Respiratory system

Question 1

Diagnostic test for esophageal anastomotic leak

Answer 1

oral contrast study with water soluble contrast - most definitive

Question 2

Clinical features of esophageal anastomotic leak

Answer 2

sudden onset atrial fibrilation, pleural collection, sepsis

Question 3

Patient in MVA presents with: Cardiogenic shock with elevated CVP and distended neck veins; muffled heart sounds, cardiac dullness to percussion; boot-shaped heart on CXR

Answer 3

Cardiac tamponade from hemopericardium

Question 4

Patient in MVA presents with: dyspnea, paradoxical respiration

Answer 4

Flail chest

Question 5

Differentiate chest findings of pneumothorax vs hemothorax

Answer 5

Both: diminished breath sounds, dyspnea

percussion findings: in pneumothorax - tympanitic; hemothorax - dull

Question 6

Physical sign that can differentiate ascites caused by CHF versus cirrhosis

Answer 6

Increased JVP - ascites d/t cirrhosis is usually associated with low or normal cardiac filling pressure. therefore increased CVP is more indicative of heart failure

Question 7

Atypical pneumonia presenting with gastrointestinal symptoms - etiology

Answer 7

Legionella spp.

Question 8

DOC for atypical pneumonia (Legionella, m, pneumonia, chlamydia)

Answer 8

Azithromycin (Macrolides)

Question 9

Initial treatment for flail chest

Answer 9

1) Intubation -> establish controlled positive pressure ventilation
2) Insertion of intercostal catheters to prevent tension pneumothorax

Question 10

Most common etiologic agent for lobar pneumonia

Answer 10

s. pneumoniae (95%)

Question 11

at risk for klebsiella pneumoniae infection

Answer 11

patients with increased risk for aspiration - elderly, alcoholics, diabetics (remember: klebsiella pneumoniae is normal enteric flora)

Question 12

pneumonia with thick gelatinous sputum (currant jelly)

Answer 12

klebsiella pneumoniae - d/t thick mucoid capsule

Question 13

4 phases of lobar pneumonia

Answer 13

Congestion
red hepatization
grey hepatization
resolution

Question 14

Pneumonia in cystic fiubrosis patients

Answer 14

p. aeurginosa

Question 15

atypical pneumonia that can cause autoimmune hemolytic anemia

Answer 15

m. pneumoniae

IgM against I antigen on RBCs

Question 16

most common cause of atypical pneumonia in infants

Answer 16

Respiratory syncytial virus (RSV)

Question 17

Most common cause of atypical pneumonia in patients undergoing posttransplant immunosuppresive therapy

Answer 17

Cytomegalovirus (CMV)

Question 18

Most common lobe involvement of aspiration pneumonia

Answer 18

Right lower lobe

Question 19

Chronic productive cough lasting at least 3 months over a minimum of 2 years; highly associated with smoking

Answer 19

Chronic Bronchitis

Question 20

Destruction of alveolar air sacs causing physiological obstruction d/t collapse of bronchioles d/t loss of elastic recoil

Answer 20

Emphysema

Question 21

Protective against normal inflammatory proteases in alveolar air sac

Answer 21

Alpha 1 Antitrypsin (Anti-protease)

Question 22

Emphysema in smokers - distribution

Answer 22

Centriacinar; more severe in upper lobes; most common

Question 23

Emphysema in A1AT deficiency - distribution

Answer 23

Panacinar; more severe in lower lobes; may also develop liver cirrhosis

Question 24

Most common Mutation in A1AT deficiency

Answer 24

PiZ (PiM is normal)

others: PiMZ, PiZZ

Question 25

Smoker, dyspneic, cough with minimal sputum, prolonged expiration with pursed lips, weight loss, barrel chest

Answer 25

Emphysema

Question 26

paO2 in hypoxemia

Answer 26

<60

Question 27

Reversible airway bronchoconstriction often due to allergic stimuli

Answer 27

Asthma

Question 28

Type of hypersensitivity reaction in asthma

Answer 28

Type I

Question 29

Curschmann spirals admixed with Charcot-Leyden crystals in mucus

Answer 29

Asthma

Question 30

Severe, unrelenting asthma attack

Answer 30

status asthmaticus

Question 31

Non-allergic causes for asthma

Answer 31

Exercise
Viral Infection
Aspirin (aspirin-intolerant asthma)
Occupational exposures

Question 32

Abnormal dilatation of large airways, leading to loss of airway tone and air trapping

Answer 32

Bronchiectasis

Question 33

primary ciliary dyskinesia presenting as neonatal respiratory distress, infertility, sinusitis, frequent lung infection, middle ear infection; also associated with bronchiectasis, situs inversus totalis

Answer 33

Kartagener syndrome