Qbank - Respiratory

Front 1

what cells regenerate lung epithelium following injury?

Back 1

type II pneumocytes
their other major fxn is pulmonary surfactant secretion

Front 2

where does pseudostratified columnar ciliated epithelium stop?

Back 2

at the level of respiratory bronchioles becomes cuboidal ciliated
cilia are absent from terminal alveolar ducts

Front 3

a stab wound just superior to the clavical risks damaging?

Back 3

lung
it extends superior to the clavical through the thoracic aperature

Front 4

why is there tachycardia w/tension pneumo?

Back 4

increased intrathoracic pressure decreases venous return and thus CO

Front 5

ansa cervicalis arise from? Innervates?

Back 5

C1, C2, C3
innervates sternohyoid, sternothyroid, & omohyoid
might be injured by penetrating trauma superior to the cricoid cartilage

Front 6

what cells release elastase?

Back 6

neutrophils & alveolar macrophages
centriacinar emphysema associated w/smoking

Front 7

what do clara cells do?

Back 7

secrete CCSP (clara cell secretory protein) - inhibits neutrophil recruitment & activation, & neutrophil dependent mucin production

Front 8

how does streptomycin inhibit mycobacterial growth?

Back 8

AMINOGLYCOSIDE
interferes w/initiation step of prtn synthesis
binds 30S subunit & changes structure

Front 9

what antibiotics interefere with translocation?

Back 9

erythromycin & clindamycin

Front 10

what prevents binding of amino-acyl tRNA to A site?

Back 10

tetracycline

Front 11

failed sterilization of mechanical ventilators leads to pneumoniae caused by what bugs?

Back 11

e. coli, klebsiella, acinetobacter, pseudomonas

Front 12

nitroblue tetrazolium testing is used for what?

Back 12

tests for NADPH oxidase activity
fails to turn blue if deficient, as is the case in Chronic Granulomatous Disease
at risk for infection by Catalase positive organisms

Front 13

why neutrophils of patients with CGD still kill catalase negative organisms?

Back 13

hydrogen peroxide produced by the organisms accumulates in the phagosome

Front 14

lecithiniase is produced by what organism?

Back 14

clostridium perfrinogens
it is alpha toxin or phospholipase C - lyses erythrocyts platelets luekocytes & endothelial cells, in part responsible for the rapid necrotizing

Front 15

how is chronic granulomatous disease inherited genetically?

Back 15

X-linked

Front 16

what PFTs are expected in emphysema?

Back 16

decreased FEV1/FVC ratio
increased TLC, decreased diffusional capacity

Front 17

Dz incidence tables - what goes top & bottom? Negative predictive value?

Back 17

Dz incidence on top
test results on vertical
Neg predictive = d/[c+d] (true neg over true neg + false neg)

Front 18

how does negatie predicitve value change with prevalence?

Back 18

NPV is inversely proportional to prevalence,

Front 19

enlarged, centrally located epithelial cell - intranuclear & cytoplasmic inclusions
context: lung transplant pt 4mos post transplant - sob cough fever, diffuse infiltrates

Back 19

Cytomegalovirus, lookup picture

Front 20

How can mycobacterium become resistant to isoniazid?

Back 20

1.) decreased activity of catalase-peroxidase, which is necessary for activation of isonizid
2.) mutation of the required peptide sequence for binding

Front 21

What bacteria found in the soil can survive boiling?

Back 21

spore forming bacteria - bacillus & clostridium
killed by autoclaving

Front 22

which polio vaccine is approved in the US?

Back 22

only the inactivated salk vaccine

Front 23

flunisolide therapy is initiated - what is it for? What complications occur and how can they be prevented?

Back 23

it's steroid aerosol for asthma, oral candidiasis can occur, oral rinsing instructions are necessary

Front 24

What bacterial immunizations require conjugation to toxoid?

Back 24

Capsular bacteria - Strep pneumoniae, neisseria meningitidis, haemophilus influenza B

Front 25

what drug inhibits fungal wall composition? What side effects does it have?

Back 25

itraconazole (inhibit demethylation of lanosterol into ergosterol)
inhibits P450 enzymes important to many other drugs

Front 26

big name p450 metabolized drugs?

Back 26

warfarin, cyclosporin, tacrilomus, phenytoin, isoniazid, rifampin, oral hypoglycemics, etc

Front 27

what drugs induce cytochrome oxidases that result in decreased levels of -azoles for fungal tx?

Back 27

rifampin and a bunch of PSYCH drugs (phenytoin, carbamazepine, phenobarbital)

Front 28

how is ARDS defined?

Back 28

acute onset lung dysfxn, pulmoary edema, normal LA pressure, & paO2/FI02 < 200

Front 29

what is the pathophys of ARDS?

Back 29

damage to endothelial cells lining pulmonary capillaries --> leakage of fluid into alveoli (exudative stage)
damage from inflammatory cytokines & neutrophils (DAD - diffuse alveolar damage)

Front 30

what are the stages of ARDS?

Back 30

exudative stage --> proliferative stage (type II pneumocytes) --> fibrotic stage

Front 31

chronic nasal discharge, occasional headaches, atrophic nasal mucosa, thinned nasal septum?

Back 31

substance (cocaine) abuse
can lead to perforation of nasal septum
also assoc w/oropharyngeal ulcers & osteolytic sinusitis

Front 32

pleural fluids - definitions for exudate vs transudate?

Back 32

Exudate: protein pleural/serum > 0.5, LD pleural/serum > 0.6, or pleural LDH > 2/3 ULN serum LDH
transudates lack these features

Front 33

pleural fluid w/high amylase level?

Back 33

pancreatitis, pancreatic pseudocyst, esophageal rupture, lung adenocarcinoma

Front 34

pleural fluid w/low glucose content?

Back 34

malignancy, infection

Front 35

changes in PaO2, PaCO2, & pH w/pulmonary embolism?

Back 35

if severe get V/Q mismatch w/areas of high AND low - PaO2 decreased (b/c of low V/Q areas)
PaCO2 decreased (b/c of high V/Q areas)
pH increases (2nd to CO2 changes? Tachypnea?)

Front 36

respiratory insufficiency following acute pancreatitis?

Back 36

ARDS - hyaline membranes will be found on autopsy (NOT alveolar destruction)

Front 37

where is the lower border of the pleura?

Back 37

midclavicular line - 7th rib
midaxillary line - 10th rib
paravertebral line - 12th rib
(lung border is ~2 rib spaces above pleural border)

Front 38

where is airway resistance greatest? Least?

Back 38

Majority of total friction is in medium & small sized bronchi, > 2 mm "large bronchi" (this is > than early track of nasal passages, pharynx, etc)
airwais < 2mm contribute less than 20% of total friction (total cross sectional area is greater)

Front 39

shipyard and/or insulation exposure?

Back 39

mesothelioma
strongly associated w/asbestos (only real risk factor), extremely rare

Front 40

radiographic evidence of PLEURAL THICKENING w/hemorrhagic pleural effusions?

Back 40

mesothelioma
strongly associated w/asbestos
parenchyma intact (think about asbestos being SO tiny it gets all the way down to alveoli & out into pleural cavity)

Front 41

how to distinguish mesothelioma from adenocarcinoma histologically?

Back 41

mesothelioma EM - numerous long slender microvilli & abundant tonofilaments
adenocarcinoma have short, plump microvilli

Front 42

chromogranin & synaptophysin positive lung tumor cells?

Back 42

small cell carcinoma
usually arising from major bronchi (hilar mass on imaging)

Front 43

bilateral reticulonodular pattern of opacities on CXR, most pronounced in lower lobes?

Back 43

pulmonary fibrosis (look up picture)

Front 44

lung biopsy of pulmonary fibrosis?

Back 44

patchy interstitial lymphocytic inflammation of alveolar walls

Front 45

clinical presentation of pulmonary fibrosis?

Back 45

gradually progressive dyspnea, end-inspiratory rales at lung bases, PFTs w/restrictive pattern (decreased FEV1 & FVC, nl ratio, decreased diffusional capacity)

Front 46

how does silicosis predisopse to tuberculosis?

Back 46

impairs macrophage killing

Front 47

how does LV hypertrophy lead to pulmonary hypertension?

Back 47

reactive vasoconstriction secondary to pulmonary venous congestion

Front 48

alveolar cells w/golden cytoplasmic granules turning dark blue w/prussian blude staining?

Back 48

"heart failure cells"
hemosiderin containing alveolar macrophages

Front 49

novel asthma therapy for pts resistant to steroid management?

Back 49

Anti-IgE antibodies subQ (omalizumab)
leukotriene antagonists & theophylline have NOT been shownt o be effective

Front 50

how does N-acetylcysteine aerosol help tx of CF patients?

Back 50

REDUCING intermolecular disulfide bridges within mucous glycoproteins, loosening the thick sputum

Front 51

nodular densities and eggshell calcifications of hilar nodes indicate exposure to?

Back 51

silica

Front 52

how does size of particles correspond to clearance from lungs? What are the ranges?

Back 52

10-15 um trapped in upper resp tract
2.5-10 um enter trachea/bronchi & cleared by mucociliar transport
< 2 um (pneumoconioses) reach terminal bronchioli & alveoli, phagocytized by macrophages

Front 53

for a given minute ventilation, where is the work of breathing minimized for restrictive lung diseases? Obstructive?

Back 53

restrictive (increased elastic resistanc) - low tidal volumes, high respiratory rate
obstructive (increased airflow resistance) - lower rate, higher volume

Front 54

what is the normal ppO2 in the alveoli?

Back 54

104 mmHg

Front 55

formula for calculating if patient w/metabolic acidosis's resp drive is beginning to fail? (how much is appropriate compensation)

Back 55

PaCO2 = 1.5 x HCO3- + 8 +/- 2

Front 56

Cheyne-Stokes respiration?

Back 56

cyclic breathing of apnea followed by gradually increasing tidal volumes

CHF or neuro dz (stroke, brain tumor

NOT sleep apnea (ventilation remains nearly constant w/no cyclical variation)

Front 57

causes of digital clubbing?

Back 57

primary, lung cancer (large-cell), TB, CF, bronchiectasis, pulm HTN, empyema, other lung dz, cyanotic congenital heart, inflammatory bowel dz (crohn, ulcerative colitis), hyperthyroidism, malabsorption

Front 58

difference between asthma and exercise induced asthma?

Back 58

allergens are a more common inciting factor for asthma
exercised induced asthma is incited by cold air and exercise by a non-immune mechanism

if see eosinophils in sputum probably is asthma, avoid inciting allergens

Front 59

what does cyanide poisoning do to O2 % sat & content? CO poisoning? Met-Hb?

Back 59

cyanide - inhibits cytochrome C, saturation & content go up (but can't be used)

CO - saturation & content decrease (competes w/O2 for binding)

metHb (Fe3+) - causes pulse ox to read ~85%...
-discrepency between ABG (PaO2) & pulse ox

Front 60

is pulmonary capillary wedge pressure elevated in ARDS?

Back 60

No
one of criteria for ARDS is absence of cardiogenic pulmonary edema

Front 61

calculate A-a gradient?

Back 61

PAO2 = 150 - (PaCO2 / 0.8) = [FiO2 x (Pb - PH2O)] - (PaCO2 / R)

Front 62

what drives respiration and where is it sensed?

Back 62

normally CO2 centrally

in prolonged hypercapnia O2 in peripheral chemoreceptors (carotid bodies)

Front 63

right lung opacification & trachea deviates towards?

Back 63

obstruction of right main bronchus

atelectisis volume loss of lung causes deviation

Front 64

PAS positive intracellular inclusions on liver biopsy?

Back 64

alpha-1 antitrypsin (A1AT)