Pulmonology Final

Front 1

Surfactant is secreted by

Back 1

Type 2 pneumocyte. Have the ability to proliferate in response to injury.

Front 2

Amniotic fluid is added to a test well containing ethanol and shaken to form stable ring of foam

Back 2

Surfactant test(lung maturity) Lecithin:sphingomyelin >2 mature.

Front 3

History of smoking, exertional dyspnea,Unable to extinguish a lit m.h matchstick with single breath(reduced fev1)

Back 3

Copd.Air trapping causes increase in residual volume.

Front 4

Cough syncope(overweight Male patient with copd)

Back 4

Increase intrathoracic pressure causes decrease venous return to the heart,decrease cardiac output and cerebral perfusion.

Hint 4

Same mechanism during valsalva maneuver

Front 5

Pa02,sa02 and oxygen content in some diseases

Back 5

Chronic blood loss- only oxygen content is decreased.

Cyanide poisoning- everything is normal.

High altitude- everything is decreased

Polycythemia-oxygen content is increased. Rest are normal.

CO poisoning-sa02 and oxygen content are decreased.

Front 6

Histoplasma

Back 6

Ohio and Mississippi river

Filamentous mold

Bird or bat droppings

Exploring caves

Inhaled into alveoli,phagocytosed by macrophage which reveals intracellular ovoid or round yeast.

Front 7

Ciliated cells are absent where

Back 7

Alveolar ducts and sacs.present in terminal bronchioles-simple ciliated Before that is pseudostratified,ciliated,columnar.

Front 8

Goblet cells produce what? And agree absent where

Back 8

Mucin-producing cells. Absent in alveolar mucosa

Front 9

Secretory cells that can act as regenerative source of ciliated cells in bronchioles

Back 9

Club cells.

Front 10

Exacerbation of Copd is usually triggered by

Back 10

Viral or bacteria respiratory infection.

Front 11

Fungal species associated with gardening

Back 11

Sporothrix schenckii. Transmitted by thorn prick,cigar shaped budding yeast.

Front 12

Ohio and Mississippi river

Back 12

Histoplasma

Blastomyces- large round yeast with doubly refractile wall and single broad based bud.

Front 13

What stimulates central and peripheral chemoreceptors?

Back 13

Central(located in medulla)-ph and pCo2 of brain interstitial fluidPeripheral(located in carotid body and aortic body)- decreased po2 <60mmhg), decreased ph of blood and increased pco2 .Peripheral senses pa02 and central senses pc02

Front 14

Selective igA deficiency

Back 14

Recurrent Sinopulmonary and Gastrointestinal infection.eg pneumonia and celiac disease. Anaphylaxis during transfusion

Front 15

The binding of oxygen to hemoglobin in the lung causes what effect

Back 15

Haldane effect- the affinity of co2 for hemoglobin is reduced. And proton H+ is released from hemoglobin binding site the H+ combined with Hco3 in the lungs to form h2co3. Then h20 and co2 which then goes to the alveoli and expired. While o2 is taken up by the hemoglobin. In peripheral tissue the opposite occurs bohrs effect.

Hint 15

In the lung, the binding of oxygen to hemoglobin drives the release of H+ and Co2

Front 16

Effect of hyperventilation on o2 and pc02 exchange

Back 16

High v/q region have little capacity to absorb additional oxygen and compensate for low v/q region.

High v/q region can easily exhale co2 and compensate for low v/a region.

Front 17

Pulmonary embolism

Back 17

Increased dead space ventilation->v/Q mismatch->hypoxemia->increase in respiratory drive->hyperventilation. Acute onset dyspnea and chest discomfort. Increased A-a gradient. Normal 5 to 10

Front 18

Physiological dead space

Back 18

Anatomical + Alveolar dead space

Anatomical- nose, mouth, pharynx, trachea, bronchi

Alveolar- ventilated but not perfused.

Front 19

Cystic fibrosis-cftr defect.

Back 19

Cl and Na are not reabsorbed into epithelia cell of eccrine duct. Hyponatremia- excessive salt wasting from sweat.

Front 20

If a parent is a carrier the probability thay the child will inherit that mutation is

Back 20

1/2.eg.1/30×1/100×1/2(1/2 from father and 1/2 from mother. =1/12,000.

Front 21

Dependent lung segment in aspiration pneumonia

Back 21

Posterior segment of right upper lobe and superior segment of right lower lobe. The right lung is more prone because the right main bronchus has a large diameter.

Front 22

Progressive dyspnea and recurrent upper respiratory infection.

Back 22

Copd

Front 23

Secondary polycythemia

Back 23

In response to hypoxemia, the renal tissue secretes erythropoietin to simulate bone marrow to increase red blood cell production and improve oxygen carrying capacity.

Front 24

Strain of h.influenzae thay causes otitis media

Back 24

Nontypable- they do not produce a capsule.

Front 25

Cystic fibrosis in respiratory mucosa and sweat gland

Back 25

. In sweat gland due to defect in cftr cl and Na cannot go to the epithelium of the eccrine gland while in respiratory mucosa cl cannot go out of the epithelia cells to the respiratory mucosa and there is increased absorption of Na and H20 into the epithelial cells.ATP gated cl channel

Front 26

Most common cause of copd exacerbation

Back 26

Upper respiratory infection by H.influenzae,moraxella,strep pneumo,rhino virus.opportunistic pseudomonas

Front 27

Ipratropium

Back 27

An anticholinergic agent and derivative of atropine, blocks acetylcholine at muscarinic receptors which prevents bronchoconstriction and reduces mucus.

Front 28

Methylxanthines such as theophylline and aminophylline

Back 28

Cause bronchodilation by blocking phosphodiesterase and increasing CYclic AMP.

Front 29

Chronic granulomatous disease

Back 29

NADPH oxidase defect.The bacteria and fungi responsible for infection are catalase positive organism which have the ability to destroy their own hydrogen peroxide which allows phagocyte to generate hypochlorite(bleach)-microbicidal agent.

Front 30

patients undergoing mechanical ventilation weaning tv and respiratory rate

Back 30

weakened respiratory muscles results to low tidal volume to minimize the work of breathing and increased respiratory rate to maintain minute ventilation

Front 31

Pneumococcal conjugate vaccine

Back 31

T cell mediated robust immune response. Contains a polysaccharide material attached to protein antigen

Front 32

Pirfenidone,nintendanib

Back 32

Tgf-b inhibitors. Slows pulmonary fibrosis

Front 33

Radial traction

Back 33

Decreased reaction-emphesema

Increased traction-fibrosis

Front 34

Exudate vs transudate

Back 34

Pleural Effusion that develops as a result of pressure changes(heart failure,cirrhosis,nephrotic syndrome are typically transudative. Those that develop due to inflammation and increased vascular membrane permeability (infection, malignancy, rheumatologic disease) are exudates.exudates have high fluid to serum ratio of total protein >0.5 and high lactate dehydrogenase>0.6

Front 35

Obstructive sleep apnea

Back 35

Daytime somnolence, Non restorative sleep, Elevated blood pressure in the setting of underlying obesity.

Front 36

Obesity hyperventilation syndrome(pickwickian)

Back 36

Decreased expansion of the chest wall due to obesity. Causing hypoventilation.Increased pc02 and decreased p02.

Front 37

most common cause of rhinitis

Back 37

Adenovirus.

Front 38

chlid with nasal polyps

Back 38

think cystic fibrosis.repeated bouts of rhinitis.also seen in aspirin intolerant asthma.

Front 39

nasal tumour of adolescent male

Back 39

angiofibroma

Front 40

most common cause of community acquired pneumonia

Back 40

strep pneumo

Front 41

increased risk for aspiration

Back 41

klebsiella pneumonia

Front 42

four classic phases of lobar pneumonia

Back 42

congestion-vasodilation and congestion of blood vessels

red hepatization-red blood cell infiltration

gray hepatization-break down of the rbc

resolution.

Front 43

Metabolic profile for emphysema

Back 43

Chronic Co2 retention leading to respiratory acidosis with compensatory high paco2, high bicarbonate and slightly acidic ph with hypoxemia pao2<75

Front 44

Nerve that crosses between the flexor digitorum superficialis and Profundus muscles.

Back 44

Median nerve.

Front 45

Reduces bronchoconstriction by Inhibiting interaction of inflammatory meditators with cell surface receptors

Back 45

Monteleukast

Front 46

Drugs that worsens asthma

Back 46

NSAIDS AND ASPIRIN. THEY CAUSE NEGATIVE FEEDBACK TO LEUKOTRIENS WHICH CAUSES BRONCHOSPASM

Front 47

Blocks binding of acetylcholine to muscarinic receptor arms commonly used for copd

Back 47

Ipratropium

Front 48

Hypoventilation leads to

Back 48

Co2 retention and acute respiratory acidosis. Seen in benzodiazepine overdose. ------With elevated oxygen gradient(copd).PE is alkalosis