Week 3

Question 1

• Occupation lung disease:
• 3 determinants of site and severity?
• 2 categories of occupational lung disease?
• AW Disease: 1.) Immunological asthma: Latency? Common LMW example? Type of immune response?
  2. ) RADS: Latency? Causes? Ex?
  3. ) Emphysema/COPD: Causes? (2)
  4. ) Bronchiolitis: Cause?

Answer 1

• Dose (duration x conc.); solubility (more water soluble); particle size (

Question 2

• Occupational lung disease: Interstitial
• 2 categories of interstitial?
  1. ) Asbestos related: 2 types?
  2. ) Silicosis: Caused by? Latency?
  3. ) Coal workers (black lung): Due to?
  1. ) Chronic Beryllium: Presents similar to? Material found where?
  2. ) Hypersensitivity (farmers lung): Due to? Immune response?

Answer 2

• Pneumoconoises; other
  1. ) Malignant and non malignant
  2. ) Sand blasting; long
  3. ) Inhalation of coal mine dust
  1. ) Sarcoidoses; plane material
  2. ) Animal proteins or dander; T cell mediated

Question 3

• How many respiratory viruses are there?
• Flu pathogenesis? (3 steps?)
• What can you often get with flu?
• Oseltamavir/ zanamavir MOA?
• Fixed obstruction: PV curve? Causes? (Causes?)
• Variable intrathoracic obstr.: PV? Cause?
• Variable extrathoracic obstr.: PV? Cause?

Answer 3

• many
• RNA virus Hematagluttin binds saliac acid to enter cell; infection initiation; Neuroaminidase cleaves it to leave
• Staph infection
• Neuroaminidase inhibitor
• Low insipiration and expiration; incubation or circumfrential airway issue
• Low expiration; non-circ. tumor
• Low inspiration; vocal cord paralysis; upper airway tumor

Question 4

• Cough:
• Major nerve of afferent cough reflex? Volun?
• SARs and RARs respond to? C fibers?
• Acute cough: Duration? Questions to ask? (2) Life threatening causes? (3) Non life threatening categories? (3)
• Sub-acute: Duration? Two questions? Two categories?
• Chronic cough: Duration? (4 causes)
• Most common chronic causes? (3)
• Most common acute? (1)

Answer 4

• Vagus; stretch/ mechanical stimuli; noxious chemical stimuli; cerebral cortex
• 8 weeks; UA cough synd., asthma; non-asthmatic eisinophillic bronchitis; GERD
• Asthma, UACS, GERD
• URI

Question 5

• Cough:
• Bronchieactasis often accompanied by?
• Chronic cough:
  1. ) Upper airway syndrome: Other name? Treatment?
  2. ) Asthma: Treatment?
  3. ) GERD: Signs? Test? Treatment?
  4. ) Non-asthmatic eisino. bronchitis: Test? Treatment?
• What complication is common with GERD?
• How long is a chronic cough in kids?

Answer 5

• Bacterial pneumonia
  1. ) Post nasal drip; 1st gen antihistamine and decong.
  2. ) Inhaled corticosteroid/ bronchodilator
  3. ) Edema/erythema of larynx; esophogeal pH; proton pump inhibitor
  4. ) Sputum w/ >3% eisinophils; inhaled corticosteroids
• Microaspiration
• > 4 weeks

Question 6

• Upper respiratory:
• Only complete ring?
• Innervates all the muscles of the larynx? Except?
• Stridor: Inspiratory? Expir? Biphasic? (3 ex?)
• Symptoms of upper airway/ larynx disorders? (3)
• Bad signs with hoarseness? (6)

Answer 6

• Cricoid cartilage
• Recurrent laryngeal; cricothyroid
• Upper airways; lower airways; fixed obstruction (trach tube scarring, croup, cancer)
• Horseness, lump, pain
• > 3 weeks, pain, blood, difficulty swallowing, lump in the neck, loss of voice

Question 7

• Upper respiratory:
• Speech: Speech area? Voice area?
• Corticobulbar tract: 3 things coordinate with laryngeal muscles, sensation and abdominal musculature?
• Superior laryngeal branch: Internal? External?
• Infectious causes of horseness?
• Non-infectious causes? (many)

Answer 7

• Temporal cortex (cerbral cortex); precentral gyri
• Vagus, nucleus ambiguous, spinal cord
• Sensation; motor of cricothyroid
• Viral laryngitis
• Acid reflux; vocal abuse; allegries; cough; polyps; trauma; age; neurological; smoking

Question 8

• Lung Cancer:
• Common? men vs. women? Family hx?
• What is a solitary pulm. nodule? Goals?
• Abnormalities on blood test? (3)
• 4 stages and treatments?

Answer 8

• Most common cancer (160k/yr); women more; important
• Lesion <3cm, round with smooth contour and no other involvement; expidite resection
• High alk. phos; Ca2+ anemia; cytopenias
  1. ) Primary tumor, no nodal involvement; surgery
  2. ) Primary tumor, lymph nodes within hilum; chemo + surgery
  3. ) Locally advanced; mediastinal lymph nodes; invades local structures; chemo + radiation
  4. ) Spread to other lung; pleaural effusion with cancer cells; chemo + radiation

Question 9

• Lung Cancer:
• 4 common genetic alterations and treatments?
• Early detection necessary?
• Does it work?
• Beta caratone/ vitamin as primary prevention?

Answer 9

1. ) EGFR: 50-80% NSCLC; erlotinib, geferitinib, cetuximab
2. ) Her/ERB: 10% NSCLC; Herceptin (trastuzimab)
3. ) vEGF: Evacimuba (Avastin)
4. ) Ras: 20% NSCLC adenocarcinoma; TKI’s
   - Yes; most present in stage 3 or later
   - Yes with low dose helical spiral CT
   - Didn’t work; actually made it worse

Question 10

• Tobacco:
• Who are high users? (5)
• How many people die prematurely per year due to tobacco? Cost?
• Other cancers from smoking? (3)
• Smoking cessation with pregnancy?
• How to counsel patients?
• Pharmacotherapy options? (3)
• Combo’s?
• Best pharm treatment order? (4)

Answer 10

• Non whites; poor; psychiatric; incarcerated; less educated
• 500k; 195 billion
• Oral; esophogus; bladder
• Encourage within first trimester
• Ask, advise, assess willingness, assist, arrange
• NRT, Bupropion (same as anti-depressive); varenicline (partial nicotine agonist/ blocks exogenous nicotine)
• Only NRT and bupronion has been shown to work
• Counseling

Question 11

• TB:
• What is TB? How do you get it? How is treated?
• Do immunocompetent patients develop LTBI?
• Who should be targeted for LTBI screen?
• Chronology of TB pathogenesis? (5 steps?)
• What can give you false positive on TST?
• Two other tests? Work how?
• Why do those who emigrate possibly get TB?
• 3 possible treatments for LTBI?

Answer 11

• Infection via Mycobacterium tuberculosis; > 3 meds
• Not usually
• HIV, immunocompromised, anti-TNFa therapy, immigrants
• Ingestion by alveolar macs; continued ingestion but not destruction; T-cells to site of infection; causeus center made; declined immunity with causeaus necrosis
• BCG; look for scar
• Quantiferon; T-Spot; IFN-gamma assays
• Vitamin D deficiency
• 9 months isozanid; 4 months rifampin; 12 weekly doses of INH + rifapentene

Question 12

• Common Ddx for kids? (6)
• Difference b/n adults and kids pulm. physio?
• Most common chronic stridor? Cause?
• Airway/cartilage abnormality?
• Acute stridor Ddx? (5)
• Most common croup cause in kids?
• Epiglottitis common cause?

Answer 12

• V/Q mismatch; hypovent.; shunt; diffusion; altitude; hemoglobinopathies
• Smaller airway (1/r^4); higher larynx, floppy epigglottis, narrow cricoid (adult=glottis), horizontal ribs, flat diaphragm
• Laryngomalacia; floppy epiglottis
• Tracheobronchomalacea
• Croup, foreign body, scalding, bacterial tracheitis, epiglottis
• Parainfluenza
• Influenza B

Question 13

• DDx for acute wheeze in kids? (5)
• Bronchopulmonary dysplasia?
• Most common chronic respiratory condition in kids? Treat with? Biggest problem?
• Most common lethal genetic disease?
• Short term asthma attack treatment? (3)

Answer 13

• Viral pneumonia; CF; Heart disease; Aspiration pneumonia, asthma
• Abnormal baseline ventilation and oxygenation
• Asthma; inhaled corticosteroids; non compliance
• CF
• B-2 agonist then anticholinergics or systemic glucocorticoids

Question 14

• Anterior mediastinum contents? (4)
• Posterior contents? (3)
• Middle contents? (5)
• Hoarseness may be related to?
• SVC syndrome causes? Sign?
• Tension pneomothorax pressures? See what?
• Most common mass in adults? Kids?

Answer 14

• CT, thymus, thyroid, lymphatic vessels
• Vagus nerve, thoracic duct, esophogus
• Heart, great vessels, trachea/bronchi, phrenic/vagus
• Compression of recurrent laryngeal nerve
• Tumor compressing great vessels; facial swelling
• P-intrapleural > P atm; structures shift
• anterior; posterior

Question 15

• Borhaaves Syndrome?
• Anterior compartment tumors? (4)
• Transudate: Protein? Cause? LDHpl/LDHser? Protpl/Protser? Causes? (3)
• Exudate: Protein? Cause? LDHpl/LDHser? Protpl/Protser? Causes? (5)
• Cancers found in pleural space? (6)

Answer 15

• Esophogeal rupture
• Terrible T’s; thymic neoplasm, teratoma, thyroid, terrible lymphoma
• Non; Increased hydrostatic P’s; 0.6; >0.5; Neoplasm, infection, PE, Sjorens, Drugs
• Lung, breast, lymphoma, GI, GU, MEothelioma