Respiratory Pathology

Front 1

what is normal for a A-a gradient and what is medically significant?

Back 1

normal = 5 mm Hg
significant = 30 mm Hg

Front 2

causes of hypoxemia with increased A-a gradient?

Back 2

ventilation defect (airway collapse), perfusion defect (pulmonary embolus), diffusion defect (interstitial fibrosis, pulmonary edema), R to L cardiac shunt (tetralogy of Fallot)

Front 3

stimulation of J receptors results in what?

Back 3

dyspnea due to decrease in full inspiration

Front 4

causes of dyspnea?

Back 4

decreased compliance, increased airway resistance, chest bellows disease, interstitial inflammation/fluid accumulation

Front 5

where are cough receptors located?

Back 5

bifurcations in airways, larynx, distal esophagus

Front 6

what drugs can cause cough and what is their pathogenesis?

Back 6

ACE inhibitors: inhibit degradation of bradykinin; cause mucosal swelling and irritation in tracheobronchial tree.
Aspirin: causes an increase in LT C-D-E4 (bronchoconstrictors)

Front 7

normal resp rate and cutoff for tachypnea?

Back 7

normal = 14-20 bpm
tachypneic >20 bpm

Front 8

what is vocal tactile fremitus?

Back 8

palpable thrill (vibration) transmitted through chest when patient says 'E' or '1,2,3' or '99'

Front 9

decreased, increased, absent vocal tactile fremitus?

Back 9

decreased when greater lung capacity, increased with consolidation, absent with airway collapse, effusion, or pneumothorax

Front 10

causes of hypoxemia with normal A-a gradient?

Back 10

depression of respiratory center in medulla (barbiturates, brain injury), upper airway obstruction, chest bellows (muscles of respiration) dysfunction (paralyzed diaphragm)

Front 11

equation for calculating PAO2?

Back 11

alveolar = %O2(713) - arterial PCO2/0.8

Front 12

which volumes and capacities are NOT directly measured by spirometry?

Back 12

FRC (functional residual capacity), TLC (total lung capacity), RV (residual volume)

Front 13

what does choanal atresia refer to?

Back 13

unilateral or bilateral bony septum between the nose and the pharynx

Front 14

what is the most common nasal polyp?

Back 14

allergic polyps due to IgE mediated allergies

Front 15

causes of obstructive sleep apnea?

Back 15

obesity, tonsillar hypertrophy, nasal septum deviation

Front 16

common pathogens that cause sinusitis?

Back 16

rhinovirus, strep pneumoniae (most common), anaerobes, systemic fungi (muro or aspergillus - diabetics commonly have sinusitis due to mucor)

Front 17

epidemiology of nasopharyngeal carcinoma?

Back 17

male, Chinese and African populations, causal relationship with EBV

Front 18

what viruses are associated with laryngeal carcinoma?

Back 18

HPV 6 and 11

Front 19

risk factors for laryngeal carcinoma?

Back 19

cigarettes, alcohol, squamous papillomas and papillomatosis (HPV 6 and 11)

Front 20

where are majority of laryngeal carcinomas located with what resulting symptom?

Back 20

true vocal cords with resulting hoarseness

Front 21

pathogenesis of resorption atelectasis?

Back 21

alveolar collapse secondary to air absorption in obstructed airway

Front 22

pathogenesis of compression atelectasis?

Back 22

air or fluid in pleural cavity under increased pressure collapses small airways beneath pleura

Front 23

when does synthesis of surfactant begin?

Back 23

28th week of gestation

Front 24

what cell synthesized surfactant and where is it stored within the cell?

Back 24

type II pneumocytes in lamellar bodies

Front 25

what is major component of surfactant?

Back 25

phosphatidylcholine (lecithin)

Front 26

what are stimulants and suppressants for surfactant production?

Back 26

synthesis is increased by cortisol and thyroxine but decreased by insulin

Front 27

what do women take to stimulate fetal surfactant synthesis?

Back 27

glucocorticoids

Front 28

most common pathogen of typical community-acquired pneumonia?

Back 28

strep pneumo

Front 29

most common viral cause of atypical pneumonia and bronchiolitis?

Back 29

RSV

Front 30

most common cause of croup?

Back 30

parainfluenza virus

Front 31

what type of antiviral drugs are zanamivir and oseltamivir?

Back 31

neuraminidase inhibitors

Front 32

most common cause of nosocomial pneumonia?

Back 32

pseudomonas

Front 33

most common systemic fungal infection?

Back 33

histoplasma

Front 34

most common aspiration site?

Back 34

superior segment of the right lower lobe

Front 35

classical clinical triad of nasal polyps?

Back 35

nonsteroidal drugs, asthma, nasal polyps

Front 36

what disease are nasal polyps associated with?

Back 36

cystic fibrosis

Front 37

recommended treatment for sinusitis?

Back 37

decongestants and antimicrobial only after 2 weeks (typically viral and are self-limited)

Front 38

lab findings in acute respiratory distress syndrome?

Back 38

severe hypoxemia not responsive to O2 therapy

Front 39

where do majority of pulmonary thromboembolism originate?

Back 39

femoral vein

Front 40

where are majority of pulmonary thromboembolisms located?

Back 40

lower lobes

Front 41

laboratory findings with pulmonary thromboembolism?

Back 41

respiratory alkalosis, PaO2 < 80mmHg, increase in A-a gradient, increase in D-dimers

Front 42

definition of pulmonary HTN?

Back 42

mean pulmonary artery pressure >25 mmHg at rest or >30 mmHg with exercise

Front 43

what mutation represents a genetic predisposition to pulmonary HTN?

Back 43

mutations in genes associated with TGF-beta

Front 44

most common presenting sign with pulmonary HTN?

Back 44

exertional dyspnea

Front 45

definition of cor pulmonale?

Back 45

combo of pulmonary HTN and right RVH leading to right-sided heart failure

Front 46

cause of pneumoconioses?

Back 46

inhalation of mineral dust into the lungs leading to interstitial fibrosis

Front 47

what forms of dust are very fibrogenic?

Back 47

silica, asbestos, beryllium

Front 48

what is caplan syndrome?

Back 48

pneumoconiosis plus large cavitating rheumatoid nodules in the lungs

Front 49

most common occupational disease in the world?

Back 49

silicosis

Front 50

what is most often implicated material in silicosis?

Back 50

quartz (crystalline silicone dioxide)

Front 51

what occupations are associated with silicosis?

Back 51

foundries (casting metal), sandblasting, working in mines

Front 52

complications of silicosis?

Back 52

cor pulmonale, caplan syndrome, increased risk for lung cancer and TB

Front 53

difference between serpentine and amphibole forms of asbestos?

Back 53

serpentine: curly and flexible producing interstitial fibrosis and lung cancer; amphibole: straight and rigid producing interstitial fibrosis, lung cancer, mesothelioma

Front 54

when does bronchogenic lung cancer and malignant mesothelioma occur relative to exposure?

Back 54

bronchogenic lung cancer: ~20 yrs after first exposure; malignant mesothelioma: ~25-40 yrs after first exposure

Front 55

consequences of asbestos exposure and smoking?

Back 55

increased risk for bronchogenic lung cancer but NOT malignant mesothelioma

Front 56

what occupations are associated with berylliosis?

Back 56

nuclear and aerospace industry

Front 57

berylliosis characteristic histology and complications?

Back 57

diffuse interstitial fibrosis with noncaseating granulomas with increased risk for cor pulmonale and primary lung cancer

Front 58

sarcoidosis?

Back 58

multisystem granulomatous disease of unknown etiology

Front 59

primary target organ of sarcoidosis?

Back 59

lung: granulomas in interstitium and mediatinal and hilar nodes

Front 60

treatment for sarcoidosis?

Back 60

majority have spontaneous remission, some may require corticosteroids, TNF inhibitors, hydroxychloroquine if skin involvement

Front 61

what causes honeycomb appearance of idiopathic pulmonary fibrosis?

Back 61

repeated cycles of alveolitis causes alveolar fibrosis leading to proximal dilation of small airways

Front 62

diagnosis for unexplained pleural effusion in a young woman?

Back 62

SLE

Front 63

pulmonary findings in RA?

Back 63

interstitial fibrosis with or without intrapulmonary rheumatoid nodules (often cavitating); pleuritis with pleural effusions

Front 64

which type of hypersensitivity is farmer's lung?

Back 64

type III upon second exposure (IgG developed from first exposure) with type IV granulomatous inflammation with chronic exposure

Front 65

occupations associated with byssinosis?

Back 65

textile workers (cotton, linen, hemp) - bacterial endotoxin from Gm(-) bacteria growing on cotton

Front 66

silo filler's disease is caused by?

Back 66

inhalation of gases (oxides of nitrogen) from plant material

Front 67

drugs associated with interstitial fibrosis?

Back 67

amiodarone, bleomycin and busulfan, cyclophosphamide, methotrexate and methysergide, nitrosourea and nitrofurantoin

Front 68

how long after radiation therapy might patients develope radiation pneumonitis?

Back 68

1-6 months

Front 69

characteristic of centriacinar or centrilobular emphysema location?

Back 69

trapping of air in respiratory bronchioles

Front 70

characteristic of panacinar emphysema location?

Back 70

trapping of air in entire respiratory unit behind the collapsed terminal bronchiole

Front 71

definition of chronic bronchitis?

Back 71

productive cough for at least 3 months for 2 consecutive years; generally caused by smoking cigarettes and cystic fibrosis

Front 72

most common chronic respiratory disease in children?

Back 72

athma

Front 73

pathogenesis of extrinsic asthma?

Back 73

type I hypersensitivity reaction with exposure to extrinsic allergens

Front 74

histologic changes in bronchi in patients with asthma?

Back 74

basement membrane thickening, edema and mixed inflammatory infiltrate, hypertrophy of submucosal glands, hypertrophy/hyperplasia of smooth muscle cells

Front 75

causes of intrinsic asthma?

Back 75

nonimmune: virus-induced respiratory infection, air pollutants, aspirin or nonsteroidal drug sensitivity, stress, exercise, cigarette smoke

Front 76

causes of bronchiectasis?

Back 76

cystic fibrosis, infections (TB is most common), bronchial obstruction (cancer), primary ciliary dyskinesia, allergic bronchopulmonary aspergillosis

Front 77

most common fatal cancer in both men and women?

Back 77

primary lung cancer

Front 78

which primary lung cancers have greatest association with smoking?

Back 78

squamous and small cell carcinoma

Front 79

which primary lung cancers are located centrally?

Back 79

squamous and small cell carcinoma

Front 80

which primary lung cancers tend to be more peripherally located?

Back 80

adenocarcinomas

Front 81

where do primary lung cancers commonly met to?

Back 81

hilar lymph nodes, then adrenal gland, liver, brain, bone (osteolytic)

Front 82

what are scar carcinomas?

Back 82

adenocarcinomas that develop in scars (e.g. old TB granuloma)

Front 83

paraneoplastic syndrome associated with squamous cell carcinoma?

Back 83

PTH-related protein

Front 84

paraneoplastic syndrome associated with small cell carcinoma?

Back 84

ADH or ACTH

Front 85

pancoast tumor?

Back 85

superior sulcus tumor: primary squamous cancer at extreme apex of lung, destruction of superior cervial sympathetic ganglion can produce horner syndrome

Front 86

thought to be in situ precursor to adenocarcinoma?

Back 86

bronchioalveolar carcinoma: malignant Clara cells spread along alveolar walls

Front 87

characteristics of transudate?

Back 87

ultrafiltrate of plasma

Front 88

characteristics of exudate?

Back 88

protein rich and cell rich fluid

Front 89

most common cause of chylous pleural effusion?

Back 89

malignancy