Respiratory

Question 1

What is the relation of the pulmonary artery to the bronchus at each lung hilus?

Answer 1

Right: Anterior
Left: Superior

Question 2

What is the equation for pulmonary vascular resistance?

Answer 2

PVR = (Ppulm.art - Patrium)/CO

Remember P = QR

Question 3

What happens to arterial PaO2 and PaCO2 during exercise?

Answer 3

They do not change! Your body tries to compensate for exercise by increasing perfusion through increased CO.

Question 4

What happens to venous O2 and CO2 content during exercise?

Answer 4

CO2 increases and O2 decreases

Question 5

What is the MCC of rhinosinusitis?

Answer 5

Viral (can cause superimposed bacterial infection)

Question 6

What is the classic triad for fat emboli?

Answer 6

Hypoxemia, petechial rash, and neuro abnormalities

Question 7

What happens with gas emboli?

Answer 7

Nitrogen bubbles precipitate in ascending divers

Question 8

How do you treat gas emboli?

Answer 8

Hyperbaric Oxgen

Question 9

What is the imaging test of choice for PE?

Answer 9

CT angiography

Question 10

What do you get from shipbuilding, roofing, plumbing?

Answer 10

Asbestosis

Question 11

What do you have if you see ivory white calcified pleural plaques?

Answer 11

Asbestosis but are not precancerous

Question 12

What are golden brown fusiform rods resembling dumbells?

Answer 12

Ferruginous bodies- macrophages that have eaten asbestos fibers and coated them with ferritin. Seen with asbestosis.

Question 13

What do you see eggshell hilar lymph node calcifications with?

Answer 13

Silicosis

Question 14

What do you get from mines, sandblasting, foundries?

Answer 14

Silicosis

Question 15

What do babies get supplemental O2 for ARDS?

Answer 15

Retinopathy of prematurity, bronchopulmonary dysplasia

Question 16

What do you use Bethamethasone for?

Answer 16

Neonatal RDS

Question 17

What do you use Beclamethasone for?

Answer 17

COPD/Asthma

Question 18

What does persistently low O2 tension in neonatal ARDS increase risk for?

Answer 18

PDA

Question 19

What do presence of bronchial breath sounds indicate?

Answer 19

Consolidation (lobar pneumonia, pulmonary edema)

Question 20

What are kulchitsky cells?

Answer 20

Small dark blue cells in small cell carcinoma

Question 21

What are the side effects of Salmeterol/Formoterol?

Answer 21

Arrhythmia, tremor

Question 22

What is the MC morbidity problem with Theophylline?

Answer 22

Tacchyarrhythmias and seizures

Question 23

What do you use for aspirin induced asthma?

Answer 23

Zafirlukast, Montlukast

Question 24

What does airspace opacities in superior region of lower lobes suggest?

Answer 24

Aspiration pneumonia (especially with leukocytosis and history of dementia)

Question 25

What is nasopharyngeal carcinoma associated with?

Answer 25

EBV

Question 26

What would hamartoma of the lung show?

Answer 26

Hyaline cartilage

Question 27

What cancer does asbestosis cause?

Answer 27

Bronchogenic adenocarcinoma > mesothelioma

Question 28

What does nitroprusside do to your Hb?

Answer 28

Causes conversion to metHb

Question 29

How do you treat Methemoglobinemia?

Answer 29

Methylene blue or ascorbic acid (converts ferric to ferrous iron)

Question 30

What is usually the cause of unilateral pleural effusion?

Answer 30

Bacterial usually

Question 31

What would you in pleural effusion (think exudate vs transudate)

Answer 31

LDH, protein

Question 32

What do you calculate CO if given arteriovenous O2 content?

Answer 32

CO = O2 consumption/ arterial O2 content - venous O2 content

Question 33

If surfactant is messed up what do you see?

Answer 33

Patchy ateclectasis

Question 34

What is the 1st line treatment for chronic asthma?

Answer 34

Fluticasone (Glucoroticoids)

Question 35

How long does bicarb compensation take?

Answer 35

3-5 days; so if you see acid-base question make sure to consider how long its been and hence if compensation is occurring

Question 36

Where do fish bones get lodged?

Answer 36

Piriform recess

Question 37

What is the diagnosis? Upper body rash, neurological symptoms, respiratory dress after long bone fracture or liposuction.

Answer 37

Fat embolus

Question 38

What causes a spontaneous pneumothorax?

Answer 38

Spontaneous sudden onset chest pain in tall think malefrom apical subpleural blets rupturing

Question 39

What happens that is important for lung devo at 26 weeks?

Answer 39

Phosphatidylcholine sharply increases and lecithin increases but very slowly

Question 40

What causes hypercalcemia in sarcoidosis?

Answer 40

Activated macrophages cause 1alpha hydroxylase mediated vitamin activation

Question 41

Why does resistance increase in medium sized compared to trachea?

Answer 41

Because of high turbulent flow

Question 42

What causes panacinar emphysema?

Answer 42

Proteases released from alveolar macrophages and neutrophils

Question 43

What does adenocarcinoma show in histology?

Answer 43

Mucin producing cells that cause copious amounts of fluid in sputum; does not invade

Question 44

What does a mutation in CFTR cause?

Answer 44

Abnormal bolding and glycosylation of CFTR

Question 45

What is the main hormone for implicated in surfactant production?

Answer 45

Cortisol

Question 46

How far up are the lung apices?

Answer 46

Above the clavicle

Question 47

What is a normal A-a gradient is?

Answer 47

10-15 mmHg

Question 48

Which of the lung cancers is inoperable?

Answer 48

Small Cell Carcinoma

Question 49

What happens with PaO2 in CO poisoning?

Answer 49

Does not change (it only lowers the saturation of Hb)

Question 50

What is a major risk factor for acute onset respiratory distress?

Answer 50

Acute pancreatitis

Question 51

What is used to treat primary pulmonary HTN (ie the heritable one)

Answer 51

Bosentan

Question 52

What does regeneration during lung damage?

Answer 52

Type II pneumocytes

Question 53

How long does it take to adjust to high altitude?

Answer 53

Two weeks

Question 54

What do you give patients that come in with acute exacerbation of asthma?

Answer 54

Leukotriene receptor inhibitors (Zafirlukast)

Question 55

What will show greater changes in PCO2, perfusion or diffusion limited?

Answer 55

Perfusion because CO2 diffuses better than O2

Question 56

What is normal alveolar and tracheal PO2?

Answer 56

Alveolar: 104 Tracheal: 150

Question 57

How does septic shock affect the lungs?

Answer 57

Causes ARDS leading to intra-alveolar edema, interstitial edema, hyaline membrane formation, inflammation

Question 58

What nerve increases bronchoconstriction?

Answer 58

Vagus by acting on M3 receptors

Question 59

How does left heart systolic failure affect the lung?

Answer 59

Decreases compliance of lung: LF systolic failure --> increased end systolic volume --> greater pressure for pulmonary artery to push against --> increased pulmonary artery pressure --> fluid leakage into parencyma --> decreased compliance of lung

Question 60

What causes dilated vessels of upper trunk and neck, facial edema and plethora, cough, dizziness?

Answer 60

SVC Syndrome

Question 61

What is Clindamycin used for?

Answer 61

Anaerobes above diaphragm and group A strep

Question 62

How do you tell a staph pneumonia apart from a strep pneumonia?

Answer 62

Staph produces cavitary lesion and strep does not (it produces necrotizing abscessing pneumonia)

Question 63

How does silicosis increase susceptibility to TB?

Answer 63

By impairing macrophage fusion with phagolysosome

Question 64

What is the diagnosis? HIV patient with lesions that on histology look like spindle shaped small vessel proliferations?

Answer 64

Kaposi sarcoma

Question 65

What else can Kaposi sarcoma cause besides red flat maculopapular lesions?

Answer 65

Diarrhea

Question 66

How does PaO2 change with CO poisoning?

Answer 66

It doesn't. PaO2 is unaffected by CO since it is dissolved. O2 content would be changed.

Question 67

What do you see with theophylline toxicity?

Answer 67

Seizures, abdominal pain, arrhythmias, vomiting, diarrhea

Question 68

What would you see just SVC syndrome with?

Answer 68

Mediastinal mass (NOT pancoast since that would also show horner's)

Question 69

Diagnosis? Interstitial fibrosis with paraseptal and subpleural cystic airpsace enlargmenet (honeycomb lung)

Answer 69

Idiopathic pulmonary fibrosis

Question 70

What is the shake stability test?

Answer 70

Multiple wells with ethanol and amniotic fluid are shaken and examined for ring of stable foam. Foam stability index is highest value well that contains ring of foam. It evaluates surfactant functionality/lung maturity.

Question 71

What happens to compliance in emphysema?

Answer 71

It increases!!

Question 72

What increases in obstructive lung diseases?

Answer 72

RV, FRC, TLC

Question 73

What is FRC equal to?

Answer 73

ERV + RV

Question 74

At what levels do structures perforate the diaphragm?

Answer 74

T8: IVC T10: Esophagus, vagus T12: aorta, thoracic duct, azygous vein "I ate ten eggs at twelve"

Question 75

A 16-year-old boy is admitted to the emergency department because of a knife wound to the left side of his chest. An x-ray of the chest shows an air-fluid level in the left side of the chest, partial collapse of the left lung, and elevation of the stomach bubble. The mediastinum is in the midline. Which of the following is the most likely diagnosis?

Answer 75

Hemopneumothorax not under tension Air fluid levels = hydropneumothorax. If there's also a stab in the scenario then its blood instead of water. No mediastinal shift means no tension

Question 76

What does altitude sickness cause?

Answer 76

High altitude pulmonary edema (a type of ARDS) that would look like bilateral fluffy infiltrates on Xray

Question 77

What would happen to numbers of type 1, type 2 pneumocytes and fibroblasts in chronic inflammatory interstitial pneumonitis?

Answer 77

Type 1 will go down (since they are destroyed) Type 2 will go up (since they regenerate) Fibroblasts go up (chronic inflammation causes fibrosis)

Question 78

What do you think of middle aged non smoking woman with SOB?

Answer 78

Idiopathic pulmonary fibrosis

Question 79

What is anthracosis?

Answer 79

Asymptomatic condition found in urban dwellers exposed to sooty air where carbon accumulates in macrophages

Question 80

What are the cmplications of sleep apnea?

Answer 80

Pulm/systemc HTN Arrhythmias Sudden cardiac death

Question 81

Why does maternal diabetes cause neonatal ARDS?

Answer 81

Insulin inhibits surfactant production