Respiratory System

Question 1

Hypersenstivity Pneumonitis

Answer 1

Fever , Chills , Cough , Dyspnea
Bilateral interstitial opacities, crackles, restrictive pattern.
bronchial lavage has lymphocytic dominance >20% Often >50%.

Question 2

Obstructive Lung Disease

Answer 2

Asthama, COPD, Old age.

PFT:

• FEV1↓ , FVC ↓ ,
• FEV1/FVC ↓(<70% ; Normal is 70%)
• TLC ↑
• RV ↑↑ , FRC (ERV-RV) ↑

Question 3

Restrictive Lung Disease

Answer 3

Pulmonary Fibrosis, Pneumoconiosis etc

PFTs:

• FEV1 ↓, FVC ↓,
• FEV1/FVC ↑ (>70-80%)
• TLC ↓, RV ↓, FRC ↓.

Question 4

SVC syndrome

Answer 4

Superior vena cava syndrome
Flushing of face + Congestion of neck veins.
Caused by pancoast tumor (Adenocarcinoma of Lungs)

Question 5

NRDS (Neonatal Respiratory Distress Syndrome)

Answer 5

Aka hyaline membrane disease

• Due to insufficient surfactant production by type II pneumocytes due to decrease in lamellar bodies (the specialized organelles that produce surfactant).
• Decrease lecithin/sphingomyelin ratio (i.e., <2.0).
• ↓ surfactant production means ↓ alveolar compliance, ↓ FRC, ↑ Airway resistance &­ ↑ elastic recoil.
• CXR shows a “reticulogranular” appearance.

Question 6

Acute respiratory distress
syndrome (ARDS)

Answer 6

Bilateral exudative chest infiltrates and decr O2 sats
in patient following: pancreatitis; aspiration of vomitus; near-drowning episodes (aspiration of fresh/sea water); improper insertion of NG tube into the lungs with feeding initiated; toxic shock syndrome; or general trauma / sepsis.

• Pulmonary decompensation associated with pancreatitis.
• Patient can be ventilated as follows: prone positioning (patient on
  stomach) + low-tidal volume setting + permissive hypercapnia.

Question 7

Pertussis

Answer 7

• Classic whooping cough presents as succession of many coughs
  followed by an inspiratory stridor.
• Can also present in adults Cough with hypoglycemia or post-tussive emesis, which means vomiting after coughing episodes.
• Pertussis can cause super-high WBC counts in the 30-50,000-range, where there are >80% lymphocytes.
• One way to prevent = vaccination (TDaP)

Question 8

Cystic Fibrosis

Answer 8

• Autosomal recessive mutation (∆F508) impairs - - CFTR function
• ATP dependant Chloride channel defective
• Chronic, productive cough
• Recurrent sinopulmonary infections (eg,Staphylococcus aureus, Pseudomonas aeruginosa)
• Pancreatic insufficiency (Def Fat Sol Vitamins)
• Male infertility (bilateral absence of vasdeferens)
• Elevated sweat chloride levels

Question 9

Sarcoidosis

Answer 9

(noncaseating granulomas)
Female with lymphedonopathy
Bilateral hilar adenopathy, uveitis
Hypercalcemia is also seen
Complication:
Granuloma express increased activity of alpha-1 hydroixylase -> increase 1,25 hydroxy vit-D-> ca+2 reabsorbtion in GI lumen, this can cause Nephrolithiasis

Question 10

Rubeola

Answer 10

High Fever & 3Cs ( Cough, Coryza, Conjuntivitis)
Koplik Spots (2-3days after symptoms)
As fever abates a Maculopapular rash starts at head and descends to cover whole body (like rubella)

Question 11

Mumps

Answer 11

Classically presents as:

• Parotidits
• Orchitis
• Meningitis

Caused by Paramyxovirus.

Question 12

Pulmonary Fibrosis

Answer 12

• Progressive dyspnea
• Digital clubbing
• Loud P2 (pulmonary hypertension due to lung disease).

Idiopathic pulmonary fibrosis affects individuals in late adulthood, and lung examination would reveal inspiratory crackles.