Respiratory Exam 4

Question 1

preferred study for PE and pulmonary nodules

Answer 1

Spiral (Helical ) CT

Question 2

Iv contrat for?

Answer 2

vasculature

Question 3

oral contrast for?

Answer 3

GI or esophageal

Question 4

how long is the dye allergic reaction delayed?

Answer 4

2-6 hrs

Question 5

Air Bronchograms

Answer 5

bronchi become visible due to increased opacity of surrounding lung

Question 6

Bronchiectasis CT finding?

Answer 6

abnormal dilation of bronchial tree

lack of tapering of the bronchi

Question 7

PE CT finding?

Answer 7

90 % sensitive for PE

well defined hypotenuse area in the pulmonary artery

Question 8

GG opacities CT finding?

Answer 8

lower density opacities rather than thick opacities

low density lung opacity not sufficient to obscure pulm. vessels

Question 9

Permanent enlargement of the air spaces DISTAL to the bronchioles

destruction of alveolar septum/wall

Answer 9

Emphysema

Question 10

Size of pulmonary nodules ?

Answer 10

<3 cm

Question 11

malignant pulmonary nodules?

Answer 11

speculated

multiple

changing in size

Question 12

Benign Pulmonayr nodule?

Answer 12

unchnaged
small
calcified
smooth 
solitary

Question 13

Septated nodules?

Answer 13

suspect primary lung malignancy

Question 14

Circumscribed nodules?

Answer 14

suspect lung mets

Question 15

Halo sign?

Answer 15

surrounded by ground glass - suspect malignancy

Question 16

how big should the heart be?

Answer 16

half the width of the chest cavity

Question 17

Left heart border (left ventricle)? Silhouettes and there adjacent structures

Answer 17

Lingula

Question 18

Right heart border (right atrium) Silhouettes and there adjacent structures

Answer 18

Right middle lobe

Question 19

Left hemidiaphragm? Silhouettes and there adjacent structures

Answer 19

left lower lobe

Question 20

Right hemidiaphragm? Silhouettes and there adjacent structures

Answer 20

right lower lobe

Question 21

Aortic knuckle ? Silhouettes and there adjacent structures

Answer 21

left upper lobe/middle mediastinum

Question 22

Descending aorta? Silhouettes and there adjacent structures

Answer 22

left lower lobe

Question 23

Right paratracheal stripe? Silhouettes and there adjacent structures

Answer 23

right upper lobe / anterior mediastinum

Question 24

Paraspinal lines ? Silhouettes and there adjacent structures

Answer 24

medial lung / posterior mediastinum

Question 25

pathology of atelectasis?

Answer 25

Volume loss of some portion of the lung Shows linear, curvilinear or wedge shaped opacities More diffuse in presentation Compensatory hyperinflation of adjacent lobes

Question 26

CFTR gene is expressed in:

Answer 26

epithelial cells in a variety of organs including | the lung, sinuses, pancreas, sweat gland, intestine, liver, and vas deferens

Question 27

CF is the most common inherited life-shortening disease of __________ in the US

Answer 27

caucasions

Question 28

CF lung disease is characterized by:

Answer 28

mucociliary clearance chronic polymicrobial infection of the airways exaggerated inflammatory response

Question 29

Sweat Chloride Test indication?

Answer 29

To diagnose CF: Recurrent respiratory infections Late passage of meconium stool Failure to thrive - not progressing like they should Chronic cough Malabsorption syndromes - greasy fatty smelly stools

Question 30

Pathophysiology of CF?

Answer 30

Abnl mutation in the CFTR (CF transmembrane conductance regulator gene) Gene encodes a synthesis of a protein that serves as a channel through which chloride enters and leaves the cells. Sweat near the base of the gland has a high sodium and chloride concentration ( deposits at base) In patients with CF transport does not occur.

Question 31

during the CF sweat chloride test... Sweating is induced by mild electrical current called?

Answer 31

(pilocarpine iontophoresis Sodium and chloride content of sweat is measured

Question 32

During the CF sweat chloride test the + electrode is ? current flow 5-12 min

Answer 32

pilocarpine hydrochloride

Question 33

During the CF sweat chloride test the - electrode is ? current flow 5-12 min

Answer 33

bicarbonate solution

Question 34

During the CF sweat chloride test the aper discs are placed on the arm and covered with ________ for air tight seal for one hour

Answer 34

paraffin

Question 35

Normal SCT results ?

Answer 35

Normal: <50 meq/L

Question 36

Equivocal SCT results?

Answer 36

Equivocal: -60 meq/L

Question 37

Abnormal SCT results?

Answer 37

Abnormal: >60 meq/L

Question 38

Interferring factors with swat chloride test?

Answer 38

Not reliable within the first few weeks of life Not reliable for pubertal adolescents Dehydration can reduce volume of sweat don’t do test after a marathon Cold room can reduce sweating because we sweat in hot environments

Question 39

Most common mutation in the CFTR gene? and what chromosome?

Answer 39

Delta AF508 chromosome 7

Question 40

Procedures for CFTR mutation analysis ?

Answer 40

Serum Chorionic villus sampling Amniocentesis - cells Uses PCR to amplify the locus for the mutation

Question 41

Mutation and chromosome for Alpha-1 Antitrypsin?

Answer 41

autosomal recessive disease caused by mutations in the SERPINA1 gene on chromosome 14, which encodes the protease inhibitor alpha-1 antitrypsin (AAT)

Question 42

where do you see Alpha-1 Antitrypsin deficiency ?

Answer 42

emphysema and COPD

Question 43

Pathophysiology of Alpha-1 Antitrypsin?

Answer 43

AAT inactivates endoproteases that can breakdown elastic fibers and collagen in the lungs A deficiency causes a build-up of those endoproteases

Question 44

Testing for the ____ and __ alleles

Answer 44

S, Z

Question 45

Normal AAT?

Answer 45

85-213 mg/dL or 0.85-2.13 g/L (SI Units)

Question 46

Gold standard for PE

Answer 46

CT

Question 47

D-dimer is a __________________ product made through the lysis of fibrin when plasmin acts on the fibrin polymer clot

Answer 47

fibrin degradition

Question 48

what can give you a false positive for D-Dimer?

Answer 48

inflammation and pregnancy, being old, having CA

Question 49

D-Dimer is very sensitive but not specific? T or F

Answer 49

T

Question 50

D-Dimer normal result?

Answer 50

<0.4 mcg/ml

Question 51

When will we have a increased D-Dimer?

Answer 51

DVT | PE

Question 52

what detects and monitors the course of sarcoidosis as well as other granulomatous disease (Differentiate between active and dormant sarcoid disease )

Answer 52

Angiotensin converting enzyme (ACE)

Question 53

where does ACE come from and what does it activate?

Answer 53

comes from the lungs(Found in pulmonary epithelial cells) and it turns Angiotension 1 into Angiotension 2

Question 54

__________ ACE levels are found in sarcoidosis pts.

Answer 54

elevated

Question 55

ACE test has somewhat low sensitivity and specificity. T or F

Answer 55

T

Question 56

Elevated levels of ACE are reported in ___ of patients with acute disease and only ___ of patients with chronic disease.

Answer 56

60% | 20%

Question 57

Normal ACE result?

Answer 57

<40 units/L

Question 58

When will we see an increase in ACE levels?

Answer 58

Sarcoidosis (more severe= higher level) ``` Gaucher disease - sphingolipids are not broken down correctly and distributed all over the body TB Leprosy Alcoholic cirrhosis Hodgkin disease amyloidosis ```

Question 59

Interfering factors of ACE?

Answer 59

False decreased levels: Hemolysis - cause decrease levels Drugs ACE inhibitors (duh)