Y2S1B2 - Path - Goljan Respiratory

Front 1

Dyspnea occurs due to stimulation of what receptors?

Back 1

J receptors, causing a decrease in full inspiration

Front 2

What is the MC cause of cough with a normal chest xray?

Back 2

Postnasal discharge

Front 3

What can nocturnal cough be caused by?

Back 3

GERD (acid reflux in tracheobronchial tree at night)
Bronchial asthma (d/t bronchoconstriction)

Front 4

Productive cough is typically caused by what problems?

Back 4

Chronic bronchitis
Typical bacterial pneumonia
Bronchiectasis

Front 5

What drugs can cause cought?

Back 5

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

Front 6

What are some causes of hemoptysis?

Back 6

Chronic bronchitis (MC cause)
Pneumonia, bronchogenic carcinoma
TB, bronchiectasis, aspergilloma (fungus living in a cavitary lesion)

Front 7

What are some causes of tachypnea?

Back 7

restrictive lung disease
pleuritic chest pain
PE w/ infarction (key finding)

Front 8

What diseases cause:

a) Decreased vocal tactile fremitus?
b) Absent vocal tactile fremitus?
c) Increased vocal tactile fremitus?

Back 8

a) Emphysema or asthma with increased AP diameter
b) Atelectasis, fluid, air in pleural space
c) Alveolar consolidation (lobar pneumonia)

Front 9

What can cause:

a) Dull percussion?
b) Hyperresonant percussion?

Back 9

a) Pleural effusion, lung consolidation, atelectasis (no air in alveoli)

b) Pneumothorax, asthma, emphysema

Front 10

What are some causes of crackles?

Back 10

pulmonary edema
lobar pneumonia
intersititial fibrosis (e.g., sarcoidosis)

Front 11

What are some causes of wheezing?

Back 11

Inflammation of segmental bronchi, small airways (e.g., asthma, chronic bronchitis)
Pulmonary edema constricting airway (called cardiac asthma)
Pulmonary infarction (release of TXA2, from platelets in embolus causes bronchoconstriction)

Front 12

What are some causes of inspiratory stridor?

What about both inspiratory and expiratory stridor?

Back 12

Epiglottitis (h influenzae) and croup (parainfluenza virus)

both is a sign of fixed upper airway obstruction (e.g., from cancer)

Front 13

What are some causes of pleural friction rub?

Back 13

pleuritis d/t cancer, infarction, pneumonia, serositis (SLE)

Front 14

After how much time is grunting in newborns considered abnormal? What condition is it common in?

Back 14

after 24 hours

common in RDS

Front 15

What are some causes of hypoxemia with an increased A-a gradient (>30 mm Hg)?

Back 15

Ventilation, perfusion, diffusion defects; right-to-left cardiac shunts

Front 16

What are some causes of hypoxemia with a normal A-a gradient (about 5 mm Hg)?

Back 16

Depression of respiratory center in medulla (barbiturates, brain injury); upper airway obstruction (epiglottitis h inflluenzae, croup parainfluenza); chest bellows disease (paralyzed diaphragm, ALS w/ degen of anterior horn cells)

Front 17

A newborn that becomes cyanotic when breast-feeding but "pinks up" again when crying may have what?

Back 17

Choanal atresia - unilateral or bilateral bony septum b/w nose and pharynx, can't breathe through nose

Front 18

What is the MC polyp seen in adults w/ a hx of IgE-mediated allergies?

Back 18

Allergic polyp

Front 19

What is the clinical triad for asthma?

Back 19

aspirin (NSAIDs), nasal polyp, asthma

Front 20

Which polyps most often occur in women w/ chronic pain syndromes?

Back 20

Nasal polyps a/w aspirin and other NSAIDs - drugs block COX leaving the lipoxygenase pathway open

Front 21

Nasal polyps in a child should cause you to order what test?

Back 21

Sweat test to rule out cystic fibrosis

Front 22

Patients with obstructive sleep apnea are at risk of developing what complication?

Back 22

pulmonary HTN leading to right ventricular hypertrophy

Front 23

Regarding sinusitis, which is the MC sinus involved in

a) adults?
b) children?

Back 23

a) maxillary
b) ethmoid

Front 24

What is the MC cause of sinusitis?

other causes?

Back 24

Viral URI (rhinoviruses)

also could be bacterial URI (MC - s pneumoniae, chronic - anaerobes, systemic fungi Mucor or Aspergillus), deviated nasal septum, allergic rhinitis, barotrauma, or smoking

Front 25

What pathogen is commonly the cause of sinusitis in diabetics?

Back 25

Mucor species of systemic fungi

Front 26

What is the most sensitive test for sinusitis?

Back 26

CT scan

Front 27

What virus is a/w the pathogenesis of nasopharyngeal carcinoma?

Back 27

Epstein-Barr virus

Front 28

A chinese male presents w/ a mass in his nasopharynx and enlarged cervical lymph nodes. Biopsy shows that it is a squamous cell carcinoma. What is the likely dx?

Back 28

Nasopharyngeal carcinoma

commonly seen in males, in Chinese and African populations
SCC or undifferentiated cancer
metastasizes to cervical lymph nodes

Front 29

What are risk factors for laryngeal carcinoma?

Back 29

Smoking (MC cause)
Alcohol (synergistic effect w/ smoking)
Squamous papillomas and papillomatosis (HPV 6 and 11)

Front 30

A smoker presents w/ persistent hoarseness and cervical lymphadenopathy. A mass is found on the left true vocal cord. Biopsy shows keratinizing squamous cell carcinoma. What's the dx?

Back 30

Laryngeal carcinoma

Front 31

What causes alveolar collapse in resorption atelectasis?

Back 31

lack of air and distal resorption of preexisting air through the pores of Kohn in the alveolar walls

Front 32

What is the MC cause of fever 24-36 hrs after surgery?

Back 32

Resorption atelectasis

Front 33

Surfactant is synthesized by __________ and stored in _______. Synthesis begins in ____ week of gestation.

Back 33

type II pneumocytes
lamellar bodies
28th week

Phosphatidylcholine is the major component

Front 34

Cortisol and thyroxine (decrease/increase) synthesis of surfactant.
Insulin (decreases/increases) synthesis of surfactant.

Back 34

Increase

Decreases

Front 35

What are some causes of respiratory distress syndrome?

Back 35

Prematurity, maternal diabetes, C-section

Front 36

How can you increase fetal surfactant synthesis when they need to be delivered prematurely?

Back 36

Maternal intake of glucocorticoids

Front 37

Chest xray of newborn with RDS shows ___________ appearance.

Back 37

"ground-glass"

Front 38

What are some complications of RDS in newborns?

Back 38

blindness and bronchopulmonary dysplasia (d/t O2 therapy)
Intraventricular hemorrhage
PDA (d/t persistent hypoxemia)
Necrotizing enterocolitis (ischemia allows entry of gut bacteria into wall)
Hypoglycemia (d/t excess insulin, can produce seizures and damage to neurons)

Front 39

What is the MC cause of pulmonary edema?

Back 39

Left-sided heart failure

other causes:
transudate - left heart failure, volume overload, mitral stenosis, nephrotic syndrome, cirrhosis

exudate - sepsis, pneumonia, drowning, aspirated gastric contents, heroin, high altitude, ARDS

Front 40

What are the main risk factors for ARDS?

Back 40

Sepsis, gastric aspiration and severe trauma w/ shock

also could be diffuse pulm infections (SARS, hantavirus), heroin, smoke, acute pancreatitis, cardiopulmonary bypass, DIC, amniotic fluid or fat embolism

Front 41

Severe hypoxemia, PA wedge pressure <18 mm Hg, and an increased A-a gradient are all indicative of what?

Back 41

ARDS

Front 42

What is the MC cause of typical community--acquired pneumonia?

MC cause of atypical community-acquired pneumonia?

Back 42

streptococcus pneumoniae

mycoplasma pneumoniae

Front 43

MC pathogen causing pneumonia in AIDS?

Back 43

Pneumocystis jiroveci

Front 44

What organism resides in phagosomes of alveolar macrophages, producing a protein that prevents fusion of lysosomes with phagosome?

Back 44

Mycobacterium tuberculosis

Front 45

What is the virulence factor of m TB?

Back 45

cord factor

Front 46

What is the MC extrapulmonary site in TB?

Back 46

Kidneys

adrenal involvement may result in Addison's dz

Front 47

TB in the vertebra is called what?

Back 47

Pott's disease

Front 48

What is the MC type of TB in AIDS?

Back 48

MAC (mycobacterium avium-intracellulare complex)

occurs when CD4 count falls below 50 cells/mm3

Front 49

Hamptom's hump on chest xray is a/w what?

Back 49

Pulmonary thromboembolism

wedge-shaped area of consolidation