Test #18 (BMR Week 2N Block 1: Pulm Physio)

Question 1

(1) Dx: Interstitial pneumonia in tx pt with intranuclear and cytoplasmic inclusion bodies (2) Characterize pathogen

Answer 1

(1) CMV Pneumonia - Opportunistic infection (2) Enveloped ds dNA virus

Question 2

(1) Dx: MVA & femoral fracture, operation, 3rd hospital day = agitated, tachypneic, & complains of chest pain, arterial blood sample = paO2 of 65 mmHg (2) Explain (3) Mechanism of hypoxemia

Answer 2

(1) Pulmonary embolism (PE) (2) Think PE if suddent onset tachypnea and chest pain in hospitalized pt. Risk factors: immobilization (produces venous stasis) & recent surgery (induces hypercoagulable state). Also, thrombi most commonly originate in deep veins of pelvis and lower extremities. (3) Ventilation/Perfusion mismatch

Question 3

Streptomycin: (1) Class of antibiotic (2) Function (be specific, including target & affected action)

Answer 3

(1) Aminoglycoside (2) Blocks 30S ribosomal subunit, preventing initiation step of translation

Question 4

(1) Definition of eythrocytosis (2) Distinguishing absolute v. relative erythrocytosis (3) Distinguishing primary vs. secondary erythrocytosis (4) Distinguishing hypoxic from other causes of secondary erythrocytosis

Answer 4

(1) Hematocrit level > 52% in men and > 48% in women (2) Measurement of red blood cell mass necessary; A normal RBC mass indicates plasma volume contraction as cause of polycythemia (3) EPO low = primary (caused by myeloproliferative disorders such as polycythemia vera) & EPO high = secondary (chronic hypoxia from high altitudes, smoking, or COPD OR abnormal secretion by neoplastic or otherwise diseased tissues) (4) Measure SaO2. If

Question 5

(1) Effect of pCO2 on brain (2) COPD patient pO2 & pCO2 as well as brain changes

Answer 5

(1) pCO2 is most potent cerebral vasodilator. It decreases cerebral vascular resistance leading to increased cerebral perfusion and increased intracranial pressure. (2) COPD patients usually have low pO2 (hypoxia) and high pCO2 (hypercapnia). Thus, their cerebral circulation most likely increased

Question 6

In respiratory tract, give epithelial cell types for: (1) Nose, paranasal sinuses, nasopharynx, most of larynx, and tracheobranchial tree (2) Oropharynx, laryngopharynx, anterior epiglottis, upper half of posterior epiglottis, vocal folds (true vocal cords)

Answer 6

(1) pseudostratified, columnar, mucus-secreting epithelium (2) Stratified squamous epithelium

Question 7

Respiratory tract lining changes in strx/fxn: (1) Bronchi have (2) Bronchioles, terminal bronchioles, & respiratory bronchioles lack (3) Terminal bronchioles have what epithelium (4) What persists to end of respiratory bronchioles

Answer 7

(1) pseudostratified columna ciliated epithelium with goblet cells and submucosal mucoserous glands and cartilage (2) generally lack goblet cells, glands, and cartilage (3) by the level of the terminal bronchioles, airway epithelium is ciliated simple cuboidal (4) epithelia cilia persist up to end of respiratory bronchioles

Question 8

(1) Upper extent of lungs (2) Possible outcome of penetrating injury in this area

Answer 8

(1) Lung apices extend above level of clavicle and first rib through the superior thoracic aperture (2) Pneumothorax

Question 9

(1) Respiratory/Acid-base physiology of panic attacks (2) Effect of this on brain

Answer 9

(1) Hyperventilation & decreased pCO2. (2) Hypocapnia causes cerebral vasoconstriction and decreased cerebral blood flow

Question 10

(1) Risk of foreign bodies swallowed and why (2) nerve mediating reflex, which may be lost in this case

Answer 10

(1) Foreign bodies (e.g., chicken or fish bones) can become lodged in piriform recess and may cause damage to (2) internal laryngeal nerve (which mediates afferent limb of cough reflex above vocal cords)

Question 11

Dx: patient with bronchial asthma found to have recurrent transient pulmonary infiltrates, eosinophilia, CT shows proximal bronchiectasis

Answer 11

Allergic broncholpulmonary aspergillosis (ABPA) may complicate asthma. ABPA can result in transient pulmonary infiltrates and eventual pulmonary bronchiectasis

Question 12

Coccidioides immitis: (1) Geography (2) Strx/Form in environment (3) Transmission form & form once in body

Answer 12

(1) southwestern US (e.g., Arizona) (2) mold (with hyphae) that forms spores (3) spores inhaled and turn into spherules in lung

Question 13

(1) Dx: acute onset dyspnea, calf swelling, obesity, and hx of prolonged immobility (2) Respiratory/Acid-Base findings

Answer 13

(1) Pulmonary embolism (2) Significant PE assoc. w/ hypoxemia and respiratory alkalosis

Question 14

(1) Relevance of 5 yo boy with high anti PRP serum levels (2) Protected against what condition

Answer 14

(1) Haemophilus influenzae type b (Hib) vaccine composed of PRP, a component of Hib capsule, conjugated with diphtheria or tetanus toxoid (2) Epiglottitis almost exclusively caused by H. influenzae type B

Question 15

(1) What center of airway pressure curve represents (2) Intrapleural pressure value at this point

Answer 15

(1) Functional residual capacity (FRC) of lungs; resting state where airways pressure equals zero (2) -5 cm H2O

Question 16

Resistance as progress through airways

Answer 16

Regional airway resistance within first 10 generations of bronchi contributes to most of total airway resistance of lower respiratory tract. Resistance maximal in 2nd-5th generation airways including segment bronchi. In contrasts, airways < 2 mm in diameter (e.g., bronchioles) contribute < 20% of total airway frictional resistance. Note: In medium sized bronchi, resistance increased due to highly turbulent flow

Question 17

Kind of mutation if deletions/additions of base pairs not in multiple of 3

Answer 17

Frameshift mutation

Question 18

Acid/base response to high altitude (lasting more than few days)

Answer 18

Chronic respiratory alkalosis - hyperventilate (in response to low PaO2 due to high altitude), creating low PaCO2

Question 19

(1) Effects of vagal stimulation on lungs & breathing (2) Drugs that counteract these effects

Answer 19

(1) Bronchoconstriction and increased bronchial mucus secretion, increasing airway resistance and work of breathing (2) Anticholinergic agents such as tiotropium and ipratropium

Question 20

(1) Dx: 74 yo, abrupt onset fever, headache, myalgias, malaise, cough throat pain, family sick withs similar sx, sent home on conservative management (2) Interpret additional findings: 5 days later, progressive dyspnea, chest pain, & productive cough

Answer 20

(1) Influenza (2) Patients old than 65 particularly prone to developing secondary bacterial pneumonia after influenza infection. In order, pathogens most responsible for secondary bacterial pneumonia are Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae

Question 21

Restrictive lung disease affect on flow rate & why

Answer 21

Assoc. with decreased lung volumes & increased expiratory flow rates at corresponding lung volumes. Increased flow rates due to decreased lung compliance (increased elastic recoil) and increased radial traction exerted on conducting airways by fibrotic lung

Question 22

Pulmonary vascular resistance (PVR): (1) Lowest point (2) Effect of increased lung volumes & why (3) Effect of decreased lung volumes & why

Answer 22

(1) FRC (2) Increased PVR due to longitudinal stretching of alveolar capillaries by expanding alveoli (3) Increased PVR due to decreased radial traction from adjacent tissues on large extra alveolar vessels

Question 23

Most common CFTR mutation and its effects

Answer 23

deltaF508 (3-base pair deletion in CFTR at amino acid position 608); Impairs posttranslational processing of CFTR, resulting in shunting of cFTR toward proteasome with complete absence of protein on apical membrane of affected epithelial cells