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my NPLEX II > Respiratory COPY > Flashcards

Respiratory COPY Flashcards

1
Q

What are the potential consequences of Group A Strep throat if left untreated?

A
  1. ) Suppurative Complications
    a. ) Otitis Media, Sinusitis
    b. ) Pneumonia
    c. ) Mastoiditis
  2. ) Direct Extension
    a. ) Retropharyngeal Abscess
  3. ) Scarlet Fever & Rheumatic Fever
  4. ) Hematogenous Spread
    a. ) Bone - Osteomyelitis
    b. ) Meningitis
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2
Q

What type of hypersensitivity is Asthma?

A

Type 1 involving IgE

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3
Q

What nutraceutical can be given to patients experiencing significant fatigue associated with CMV?

A

CoQ10 500mg

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4
Q

What condition is associated with a grey pseudomembranous pharynx

A

Diphtheria

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5
Q

What is Rheumatic Fever?

A

An inflammatory cross-reaction (molecular mimicry) due of GAS infection characterized by:

  1. ) Subcutaneous nodules = pea sized, firm, non-tender on extensor surfaces
  2. ) Pancarditis (Pericardium, Myocardium, Endocardium)
  3. ) Arthritis (migratory) = very tender, red, warm, swollen joints
  4. ) Chorea (Sydenham’s Chorea)
  5. ) Erythema marginatum = pink macules on the trunk with central blanching (non-pruritic)

Mnemonic: SPACE

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6
Q

What complication of Strep Throat occurs irrespective of antibiotic treatment?

A

Acute Glomerulonephritis

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7
Q

Local health authorities need to be notified of Diphtheria immediately. What are its sequelae?

A
  1. ) Myocarditis
  2. ) Peripheral Nerve Palsy
  3. ) Respiratory distress
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8
Q

If the cardiac silhouette on a lung X-Ray is greater than what size (in relation to the chest wall) is it considered Cardiac Hypertrophy?

A

1/2 the width of the chest wall

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9
Q

This fungal infection most commonly presents as atypical pneumonia with patchy infiltrates on X Ray and with concomitant flu-like symptoms.

A

Histoplasmosis (carried by bat droppings)

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10
Q

Would a pulmonary embolism show up radiopaque or radiolucent on X-Ray?

A

Radiolucent on XRay

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11
Q

What is the term used to describe the alternation of tachypnea with apnea in patients with neurologic diseases or congestive heart failure?

A

Cheyne-Stokes Respiration

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12
Q

Would atelectasis result in radiopacity or radiolucency?

A

Radiopacity

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13
Q

All patients with cryptococcal pneumonia should undergo what investigative study?

A

Lumbar Puncture to rule out a comorbid meningitis

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14
Q

Before taking a sputum culture, how do you prepare the mouth?

A

Rinse the mouth with sterile water to try and remove normal oral flora. The sample then needs to be preceded by a deep productive cough

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15
Q

X Ray shows apical lung lesions with calcification and fibrosis. This pathogen is diagnosed via sputum culture and biopsy- not serology

A

Histoplasmosis

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16
Q

What condition produces Charcot-Leydon Crystals in the sputum?

A

Asthma

These crystals are derived from eosinophils

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17
Q

Describe the spirometry features of Restrictive Lung Conditions

A
  1. ) Decreased Total Lung Capacity
  2. ) Decreased FVC, FEV1
  3. ) FEV1:FVC ratio is increased (>80%
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18
Q

What should acute onset of dyspnea with a normal chest X Ray be considered until proven otherwise?

A

Pulmonary Embolism

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19
Q

Histiologically, what happens in chronic bronchitis?

A

Mucinous hypertrophy. The Reid Index (ratio of mucinous glands relative to the total thickness of the bronchial wall) is > 50%

The mucinous hypertrophy explains why people with chronic bronchitis have a very productive cough

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20
Q

Why isn’t mycoplasma pneumoniae visible on gram stain?

A

M. pneumoniae does not have a cell wall

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21
Q

This fungal infection is diagnosed by serological testing (IgM precipitins

A

Coccidiomycosis

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22
Q

Describe the spirometry findings of COPD

A
  1. ) Decreased FVC, FEV1, FEV1:FVC ratio

2. ) Increased Total Lung Capacity (air trapping)

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23
Q

Percussion during a pneumothroax would reveal what type of sound?

A

Dullness

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24
Q

Eosinophilic debris in the alveoli of patients working within the sandblasting, mining, or glass manufacturing industries?

A

Silicosis caused by the inhalation of Silicon dioxide

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25
Q

Where does secondary TB occur?

A

It typically occurs in the apex of the lung.

Secondary TB is the reactivation of TB from the Ghon complex of the lower lobe and is commonly associated with immunodeficiency

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26
Q

What is the most common cause of Secondary Pneumonia?

A

Staphylococcus aureus

Secondary pneumonia is a bacterial pneumonia superimposed on a viral pneumonia that knocked out the mucociliary escalator, making it easier for bacteria to colonize the bronchioles

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27
Q

Infectious lung condition that is acquired by inhalation of the pathogen’s spores in Arizona, California, New Mexico, or Texas

A

Coccidiomycosis

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28
Q
  1. ) Mycoplasma pneumoniae produces what pattern of pneumonia?
  2. ) What population group are predisposed?
A
  1. ) Atypical (Interstitial) Pneumonia

2. ) Military recruits, college students living in a dorm

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29
Q

What is the most common cause of atypical pneumonia?

A

Adults = Mycoplasma pneumoniae
Infants = RSV
Immunodeficient Patients = CMV

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30
Q

Pneumonia normally presents with a low fever. In one sub-classification of atypical pneumonia, patients may present with a high fever- termed Q Fever. What is the causative rickettsial agent?

A

Coxsiella burnetii

This version of atypical pneumonia is seen in farmers and veterinarians

Note: Coxsiella is an atypical rickettsial microorganism because it does not require an arthropod vector and does not cause a skin rash. It is also atypical because it causes pneumonia.

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31
Q

Do the typical TB related symptoms (Fever, night sweats, cough with hemptysis, weight loss) occur in primary or secondary TB?

A

Secondary

In Primary TB it is rare to have symptoms. The only sign is usually a Ghon complex in the lower lobe

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32
Q

What are the most common causes of Lobar Pneumonia?

Lobar pneumonia is usually a bacterial infection

A
  1. ) Streptococcus pneumoniae (95%)
    i. ) Most common cause of community-acquired pneumonia (middle-aged adults & elderly)
  2. ) Klebsiella pneumoniae
    i. ) Enteric flora that is aspirated; nursing homes, alcoholics, diabetics
33
Q

What are the complications associated with Mycoplasma pneumoniae infection?

A
  1. ) Hemolytic anemia (r/t cold agglutinin disease from elevated IgM antibody titers)
  2. ) Erythema multiforme
34
Q

What is the most common organ to be affected by systemic tuberculosis (other than the lung)?

A

Kidney; causing sterile pyuria

35
Q

A pathogen spread via pigeon droppings. This pathogen can cause pneumonia and meningitis; more commonly meningitis in immunocompromised people.

A

Cryptococcal neoformans (encapsulated yeast)

36
Q
  1. ) Klebsiella-related pneumonia forms what type of pattern on chest xray?
  2. ) What patients are most likely to have Klebsiella pneumonia?
A
  1. ) Lobar Pneumonia with significant risk of abscess formation
  2. ) Elderly in nursing homes, alcoholics, and diabetics; because they are at an increased risk of aspiration. Klebsiella pneumoniae is an enteric bacteria that is aspirated
37
Q

A tumour located in the apex of the lung that results in compression of the sympathetic chain causing:

    i. ) Ptosis
    ii. ) Pinpoint Pupils
    iii. ) Anhidrosis
A

Pancoast Tumour

38
Q

The most common lung cancer occurring in non-smokers and in female smokers. This classically occurs in peripherally in the lung

A

Adenocarcinoma

39
Q

Why is it important to distinguish small cell carcinoma from non-small cell carcinoma?

A

Small cell carcinoma is treated with chemotherapy while non-small cell carcinoma is treated with surgery

40
Q

What two lung cancers are associated with smoking, present centrally in the lung, and are associated with paraneoplastic syndrome?

A

Small Cell Carcinoma & Squamous Cell Carcinoma

Mnemonic = if the lung cancer starts with an S then it happens Sentrally (central) in Smokers and causes paraneoplastic Syndrome

41
Q

Keratin pearls or intercellular bridges present on histology in this centrally occurring lung tumour

A

Squamous cell carcinoma

42
Q

Poorly differentiated neuroendocrine cells found centrally in the lung. These cells may produce ADH or ACTH (Cushing’s) and may cause Eaton-Lambert Syndrome

A

Small Cell Carinoma

Eaton-Lambert Syndrome (antibodies against presynaptic calcium channels resulting in muscle weakness)

43
Q

Where does a mesothelioma neoplasm occur?

A

In mesothelial cells located between the parietal and visceral pleura.

Mesothelia cells are responsible for the production of a lubricating fluid that allows frictionless movement of the lung in relation to the chest wall

44
Q

What are the major subtypes of Non-small Cell Carcinoma?

A
  1. ) Adenocarcinoma (40%)
    i. ) associated with glands & mucin
  2. ) Squamous cell carcinoma (30%)
    i. ) associated with keratin pearls & intercellular bridges
  3. ) Large Cell Carcinoma
    i. ) associated with the lack of keratin pearls, glands, mucin, or intercellular bridges
45
Q

What is the next step after discovering a solitary nodule in the lungs of a patient with nonspecific symptoms?

A

To go back and compare the XRay with a previous XRay.

If the coin lesion (solitary nodule) has been present over a long time and remains unchanged then it is most likely benign.

If the coin lesion is new or growing, then biopsy is required to diagnose lung cancer

46
Q

What are the symptoms of Woolsorter’s disease (Pulmonary anthrax)?

A
  1. ) Pulmonary hemorrhage
  2. ) Mediastinitis
  3. ) Shock
47
Q

What are the main pathogenic causes of pneumonia in children?

A

RSV, Mycoplasma, Chlamydia trachomatis, Streptococcus pneumoniae

Runts May Cough Sputum

48
Q

What is Pneumoconioses?

A

Interstitial fibrosis (restrictive lung condition) caused by occupational exposure of small particles that are fibrogenic (caused by macrophages in the bottom of the lung)

Some examples include: coal worker’s pneumoconiosis, silicosis, asbestosis

49
Q

Restrictive lung condition with non-caseating granulomas

A

Sarcoidosis

50
Q

What is the most common consequence of a pulmonary contusion?

What are the main treatment interventions for a pulmonary contusion?

A

Acute Respiratory Distress Syndrome

Most contusions do not require specific therapy.

Large contusions may affect gas exchange and lead to hypoxemia (after 24-48 hours). Close monitoring of vitals and oxygen delivery may be required. Tracheal intubation may also be required.

51
Q

What are the major causes of bronchiectasis?

A
  1. ) Infections that damage the airway (pneumonia, tuberculosis)
  2. ) Foreign object blocking off part of the airway
  3. ) Cystic Fibrosis
52
Q

In what condition do you find plexiform lesions?

A

Long standing pulmonary hypertension (a tuft of capillaries)

53
Q

Describe the pathophysiology of acute respiratory distress syndrome

A
  1. ) Damage (sepsis, infection, shock, trauma, aspiration, etc) to capillary interface of the alveoli.
    i. ) Results in leaking of protein-rich fluid
  2. ) The protein-rich fluid is then reorganized into a Hyaline Membrane
  3. ) The Hyaline membranes then cause the following complications:
    i. ) Thickened diffusion area for gases resulting in hypoxemia
    ii. ) Increased surface tension of the alveoli resulting in collapsed air sacs
54
Q

What are the 2 major sequelae of neonatal respiratory distress syndrome?

A
  1. ) Persistence of the patent ductus arteriosus
  2. ) Necrotizing enterocolitis

Both are caused by hypoxemia in the neonate

55
Q

What is the most common restrictive condition of the lungs?

A

Interstitial Fibrosis

56
Q

What is a major consequence of respiratory distress syndrome?

A

Interstitial fibrosis

57
Q

Localized sharp pain made worse by inhalation, movement, or cough

A

Pleuritis

58
Q

What are the chances of a pulmonary embolism with DVT?

A

50%

59
Q

What COPD condition may result in secondary amyloidosis?

A

Bronchiectasis

60
Q

Describe the pathophysiology of Cor Pulmonale

A

Increased PaCO2 & decreased PaO2 in the lung cause blood vessels to constrict and shunt blood to another area of the lung, that is properly diffusing oxygen and carbon dioxide. In some cases (example = chronic bronchitis), the poor diffusion of gases is diffusely present, resulting in diffuse respiratory blood vessel constriction. The vasoconstriction results in an increase in pulmonary blood pressure and eventually fatigues the right ventricle of the heart. Long-term that results in Right-sided heart failure, aka Cor Pulmonale

61
Q

What are the clinical features of lung sarcoidosis?

A
  1. ) Dyspnea/Cough
  2. ) Elevated serum ACE
  3. ) Hypercalcermia
    i. ) The granulomas may activate vitamin D (activates 1 alpha hydroxylase)
62
Q

Why is a tension pneumothorax a medical emergency?

A

The pressure from a tension pneumothorax may interfere normal heart function

63
Q

What is the typical sequela of asbestos inhalation?

A

Pulmonary Fibrosis

Mesothelioma

64
Q

What is the cause of Neonatal Respiratory Distress Syndrome?

A

Inadequate surfactant levels (because the Type-II pneumocytes are deficient)

Type-II pneumocytes have 2 functions: i.) produces surfactant; ii.) stem cell for lung

65
Q

What are the 3 risk factors associated with neonatal respiratory distress syndrome?

A
  1. ) Prematurity
  2. ) C-section
    i. ) Vaginal birth is a stressful period for the infant. The stress results in a release of glucocorticoids that stimulate surfactant
  3. ) Maternal Diabetes
    i. ) Hyperinsulinemia suppresses surfactant release
66
Q

What is the primary preventative strategy for suspected infant respiratory distress syndrome?

A

If the mother goes into labour prematurely the infant will be at a greater risk of IRDS. The mother will be given glucocorticoids to speed the production of surfactant in the neonate

67
Q

What prompts the destruction of alveoli in emphysema?

A

An imbalance of preteases and antiproteases (Alpha-1-antitrypsin)

  1. ) Smoking (m/c cause of emphysema) prompts excessive release of proteases
  2. ) Alpha-1 Antitrypsin Deficiency (relatively rare)
68
Q

Allergens associated with asthma induce a Th2 phenotype in CD4+ T Cells that results in the release of what cytokines? What do each of the respective cytokines do?

A
  1. ) IL-4
    i. ) Allows plasma cells to class switch to IgE
    a. ) Activates mast cells leading to inflammation
    b. ) Perpetuates bronchoconstriction
  2. ) IL-5 (Calls in Eosinophils)
  3. ) IL-10
    i. ) Inhibits Th1 & promotes Th2 response (potentiates the asthma reaction)
69
Q

What is heard on auscultation of a patient with pleuritis?

A

Friction Rub

70
Q

In atelectasis, what direction does the trachea shift?

A

Ipsilateral

71
Q

If a patient is given a bronchodilator and the wheeze has not improved, what are your 3 DDxs?

A
  1. ) Foreign Body
  2. ) Cancer
  3. ) Abscess
72
Q

What is status asthmaticus?

A

Status asthmaticus is an acute exacerbation of asthma that does not respond to standard treatments. Symptoms include: chest tightness, rapidly progressive dyspnea (shortness of breath), dry cough, use of accessory muscles, laboured breathing, and extreme wheezing. It is a life-threatening episode of airway obstruction considered a medical emergency.

73
Q

When do you typically see exudative pleural effusion?

A

Infections

74
Q

When do you typically see transudative pleural effusion?

A

Congestive Heart Failure

75
Q

what direction does the trachea shift from a pneumothroax?

A

Ipsilateral to a spontaneous pneumothorax (rupture of the emphysematous bleb)

Contralateral to a tension pneumothorax (trauma)

76
Q
  1. ) What is the cause of Infant respiratory distress syndrome (IRDS)?
  2. ) Describe the symptoms of IRDS
A

1.) Cause = immature lung structure and/or insufficient surfactant causing hyaline membrane disease. It most commonly occurs in premature neonates

  1. ) Symptoms
    i. ) Tachypnea & Tachycardia
    ii. ) Chest wall retraction
    iii. ) Expiratory grunting with nasal flaring
    iv. ) Cyanosis
77
Q

What electrolyte is significantly elevated in the sweat of a patient with cystic fibrosis?

A

Chloride > 80 meq/L

78
Q

What are the presenting symptoms of Cystic Fibrosis?

A
  1. ) Chronic Cough
  2. ) Failure to Thrive
  3. ) Pancreatic insufficiency (steatorrhea)
  4. ) Alkalosis
  5. ) Neonatal intestinal obstruction (meconium ileus)
  6. ) Nasal Polyps
  7. ) Clubbing of Fingers
  8. ) Rectal Prolapse
  9. ) Elevated Electrolytes in Sweat (salty skin)
  10. ) Sputum with Staphylococcus or Pseudomonas

Mnemonic = CF PANNCREAS

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