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2020 CPR II Pulm Exam 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the most common cause of rhinitis?

A

Rhinovirus

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2
Q

What is a common cause of a nasal polyps in children? In adults?

A

children = Cystic fibrosis

adults = aspirin intolerant asthma

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3
Q

What is the triad of Aspirin-Resistant Asthma?

A

asthma

aspirin induced bronchospasm

nasal polyps

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4
Q

What is an angiofibroma? What is an angiofibroma composed of?

A

benign tumor of nasal mucosa

blood vessels and fibrous tissue

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5
Q

What patient population is angiofibroma often seen?

A

adolescent males

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6
Q

What virus is associated with nasopharyngeal carcinoma? Which lymph nodes does the commonly involve?

A

EBV

cervical

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7
Q

Nasopharyngal carcinoma is classically seen in what two populations?

A

African children

Chinese adults

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8
Q

What are the two histological characteristics of Nasopharyngeal Carcinoma seen on biopsy?

A

pleomorphic keratin positive epithelial cells

background of lymphocytes

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9
Q

What is the most common cause of epiglottitis? Immunized, nonimmunized or both?

A

H. influenzae Type B

both

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10
Q

What virus causes Croup?

A

Parainfluenzae

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11
Q

What material composes a vocal cord nodule? Unilateral or bilateral? Why?

A

myxoid

bilateral

excessive use

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12
Q

Which HPV isotypes would be found in Laryngeal Papilloma? How does this appear in adults? Children?

A

6 and 11

adults = single

children = multiple

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13
Q

Where does a Laryngeal Carcinoma usually arise from? Arise from laryngeal papilloma?

A

epithelial tissue of vocal cord

no

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14
Q

Which two bacteria make up the majority of Lobar Pneumonia? Which one is the stark majority?

A

Strep. pneumoniae (majority)

Klebsiella pneumoniae

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15
Q

Which three bacterial Genus are most likely to cause Aspiration pneumonia?

A

Bacteroides

Fusobacterium

Peptococcus

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16
Q

What is Secondary Pneumoniae? Which bug is most likely to cause Secondary Pneumonia?

A

bacterial pneumonia superimposed on viral pneumonia

S. Pneumoniae

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17
Q

What is the most common mechanism by which Klebsiella pneumoniae can establish an infection in the lungs?

A

Aspiration

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18
Q

Which patient population is most likely to be affected by Klebsiella pneumoniae?

A

alcoholics/elderly/debilitated

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19
Q

What bacteria is the 2nd most common cause of Secondary Pneumonia?

A

S. aureus

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20
Q

Patients with COPD are most likely to get pneumonia from what two bugs?

A

Haemophilus influenzae

Moraxella catarrhalis

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21
Q

What bug causes pneumonia in CFTR patients?

A

P. aeruginosa

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22
Q

Legionella pneumophilia requires what to infect people?

A

a water source

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23
Q

Which pneumonia causing bug can be visualized with a silver stain?

A

Legionella pneumophilia

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24
Q

What bug is the most common cause of atypical pneumonia? In what two patient populations?

A

Mycoplasma pneumonia

military recruits or college students

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25
Q

What bug is the second most common cause of atypical pneumonia in young adults?

A

Chlamydia pneumoniae

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26
Q

Which virus is most common to cause viral pneumonia is a post-transplant patient?

A

CMV

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27
Q

Where are the two sources for coxiella?

A

ticks or cattle placenta

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28
Q

In what two patient populations does Coxiella cause pneumonia?

A

farmers or veterinarians

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29
Q

Which lobe does aspiration pneumonia most often effect?

A

lower right

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30
Q

Where is the specific part of the brain where TB accumulates?

A

base of brain in meninges

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31
Q

Where in the lung does secondary TB most often effect?

A

apex

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32
Q

What are four sites of common TB systemic spread?

A

Meninges

cervical lymph nodes

kidney

lumbar spine

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33
Q

What hypertrophies during Chronic Bronchitis?

A

bronchial mucinous glands

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34
Q

What type of emphysema does smoking lead to? What lobe?

A

Centri-acinar

upper

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35
Q

What type of emphysema does α1AT deficiency lead to? What part of the lung?

A

panacinar

lower lobe

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36
Q

What is the normal α1AT allele? What is the mutant α1AT allele?

A

normal = PiMM

mutant = PiZZ

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37
Q

What three ILs do TH2 cytokines release during asthma?

A

IL4/IL5/IL10

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38
Q

What is the function of IL-4?

A

class type switch to IgE

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39
Q

What is the function of IL-5?

A

recruit eosinophils

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40
Q

What is the function of IL-10?

A

inhibit TH1 response

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41
Q

Does the first exposure or re-exposure to antigens result in degranulation of mast cells? What is the first cytokine released?

A

second exposure

histamine

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42
Q

Which leukotrienes are released during an asthma attack?

A

C4/D4/E4

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43
Q

Which protein mediates most of the damage/inflammation during asthma? What cell releases this protein?

A

major basic protein

eosinophils

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44
Q

What is bronchiectasis?

A

permanent dilation of bronchioles and bronchi

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45
Q

What causes Bronchiectasis?

A

Necrotizing Inflammation

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46
Q

What type of specific lung pathology is caused by Cystic Fibrosis?

A

bronchiectasis

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47
Q

What type of lung pathology is caused by Kartagener Syndrome?

A

bronchiectasis

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48
Q

What protein is defective during Kartagener Syndrome?

A

dynein arm

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49
Q

What is dynein important for?

A

motion of cilia

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50
Q

What are the three physical manifestations of Kartagener Syndrome?

A

sinusitis

infertility

situs inversus

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51
Q

What type of lung pathology can be created by Aspergillus? In what two patient groups?

A

Bronchiectasis

CF and asthmatics

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52
Q

Why can bronchiectasis produce amyloidosis?

A

chronic inflammation

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53
Q

What cytokine mediates the progression of pulmonary fibrosis?

A

TGF-β

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54
Q

What is pneumoconioses? What cell mediates this?

A

inhaled particles are engulfed by alveolar marophages and induce release of cytokines which mediate fibrosis

macrophages

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55
Q

Is sarcoidosis a caseating or non-caseating granuloma?

A

non-caseating

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56
Q

What is the race of the classic person to present with sarcoidosis?

A

african american, female

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57
Q

Would sarcoidosis be a restrictive or obstructive disease?

A

restrictive

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58
Q

What is the characteristic histological finding seen during Sarcoidosis?

A

asteroid body

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59
Q

What are the two classical lab findings during sarcoidosis?

A

elevated ACE

hypercalcemia

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60
Q

What is the Tx for sarcoidosis?

A

steroids

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61
Q

Coal Workers Lung is associated with what other disease?

A

Rheumatoid Arthritis

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62
Q

Does silicosis generally effect the upper lobe or lower lobe of the lung?

A

upper

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63
Q

What disease does silicosis carry an increased risk for developing? Why?

A

TB

silica impairs phagolysosome formation

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64
Q

Workers from what industry can present with berylliosis? What type of granuloma?

A

aerospace

beryllium = non-caseating granuloma

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65
Q

What disease does berylliosis mimmic?

A

Sarcoidosis

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66
Q

Does asbestos cause lung carcinoma or mesothelioma more often?

A

lung carcinoma

67
Q

Asbestos Bodies contain what?

A

Iron

68
Q

Primary Pulmonary HTN is clasically seen in what patient population?

A

young adult females

69
Q

What gene can be implicated during Primary Pulmonary HTN? What is the result?

A

BMPR2

proliferation of smooth muscle

70
Q

What are the three causes of Secondary Pulmonary HTN?

A

increased volume

hypoxemia

recurrent pulmonary embolism

71
Q

What structure is damaged during Acute Respiratory Distress Syndrome?

A

Alveolar/Capillary Interface

72
Q

Would Acute Respiratory Distress Syndrome feature exudate or transudate?

A

transudate

73
Q

Which type of pneumocyte makes surfactant?

A

Type II

74
Q

What is the main molecular component of surfactant?

A

Phosphatidylcholine

75
Q

What is another name for phosphatidylcholine regarding surfactant?

A

Lecithin

76
Q

What ratio is used to screen for neonatal respiratory distress?

A

Lecithin/Sphingomyelin

77
Q

At what week of development does surfactant production begin? When is an adequate level reached?

A

28 = begin

34 = sufficient

78
Q

What does the lecithin/sphingomyelin ratio need to be to ensure adequate surfactant production?

A

> 2

79
Q

What molecule increases the production of surfactant?

A

steroids

80
Q

What molecule decreases the production of surfactant?

A

insulin

81
Q

What keeps the PDA open? What causes a PDA to close?

A

open = hypoxemia

good oxygenation

82
Q

What are the two particularly mutagenic carcinogens regarding lung cancer?

A

polycyclic aromatic hydrocarbons

arsenic

83
Q

Radon is formed from the decay of what atom?

A

uranium

84
Q

What are the two most common causes of a non-cancerous coin lesion in the lung?

A

Granuloma or Hamartoma

85
Q

Which fungus is particularly notable for causing a lung granuloma? Where in the country can this be found?

A

Histoplasma

Midwest

86
Q

What cell type does small cell lung cancer arise from? Also called?

A

Neuroendocrine

Kulchitsky

87
Q

Which are three PNPs of small cell lung cancer?

A

ADH

ACTH

Eaton-Lambert

88
Q

Eaton-Lambert Syndrome is associated with what specific lung cancer?

A

small cell

89
Q

What two tissues compose a bronchial hamartoma? What often happens to this lesion?

A

lung tissue and cartilage

calcification

90
Q

What are the two defining characteristics of squamous cell lung cancer on histology?

A

keratin pearls

intercelular bridges

91
Q

What hormone may squamous cell carcinoma produce? Leading to?

A

PTHrp

hypercalcemia

92
Q

Is squamous cell carcinoma more common in males or females?

A

males

93
Q

What two populations present with adenocarcinoma of the lung?

A

females and nonsmokers

94
Q

Which lung cancer often arises in a peripheral location?

A

adenocarcinoma

95
Q

Does squamous cell cancer of the lung produce a central or peripheral lesion?

A

central

96
Q

What type of lung cancer lacks any real defining characteristics on histology?

A

Large Cell Carcinoma

97
Q

What is the definition for Bronchioloalveolar Carcinoma?

A

columnar cells that grow along pre-existing bronchioles and alveoli

98
Q

What type of lung cancer arises from Club/Clara cells?

A

bronchoalveolar

99
Q

Carcinoid tumors are derived from what cell?

A

neuroendocrine

100
Q

What stain do carcinoid tumors stain for?

A

Chromogranin

101
Q

What structure does a Carcinoid tumor usually present as in the lung?

A

polyp in bronchus

102
Q

What two organs most often metastasize to the lungs?

A

breast and colon

103
Q

Does pleural involvement occur more often with squamous cell or adenocarcinoma of the lung?

A

Adenocarcinoma

104
Q

What are the three symptoms of Horner Syndrome?

A

Miosis

Ptosis

Anhydrosis

105
Q

What is the unique site of spread of lung cancer?

A

adrenal glands

106
Q

Which lung cancer encases the lung?

A

Mesothelioma

107
Q

How does mesothelioma often present?

A

recurrent pleural effusion

108
Q

Repeated bouts of rhinitis can give rise to what?

A

Nasal Polyp

109
Q

What are the two most common risk factors for a Laryngeal Carcinoma?

A

alcohol and tobacco

110
Q

Is interstitial pneumonia most often caused by virus or bacteria?

A

virus

111
Q

What is a high-yield complication of Mycoplasma pneumonia infection?

A

autoimmune hemolytic anemia

112
Q

Which specific lobe is most commonly affected during aspiration pneumonia?

A

right lower lobe

113
Q

What are the two components of a Ghon complex?

A

fibrosis and calcification

114
Q

Where in the brain can TB produce meningitis?

A

base of brain

115
Q

What is the most common organ to be affected by spread of TB?

A

kidney

116
Q

What is the first mechanism by which mast cells create inflammation? What is the 2nd phase?

A

1st = histamine

2nd = leukotrienes

117
Q

What composes Charcot-Leyden crystals?

A

Major Basic Protein

118
Q

Where in the lung does interstitial fibrosis most usually begin?

A

subpleural

119
Q

Is sarcoidosis caseating or noncaseating?

A

non-caseating

120
Q

What does non-caseating mean?

A

all cells of granuloma are alive

121
Q

Hypersensitivity Pneumonitis features what two characteristics?

A

Granulomas

Eosinophils

122
Q

How many mm of Hg counts as pulmonary HTN?

A

25 mm Hg

123
Q

What is a plexiform lesion? When is a plexiform lesion seen?

A

close group of capillaries

pulmonary HTN

124
Q

What patient population is most likely to present with pulmonary HTN?

A

young females

125
Q

Which pneumocytes get damaged during ARDS? Protein rich or poor fluid?

A

Type I and Type II

protein rich

126
Q

What are the two major complications of giving an infant with NRDS oxygen?

A

retinal damage

bronchopulmonary dysplasia

127
Q

Which lung cancer is treated with surgery?

A

non-small cell

128
Q

Which lung cancer is treated with chemotherapy?

A

small cell

129
Q

What are the intercellular bridges of squamous cell carcinoma composed of?

A

desmosomes

130
Q

If a lung cancer starts with an ‘S’, what are the three things it means?

A

smoking

central

(paraneoplastic) Syndromes

131
Q

Are small cell lung cancers poorly differentiated or well differentiated? Carcinoid tumors poorly differentiated or well differentiated?

A

small cell = poorly

carcinoid = well

132
Q

What is the name of a tumor that arises in the apex of the lung?

A

Pancoast tumor

133
Q

What is Caplan Syndrome?

A

Rheumatoid Arthritis and coal workers pneumoconioses

134
Q

What is another name for Croup?

A

Laryngotracheobronchitis

135
Q

Does Croup present with inspiratory or expiratory stridor?

A

inspiratory

136
Q

What causes gray hepitization?

A

degradation of red cells within exudate

137
Q

Which two bacteria like to superimpose on top of viral pneumonia?

A

S. aureus

H. flu

138
Q

Is Coxiella a rickettsial organism?

A

yes

139
Q

Would a positive PPD occur during primary or secondary TB?

A

primary

140
Q

What is the definition of bronchitis?

A

productive cough lasting three months over a two year period

141
Q

What is the Reid Index?

A

thickness of mucus glands compared to bronchial wall thickness

142
Q

Why does A1AT damage hepatocytes?

A

protein accumulation in ER

143
Q

Are A1AT heterozygotes symptomatic?

A

no

144
Q

What does IL10 due to TH2 cells? TH1?

A

stimulate TH2

inhibit TH1

145
Q

What composes Curschmann Spirals?

A

mucus

146
Q

Is dynein responsible for retrograde or anterograde?

A

retrograde

147
Q

What is ABPA?

A

allergic bronchopulmonary aspergillosis

148
Q

In what two groups is ABPA more common?

A

asthma or cystic fibrosis

149
Q

Is sarcoidosis driven by CD4 or CD8 cells?

A

CD4

150
Q

Which immune cell drives ARDS?

A

neutrophil

151
Q

Which pneumonia causing bug is part of the enteric flora?

A

Klebsiella pneumoniae

152
Q

What is the timeframe for bronchitis?

A

at least three months for at least two years

153
Q

What does the Reid Index have to be do diagnose bronchitis?

A

> 50%

154
Q

Which organelle does mis-folded A1AT get trapped?

A

endoplasmic reticulum

155
Q

PiMZ heterozygotes shouldnt do what?

A

smoke

156
Q

Which lung disease can produce amyloidosis?

A

Bronchiectasis

157
Q

What is anthracosis?

A

build up of carbon in macrophages

158
Q

What cancer does Berylliosis increase the risk of?

A

lung

159
Q

What autoimmune disease can sarcoidosis mimmic?

A

Sjogren

160
Q

What is a common enzyme of all non-caseating granulomas?

A

1-alpha-hydroxylase

161
Q

Is BMPR2 activated or inactivated during pulmonary HTN?

A

inactivated

162
Q

What type of membrane for ARDS?

A

hyaline

163
Q

What structure of squamous cell carcinoma of the lung compose the intercellular bridges?

A

desmosomes

2020 CPR II Pulm Exam 2 (28 decks)

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