Respiratory

Question 1

What should you consider with a child with nasal polyps

Answer 1

Cystic fibrosis

Question 2

Triad seen in aspirin (ASA) intolerant Asthma

Answer 2

Asthma
Aspirin induced bronchospasm
Nasal polyps

Question 3

Adolescent male
Tumor
Profuse epistaxis

Answer 3

Angifibroma

Question 4

Pleomorphic keratin positive epithelial cells in a background of lymphocytes

What are the 2 demographic profile of patients commonly seen with this disease?

Answer 4

Nasopharyngeal carcinoma

African children
Adolescent Chinese

Question 5

Laryngeal papilloma is associated with what HPV

Answer 5

HPV 6 & 11 (low risk HPV)
Presenting with koilocytic change
Single in adults
Multiple in children

Question 6

Key mediators of pain

As in pleuritic chest pain in pneumonia

Answer 6

Bradykinin

Prostaglandin E2

Question 7

Most common causes of lobar pneumonia

Answer 7

Strep pneumoniae (95%) — most common cause of CAP
Klebsiella pneumoniae —enteric flora that is aspirated (patient prone to aspiration at risk: alcoholics, diabetics, nursing home px); currant jelly sputum is from thick mucoid capsule of K. Pneumoniae

Question 8

Four phases of lobar pneumonia

Answer 8

Congestion — congestive vessels and edema
Red hepatization — develop exudate in the lung (consolidation)
Grey hepatization — break down of exudates
Resolution — heal lung by regeneration of lining (Type Il pneumocytes)

Question 9

Most common cause of atypical pneumonia
Young adults, miltary recruits, students living in dormitory

Complication associated with it is?

Answer 9

Mycoplasma pneumoniae

autoimmune hemolytic anemia— IgM against I antigen on RBCs

Question 10

Bacterial cause of aspiration pneumonia

Answer 10

Bacteroides
Fusobacterium
Peptococcus

— anearobic bacteria in oropharynx

Question 11

Cytokines involved in Asthma

Answer 11

IL 4
IL 5
IL 10

—all released by TH2 lymphocytes

Question 12

Allows plasma cell to class switch into IgE

Answer 12

IL 4

Question 13

Causes chemotaxis of eosinophils

Answer 13

IL 5

Question 14

Inhibits differentiation of T cells to TH1 cells

Inducing Th2 cell production

Answer 14

IL 10

Question 15

Describe pathophysio early phase of asthma

Answer 15

Early phase—mast cells has surface IgE receptors that are stimulated by allergens causing cross linking, activating mast cells
Mast cells dump preformed histamine granules

Question 16

What are the effects of preformed histamine granules released from activated mast cells?

Answer 16

Histamine induced vasodilation (at arterioles)

Histamine induced increased vascular permeability (at post venule capillaries)

Question 17

Describe second phase of mast cell activation

Answer 17

Inflammation
Production of leukotrienes — LTC4, LTD4, LTE4
— vasoconstriction (constrict smooth muscles of blood vessels)
— increased vascular permeability (constrict the pericytes)
— bronchoconstriction (constrict smooth muscle of bronchus)

Question 18

What are the key players in late phase of Asthma?

Answer 18

Continued inflammation
Eosinophils release major basic protein
Perpetuation of bronchoconstriction

Question 19

What are the 2 pathologic findings associated with asthma?

Answer 19

Curshmann spirals

Charcot Leyden crystals

Question 20

Shed epithelium that form whorled mucus plugs

Answer 20

Curshmann spirals

Question 21

Breakdown of major basic protein from eosinophils

Eosinophilc, hexagonal, double pointed needle - like crystals

Answer 21

Charcot-Leyden crystals

Question 22

Triad of Aspirin induced asthma

Answer 22

Asthma
Bronchospasm
Nasal polyps

—COX inhibition causes leukotriene overproduction = airway constriction

Question 23

What part of cilia is affected in Kartagener syndrome

Answer 23

Dynein arm