Respiratory

Question 1

Alpha-1 Antitrypsin does what?

Answer 1

reduces tissue damage caused by inflammation through the inhibition of neutrophil elastase.

Question 2

What is seen histologically in a1antitrypsin deficiency?

Answer 2

red/[ink PAS positive granules in periportal hepatocytes.

Question 3

What 2 organ systems are affected by a1 antitrypsin deficiency? and how are they affected.

Answer 3

Liver- FIRST. accumulation of A1AT molecules => cirrohsis, hepatocellular carcinoma

LUNGS- destruction of alveolar walls, large amounts of elastin, by tissue damaging enzyemes. => panacinar emphysema

Question 4

What occurs in the lung when hypoxemia occurs in an underventilated area?

Why is this?

Answer 4

vasoconstriction occurs in the small muscular pulmonary arteries

diverts blood flow from underventilated area toward more well-ventilated areas

Question 5

Where is the lowest pulmonary vascular resistance located on Lung volumes graph?

Answer 5

functional residual capacity (FRC) because here the

lung is maximally compliant,
intrathoracic and atmosphere pressures equal,
allveoli do not eert pressure on vasculature

Question 6

2-4 weeks after initial TB infection what pathenogenesis occurs?

Answer 6

interferon secrtion by activated Tcells leads to M0 activation =>
M0 form epithelioid cells and improves their ability to kill intracellular TB

Question 7

Characteristic of VIRULENT mycobacterial strains?

Answer 7

growth of thick ropelike cords of MB in serpentine = presence of cord factor (virulence factor):

inactivates neutrophils, magages mitochondria, induce rls of TNF

Question 8

In the pathogenesis of Center acinar emphysema proteases such as elastase early strong which to type of cells?

Answer 8

Infiltrating neutrophils

alveoli macrophages

Question 9

DOC theophylline induced cardiac tachycardias?

Morbid SE of Theophyline?

Answer 9

B-blockers

Siezures

Question 10

What physiologic change in alveolar ventilation causes hypocapnia?

What directly indicates this change?

Answer 10

hyperventlation

arterial PaCO2

Question 11

Cheyne-Strokes Respiration description:

When are they seen?

Answer 11

cyclic breathing-> increasing tidal vol, then decr. tidal volume. with intermittent apnea

CHF

Question 12

Kussmal breathing is associated with what disease and what metabolic state?

Answer 12

DKA

Metabolic Acidosis

Question 13

3 main descriptions of Cluster headaches +3 others

Answer 13

unilateral, severe episodic, temporal

ptosis, lacrimation, nasal congestion

Question 14

HIV DRUGS:
Fusion Inhibitors
Protease Inhibitors
Reverse transcriptase inhibitors
Integrase Inhibitors
CCR5 Receptor Inhibitors

Answer 14

F-Enfuviritide
P-saquinivir, ritonavir
RTi-tenofivir, lamovudine, efavirinez
I-Raltegravir
CCR5-maraviroc

Question 15

defective enzymes in orotic aciduria
Presentation (4)
Treatment

Answer 15

Oroate phosphoribyl transferase, OMP decarboxylase

Megaloblastic anemia, neuro abnormalities, growth retardation, orotic acid in urine

Uridine

Question 16

Proto Oncogenes 6

Answer 16

ras
N-myc
ERB-B1/2
TGF
sis
abl

Question 17

Tumor Suppressors 7

Answer 17

BRCA1/2
NF1
APC
DCC
p53
RB
WT1

Question 18

RESPITORY INFXN:Virus
nasopharyngitis/commoncold:
Larygeotracheitis/croup:
Epiglottitis:
Bronchiolitis:

Answer 18

N-Rhino/Inflluenza/Corona
L-Parainfluenza virus
E-Haemophilus Influenza
B-RSV-respiratory syncitial virus

Question 19

Virion protein: host cell receptor
HIVgp120:
EBV gp350:
Parvovirus B19

Answer 19

CD4
CD21
Erythrocyte P antigen

Question 20

Pulmonary lungs chart: what does COPD increase?

Answer 20

RV

Question 21

NonNucleoside Reverse Transcriptase inhibitors-name3

Answer 21

Nevirapine
efavirenz
delavirdine

Question 22

What enzyme is necessary for NRTI’s to fxn? name 2

Answer 22

zidovudine
Zalcitabine

thymidine kinase

Question 23

Common problems associated with left ventricular infarct (4)

Answer 23

Left ventricular failure
Cardiogenic acute pulmonary edema
Pulmonary venous hypertension
Transudate of Plasma into lung intersitium/alveoli

Question 24

Where should you perform thoracocentesis?
Midclavicular
Midaxillary
Posterior scapular line

Answer 24

MC- Above 7th Rib
MA- Above 9th Rib
PS- Above 11th Rib

Question 25

where are meningiomas located?

what symptoms are seen in a parasagittal meningioma?

Answer 25

Adjacent to cerebral surface

contralateral spastic paresis of left leg.

Question 26

Pleural aggitation will cause pain where? what is this called?

Answer 26

sharp “Referred” pain in C3-C5 due to phrenic nerve. SHoulders /back

Question 27

WHat does an obstructive flow-volume loop profile look like & what 2 conditions would cause this?

Answer 27

Chronic Bronchitis- increased bronchial resistance

Emphysema- Decreased lung elasticity

Expiratory flow rate DEcreased
RV (Increased) blob moves left.

Question 28

What can cause a restrictive flow-volume pattern?

Answer 28

Pulmonary fibrosis, Hyaline membranes, diffuse intraalveolar hemorrhage, Atelectasis

RV & Expiratory flow rate stay about the same

Decreased Lung volume & Compliance

Question 29

What test is sensitive but not specific for testing the degree of bronchial hyperreactivity in asthma?

Answer 29

negative methacholine challenge test can RULE OUT.

Question 30

what does MCA of brain supply? 3 major areas

Answer 30

face & arms of motor and sensory cortex. Broca’s & Wernicke’s speech areas & Frontal eye fields

Question 31

what is an acceptable add on therapy for sever allegic asthmatics?

Answer 31

Omalizumab

Question 32

Emphysema-
FEV/FVC ratio?
Total lung capacity?
Diffusing capacity?

Answer 32

decr
incr.
decr

Question 33

What is included in Alveolar ventilation calculation that is not in Minute Ventilation?

Answer 33

Dead Space

Question 34

what is The reid index?

Answer 34

The ratio of thickness of mucosous gland layer in the bronchial wall submucosa to the thickness of the bronchial wall between the respiratory epithelium and bronchial cartilage