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Respiratory Flashcards

1
Q

What is the most common cause of lobar pneumonia in adults?

A

Streptococcus pneumoniae

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2
Q

Unvaccinated child with paroxysmal cough and inspiratory whoop - diagnosis?

A

Whooping cough caused by bordetella pertussis

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3
Q

Why does bordetella cause hypoglycemia?

A

Toxin activates islets of Langerhans

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4
Q

What is the most common cancer arising from scarred lung?

A

Adenocarcinoma

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5
Q

What are tumors that arise peripherally and cause coin lesions?

A

Adenocarcinoma, bronchioloalveolar carcinoma, large cell carcinoma

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6
Q

What acid-base disturbance does acute salicylate poisoning lead to?

A

Respiratory alkalosis

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7
Q

How does hyperventilation affect cerebral blood flow and cerebral vascular resistance?

A

Decreased cerebral blood flow
Increased cerebral vascular resistance

Because decreased levels of CO2 cause cerebral vasoconstriction

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8
Q

What would a biopsy of tissue infected with Histoplasma show?

A

2-5 micrometer yeast with a thin cell wall but no real capsule

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9
Q

What should you think of if you see an immunosuppressed patient with owl’s eye inclusion bodies in cells?

A

CMV

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10
Q

What lab values will change when giving supplemental oxygen to a patient with pulmonary diseaese?

A

Increase PAO2, PaO2, A-a gradient

Will NOT change lung diffusion capacity

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11
Q

Why does the abdominal wall move inward on inspiration with a diaphragmatic injury?

A

Contraction of the intercostal muscles during inspiration results in the diaphragm being sucked upward (negative pressure in the pleural space) and the abdominal wall being sucked inward

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12
Q

What happens to pulmonary vessels at high altitude?

A

Vasoconstriction (decreased diameter) due to hypoxia

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13
Q

What PO2 level decreases in anemic patients?

A

Mixed venous PO2

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14
Q

What should be at the top of your differential for a unilateral pleural effusion?

A

Bacterial infection

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15
Q

What respiratory infection should you suspect among infants in the winter months?

A

RSV

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16
Q

How do you treat an RSV infection?

A

Palivizumab - antibody directed against the fusion protein of RSV

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17
Q

What antibiotic inhibits translocation of the growing peptide chain along the mRNA?

A

Macrolide

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18
Q

Why are asthmatic patients at increased risk of oral candidiasis?

A

Use of inhaled corticosteroids

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19
Q

Presentation: bilateral hilar adenopathy, history of nonspecific joint inflammation, cutaneous symptoms

Diagnosis?

A

Sarcoidosis

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20
Q

How is CFTR regulated?

A

Gated by ATP hydrolysis and involves regulation by protein kinase A phosphorylation

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21
Q

Presentation: history of asthma, sudden onset shortness of breath, altered breath sounds

What should you suspect?

A

Pneumothorax

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22
Q

How does pneumothorax look on X ray?

A

Radiolucency

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23
Q

What is a chylous effusion?

A

Exudative effusions (pleural fluid protein to serum protein > 0.5, pleural to serum LDH > 0.6) with high lipid content, most commonly related to trauma and malignancy

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24
Q

How does the vagus nerve affect the lungs?

A

Bronchoconstriction leading to increased airway resistance and work of breathing

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25
Q

What fungus, at body temperature, is a spherule filled with endospores?

A

Coccidioides

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26
Q

What is the mechanism of action of aminoglycosides?

A

Inhibit the initiation of protein synthesis by binding to and distorting the structure of the prokaryotic 30s ribosomal subunit

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27
Q

What medications target synthesis of the fungal cell wall?

A

Echinocandins (e.g. caspofungin and micafungin) inhibit synthesis of the polysaccharide glucan, an essential component of the fungal cell wall

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28
Q

What happens to diffusing capacity (DLCO) in emphysema patients?

A

Decreases

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29
Q

What is Cheyne Stokes respiration?

A

Cyclic breathing in which apnea is followed by gradually increasing tidal volumes and then decreasing tidal volumes until the next apneic period

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30
Q

When is rifampin used as monotherapy?

A

For prophylaxis against Neisseria meningitidis

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31
Q

Presentation: Recurrent sinopulmonary and GI tract infections, anaphylactic response to transfused blood products

Diagnosis?

A

IgA deficiency (most common primary immune deficiency)

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32
Q

Which TB drug can adversely affect the eye?

A

Ethambutol can cause optic neuritis (presents in conjunction with decreased visual acuity, central scotoma, color blindness)

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33
Q

How does N-acetylcysteine help CF patients?

A

Mucolytic agent - it cleaves the disulfide bonds within mucus glycoproteins (loosens thick sputum)

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34
Q

What are the most common bacterial infections (secondary pneumonia) that superimpose over influenza infection?

A

Strep pneumo > Staph > H. flu

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35
Q

What does it mean if mycobacterium can grow in parallel chains?

A

These are serpentine cords meaning the mycobacterium has cord factor meaning it is a virulent strain

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36
Q

Why is expiratory flow rate increased in restrictive lung disease?

A

Expiratory flow rate is increased due to decreased lung compliance (increased elastic recoil) and increased radial traction exerted on the conducting airways by the fibrotic lung

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37
Q

Which TB drug requires an acidic environment?

A

Pyrazinamide (works best within phagolysosomes)

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38
Q

If a patient has tracheal PO2 that does not match alveolar PO2, what is that indicative of?

A

Should equilibrate in normal conditions because O2 is a perfusion limited gas so in this case it means there’s poor perfusion

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39
Q

Where does the recurrent laryngeal nerve travel relative to the aorta?

A

Goes beneath the arch of the aorta (but above the pulmonary artery) through the aorticopulmonary window

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40
Q

How does sarcoidosis affect the elasticity of the lung?

A

Increases it (as do other restrictive lung diseases)

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41
Q

What acid-base disturbance does acute salicylate poisoning lead to?

A

Respiratory alkalosis

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42
Q

What is on your differential for an interstitial pneumonia that responds to macrolides?

A

Mycoplasma pneumoniae or legionella

If it didn’t respond to macrolides, you would think of viral etiologies

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43
Q

What responds more quickly to changes in PCO2 - peripheral or central chemoreceptors?

A

Peripheral

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44
Q

Assuming normal PO2 of 100 mm Hg, what would you expect in terms of oxygen bound to hemoglobin in a patient with 75% of normal hemoglobin (anemic)?

A

Arterial blood has 75% as much oxygen bound to hemoglobin because Hb is 100% saturated with oxygen at 100 mm Hg

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45
Q

How would you differentiate between histoplasmosis and blastomycosis on histology?

A

Histoplasmosis - tiny oval forms within macrophages

Blastomycosis - larger, round budding yeast forms in tissues

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46
Q

Is strep pneumo alpha, beta, or gamma hemolytic?

A

Alpha

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47
Q

What is the most common form of lung cancer?

A

Bronchogenic adenocarcinoma

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48
Q

Post influenza bacterial pneumonia with cavitary lesions - likely cause?

A

Staph

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49
Q

What antibiotic would be contraindicated in treating a patient for H. influenza if that patient was also on anticoagulants?

A

Macrolides because they inhibit CYP 450 and would potentiate the effects of warfarin

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50
Q

What is the mechanism of action of macrolides?

A

Bind to the P site of the 50s ribosomal subunit and interfere with bacterial protein synthesis

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51
Q

What acid base disturbance does heroin overdose lead to?

A

Acute respiratory acidosis from hypoventilation

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52
Q

How can you differentiate between SCID and DiGeorge?

A

DiGeorge is a type of SCID but in terms of picking an answer:

DiGeorge - look for classic findings like facial abnormalities, hypoparathyroidism, cardiac defects

SCID - more severe immune dysfunction

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53
Q

Why is someone with a seizure disorder at increased risk of lung abscess?

A

Aspiration of oropharyngeal contents (e.g. mouth flora like peptostreptococcus, fusobacterium)

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54
Q

What is the effect of ether (and other organic solvents) on viruses?

A

Can dissolve the lipid bilayer that makes up the outer viral envelope - leads to loss of infectivity

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55
Q

If a foreign body becomes lodged in the piriform recess, what nerve can it damage?

A

Internal laryngeal (branch of vagus that is involved in the cough reflex)

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56
Q

What bacteria is the most likely cause of pneumonia in a patient with GI symptoms, neurological symptoms, and recent exposure to contaminated water (e.g. cruise ships or hotels)?

A

Legionella pneumophila

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57
Q

What is the most common laboratory abnormality seen with Legionella?

A

Hyponatremia

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58
Q

Neutrophils fail to turn blue upon nitroblue tetrazolium exposure - what does this mean?

A

Chronic granulomatous disease - patients cannot reduce nitroblue tetrazolium because they have a genetic defect resulting in NADPH oxidase deficiency

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59
Q

What kind of organisms are neutrophils in chronic granulomatous disease bad at killing?

A

Not effective at killing catalase positive organisms

60
Q

What vitamin deficiencies are associated with cystic fibrosis?

A

A, D, E, K

Because these are fat soluble vitamins and pancreatic insufficiency inhibits fat absorption

61
Q

Lung abscess is a common complication of what disease?

A

Aspiration pneumonia

62
Q

Histology: round yeast with doubly refractive walls and broad based budding?

A

Blastomyces

63
Q

What do you worry about injuring above the clavicle and just lateral to the sternal manubrium?

A

Apex of the lung or the pleura (think pneumothorax)

64
Q

What three cytokines help raise the ESR through a systemic inflammatory response?

A

IL-1, IL-6, TNF-alpha

Stimulate hepatic production of acute phase reactants like fibrinogen

65
Q

What is another name for phosphatidylcholine?

A

Lecithin

66
Q

Describe how lecithin vs. sphingomyelin levels in the amniotic fluid change during pregnancy.

A

Sphingomyelin - fairly constant

Lecithin - approximately equal to sphingomyelin until 3rd trimester and then shoots up

An L:S of 2:1 is a marker for healthy lung maturation

67
Q

For an autosomal recessive disease, what is the chance that an unaffected individual with unaffected parents (but who are both carriers) with be a carrier for the disease?

A

2/3

68
Q

What test is carbolfuchsin dye used for?

A

Acid fast

69
Q

What does acid fast stain stain for?

A

Mycolic acid

70
Q

What do we use to treat IL-12 deficient patients?

A

IFN-gamma (helps promote Th1 response which they have trouble doing without IL-12

71
Q

What fungal infection can complicate asthma?

A

Aspergillus fumigatus

72
Q

How can bronchioalveolar lavage fluid be used to diagnose sarcoidosis?

A

High CD4/CD8 ratio is diagnostic of sarcoidosis

73
Q

What is pyridoxine?

A

Vitamin B6

74
Q

What drug is pyridoxine related to?

A

Isoniazid

75
Q

When is pulmonary vascular resistance lowest?

A

At functional residual capacity (after normal tidal volume)

76
Q

Describe how airway frictional resistance changes as you move from the larger bronchi to the smaller ones. Where does it reach its maximum?

A

Most of the airway resistance comes from the first ten generations of bronchi (maximum at generations 2-5) vs. very little from the smallest ones

77
Q

What is the typical mechanism of resistance against streptomycin?

A

Altered structure of bacterial ribosomal proteins because streptomycin (like other aminoglycosides) work by inactivating the 30s subunit

78
Q

What do you need to know in order to PCR sequence a segment of DNA?

A

The sequence of the flanking regions

79
Q

Why does chloride shift into erythrocytes in venous vs. arterial blood?

A

In venous blood, erythrocytes are carrying carbon dioxide which gets converted to H+ and bicarbonate from carbonic anhydrase. The bicarbonate diffuses out into the plasma and so chloride shifts into the RBC to maintain electroneutrality.

80
Q

What is the primary virulence factor of strep pneumo?

A

Polysaccharide capsule that inhibits phagocytosis

81
Q

What part of the respiratory system is particularly affected by chronic rejection in lung transplantation?

A

Small airways - bronchiolitis obliterans syndrome

82
Q

Does small cell or squamous cell lung cancer stain positive for chromogranin?

A

Small cell

83
Q

What would you expect as an acid-base disturbance from chronic exposure to high altitude?

A

Respiratory alkalosis (due to hyperventilation) with decreased bicarbonate as renal compensation

84
Q

What cytokine is important for the formation of a granuloma?

A

IFN-gamma

85
Q

What receptors can be pharmacologically targeted for asthma?

A
  1. Leukotrienes - LTC4, LTD4, LTE4

2. Acetylcholine

86
Q

What does the pneumococcal vaccine contain?

A

Capsular polysaccharides

87
Q

What causes the tissue damage that allows a lung abscess to form?

A

Lysosomal enzymes released from neutrophils and macrophages

88
Q

Pain upon inspiration in the neck and shoulder region is coming from what nerve?

A

Referred pain from phrenic nerve (C3 - C5)

Likely due to irritation of the pleura

89
Q

Which RNA polymerase synthesizes the vast majority of rRNA from within the nucleolus?

A

RNA polymerase I

90
Q

Where is the most highly oxygenated blood in fetal circulation?

A

Umbilical vein which empties directly into the IVC via the ductus venosus

91
Q

Why is the mucus dehydrated in CF?

A

CFTR isn’t working –> inhibits Cl secretion –> drives Na reabsorption –> dehydrates the mucus

92
Q

Which antifungals bind ergosterol in the fungal cell membrane?

A

Polyenes (amphotericin B and nystatin)

93
Q

What are the major toxicities of theophylline overdose?

A

Abdominal pain, vomiting, seizures

94
Q

For a naked RNA virus to induce the host cell’s own machinery to synthesize proteins, does it have to be positive or negative?

A

Positive - meaning it is acting directly as mRNA

95
Q

What is the difference between t-test and ANOVA?

A

T-test: compare the difference between the means of 2 groups

ANOVA (analysis of variance): compare the difference between the means of 2 or more groups

96
Q

Aside from histamine, what other mast-cell specific enzyme is released in excess during anaphylaxis?

A

Tryptase

97
Q

What is the intrapleural pressure at FRC?

A

-5 cm H2O

98
Q

What is arterial PaCO2 a direct indicator of?

A

Alveolar ventilation

99
Q

Is blastomyces or aspergillus more likely to cause chronic pneumonia in an immunocompetent host?

A

Blastomyces

100
Q

What is cromolyn?

A

Mast cell stabilizing agent - inhibits mast cell degranulation

Nedocromil is another mast cell stabilizing agent

101
Q

In a patient with lobar pneumonia, if the lung is pale but has fragments of RBCs, is it in red hepatization or gray hepatization?

A

Gray

102
Q

Histology: well differentiated lung tumor with composed of tall, columnar cells that line the alveolar septa without evidence of vascular or stromal invasion

Diagnosis?

A

Bronchioloalveolar carcinoma

103
Q

Why is capillary wedge pressure normal in acute respiratory distress syndrome?

A

One of the minor diagnostic criteria = absence of cardiogenic pulmonary edema

104
Q

How does the body get rid of strep pneumo?

A

Bacterial clearance via spleen (encapsulated organism)

105
Q

How does the influenza vaccine work?

A

Composed of inactivated viral components that increases host circulating antibodies against hemagglutinin so that the virus has trouble entering cells

106
Q

What kind of epithelium is found in the oropharynx, laryngopharynx, anterior epiglottis, upper half of the posterior epiglottis, and vocal folds?

A

Stratified squamous epithelium

107
Q

What TB drug must be processed by mycobacterial catalase-peroxidase for the drug to be activated within the bacteria?

A

Isoniazid

108
Q

What is the difference between central vs. peripheral chemoreceptors and what they respond to?

A

Central - senses CO2 levels to regulate respiratory drive

Peripheral - senses O2 levels in severe cases of hypoxia

109
Q

What is the most common cause of acute epiglottitis and why do we not see it much anymore?

A

H influenza type B

Decreased because of vaccine

110
Q

Normal PaO2 and % sat, but low O2 content.

What is this suggestive of?

A

Anemia (e.g. chronic blood loss)

111
Q

Is strep pneumo bile sensitive or bile resistant?

A

Bile sensitive

112
Q

What is another way to describe aspergilloma?

A

Colonizing aspergillosis

113
Q

What is a common cause of bilateral absence of vas deferens?

A

Cystic fibrosis

114
Q

What category of drugs will only reverse vagally-mediated bronchoconstriction?

A

Antimuscarinics (e.g. ipratropium)

115
Q

What happens during the first week of exposure with TB?

A

Intracellular bacterial proliferation

116
Q

What are hamartomas composed of?

A

Disorganized cartilage, fibrous and adipose tissue

117
Q

What is the Reid index?

A

Ratio of the thickness of the mucous gland layer to thickness of the bronchial wall between respiratory epithelium and cartilage

118
Q

What can be used as prophylaxis in patients at risk for MAC?

A

Weekly azithromycin

119
Q

What is mucicarmine stain used for?

A

Stains the polysaccharide capsule of cryptococcus neoformans

120
Q

Which viruses exhibit a form of replication in which they produce a polyprotein product that is later cleaved by a viral protease to produce functional, individual proteins?

A

Single-stranded, positive sense, linear, non-segmented RNA viruses (e.g. Picornaviruses like echovirus)

121
Q

How far down (rib number) do the lungs go on the mid axillary line?

A

Rib 9

122
Q

What is the best lab value for helping to determine the cause of metabolic alkalosis?

A

Urinary Cl - it will be decreased if the cause is loss of hydrogen ions from the body (e.g. vomiting) and increased if the cause is diuretics/primary hyperaldosteronism

123
Q

Describe what happens to pH, PaO2, PaCO2, plasma HCO3 in the setting of pulmonary embolism.

A

Hypoxemia leading to hyperventilation which leads to increased pH (respiratory alkalosis), decreased PaCO2, decreased PaO2 (hypoxemia), and decreased HCO3 (to account for the loss of H+ to increase the pH)

124
Q

Oral thrush, interstitial pneumonia, and severe lymphopenia during the first year of life suggest vertical transmission of what?

A

HIV

125
Q

How can vertical transmission of HIV be reduced?

A

Maternal prophylaxis during pregnancy with the nucleoside analog zidovudine (ZDV, AZT) - a retroviral reverse transcriptase inhibitor

126
Q

Why are patients with silicosis at increased risk of TB infection?

A

Disruption of macrophage phagolysosomes by internalized silica particles

127
Q

What happens if a patient has a defect in antibody class switching?

A

Hyper-IgM

128
Q

What would you give in terms of medication to an alcoholic with a lung abscess?

A

Clindamycin - covers both the gram positive strep pneumo pneumonia as well as anaerobes that likely cause the abscess from aspiration

129
Q

What medication would you consider giving to a child/infant with severe RSV infection?

A

Ribavirin

130
Q

What does amphotericin B bind to?

A

Ergosterol in fungal cell membranes but can also bind to cholesterol in human cell membranes (causing most of its toxicities)

131
Q

What drug can assist patients with cessation of tobacco use by reducing withdrawal cravings and attenuating the rewarding effects of nicotine?

A

Varenicline - partial agonist of nicotinic acetylcholine receptors

132
Q

Why is the pO2 in the left atrium lower than that in the pulmonary capillaries?

A

Deoxygenated blood from the bronchial arteries mixes with oxygenated blood in the pulmonary veins

133
Q

What vaccines use diphtheria toxoid as their protein carrier?

A
  1. Strep pneumo
  2. Neisseria meningitidis
  3. H flu
134
Q

What is a common cause for legionella outbreak in a hospital setting?

A

Colonization of the hospital water system (e.g. humidification system, air conditioning, water-based cooling system)

135
Q

What protects bacteria from osmotic stress?

A

Peptidoglycan wall

136
Q

What 3 class of antibiotics disrupts the bacterial peptidoglycan wall?

A
  1. Penicillins
  2. Cephalosporins
  3. Vancomycin
137
Q

Histology: Large spherule filled with endospores?

A

Coccidioides

138
Q

Deletions or additions of a number of base pairs not in a multiple of 3 indicates what kind of mutation?

A

Frameshift

139
Q

Antibodies to polyribitol ribose phosphate (PRP) carry protection against?

A

H flu type B (PRP is in its capsule)

140
Q

What is the difference between TB and sarcoid on biopsy?

A

TB - caseating granulomas, acid-fast bacilli

Sarcoidosis - noncaseating granulomas

141
Q

What are the 2 most common causes of SVC syndrome?

A
  1. Lung cancer

2. non-Hodgkin lymphoma

142
Q

The green discoloration of pus or sputum during bacterial infections is associated with the release of what?

A

Myeloperoxidase from neutrophil azurophilic granules - myeloperoxidase is a heme containing pigmented molecule

143
Q

Pneumoconiosis with egg-shell calcifications of hilar nodes and birefringent particles surrounded by dense collagen fibers?

A

Silicosis

144
Q

Why does mycoplasma pneumoniae infection cause anemia?

A

Cold agglutinins - the body lyses some of its own RBC’s as the antibodies against mycoplasma share some of the antigens

145
Q

What component of inflammatory exudate is most important for inducing rapid neutrophil locomotion?

A

LTB4

146
Q

What are the 4 major causes of hypoxemia (low PaO2)?

A
  1. Alveolar hypoventilation
  2. V/Q mismatch
  3. Diffusion impairment
  4. Right to left shunting
147
Q

How can you distinguish alveolar hypoventilation from the other causes of hypoxemia?

A

Hypoventilation shows normal A-a gradient

Step 1 Smart Book (13 decks)

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