Respiratory

Question 1

Which part of the respiratory track have squamous epithelium?

Answer 1

Oropharynx, Laryngopharynx and vocal cords. As well as most of the epiglottis.

Question 2

What is the purpose of pious and fimbria on bacterias?

Answer 2

They attach to the host wall.

Question 3

Which leukocytes predominates in sarcoidosis?

Answer 3

CD4+ T Cell

Question 4

What is the mechanism of action of Bosentan? What is it used for?

Answer 4

Endothelin receptor antagonist. Endothelin is a vasoconstrictor especially in pulmonary arteries. So Bosentan is used in pulmonary hypertension.

Question 5

What is the most common cancer caused by Asbestos exposure?

Answer 5

Bronchogenic Carcinoma (NOT Mesothelioma)

Question 6

What is the acid-base disturbance caused by high altitude?

Answer 6

Respiratory alkalosis with bicarb compensation. High pH and low PaO2, PCO2 and Bicarb.

Question 7

Which cell type is most responsible for the histologic findings in emphysema?

Answer 7

Macrophages get activated and recruit neutrophils to the site. Neutrophils themselves are the ones that secrete elastase which destroys the alveolar wall. So Neutrophils.

Question 8

What are the signs and symptoms of legionnaires’ disease?

Answer 8

Fever, Bradycardia, Diarrhea, Headache & Confusion. Bacteria are often NOT found on sputum gram stain.

Question 9

Other than trauma, what can cause a spontaneous pneumothorax on a young patient?

Answer 9

Apical Subpleural Blebs

Question 10

What is the difference between Conversion and Somatization disorder?

Answer 10

Conversion is one “neurologic” weakness. Somatization must impact function and have pain, GI, sexual and pseudoneurologic symptom.

Question 11

What are the first generation H1 blockers?

Answer 11

Diphenhydramine, dimenhydramine, chlorphenhidramine. Also promethazine and hydroxyzine. Not only used for allergies but also for motion sickness and sleeping.

Question 12

What are the second generation H1 blockers?

Answer 12

Loratadine, Fexofenadine, desloratadine, cetirizine

Question 13

Describe the difference in work of breathing for obstructive versus restrictive lung diseases.

Answer 13

In obstructive diseases slow flow is favored to reduce work so the patients breath deep slow breaths. In restrictive shallow breaths are favored to not expand the lung. So the breath fast shallow breath.

Question 14

What causes Kussmaul Breathing?

Answer 14

Ketones (DKA)
Uremia
Sepsis
Salicylates
Methanol
Aldehydes
(u)
Lactic Acid

Question 15

Describe the physiology of Humoral Hypercalcemia of Malignancy?

Answer 15

Tumors secrete PTHrp (rp = releated peptide) that acts like PTH and causes hypercalcemia. Assc w/ Squamous Cell Carcinoma, Renal cell carcinoma and breast cancer.

Question 16

Describe the pathology seen on lung tissue that is caused by left ventricular failure.

Answer 16

Increased pressure causes extravasation of RBCs. The Fe from RBC stays in alveolar macrophages as golden hemosiderin deposits. These deposits stain blue with Prussian Blue staining.

Question 17

How does chronic rejection manifest in the lung?

Answer 17

Bronchiolitis Obliterans (inflammation of the small bronchioles), with dyspnea and wheezing.

Question 18

Why are patients with sarcoidosis or other granulomatous diseases likely to develop hypercalcemia?

Answer 18

They have excess of active Vitamin D, Calcitriol, which is activated by Macrophages.

Question 19

How can mesothelioma be distinguished form adenocarcinoma on biopsy?

Answer 19

The EM of mesothelioma will show long vili and abundant tonofilaments/desmosomes. Adenocarcinoma will show short vili.

Question 20

What is omalizumab?

Answer 20

It is an anti-IgE antibody used in severe allergic asthma that is not resolved with beta agonist or steroids.

Question 21

What is the preferred treatment for aspiration pneumonia with lung abcesses?

Answer 21

Clindamycin because it cover all anaerobes plus the typical pneumonia of Strep Pneumo. Using a first generation cephalosporin will only cover Klebsiella and that’s not good enough.

Question 22

Where is total airway resistance the highest along the bronchial tree?

Answer 22

At medium sized bronchi (2nd to 5th generation) because they have turbulent flow.

Question 23

What is the lowest rib level reached by the parietal pleura along the midclavicular line? Midaxillary? Paravertrebal?

Answer 23

Midclavicular = 7th rib
Midaxillary = 10th rib (top on the right, bottom on the left)
Paravertebral = 12th rib
The lung is about 2 ribs above all of these.

Question 24

What are fenfluramine and phentermine and what do they predispose patients to?

Answer 24

They are appetite suppressants. Patients can have pulmonary hypertension.

Question 25

What should be monitored in patients with Ankylosing Spondylitis?

Answer 25

Chest expansion. Inflammation of cost vertebral and costosternal joints (enthesitis) can decrease chest expansion leading to hypoventilation.

Question 26

Describe the presentation of fat emboli.

Answer 26

Thrombocytopenic peticheal rash, respiratory distress and non-focal CNS symptoms seen in a post fracture or post liposuction patient. The stain commonly used in black in color.

Question 27

What is the index used to determine severity of Chronic Bronchitis?

Answer 27

Gland size to thickness of bronchial wall. (Cartilage is not included.) This is called the Reid Index and it is normally 0.4

Question 28

Why are the responses by central chemoreceptors and peripheral chemoreceptors different?

Answer 28

Central chemoreceptors respond to pH, so mostly PaCO2. Peripheral chemoreceptors respond to PaO2. Patients with long standing COPD can loose the central receptors and thus administration of O2 can decrease ALL respiratory drive.

Question 29

What is Varenicline?

Answer 29

Nicotine analog with partial agonist activity that reduces craving and reduces the effects of nicotine itself. VARenicline is a VARiation of regular nicotine.