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(***) (U-World) All Subjects > Pulmonary and Critical Care > Flashcards

Pulmonary and Critical Care Flashcards

1
Q

pleuritic chest pain arising from the mediastinal or diaphragmatic pleura will be carried by the _____ nerve

A

phrenic

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2
Q

amniotic fluid lecithin (phosphatidylcholine) to sphinomyelin ration (L/S) is measured to assess ______

considered mature when ration is greater than

A

fetal lung maturity

2

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3
Q

probability of a child from two parent populations with different mutant allele carrier frequencies will inherit and AR disease is =

A

25% multiplied by the carrier frequencies

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4
Q

_______ pneumocytes regenerate alveolar lining following injury and produce surfactant

A

Type II

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5
Q

COPD encompasses _______ and _______. _________ causes destruction of interalveolar walls and decreased ____________, leading to increased ________, ___________, _______________

patients present with hyperinflated lungs, flattened diaphragm, barrel shaped chest

A

chronic bronchitis and emphysema

emphysema

lung elastic recoil

residual volume, functional reserve capacity, total lung capacity

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6
Q

smaller spheres w/o surfactant will ______ compared to larger ones due to laplace’s law and the difference in _____

A

collapse

surface tension

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7
Q

ill school children spread to older adult, abrupt onset fever, HA, myalgia, and malaise, symptoms gradually improve =

predisposes to secondary infection bacterial pneumonia from (3)

A

influenza A

streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae

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8
Q

cromoglycates such as ______ block mast cell degranulation independent of the triggering stimulus

A

cromolyn and nedocromil

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9
Q

the F508 mutation in the _____ protein is the most common mutation in patients with ____. These patients produce eccrine sweat with higher than normal concentrations of sodium and chloride, thus exposure to high temperatures and exercise can lead to ______

A

CFTR

CF

hyponatremia

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10
Q

early onset, no smoking history of emphysema is likely due to ______ and shows as lower lobe predominant

due to breakdown of _____

properties of this protein are due to extensive crosslinking between monomers, facilitated by

A

alpha 1 antitrypsin deficiency

elastin

lysyl oxidase

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11
Q

_________ and aceetylcholine have pharmacologic receptor antagonists that offer clear therapeutic benefit in allergic asthma, while _______ plays a minor role

A

Leukotrienes (LTC4, D4, E4)

Histamine

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12
Q

anaphylactic shock is due to _____ hypersensitivity which occurs when cell surface bound ____ bridge by ______. This is mediated by basophils, mast cells and ____

A

Type I

Antibody

Antigen

IgE

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13
Q

pulmonary vascular resistance is lowest at the _____

A

functional residual capacity

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14
Q

Each MHC class I molecule consists of a heavy chain and a _______. These molecules interact with

A

Beta 2 microglobulin

CD8 CTL

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15
Q

minute ventilation includes _______ while alveolar ventilation does not

A

dead space volume

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16
Q

antiretroviral therapy prenattaly will decrease

A

HIV transmission to infant

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17
Q

F508 mutation in CF leads to protein _____ and failure of ______ followed by proteasome mediated degradation of CFTR proteins

A

misfolding and failure of glycosylation

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18
Q

the most highly oxygenated blood in the fetus is carried by the _______ which empties directly into the _____ via the ________

A

umbilical vein

inferior vena cava

ductus venosus

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19
Q

alveolar fluid contains natural proteases like elastase that are derived from infiltrating ________ and alveolar _______

A

neutrophils

macrophages

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20
Q

hyperinflated lungs, airway mucus plugging, cellular infiltrate of the bronchial wall =

cellular infiltrate due to =

controlled most strongly by

A

chronic bronchial asthma

leukotrienes

glucocorticoids like fluticasone (inhaled)

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21
Q

HIV pneumonia with CD4+ count 400-1400 =

less than 200 =

A

Strep pneumo

P jiroveci

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22
Q

the most common cause of lung abscesses in alcoholics is a __________ infection of ________ that should be treated with _________

another common cause of aspiration pneumonia in alcoholics is ______ that should be treated with _______

A

polymicrobial

anaerobes

clindamycin

Klebsiella

cephalosporins

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23
Q

recurrent respiratory infections, dextrocardia, infertility = which is a form of primary ciliary dyskinesia. This disorder is characterized by situs inversus, chronic sinusitis, and bronchiectasis and is due to the failure of _________ to develop normally

A

Kartagener syndrome

dynein arms

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24
Q

immunosuppressed, lung infection with infiltrates, unresponsive to antibiotics, stains red on ________ is indicative of ______________ infection. The polysaccharide capsule appears clear and unstained on india ink

A

mucicarmine

Cryptococus neoformans

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25
Q

immunosuppressed, fever, weight loss, HSM, painful oral ulcers, cough, bone marrow aspirate shows intracellular ovoid bodies in macrophages =

A

Histoplasma capsulatum

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26
Q

________ is the most aggressive type of lung cancer and can present with paraneoplastic SIADH and hyponatremia. These have neuroendocrine origin and will stain for markers such as _______ or CD56, enolase, chromogranin, and synaptophysin

A

Small cell carcinoma of the lung

Neural cell adhesion molecule (NCAM)

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27
Q

chest tube placement for pleural effusion is placed into the 4th or 5th intercostal space in the anterior axillary or midaxillary line and traverses through ________, _________, and the parietal pleura

A

serratus anterior

intercostals

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28
Q

IL-12 stimulates the differentiation of naive Thelper cells into the ______ cell. Patients with IL 12-R deficiency suffer from severe mycobacterial infections due to the inability to mount a strong cell mediated ______immune response. They are treated with ______

IL2, IFNy, lymphotoxin B secreted by

IL4, 5, 10, 13 secreted by

A

Th1

granulomatous

IFN-y

Th1

Th2

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29
Q

obstructive lung disease due to _______ or _______ shows as a left shift and shrinkage on a volume flow loop, where as restrictive lung disease due to _______ will show as a right shift and shrinkage on a volume flow loop

A

chronic bronchitis or emphysematous destruction of interalveolar walls

pulmonary fibrosis

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30
Q

________ is a fast acting, depolarizing neuromuscular blocking agent used for rapid sequence intubation that has two phases of blockade

A

Succinylcholine

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31
Q

sudden onset dyspnea in a setting of calf swelling is strongly suggestive of _____. This leads to the development of a ______ mismatch, hypoxemia, hyperventilation, and ________

A

pulmonary embolism

V/Q

respiratory alkalosis

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32
Q

________ has an inactivating mutation affecting _____ that results in recurrent infections with catalase positive bacteria and fungi affecting the lungs, skkin, lymph nodes and shows diffuse granuloma formation. These patients lack neutrophil superoxide production.

inheritance =

A

chronic granulomatous disease

NADPH oxidase

X linked

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33
Q

sensitized ___ cells secrete ____ and _____ which promote B lymphocyte classing switching for IgE synthesis

A

Th2

IL4

IL13

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34
Q

_________, _________, _________ are able to disrupt the peptidoglycan cell wall of G+ and G- organisms: after treatment, these organisms lose their ability to tolerate ______ stress

A

penicillins

cephalosporins

vancomycin

osmotic

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35
Q

worsening shortness of breath, normal PaO2, normal SaO2, low oxygen content =

A

chronic blood loss

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36
Q

daytime somnolence, non restorative sleep with frequent awakenings, morning headaches, obese, systemic HTN =

A

obstructive sleep apnea

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37
Q

during aerobic exericse, increased skeletal muscle ______ production increases the ______ of ______

A

CO2

PCO2

Mixed venous blood

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38
Q

patient with chronic fatigue, dyspnea, difficulty concentrating, and increased PaCO2 in the setting of obesity likely has _________, which is an important causes of hypoxemia with a normal alveolar to arterial oxygen gradient

A

obesity hypoventilation syndrome

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39
Q

aging is associated with steady decreases in chest wall compliance, but increases in lung compliance due to loss of ______ recoil. THis causes an _______ in residual volume, a _________ in forced vital capacity, and an unchanged total lung capacity

A

elastic

increase

decrease

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40
Q

older adult with incidental pleural thickening with calcification of the posterolateral midlung zones and diaphragm likley has

full blow _______ presents with slowly progressive diffuse pulmonary fibrosis

A

asbestos related pleural disease

asbestosis

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41
Q

pulmonary _______ resembles sarcoidosis with nodular infiltrates, enlarged lymph nodes, noncaseating granulomas

A

berylliosis

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42
Q

nodular densities and eggshell calcifcations of the hilar nodes are seen in

A

pulmonary silicosis

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43
Q

radiographic multiple discrete nodules most prominent in the upper lung zones

A

coal workers pneumoconiosis

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44
Q

in left ventricular failure, fluid accumulation in the lung interstitium leads to

A

decreased compliance

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45
Q

polyribosylribitol phosphate, or PRP is a capsule component and major virulence factor for ______. This is the most common cause of _____, and presents with fever, stridor, and dyspnea in unvaccinated children

A

Haemophilus influenzae type b

epiglottitis

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46
Q

most inhaled particles that lodge in the bronchial tree are removed via proximal transport by ________ epithelial cell

A

ciliated

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47
Q

adult with long lasting cough, with bursts of coughing so severe that they vomit, that is around kids often =

this a _______ coccobacillus

A

pertussis (whooping cough)

Gram -

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48
Q

acute respiratory distress syndrome develops results in formation of interstitial and alveolar edema and exudate resulting from increased _______. This leads to _____ lung compliance, _______ work of breathing, ________ V/Q mismatching, and a _________ pulmonary capillary wedge pressure

A

pulmonary capillary permeability

decrease

increase

worsening

normal

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49
Q

immunosuppressed due to lung tranplant, pneumonitis, enlarged cells with intranuclear and intracytoplasmic inclusions (owls eyes) =

type of virus

A

CMV

enveloped, dsDNA virus

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50
Q

candida albicans is a normal inhabitant of the _______ including ______, thus it is a common contaminant of sputum culture

looks like

A

GI tract

oral cavity

budding yeast

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51
Q

sepsis is one of the most common risk factors for ______. As cytokines circulate in response to infection, they activate the pulmonary epithelium and provoke and neutrophil inflammatory response that leads to capillary damage and the leakage of protein and fluid into the alveolar space

A

acute respiratory distress syndrome

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52
Q

FEV1 <80% =

FEV1/FVC <70%? >70%?

FVC normal? or decreased? less than 80%?

A

obstructive or restrictive

obstructive, restrictive

obstructive, obstructive, restrictive

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53
Q

emphysema will cause an ______ in total lung capacity, a _______ in diffusing capacity for carbon monoxide, and a _______ in FEV1/FVC ratio

A

increase

decrease

decrease

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54
Q

cruise travel or hotel visit, headache, confusion, watery diarrhea, fever, bradycardia =

lab findings =

culture on

A

Legionella pneumonia

hyponatremia

BCYE

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55
Q

COPD can cause hypoxia suffiicient enough to stimulate _____ production

A

EPO

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56
Q

the ____________ mediates the afferent limb of the cough reflex above the vocal cords. Foreign bodies lodged in the piriform recess can cause damaged to this nerve

A

internal laryngeal nerve

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57
Q

progressive exertional dyspnea and dry cough, restrictive profile on PFT, and interstitial fibrosis with cystic air space enlargement are characteristic of _______, with honeycomb changes and fibroblastic foci more prominent in the subpleural and paraseptal spaces. This is in the absence of any other indicating symptoms

A

idiopathic pulmonary fibrosis

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58
Q

_______ infection by M tuberculosis occurs after inhaling the organism. This infection is characterized by a Ghon complex, which consists of lower lobe lung lesion (Ghon focus) and ipsilateral hilar adenopathy with calcification

A

Primary

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59
Q

________ commonly contaminates hospital _______. The culture is performed on BCYE with L cysteine and iron, and the organism is best visualized with silver stains

A

Legionella

water systems

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60
Q

young adult african american women with progressive dyspnea on exertion, nonproductive cough, and fatigue with a family history of RA. Non caseating granulomas with aggregates of epitheloid macrophages and multinucleated giant cells

A

Sarcoidosis

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61
Q

the inflammatory cells that mediate COPD are _____, _____, and ____

A

neutrophils

macrophages

CD8+ CTL

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62
Q

chronic cough and progressive weight loss with positive acid fast bacilli =

samples of granulomas will yield ______ giant cells with multiple nuclei on the periphery in a horsehoe pattern. The macrophages that form these giant cells are activated by _______

A

pulmonary tuberculosis

Langerhans

CD4+ Th1 lymphocytes

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63
Q

F508 mutation in CF impairs ____ of CFTR

A

post translational processing

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64
Q

the intercostal vein, artery, and nerve lie in the subcostal groove on the ______ of the rib.

Thoracentesis should be performed above the 8th rib at the midclavicular line, the 10th rib along the mixaxillary line, and the 12th rib along the posterior scapular and paravertebral line. At the 10th rib, you risk injuring the ____

A

inferior border

right hepatic lobe

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65
Q

stab wound above the clavicle between the mid clavicular line and the lateral sternal line risks injuring the ______

A

lung pleura

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66
Q

thickened bronchial walls, lymphocytic infiltrate, mucous gland enlargement, and patchy squamous metaplasia of the bronchial mucosa indicates =

_______ is the leading cause of chronic bronchitis

A

chronic bronchitis

cigarette smoking

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67
Q

drug that reduces nicotine cravings while decreasing pleasurable effects of cigarettes and other tobacco products =

MOA?

A

varenicline

parital agonist of NAChR

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68
Q

_______ is the antifungal of choice for oropharyngeal candidiasis in patients without advanced immunodeficiency

A

Nystatin

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69
Q

Arterial PaCO2 is a direct indicator of ________ status. Hypocapnia implies alveolar _______.

hypercapnia implies ________

upper airway obstruction, reduced ventilatory drive, respiratory muscle fatigue, and decreased chest wall compliance are possible causes of _______

A

alveolar ventilation status

hyperventilation

hypoventilation

hypoventilation

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70
Q

Th1 cells, IL2, IFN-y, and macrophages contribute to the noncaseating granulomas seen in

african american female with pulmonary infiltrates and hilar adenopathy

A

sarcoidosis

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71
Q

the work of breathing is minimized in patients with _______ when their respiratory rate is high and tidal volume is low (fast shallow breaths). in contrast, patients with ______ breathe at a lower rate/higher tidal volume (slow deep breaths) in order to minimize work of breathing

A

pulmonary fibrosis

asthma/COPD

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72
Q

_______ is an anticholinergic agent and derivative of atropine that blocks the action of ACh at MAChR, preventing ________ and reducing parasympathetic stimulation of tracheobronchial submucosal glands in the lungs

A

Ipratropium

bronchoconstriction

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73
Q

most common site for MRSA colonization is the

A

anterior nares

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74
Q

in patients with alpha-1 antitrypsin deficiency, _______ dramatically increases the risk of developing panacinar emphysema

A

smoking

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75
Q

immunocompromised patient with fever, HA, ring enhancing lesion on brain MRI, respiratory symptoms with pulmonary nodules, and sputum studies revealing branching G+ organisms that look like thin fungal hypahe

A

Nocardia asteroides

76
Q

the center of the airway pressure volume curve is the ______, where the airway pressure equals zero. The intrapleural pressure at this point is _____

A

FRC

-5

77
Q

CD19 and CD20 cells =

A

B lymphocytes

78
Q

erythrocytosis is defined as a hematocrit level > ____ in men and _____ in women.

hypoxic erythrocytosis occurs when SaO2 < ____

a normal red blood cell mass with apparent polycythemia is ______

A

52%, 48%

92%

relative erythrocytosis

79
Q

older man presents with heavy hemoptysis, blood tinged sputum over the past few months, with a PMH significant for TB that was treated, round mass in an old left upper lobe cavity =

looks like

A

aspergillus fumigatus infection

septate hyphae at 45 degree angles

80
Q

tall thin young individual can have _______ blebs that result in a ________

A

apical subpleural

primary spontaneous pneumothorax

81
Q

CFTR protein is a transmembrane ______ chloride channel

A

ATP gated

82
Q

PE post operative results in hypoxemia due to

A

V/Q mismatch

83
Q

Chronic granulomatous disease results from a genetic defect in _______

5 catalase positive organism they’re susceptible to

A

NADPH oxidase

Staph aureus, Burkholderia cepacia, Serratia marcescens, Nocardia, Aspergillus

84
Q

killed virus vaccine stimulate

live vaccines stimulate

A

humoral immunity

cell mediated immunity

85
Q

lots of neutrophils but no bacteria on gram stain sputum =

A

legionella

86
Q

__________ is a dimorphic fungus endemic to the ______ US. Forms endo spores and turn into spherules in lungs

IC patient and pigeon droppings =

Mississippi and Ohio River basins, caving or cleaning bird droppings =

A

Coccidioides immitis

SW

Cryptococcus neoformans

Histoplasma capsulatum

87
Q

____ is released by eosinophils to kill ______ and contributes to bronchial epithelial damage in atopic asthma

A

MBP

helminths

88
Q

dimorphic fungus located intracellularly within _________ indicative of

A

macrophages

histoplasma capsulatum

89
Q

G+, alpha hemolytic, optochinin sensitive, bile soluble diplococci

A

strep pneumo

90
Q

perfusion increases from the ____ of the lung to the _____. ventilation increases slightly from the ______ to the _________. The V/P ratio decreases from _______ to _________

A

apex

base

apex

base

apex

base

91
Q

ether and other organic solvents can inactivate ________ viruses

A

enveloped

92
Q

gray -brown firm lonbe with fragmented RBCs, alveolar exudate w/ neutrophils and fibrin =

red, full RBCs, neutrophils, fibrin =

exudate w/ mostly bacteria =

enzymatic degradation of exudate =

A

gray hepatization

red hepatization

congestion

resolution

93
Q

abnormal premature baby retinal neovascularization is a result of ____ for neonatal respiratory distress syndrome. major cause of ______ in developed nations

A

concentrated oxygen therapy

blindness

94
Q

apical cavitary lesions and hemoptysis is indicative of

A

reactivation tuberculosis

95
Q

long bone and pelvic fracture with neurologic abnormalities, hypoxemia, and petechial rash post trauma =

A

fat embolism syndrome in pulmonary arterioles

96
Q

the ___ is the lung volume that remains after maximal expiration and is increased in COPD

A

Residual volume, RV

97
Q

eggshell calcification of the rim of hilar nodes (eggshell) and birefringent particles surrounded by dense collagen fibers

A

Silicosis

98
Q

great lakes trip, large yeast cell with a single bud, incupated at 24C, multicellular structure with branching tubular cells grows =

A

blastomyces dermatitidis

99
Q

smoking or chronic irritation in the lungs can lead to ______

this also occurs in ______ (GI)

A

squamous metaplasia

Barrett esophagus

100
Q

neuromuscular weakness of the _____ is involved in obstructive sleep apnea. Electrical stimulation of the ________ nerve increases the diameter of the oropharyngeal airway and decreases the frequency of apneic events

A

oropharynx

hypoglossal

101
Q

______ are present throughout the respiratory bronchioles but are not present in the alveoli or alveolar ducts

Bronchi have ________ epithelium with goblet cells and submucosal glands and cartilage.

bronchioles, terminal bronchioles, respiratory bronchioles lack ______, glands, and cartilage

terminal bronchioles have ________ epithelium

A

cilia

pseudostratified columnar ciliated

goblet cells

simple ciliated cuboidal

102
Q

theophylline is an _______ antagonist and an indirect adrenergic agent with a narrow ______. Inhibition of hepatic cytochrome oxidases by ___________, cimetidine, macrolides, or verapamil can raise serum concentration to a toxic level

A

adenosine receptor

therapeutic index

ciprofloxacin

103
Q

rapidly progressive fever, sore throat, drooling, stridor, cherry red epiglottis =

most like missed =

A

H Influenzae type b

vaccine

104
Q

medial hypertrophy, intimal fibrosis, luminal narrowing of pulmonary vessels with family history of similar symptoms (dyspnea and weakness), young =

treatment during waiting period before transplant

mechanism

A

idiopathic pulmonary HTN

Bosentan

endothelin receptor antagonist

105
Q

active tuberculosis = biopsy shows

macrophages secrete _____ to induce Th1 differentiation. Th1 cells produce ______ to activate macrophages. Activated macrophages produce _____ to recruit additional monocytes and macrophages to the area

A

epitheloid macrophages and multinucleated giant cells

IL12

IFNy

TNFa

106
Q

TB granulomas form as _______ of activated ________

A

aggregations

leukocytes

107
Q

The ____________ of type II pneumocytes store and release ________. A surfactant deficiency can cause alveolar _________, or collapsed alveoli, as seen in _______

A

lamellar bodies

surfactant

atelectasis

neonatal respiratory distress syndrome

108
Q

African American presenting with constitutional symptoms, bilateral hilar adenopathy, and pulmonary complains with non caseating granulomas on biopsy =

same case with a caseating granuloma and hemoptysis =

A

Sarcoidosis

TB

109
Q

The pO2 in the left atrium and ventricle is lower than that in the ______________ due to mixing of oxygenated blood and deoxygenated blood

A

pulmonary capillaries

110
Q

prolonged, untreated obstructive sleep apnea can cause _________ and ______ heart failure

A

pulmonary hypertension

Right sided

111
Q

normal tracheal pO2 is

normal alveolar pO2 is

normal alveolar PCO2 is

with poor alveolar perfusion PO2 goes ____ and alveolar PCO2 goes

A

150

104

40

up

down

112
Q

apnea followed by gradually increasing then decreasing tidal volumes until the next apneic period =

commonly seen in

A

Cheyne Strokes breathing

CHF

113
Q

Pancreatitis is a major risk factor for ________ as it results in a release of large amounts of inflammatory cytokines and pancreatic enzymes, which leads to activation of ________ in the alveolar tissue. The alveoli become lined with _________

A

ARDS

neutrophils

hyaline membranes

114
Q

alveolar hypoventilation, ventilation perfusion mismatch, diffusion impairment, and right to left shunting are the 4 major causes of _______. The A-a gradient is normal with ___________, which helps distinguish it

A

hypoxemia, low PaO2

alveolar hypoventilation

115
Q

6 month history of cough, fatigue, malaise, weight loss, carpenter (________), HIV negative, lower lobe infiltrate, large yeast with single broad based bud =

A

rotten organic material

Blastomyces dermatitidis

116
Q

In the pulmonary vascular bed, tissue ______ results in a vasoconstrictive response

A

hypoxia

117
Q

The twisted serpetine ropes of TB are consistent with ________ a virulence factor.

A

cord factor

118
Q

airway resistance from the trachea to terminal bronchioles increses to the_______ generation of segmented bronchi, then drops of shaprly

A

5th

119
Q

S Pneumo is able to undergo transformation via ________ in order to gain virulence

A

direct extracellular DNA uptake

120
Q

which bacteria is found in soil and capable of surviving past the boiling point of water ?

A

Bacillus anthracis

121
Q

in pulmonary sarcoidosis, bronchoalveolar lavage fluid will dominate with ______ lymphocytes. Patients will also have elevated _____

A

CD4+

ACE

122
Q

nagging, nonproductive couhg, low grade fever, many people who work and live together with similar symptoms, CXR looks worse then symptoms let on =

Mycoplasma species require _____ to grow on artificial medium

A

Walking Pneumonia: Mycoplasma pneumoniae

cholesterol

123
Q

infant with brassy, barking cough, dyspnea and recent history of URTI =

caused by

A

croup

paramyxovirus (parainfluenza)

124
Q

inhaled glucocorticoids long acting can cause oropharyngeal _______ and require ringing the mouth after use to reduce the risk

A

Candidiasis

125
Q

________, an anti IgE antibody is an effective add on therapy for patients with severe allergic asthma

A

Omalizumab

126
Q

no evidence of pulmonary infarction acutely after PE, why?

A

collateral circulation from pulmonary and bronchial arteries

127
Q

Superior vena cava syndrome will present with a ______ and ________ swelling due to a mediastinal mass pressing on the SVC. It will also show ______distention around the neck and chest

A

dry cough

facial

128
Q

The most common asbestos related cancer is _______, not malignant mesothelioma

A

bronchogenic carcinoma

129
Q

all Mycoplasma, including ureaplasma, lack ___________ and are resistant to agents that attack it such as penicillins, cephalosporins, carbapenems, and vancomycin. They can be treated with anti ribosomal agents like ________ and ________

A

peptidoglycan cell wall

tetracycline, macrolides

130
Q

Chronic granulomatous disease: neutrophils unable to kill _______ + organisms

A

catalase

131
Q

alpha 1 antitrypsin deficient leads to young onset

A

panacinar emphysema in lower lobes

132
Q

acutely after MI, ______ accumulates in the ______ lumen

A

transudate

alveolar

133
Q

_____________ presents with nagging cough and cold agglutinins that coagulate blood in cold temperatures

A

Mycoplasma pneumoniae

134
Q

_______ are the most common benign lung tumors, present with a _____ lesion and are composed of ________

A

hamartomas

coin

cartilage, fat, fibrous tissue

135
Q

high chloride content in venous blood compared to arterial blood due _______ and is driven by _______

A

chloride shift

carbonic anhydrase

136
Q

supine vomiting, most likely lung lobe affected

A

posterior segment up right upper lobe

137
Q

heavy smoking history and CT indicative of centriacinar emphysema due to activated

A

macrophages and neutropohils

138
Q

____________ due to aspergillus fumigatus may complicate asthma and can result in recurrent pulmonary infiltrates and eventual proximal _________

A

allergic bronchopulmonary aspergillosis

bronchiectasis

139
Q

decreased breath sounds, hemithorax opacification, deviation of the trachea to the opacified side on CXR are suggestive of _______ due to _______

trachea deviated away from affected lung =

A

collapsed lung

bronchial obstruction

tension pneumothorax or large pleural effusion

140
Q

_____ stimulates neutrophil migration to sites of inflammation, along with 5 HETE, C5a, and IL8

A

LTB4

141
Q

during the first week of TB exposure in non exposed patient, ___________________ occurs in alveolar macrophages

A

intracellular bacterial proliferation

142
Q

infant, thymic aplasia, severe bacterial and viral infections, chronic diarrhea, mucocutaneous candidiasis =

presents with absent T cells and _____

A

SCID

hypogammaglobulinemia

143
Q

______ overdose can present with acute respiratory acidosis

A

Heroin

144
Q

encapsulated, lactose fermenting, gram negative bacillus appears mucoid in culutre, pink colonies on MacConkey agar with alcoholic history =

A

Klebsiella pneumoniae

145
Q

high altitude exposure results in _____ with respiratory ________. Over the course of a few days, chronic respiratory ________ sets in with a decrease in serum HCO3 as renal compensation

A

hypoxemia

alkalosis

alkalosis

146
Q

shoulder pain, long smoking history, numbness in fingers and hemoptysis =

arise in the =

A

Pancoast tumor at apex

superior sulcus

147
Q

administration of excessively high O2 concentrations to patients with COPD can lead to increased ______, resulting in confusion and lethargy. This is due to the increased _______________ as the poorly venitlated alveoli are perfused

A

CO2 retention

physiologic dead space

148
Q

pulmonary abscesses in unresolved pneumonia are primarily caused by __________ from neutrophils and ________

A

lysosomal enzyme release

Macrophages

149
Q

patient with intermittent SOB, unable to link it to _______, which is the most common cause of ______. The most useful excluding test would be a __________

A

allergies

asthma

negative methacholine challenge

150
Q

finding of squamous metaplasia in the pancreatic ducts in a patient with CF due to deficiency of ______

A

Vitamin A

151
Q

In patients with COPD, response to PaCO2 has been blunted, and ______ becomes the important contributor to respiratory drive, which is monitored at the ______ chemoreceptors. PaCO2 is monitored at the ______ chemoreceptors

example of a peripheral chemo receptor

A

PaO2

peripheral

central

carotid or aortic body

152
Q

CFTR reduces luminal chloride secretion, which increases _______ and ______ absorption and results in _______ and a more negative __________.

A

sodium and water

dehydrated mucus

transepithelial potential difference

153
Q

hemorrhagic pleural effusions, pleural thickening, tumor cells with long slender microvilli and abundant tonofilaments =

A

mesothelioma

154
Q

pathogenicity of H influenza depends on the presence of an antiphagocytic _________

A

polysaccharide capsule

155
Q

budding yeast with thick halo capsules in HIV patient with pneumonia and Mucicarmine staining =

usually manifest as

A

cryptococcos neoformans

meningoencephalitis

156
Q

pulmonary embolism leads to an area of ______ defect without ______ defect

A

perfusion

ventilation

157
Q

peptostreptococcus, prevotella, bacteroides, ad fusobacterium grown on culture. These are _______ bacteria found in the _______ and the most frequent cause of lung abscess. Risk factors include aspiration risk due to ______, ______ , drug abuse, stroke, and dementia

A

anaerobic

oral cavity

alcoholism

seizure disorders

158
Q

carbolfuchsin is part of the _______ stain in order to ID _______ in Mycobacterium and some Nocardia species

A

acid fast

mycolic acid

159
Q

bowel obstruction, green insipissated mass in distal ileum of a newborn is indicative of _______ which is found in _______. These patients will ultimately succumb to ________

A

meconium ileus

CF

Pneumonia

160
Q

gradually progressive dyspnea and bilateral honeycomb reticulonodular opacities on CXR

A

pulmonary fibrosis

161
Q

CD4 count < 50, risk for? Prophylaxis

CD4< 100?

CD4< 150?

CD4<200

A

Mycobacterium avium complex: azithromycin

Toxoplasma gondi: TMP-SMX

Histoplasma capsulatum: Itraconazole

Pneumocystis jirovecii: TMP-SMX

162
Q

_______ is a slowly progressive disease caused by gram + anaerobic bacteria in people at risk for aspiration pneumonia (alcoholics). Bacteria have unique __________ and characteristic ______ granules. Treat with ______

A

Actinomycosis

filamentous branching patterns

sulfur

penicillin

163
Q

fibrous bronchiolitis obliterans in lung transplant patient due to

A

chronic rejection

164
Q

patients having panic attacks who _______ventilate will experience dizziness, weakness, and blurred vision due to _______ which causes cerebral ________

A

hyper

decreased pCO2

vasoconstriction

165
Q

strep pneumo vaccine that encompasses 23 serotypes contains _____

A

outer polysaccharide covering

166
Q

RBC fall rate is =

cytokines that inc this via stimulation of hepatic acute phase proteins

A

ESR

IL1, 6, TNFa

167
Q

progressive exertional dyspnea and fatigue, pain and bluish discoloration of fingers and toes when cold, tightening of skin over fingers =

can lead to intimal thickening of _____

A

systemic sclerosis

pulmonary arteries

168
Q

delayed hypersensitivity tests are due to the action of

A

T lymphocytes

169
Q

_______ of H influenza can still infect after vaccination because they do not form an ___________

A

nontypable forms

antiphagocytic capsule

170
Q

paroxysmal breathlessness and wheeing in a young patient without obvious trigger =

findings include eosinophils and ______ crystals

Eosinophils are recruited and activated by ____ secreted by Th2 cells

A

extrinsic allergic asthma

Charcot Leyden

IL5

171
Q

celiac disease, young, recurrent pulmonary infections, given blood transfuison and develops anaphylaxis due to ________

A

selective IgA deficiency

172
Q

young patient presenting with respiratory symptoms and central obesity without a history of pulmonary disease likely has ______

most common indicator is a ______ in ERV and functional residual capacity

A

obesity related restricted lung disease

reduction

173
Q

a virus that is naked, purified RNA infectious molecule that can induce protein synthesis and and viral genome replication must be

most likely virus in a young man with fever, cough, sore throat and runny nose

A

ssRNA positive sense

Rhinovirus

174
Q

interstitial lung disease leads to ____ elastic recoil that results in ____________ on the airways, leading to increased expiratory flow rates when corrected for low lung volume

A

increased

increased radial traction

175
Q

________ is the most common lung cancer in the general population and in nonsmoking women. tumor cells form papillary or glandular structures

A

Adenocarcinoma

176
Q

cough and fever, desert areas of US and mexico, thick walled spherules packed with many endospores =

A

coccidoides immitis

177
Q

strep pneumo infection, green mucous color caused by neutrophil ____

A

myeloperoxidase

178
Q

Reid index to measure severity of chronic bronchitis due to smoking is the ratio of the thickness of the _____ to the thickness of the _____ between the respiratory epithelium and the bronchial cartilage

A

mucous gland layer

bronchial wall

179
Q

chronic rejection of lung transplant affects the

A

small airways

180
Q

defense mechanism most directly responsible for clearing particles from the respiratory bronchioles and alveolar ducts -

A

phagocytosis

181
Q

animal dander, dust mites, cockroaches, pollen, smoke, aspirin or NSAIDs, exercise, cold dry air, all triggers for

A

asthma

182
Q

pulmonary infiltrate with columnar mucin secreting cells that line the alveolar spaces without invading stroma or vessels, copious amounts of pale/tan colored sputum =

benign or malignant

A

Adenocarcinoma in situ

malignant

183
Q

Risks of smoke in a newborn

A

sudden infant death syndrome

184
Q

beta hemolytic gram positive cocci in chains that are bacitracin resistant =

what would prevented a newborn infection

A

S. agalactiae

intrapartum ampicillin

185
Q

IV drug users are at risk for _______ and developing

A

tricuspid valve endocarditis

septic pulmonary emboli

186
Q

primary virulence factor of S pneumo is

A

polysaccharide capsule

(***) (U-World) All Subjects (20 decks)

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