Misc lung diseases

Question 1

2 classification of hemodynamic causes of pulmonary edema

Answer 1

Increased hydrostatic pressure
Decreased oncotic pressure
Lymphatic obstruction

Question 2

Causes of increased hydrostatic pressure leading to pulmonary edema

Answer 2

LHF
Volume overload
Pulmonary vein obstruction

Question 3

Causes of decreased oncotic pressure leading to pulmonary edema

Answer 3

Hypoalbuminemia
Nephrotic syndrome
Liver disease
Protein-losing enteropathies

Question 4

Direct alveolar wall injury causes leading to pulmonary edema

Answer 4

Infections
Inhaled gasses
Liquid aspiration
Radiation
Lung trauma

Question 5

Indirect alveolar wall injury causes leading to pulmonary edema

Answer 5

Systemic inflammatory response
Blood transfusion related
Drugs and chemicals

Question 6

Abrupt onset of hypoxemia and bilateral pulmonary infiltrates in the absence of cardiac failure

Answer 6

Acute lung injury and ARDS

Question 7

Most important causes of ARDS

Answer 7

Sepsis
Diffuse pulmonary infections
Gastric aspiration
Mechanical trauma, including head injuries

Question 8

Diagnostic criteria for mild ARDS

Answer 8

PaO2/FIO2 between 200-300 mmHg

Question 9

Diagnostic criteria for moderate ARDS

Answer 9

PaO2/FIO2 between 100-200 mmHg

Question 10

Diagnostic criteria for severe ARDS

Answer 10

PaO2/FIO2 </= 100 mmHg

Question 11

Microscopy findings in proliferative phase of ARDS

Answer 11

Proliferation of type II pneumocytes and granulation tissue formation

Question 12

Microscopy shows alveolar wall lined by waxy hyaline membranes. There is fibrin rich edema fluid mixed with cytoplasmic and lipid remnants of necrotic epithelial cells.

Answer 12

ARDS - exudative phase

Question 13

Complications of ARDS

Answer 13

Sepsis, multiorgan failure, and death
Interstitial fibrosis and restrictive lung disease

Question 14

Disease characterized by a layer of hyaline proteinaceous material deposited in the peripheral airspaces of neonates

Answer 14

Neonatal respiratory distress syndrome (NRDS)

Question 15

Risk factors for NRDS

Answer 15

Preterm
Male
Maternal DM
C section

Question 16

Reason that maternal DM is a risk factor for NRDS

Answer 16

Treatment with insulin –> insulin inhibits surfactant synthesis

Question 17

These cells produce surfactant

Answer 17

Type II alveolar cells/pneumocytes

Question 18

When is production of surfactant accelerated during gestation?

Answer 18

After wk 35

Question 19

CXR findings in NRDS

Answer 19

Reticulogranular densities

Question 20

Medication given to mother to induce fetal lung maturation

Answer 20

Corticosteroid

Question 21

Useful marker of fetal lung maturity

Answer 21

Amniotic fluid phospholipid levels

Question 22

When is prophylactic administration of exogenous surfactant given at birth?

Answer 22

Neonate <28 wks

Question 23

Complications associated with high concentration of ventilatory administered oxygen in neonates

Answer 23

ROP
Bronchopulmonary dysplasia
Emphysema and pneumothorax

Question 24

Growth factor associated with ROP

Answer 24

VEGF

Question 25

Decrease in alveolar septation and a dysmorphic capillary configuration, a complication associated with NRDS

Answer 25

Bronchopulmonary dysplasia

Question 26

Infants who recover from NRDS are at an increased risk for what?

Answer 26

PDA Intraventricular hemorrhage Necrotizing enterocolitis

Question 27

Conditions predisposing to HAPE at altitudes below 2500 m

Answer 27

Increased pulmonary blood flow Pulmonary HTN Increased pulmonary vascular reactivity

Question 28

Causes of central sleep apnea

Answer 28

Stroke Neuromuscular disease Narcotics

Question 29

ABG findings in sleep apnea

Answer 29

Increased bicarbonate

Question 30

Complications associated with sleep apnea

Answer 30

Systemic and/or pulmonary HTN Arrhythmias Increased risk of cardiovascular disease Mild polycythemia Sudden death

Question 31

Characteristic of Pickwickian syndrome that separates it from OSA

Answer 31

Diurnal hypercapnia

Question 32

Atelectasis that occurs due to airway obstruction

Answer 32

Resorption/obstructive

Question 33

Causes of obstructive atelectasis

Answer 33

Mucus plugs Aspiration of foreign bodies Tumor fragments Mediastinum shifts toward affected lung

Question 34

Atelectasis that occurs from fluid, tumor, or air accumulation within the pleural cavity

Answer 34

Compression

Question 35

Which way will the mediastinum shift in compression atelectasis?

Answer 35

Away from affected lung

Question 36

Atelectasis type that occurs from focal or general pulmonary or pleural fibrosis prevents full lung expansion

Answer 36

Contraction

Question 37

Atelectasis type that occurs in neonates with respiratory distress syndrome

Answer 37

Patchy or micro

Question 38

Only non-reversible type of atelectasis

Answer 38

Contraction

Question 39

Common cause of pleural effusion caused by increased hydrostatic pressure

Answer 39

CHF

Question 40

Common cause of pleural effusion caused by increased vascular permeability

Answer 40

Pneumonia

Question 41

Common cause of pleural effusion caused by decreased osmotic pressure

Answer 41

Nephrotic syndrome

Question 42

Common cause of pleural effusion caused by increased intrapleural negative pressure

Answer 42

Atelectasis

Question 43

Causes of hemothorax

Answer 43

Chest injury Ruptured aortic aneurysm

Question 44

Causes of transudate hydrothorax

Answer 44

Liver failure Cardiac failure Renal failure

Question 45

Causes of exudate hydrothorax

Answer 45

Tumor Infection Inflammation

Question 46

Causes of chylothorax

Answer 46

Neoplastic obstruction of thoracic lymphatics

Question 47

Tracheal deviation in pleural effusion

Answer 47

Away from affected lung

Question 48

Physical exam findings in pleural effusion

Answer 48

Dullness to percussion Decreased breath sounds Decreased tactile fremitus

Question 49

Light's criteria

Answer 49

Pleural fluid protein/serum protein > 0.5 Pleural LDH/serum LDH >0.6 Pleural fluid LDH greater than 2/3 the upper limit of serum LDH

Question 50

Elevated RBC count in pleural effusion exudate is indicative of what origin?

Answer 50

Traumatic or malignant

Question 51

Elevated WBC count in pleural effusion exudate is indicative of what origin?

Answer 51

Empyema

Question 52

Elevated eosinophil count in pleural effusion exudate is indicative of what origin?

Answer 52

Collagen vascular disease Pleural air Blood

Question 53

If pleural effusion exudate pH is <7.2 what is indicated about its origin?

Answer 53

Malignancy RA Infection

Question 54

If amylase is elevated in pleural effusion exudate what is indicated about its origin?

Answer 54

Esophageal rupture Acute pancreatitis

Question 55

In what type of pleural effusion is triglyceride levels elevated?

Answer 55

Chylothorax

Question 56

Treatment required for pneumothorax

Answer 56

Needle thoracostomy to relieve pressure

Question 57

Hyperresonance on percussion with decreased breath sounds and decreased tactile fremitus

Answer 57

Pneumothorax

Question 58

Focal protrusion of edematous, inflamed nasal mucosa

Answer 58

Nasal polyp

Question 59

Microscopy shows edematous finger-like masses lined by epithelium with fibrovascular core, and edema and eosinophil rich inflammatory infiltrate

Answer 59

Nasal polyp

Question 60

Benign, highly vascularized tumor of the posterolateral wall of the roof of the nasal cavity. Seen exclusively in fair, red-headed, adolescent males.

Answer 60

Nasopharyngeal angiofibroma

Question 61

Microscopy findings in nasopharyngeal angiofibroma

Answer 61

Slit-like vascular structures in collagenous stroma

Question 62

Malignant tumor of nasopharyngeal epithelium associated with EBV and diets rich in nitrosamines

Answer 62

Nasopharyngeal carcinoma

Question 63

Demographic associated with nasopharyngeal carcinoma

Answer 63

African children Chinese adults

Question 64

Standard treatment for nasopharyngeal carcinoma

Answer 64

Radiotherapy

Question 65

Occupational risk factor for nasopharyngeal carcinoma

Answer 65

Wood dust exposure

Question 66

3 microscopic patterns of nasopharyngeal caricnoma

Answer 66

Keratinizing SCC Non-keratinizing SCC Undifferentiated/basaloid carcinoma

Question 67

Microscopic features of reactive nodules of the larynx

Answer 67

Loose myxoid tissue covered by squamous epithelium

Question 68

Squamous benign neoplasms located on the true vocal cords associated with HPV 6 and HPV 11

Answer 68

Squamous papilloma and papillomatosis

Question 69

Microscopy of larynx lesion shows multiple finger-like projections supported by central fibrovascular cores and covered by stratified squamous epithlium

Answer 69

Squamous papilloma and papillomatosis

Question 70

Soft, raspberry-like proliferations on the true vocal cords

Answer 70

Squamous papilloma and papillomatosis

Question 71

Risk factors for carcinoma of the larynx

Answer 71

Smoking Alcohol Asbestos Irradiation HPV

Question 72

Large, ulcerated, fungating lesion involving the vocal cord and pyriform sinus, commonly in men in their 60s

Answer 72

Carcinoma of the larynx