Respiratory Path From Goljan Rapid Review

Front 1

What is the most common cause of typical community acquired pneumonia?

Back 1

Streptococcus pneumoniae

Front 2

What is the most common cause of atypical pnuemonia?

Back 2

Mycoplasma Pneumoniae

Front 3

Interstitial pneumonia is...

Back 3

atypical

Front 4

bronchopneumonia is...

Back 4

typical

Front 5

signs of consolidation, in terms of percussion, egophany, tactile fremitus, whispered pectorliloquy

Back 5

dullness to percussion
egophany +
increased tactile fremitus
whipsered pectoriliquy +

Front 6

Consolidation indicates atypical or typical pneumonia?

Back 6

Typical.

Front 7

What is the most common source of nosocomial pneumonia infection?

Back 7

Respirators.

Front 8

What pathogen is usu responsible for respirator contracted pneumo?

Back 8

Pseudomonas aeruginosa

Front 9

What three pathogens are associated with nosocomial pneumo?

Back 9

Pseudomonas aeruginosa, Escheria coli, Staph aureus.

Front 10

Most common cause of the common cold.

Back 10

Rhinovirus

Front 11

What type of influenzavirus is most often involved?

Back 11

A

Front 12

2nd most common cause of atypical pneumonia

Back 12

Chlamydia pneumoniae

Front 13

Case: newborn: afebrile, staccato cough, conjunctivitis, wheezing. Pathogen?

Back 13

Chlamydia trachomatis

Front 14

Water loving bacteria that causes green sputum

Back 14

Pseudomonas aeruginosa (respirators!)

Front 15

Most common cause of pneumonia in alcoholics. Then another cause.

Back 15

Klebsiella pneumoniae or just S. pneumoniae.

Front 16

How do you differentiate between the two common causes of pneumo in alcoholics?

Back 16

Klebsiella pneumoniae causes thick mucoid sputum, where as S pneumo does not.

Front 17

What bacterial cause of pneumo is associated with water coolers and produce mists?

Back 17

Legionella pneumophila

Front 18

Case: Pneumo with hyponatremia. Pathogen and pathophys?

Back 18

Legionella can cause tubulointerstitial disease with JG destruction learing to hyporeninemic hypoaldosteronism with hyponatremia, hyperk, and met acid.

Front 19

What is the most common opportunistic fungal infection and where is it found in the community?

Back 19

Cryptococcus neoformans, found in pigeon poop.

Front 20

What fungal infection is associated with Ohio/central Mississippi River valley? What 3 animals carry it?

Back 20

Histoplasma capsulatum. Bats, starlings, chickens. Thus assoc with cave explorers, spelunkers, and chicken farmers.

Front 21

What systemic fungi is associated with the central and southeast US?

Back 21

Blastomyces dermatidis.

Front 22

SW "Valley fever," increases after earth quakes (in dust).

Back 22

Coccidioides immitis.

Front 23

Cave explorer in the Arizona desert with nonproductive cough.

Back 23

Coccidioides, not Histoplasma. SW! dry!

Front 24

I say pigeons, you say...

Back 24

Cryptococcus neoformans!

Front 25

What yeast will be phagocytosed by macrophages?

Back 25

Histoplasma

Front 26

A nasal polyp in a kid is most likely caused by...

Back 26

Cystic fibrosis.

Front 27

A nasal polyp in an adult is most likely caused by...

Back 27

Allergies.

Front 28

A woman with chronic pain has asthma. What else?

Back 28

A nasal polyp caused by NSAID use. Block cyclooxygenase, leave lipoxygenase path open. Leukotrienes C-D-E are increased, causing bronchoconstriction.

Front 29

What is a medically significant A-a gradient?

Back 29

> 30

Front 30

What causes an increased A-a gradient?

Back 30

Hypoxemia of pulmonary origin.

Front 31

Calculate and A-a gradient in a pt breathing .3 O2 who has PCO2 of 80 mmHg and PaO2 of 40 mmHg.

Back 31

PAO2 = 0.3 (713) - 80/0.8 = 114 mmHg
A-a = 114-40 = 74 mm Hg, which is clinically significant

Front 32

Name 3 causes of hypoxemia with a normal A-a gradient.

Back 32

1. Depression of medullary resp centers
- barbituates, brain injury
2. Upper Airway obstruction
-food block, epiglottitis, croup
3. Muscles of respiration dysfunction
-paralyzed diaphragm

Front 33

Name 3 general causes of hypoxemia with an increased A-a gradient

Back 33

1. Ventilation defect
2. Perfusion defect
3. Diffusion defect

Front 34

Example of a ventilation defect

Back 34

Airway collapse in ARDS - impaired O2 deliver to alveoli

Front 35

Example of perfusion defect

Back 35

Pulmonary emobolus blocks blood flow to alveoli

Front 36

2 Examples of Diffusion defects

Back 36

Interstitial Fibrosis
Pulmonary Edema
O2 can't diffuse alveoli->capillary

Front 37

What is the most common cause of fever 24-36 hours after surgery?

Back 37

Resorption atelectasis.
Ex: mucus plug obstructs airway, alveoli collapse.

Front 38

On Tension pneumothorax, what side does the trachea deviate to?

Back 38

Contralateral - pushed by air compressing the lung.

Front 39

With resorption atelectasis, what side does the trachea deviate to?

Back 39

Ipsilateral - goes where there is space.

Front 40

What cell synthesizes surfactant?

Back 40

Type II pneumocytes.

Front 41

What increases surfactant synthesis? (2) Decreases? (2)

Back 41

Increases: cortisol and thyroxine
Decreases: insulin (maternal diabetes), prematurity, c-section (less cortisol)

Front 42

How does surfactant work?

Back 42

Prevents alveolar collapse on expiration by reducing surface tension.

Front 43

Is Infant RDS a ventilation, perfusion, or diffusion defect?

Back 43

Ventilation, alveoli collapse.

Front 44

infant RDS treatment

Back 44

PEEP

Front 45

Free radicals from O2 thrx in infant RDS can cause...(2)

Back 45

blindness
bronchopulmonary dysplasia

Front 46

What causes hypoglycemia in the newborn?

Back 46

Excess insulin from response to fetal hyperglycemia in maternal diabetes.

Front 47

What causes hyaline membranes?

Back 47

proteins leaking out of damages pulmonary vessels

Front 48

What causes ARDS? Pathophys.

Back 48

Pulmonary edema from acute alveolar capillary damage.

Front 49

What causes capillary damage in ARDS?

Back 49

Acute damage ->macrophages release cytokines-> chemotactic to netrophils -> neuts transmigrate through pulm capillaries -> leave holes -> protein leakage -> hyaline membranes

Front 50

Gram + diplocci on sputum stain =
How do you treat?

Back 50

Strep Pneumo. Treat with Penicillin G.

Front 51

How do you prevent Pneumocystis in AIDS pts?

Back 51

Rx TMP/SMX (trimethoprim-sulfamethxazole) when CD4 is <200.

Front 52

What 3 things can Aspergillus cause?

Back 52

1. Aspergilloma: fungus ball in old TB site, hemoptysis
2. Allergic reaction
3. Vessel invasion with hemorrhagic infarction and necrotic bronchopnuemo

Front 53

Where do most PE's come from?

Back 53

Clot in femoral vein, NOT lower leg DVT.

Front 54

Where will an aspiration mass go if you are sitting? supine? right sided? Which is most common?

Back 54

Sitting = R lower lobe, posterobasal
Supine = R lower lobe, superior seg
*most common
Right side= R upper lobe, superior seg

Front 55

What 2 diagnostic tests are used to diagnose PE? Gold standard?

Back 55

1. VQ scan - V normal, Q off
2. Gold = pulm angiogram

Front 56

How do you prevent Pneumocystis in AIDS pts?

Back 56

Rx TMP/SMX (trimethoprim-sulfamethxazole) when CD4 is <200.

Front 57

What 3 things can Aspergillus cause?

Back 57

1. Aspergilloma: fungus ball in old TB site, hemoptysis
2. Allergic reaction
3. Vessel invasion with hemorrhagic infarction and necrotic bronchopnuemo

Front 58

Where do most PE's come from?

Back 58

Clot in femoral vein, NOT lower leg DVT.

Front 59

Where will an aspiration mass go if you are sitting? supine? right sided? Which is most common?

Back 59

Sitting = R lower lobe, posterobasal
Supine = R lower lobe, superior seg
*most common
Right side= R upper lobe, superior seg

Front 60

What 2 imaging diagnostic tests are used to diagnose PE? Gold standard?

Back 60

1. VQ scan - V normal, Q off
2. Gold = pulm angiogram
NOT spiral CT.
D-dimers also useful. Neg rules out PE.

Front 61

Interstitial Fibrosis
Restrictive or Obstructive?
FEV1
FVC
FEV1/FVC
TLC

Back 61

Restrictive, all V decreased.
FVC, TLC down
FEV1/FVC increased - FEV1 up bc of increased elasticity

Front 62

What is Caplan syndrome?

Back 62

Rheumatoid nodules in lung + restrictive disease like Coal WP or Asbestos disease.

Front 63

What does Coal WP do to TB risk? Cancer risk?

Back 63

Does not affect TB or cancer risk.

Front 64

What does silicosis do to cancer and TB risk?

Back 64

Increases risk of cancer and TB

Front 65

What do lung opacities contain in silicosis?

Back 65

Collagen and quartz. HARD as rocks, as they are made of rocks. Quartz is super fibrogenic

Front 66

What is the most common lesion related to asbestos exposure? What is the most common disease process?

Back 66

1. Benign plueral plaques
2. Primary bronchogenic carcinoma
-Mesothelioma takes longer to show up, thus less common than primary cancer

Front 67

What 2 complications are common in all 3 pneumoconiosis? (silicosis, coalwp, asbetosis)

Back 67

Cor pulmonale
Caplan syndrome

Front 68

What do roofing and working in shipyards expose you to?

Back 68

Asbetos

Front 69

What do foundries (casting metal), sandblasting, and mines expose you to?

Back 69

Quartz / Silicosis

Front 70

What is the most common sxs of Sarcoidosis?

Back 70

Dyspnea

Front 71

What does sarcoidosis do to the lung?

Back 71

causes granulomas in interstitium and nodes, contain multinucleated giant cells

Front 72

Name 3 other manifestations of sarcoidosis (outside the lung)

Back 72

1. Nodular skin lesions
2. Eye lesions
3. Granulomatous hepatitis
4. Enlarged lacrimal glands
5. increased ACE
6. Hypercalcemia

Front 73

What is the likely cause of a pleural effusion in a young woman?

Back 73

SLE - Lupus
example of serositis

Front 74

Farmer's Lung is caused by...

Back 74

Moldy hay = saccharopolyspora rectivirgula / thermophilic actinomyces
Type III hypersensitivity - immune complex mediated
Type IV with Chronic exposure -> granuloma

Front 75

In Emphysema, compliance___ and elasticity___.

Back 75

Compliance increases (inhalation)
Elasticity decreases (exhalation)

Front 76

What's the difference between a transudate and an exudate?

Back 76

Transudate: ultrafiltrate of plasma. ex: heart failure

Exudate: protein-rich, cell-rich fluid
ex: pneumonia, infarction, metastasis

Front 77

Pleural fluid protein / serum protein = 0.6

Transudate or exudate?

Back 77

over 0.5 = exudate

(more protein in fluid than plasma)

Front 78

Pleural fluid LDH/serum LDH = 0.7

Transudate or exudate?

Back 78

over 0.6 = Exudate

Front 79

What lung cancer can cause Horner's syndrome and why?

Back 79

Pancoast tumor of superior sulcus - usu primary sq cell cancer in extreme apex. Can destroy superior cervical ganglion and cause horners (eye lid lag, miosis - pinpoint pupil, anhydrosis - no sweating)

Front 80

What is the most common type of lung cancer?

Back 80

Metastatic more common than primary.

Primary, most common is Adenocarcinoma.

Front 81

Are cancers caused by smoking usually peripheral or central?

Back 81

Central
However, after filters were installed in cigarettes, the big carcinogens got filtered out. Now, peripheral cancers caused by the small carcinogens are increasing.

Front 82

Which two cancers have the strongest association to smoking?

Back 82

1. Squamous cell
2. Small cell

Front 83

Is adenocarcinoma related to smoking? Where in the lungs is it usually found.

Back 83

Adenocarcinoma is not usually associated with smoking, usually found peripherally.

Front 84

What is the most important first step in evaluating a "coin lesion" on a chest x-rays.

Back 84

Compare size from previous x-rays.

Front 85

What three cancers are most often associated with lung mets?

Back 85

1. Primary Breast
2. Colon, Renal Cell

Front 86

What is the most common symptom of primary lung cancer? What about metastatic?

Back 86

Cough for primary, dyspnea for metestatic. (Still have dyspnea in primary.)

Front 87

Where does primary lung cancer metastisize to?

Back 87

1. Hilar lymph nodes
2. Adrenal gland
3. Liver (50%), brain (20%), bone

Front 88

Name 5 issues associated with CF that are not pulmonary.

Back 88

1. Malabsorption - pancreatic exocrine def
2. Type 1 diabetes - chronic pancreatitis
3. Male infertility
4. Meconium ileus in bebes
5. 2ary Biliary cirrhosis - bile duct obstruction by thick secretions

Front 89

What is the most common respiratory pathogen in CF?

Back 89

pseudamonas aeruginosa

Front 90

What is the most common cause of death in CF?

Back 90

Respiratory infection.

Front 91

Most common cause of bronchiectasis in US? INternational?

Back 91

US - CF
Int - TB

Front 92

What condition is associated with cupfuls of sputum production?

Back 92

Bronchiectasis, due to dilation of bronchi and bronchioles that get filled with pus. Ew.

Front 93

Extrinsic asthma is associated with what type of hypersensitivity rxn?

Back 93

Type 1 - IgE dependent activation of Mast cells.

Front 94

All these things are involved in asthma pathology. Tell me the story of how: Eotaxin, IL4, T cells, eosinophils, mast cells, major basic protein, IL5, histamine, cationic protein, LTC-D-E, Acetylcholine

Back 94

1. Inhaled allergen sensitizes by stimulating helper T cells (CD4Th2) that release IL 4 and IL 5.
IL 4 - IgE production
IL 5 - production and activation of eosinophils
2. Antigens crosslink IgE on mast cells, release histamine + mediators -> bronchoconstriction, mucus, leukocytes
3. Late phase (4-8 hrs later)
Eotaxin - chemotactic for eosinophils
Eosinophils release major basic protein and cationic protein, which damage epithelial cells and produce airway constriction
LTC-D-E cause prolonged bronchoconstriction
Acetylcholine causes airway muscle contraction.

Front 95

How are IL4 and IL5 involved in extrinsic asthma?

Back 95

Released by Tcells
IL4 stimulates isotope switching to IgE production.
IL5 stimulated production and activation of eosinophils.

Front 96

Name two causes of emphysema

Back 96

1. Smoking
2. alpha-1-antitrypin def (AAT)

Front 97

What causes airway collapse in emphysema?

Back 97

Loss of elastic tissue - loss of radial traction.

Front 98

What causes panacinar emphysema? Centriacinar?

Back 98

Panacinar = AAT def
Centriacinar = smoking

Front 99

Curschmann spirals and Charcot-Leyden crystals are histologic evidence of what disease?

Back 99

Asthma.

Front 100

What lung cancer is associated with hypercalcemia?

Back 100

Squamous Cell

Front 101

What lung cancer is associated with Cushings?

Back 101

Small Cell