ARDS, NRDS, Pneumonia, TB

Question 1

What can cause Acute Respiratory Distress Syndrome (ARDS)?

Answer 1

Infection, sepsis, shock, aspiration, near-drowning, opioid drug use

Question 2

What are the clinical features of a patient with ARDS?

Answer 2

Tachypnea and dyspnea
Hypoxemia
Hyaline membrane appearance on alveolar septa
Late cyanosis

Question 3

A “Hyaline membrane” appearance on alveolar septa is indicative of what pathology?

Answer 3

Acute Respiratory Distress Syndrome (ARDS)

Question 4

How will ARDS appear on a radiograph?

Answer 4

Bilateral alveolar infiltrates showing increased density

Question 5

Adult patient presents to your office in Hawaii after a near-drowning experience two weeks prior on a fishing trip. They are experiencing shortness of breath during their runs lately. Biopsy of lung tissue shows a “Hyaline membrane” appearance to the alveolar septa. What is a likely diagnosis?

Answer 5

Acute Respiratory Distress Syndrome (ARDS)

Question 6

What causes Neonatal Respiratory Distress Syndrome (NRDS)?

Answer 6

Immaturity of surfactant system at birth due to prematurity

Question 7

What cells secrete surfactant?

Answer 7

Type II alveolar cells

Question 8

A newborn baby presented with high APGAR scores at birth and the delivery went smoothly. It is noted after one hour that they are developing a heightened respiration rate and bellowing of their abdominal muscles. What is this baby likely suffering from?

Answer 8

Neonatal Respiratory Distress Syndrome (NRDS)

Question 9

What are the vast majority of upper respiratory tract infections caused by?

Answer 9

Virus

Question 10

What is the portal of entry for most pneumonias?

Answer 10

Respiratory tract

Question 11

What is the most common etiologic agent of bacterial pneumonia?

Answer 11

Streptococcus pneumoniae

Question 12

What are the two gross patterns of bacterial pneumonia?

Answer 12

Lobular bronchopneumonia and lobar pneumonia

Question 13

What is the dominant gross characteristic of bronchopneumonia?

Answer 13

Patchy consolidation of the lung

Question 14

What is lobar pneumonia?

Answer 14

Acute bacterial infection resulting in fibrinosuppurative consolidation of a large portion of the a lobe or of an entire lobe of lung

Question 15

Patient presents with a fever measuring 102.5 degrees, a mucous-laden green cough, and general fatigue. A CBC shows 85% neutrophils and leukocytosis. What is a likely diagnosis for this patient?

Answer 15

Bacterial pneumonia

Question 16

Red hepatization is indicative of (Early/Late) stage bacterial pneumonia?

Answer 16

Early

Question 17

Gray hepatizaton is indicative of (Early/Late) stage bacterial pneumonia?

Answer 17

Late

Question 18

Bronchopneumonia is also known as ____ pneumonia?

Answer 18

Lobular

Question 19

Lobar bacterial pneumonia involves patchy consolidation along the roots of the bronchi (TRUE/FALSE)?

Answer 19

FALSE

Question 20

What are etiologic agents of viral pneumoniae?

Answer 20

Cytomegalovirus, measles, influenza, adenovirus

Question 21

Patient presents with a low grade fever of 100 degrees and a nagging cough. WBC count is slightly elevated. An alveolar biopsy shows thickened alveolar septal walls with moderate space inside of the alveoli. Radiograph shows a “Bat wing” appearance of the thoracic cavity. What is the likely diagnosis?

Answer 21

Viral pneumonia

Question 22

What form of pneumonia has an “interstitial” pattern of inflammation?

Answer 22

Viral pneumonia

Question 23

What form of pneumonia will present with heightened levels of IgG and lymphocytes?

Answer 23

Viral pneumonia

Question 24

A lung abcess is a(n) (Acute/Chronic) issue?

Answer 24

Acute

Question 25

What is a lung abscess?

Answer 25

Local suppurative process within the lung characterized by liquefactive necrosis of lung tissue

Question 26

What is the main mechanism for abscess formation in the lungs?

Answer 26

Aspiration of infective materials as in choking on your own vomit

Question 27

Septic emboli on the right side of the heart can trap in the lung and cause a lung abcess (TRUE/FALSE)?

Answer 27

TRUE

Question 28

Patient presents with a high fever and cough. CBC shows leukocytosis. The patient reports a bad stomach bug that he is still getting over in which he was vomiting often and even vomited while laying down on his back for a moment when it came on at night. Upon speaking to the patient you note that he has severe halitosis and sputum. What is the likely diagnosis based on this history?

Answer 28

Lung abscess

Question 29

What is the etiologic agent of pulmonary tuberculosis?

Answer 29

Mycobacterium tuberculosis

Question 30

Granulomas, Ghon lesions, and Ghon complex's are indicative of what pathology?

Answer 30

Pulmonary tuberculosis

Question 31

A granuloma is a(n) (Acute/Chronic) issue?

Answer 31

Chronic

Question 32

What is the first lesion of primary tuberculosis?

Answer 32

Ghon lesion

Question 33

Where does a Ghon lesion often situate itself in the lungs?

Answer 33

Upper lobes

Question 34

What is a Ghon complex?

Answer 34

A Ghon lesion with associated mediastinal lymph node involvement

Question 35

What pattern of necrosis is present in a Ghon lesion of tuberculosis?

Answer 35

Caseous necrosis

Question 36

What can cause secondary tuberculosis?

Answer 36

Erosion of a bronchus by a necrotizing process

Question 37

A reactivated patient is visiting your office again for the first time in 6 months. His chief complain is a chronic nagging cough that has lasted for "At least a month". He presents with mild chest pain and reports occasionally coughing up blood. When you last saw this patient he weighed 230 pounds. Currently, he is 170 pounds and reports no changes in diet or exercise habits. He is running a low fever. What pathology is likely being described?

Answer 37

Pulmonary tuberculosis

Question 38

What is miliary tuberculosis?

Answer 38

A disseminated TB infection leading to millet-sized granulomas and is highly virulent and less treatable than normal TB

Question 39

What is the giant cell present in pulmonary tuberculosis?

Answer 39

Langhan giant cell

Question 40

What cells are present in a granuloma?

Answer 40

Epitheloid cells, fibroblasts, lymphocytes, and Langhan giant cells

Question 41

What are the clinical features of neonatal respiratory distress syndrome?

Answer 41

- high APGAR scores at birth - increased respiratory rate - forceful respirations using accessory mm - flaring of nostrils - cyanosis of lips