Muthiah's questions

Question 1

Most common cause of hypoxemia

Answer 1

V/Q mismatch

Question 2

As ventillation increases CO2…..

Answer 2

Decreases

Question 3

As ventillation decreases CO2

Answer 3

Increases

Question 4

Anything that causes a decrease in ventillation area would cause what?

Answer 4

A shunt

Question 5

Know the hemeglobin oxygen dissociation curve

Answer 5

ok

Question 6

Nocturnal asthma is due to

Answer 6

decrease of catecholamines/cortisol at night, thus decreased beta 2 activity leads to nocturnal bronchiol constriction

Question 7

The Haldane effect

Answer 7

CO2 increases upon giving supplemental oxygen because if you are hypoxemic, hemoglobin binds CO2 with increased affinity and as O2 is restored, the CO2 is displaced and appears in the blood

Question 8

Hypoxemia of interstitial lung disease is due to what?

Answer 8

V/Q mismatch

Question 9

What happens to Type II pneumocytes in interstitial lung disease

Answer 9

They increase

Question 10

What does ILD look like of cxr

Answer 10

ground glass

Question 11

Asthma due to aspergillus exposure is what type of immune respone

Answer 11

IgE mediated reaction and TYPE 3 IgE mediated response

Question 12

What are the criteria needed to diagnose ABPA

Answer 12

• poorly controlled
• Eosinophilia (Positive skin antigen test for A fumigatus, IgG antibody
• IgE over 1,000ng/ml

-proximal bronchiectasis, fleeting chest infiltrates, peripheral eosinophilia with chest infiltrates

Question 13

Major cytokines and antibodies in asthma

Answer 13

IgE, IL-5, PAF, Histamine, Eosinophils

Question 14

What does Westermark’s sign show

Answer 14

A complete lack of vasculature in one of the lungs. It means that there is a pulmonary embolism and the vessel has collapsed down stream. Only seen in 2% of pts though. Most ppl with a PE have a normal chest x-ray

Question 15

What are the features of malignancy on a chest x-ray

Answer 15

• spiculated nodules
• non-calcified nodules
• associated mediastinal or lymph node masses
• Cavitation
• Large nodules

Question 16

Types of benign calcification

Answer 16

Popcorn, Lamellar, Dense

Question 17

What are the features of benignity

Answer 17

well defined nodules, calcified, no associated lymph or mediastinal mass, no satellite lesions

Question 18

What are the features of benignity

Answer 18

well defined nodules, calcified, no associated lymph or mediastinal mass, no satellite lesions

Question 19

Management of stable COPD includes all of the following except?

Answer 19

Oral gluccocorticoids for mil COPD

Question 20

Long term management with oxygen therapy is most helpful for COPD

Answer 20

24 hrs is better than 16.

Question 21

Centrilobular emphysema

Answer 21

smoking. MOST COMMON

Question 22

panlubular

Answer 22

Alpha 1 AT

Question 23

Major site of airflow limitation in COPD

Answer 23

Small conducting airways

Question 24

CD4 lymphocytes predominate in ?

Answer 24

ASTHMA

Question 25

CD8 lymphocytes predominate in?

Answer 25

COPD

Question 26

Definition of clinical bronchitis

Answer 26

Productive sputum for 3 months in 2 consecutive years. THE OPPOSITE OF MJs number

Question 27

DLCO (diffusion capacity) is limited in EMphysema but is normal in….

Answer 27

Chronic Bronchitis and Asthma,,,,the other two obstructive diseases.

Question 28

Increases in cardiac output increase DO2 linerally

Answer 28

true

Question 29

Restrictive lung diseases involving the parenchyma of the lung

Answer 29

Interstitial lung disease

Resection of the lung

Question 30

Hallmarks of ILD

Answer 30

Reduced total lung capacity, reducd vital capacity, reduced diffusion capacity

Question 31

Normal bronchioalveolar lavage

Answer 31

90% macrophages, 10% lymphocytes, 1% PMNs

Question 32

Clubbing is a sign of lung fibrosis

Answer 32

truw

Question 33

ARDS is characterized by

Answer 33

Acute decrease in lung compliance

Question 34

Decreasing tidal volume is significant in ARDS because it prevents the lungs from expanding so much which reduces injury

Answer 34

true…decreases mortality

Question 35

How do you improve oxygenation in ARDS

Answer 35

increase the PEEP…PEEP allows you to break the shunt

Question 36

SIRS criteria

Answer 36

temp over 38 or under 36, HR over 90, RR over 20, WBC above 12,000 or under 4,000 or more than 10% bands

Question 37

Afebrile sepsis can be related to

Answer 37

Extremem age, kidney disease, steroid use, Tylenol Use, Diabetes, etc…

Question 38

each hour delay in antibiotics increases mortality by

Answer 38

6-7%

Question 39

Goals of sepsis treatment

Answer 39

central venous pressure 8-12
mean arterial pressure over 65
urine output over .5 ml/kg/ hr

Question 40

Aspiration pneumonia

Answer 40

Generally bacteria

Question 41

Inhalation pneumonia

Answer 41

generally viral

Question 42

Bronchial breath sounds are a sign of

Answer 42

consolidation

Question 43

What determines outcome in pts with pneumonia

Answer 43

host response

Question 44

Resolution of pneumonia is usually clinical before its radiologic.

Answer 44

You will see a decrease in respiration rate before you see resolution on cxr

Question 45

If pt deteriorates quickly, its probably MRSA

Answer 45

treatment for MRSA is streptomycin

Question 46

What pathognomonic EKG is pressent in a minority of DVT patients

Answer 46

S1Q3T3

Question 47

What is the significance of a factor V Leiden Mutation

Answer 47

Factor V Leiden activates protein C, which is a natural anticoagulant. Withough factor V, protein C cannot be activated and coagulation occurs