบไหน ที่จะ increase minute ventilation RR and Tidal volume

Answer 9

Ans. Increase RR and decrease Tidal volume Physiologic dead space = Anatomic dead space(permanent) + Alveola dead space Pt being wean from mechanical ventilation typically breath at low tidal volume (weakening of respi m.) >> compensate increase in RR to maintain minute ventilation

Question 10

The airway resistance at each level of the lower respiratory tract

Answer 10

high in trachea , peak at medium-sized bronchi

Question 11

CXR : nodular densities in both lungs that prominent in apical regions Calcification of hilar LN also seen Bronchoscopy with transbronchial biopsy : polarized microscopy shows birefringent particles surrounded by dense collagen fibers pt exposed to?

Answer 11

Silica (Silica and coal from the base, affected the roof, Asbestose from the roof , affected the base) characteristic of silica >> eggshell calcification

Question 12

Aging in pulmonary function Total lung capacity Forced vital capacity Residual volume

Answer 12

Pt age > 35 : decrease chest wall compliance due to stiffness from rib calcification ** Lung compliance increase due to loss of elastic recoil Diminished in elastic recoil and collapse of supporting tissues cause increase in residual volume

Question 13

Farmer lives in Mississippi CXR: pulmonary infiltration in right upper lobe Bronchoscope: granulomatous infiltration organism?

Answer 13

Blastomyces dermatitidis cause pulmonary disease in immunocompetent host dimorphic fungus ( mold in environment) entering lungs>> yeast endemic areas :: Ohio river valleys and Mississippi (overlap with Histoplasmosis) Characteristics: granuloma formation **Round yeast with thick wall and BROAD-BASED BUDDING** TX: Itraconazole

Question 14

HIV patient present with non productive cough, low grade fever and worsening fatigue PE : hepatosplenomegaly, pancytopenia, LFts increase BM aspiration : multiple yeasts inside macrophage

Answer 14

Histoplasma capsulatum replicates in phagosome of macrophages

Question 15

Pt with TB

Lung biopsy