Pathology

Question 1

Most common site of nasal polyp

Answer 1

middle meatus

Question 2

Most common nose bleed

Answer 2

anteroinferior nasal septum

Question 3

Life threatening hemorrhage in nose

Artery involved?

Answer 3

posterior segment

sphenopalatine artery a branch of maxillary artery

Question 4

Kiesselbach plexus formed by

Answer 4

LEGS: superior Labial artery, anterior and posterior Ethmoidal arteries, Greater palatine artery, Sphenopalatine artery.

Question 5

Rapidly declining effect of topical nasal decongestant is due to

Answer 5

Tachyphylaxis

↓production of endogenous norepinephrine

Question 6

lab test used clinically to rule out DVT:

Imaging test of choice is :

Answer 6

►D-dimer

►compression ultrasound with Doppler.

Question 7

Most pulmonary emboli arise from

Answer 7

proximal deep veins of lower extremity.

Question 8

______ is imaging test of choice for PE

Answer 8

CT pulmonary angiography

Question 9

______ is imaging test of choice for PE in CKD

Answer 9

ventilation/perfusion scan

Question 10

Changes in flow-volume curve in PE

Answer 10

normal, as there is no effect on ventilation. only effect on perfusion

Question 11

_____ doesnot remain constant after 30 years even in non-smokers

Answer 11

FEV1

Question 12

Hypercoagulable state: Pregnancy changes

Answer 12

Compression of IVC and iliac vein
↑ production of coagulation factors
↓ Protein S
Protein C resistance

Question 13

Ruptured alveoli allow tracking of air into the mediastinum via

Answer 13

peribronchial and perivascular sheaths

Question 14

Pneumomediastinum Clinical features:

Answer 14

Clinical features: chest pain, dyspnea, voice change, subcutaneous emphysema, ⊕ Hamman sign (crepitus on cardiac auscultation).

Question 15

Chronic mediastinitis—also known as ____

Common cause

Answer 15

fibrosing mediastinitis; due to proliferation of connective tissue in mediastinum.

Histoplasma capsulatum is common cause

Question 16

Posterior mediastinal masses—

Answer 16

►neurogenic tumor (eg, neurofibroma),

►multiple myeloma.

Question 17

______ increase respiratory rate in response to pathologic alveolar process (eg. pulmonary edema, pneumonia)

Answer 17

Alveolar juxtacapillary receptors

Question 18

_______ is the major cause of dyspnea and exercise limitation in COPD

Answer 18

Dynamic hyperinflation

Question 19

Dynamic hyperinflation

Answer 19

Hyperinflation in COPD during exercise. patient requires extra time for exhalation → increasing trapped air during rapid breathing → ↓tidal volume

Question 20

Depth and rate of respiration are controlled by _____ based on _______

Answer 20

medullary respiratory center

based on inputs from central and peripheral chemoreceptors

Question 21

Damage in late phase of asthma is due to

Answer 21

Major basic protein released by eosinophils

Question 22

Damage in early phase of asthma due to

Answer 22

PREFORMED Histamine

GENERATION of LT C4,D4,E4

Question 23

Most common cause of COPD exacerbation is

Answer 23

1. Viral (rhino, influenza, parainfluenza)

2. Bacterial

Question 24

Current Jelly & Rusty coloured sputum is due to

Answer 24

Extravasation of RBCs and Hb in sputum

Question 25

ABPA microscopy

Answer 25

Fungi donot invade mucosa and non-caseating granulomas would not be seen

Question 26

Air enters pleural space but cannot exit.

Answer 26

tension pneumothorax

Question 27

tension pneumothorax complication

Answer 27

May lead to increased intrathoracic pressure → mediastinal displacement → kinking of IVC  → ↓venous return  → →cardiac output.

Question 28

Obstructive hyperinflation occurs in

Answer 28

partial airway obstruction (dilated during inspiration but closed during expiration)

Question 29

Atelectasis X-ray finding

Answer 29

Opacification

Question 30

Partial obstruction of large airway physical finding

Answer 30

A focal, monophasic wheeze

Question 31

Diffuse alveolar hemorrhage: Restrictive or Obstructive pattern?

Answer 31

dilutes surfactant → alveolar atelectasis → Restrictive flow-volume pattern

Question 32

Atelectasis: Restrictive or Obstructive pattern?

Answer 32

Restrictive flow-volume pattern

Question 33

Atelectasis etiologies:

Answer 33

Obstructive Compressive Contraction Adhesive: due to lack of surfactant

Question 34

Hepatic hydrothorax

Answer 34

ascites forced into right sided pleural cavity through fenestrations in diaphragm (transudative)

Question 35

Mesothelioma Histology

Answer 35

Psammoma bodies seen on histology. Calretinin and cytokeratin 5/6 ⊕, pancytokeratin cuboidal/spindle shaped cells

Question 36

BOOP 4 features

Answer 36

Foamy macrophages Masson bodies Interstitial collagen deposition Uniform fibroblastic proliferation

Question 37

PE physical exam

Answer 37

Diffuse crackles, ronchi, scattered wheeze

Question 38

Progressive hypoxemia refractory to oxygen therapy

Answer 38

ARDS

Question 39

ARDS symptoms

Answer 39

►Abnormal chest X-ray (bilateral lung opacities) ►Respiratory failure within 1 week of alveolar insult ►Decreased Pao2/Fio2 (ratio < 300, hypoxemia due to  intrapulmonary shunting and diffusion abnormalities) ►Symptoms of respiratory failure are not due to HF/fluid overload

Question 40

Non cardiogenic pulmonary edema seen in

Answer 40

ARDS | High altitude

Question 41

OSA is primarily a problem of _____ not _____

Answer 41

pharynx, not larynx

Question 42

Most common indicator of obesity hypoventilation syndrome is

Answer 42

↓ Expiratory reserve volume ↓ Functional residual capacity Normal RV

Question 43

Obesity hypoventilation syndrome is also known as During waking hours During sleep

Answer 43

►Also known as Pickwickian syndrome. | ► ↑Paco2 during waking hours (retention); ↓ Pao2 and ↑ Paco2 during sleep.

Question 44

Pulmonary hypertension: death from

Answer 44

decompensated cor pulmonale.

Question 45

Pulmonary arterial hypertension: Heritable PAH can be due to

Answer 45

an inactivating mutation in BMPR2 gene (normally inhibits vascular smooth muscle proliferation)

Question 46

Portal HTN causes pulmonary HTN, how?

Answer 46

Portopulmonary HTN ►Portal HTN → portosystemic shunt → unmetabolized substances into pulmonary circulation (serotonin) → smooth muscle hyperplasia of pulmonary capillaries → pulmonary HTN ► ↑hydrostatic pressure on portal vein releases endothelin →portosytemic shunt → pulmonary HTN

Question 47

Silicosis histology:

Answer 47

Nodules composed of whorled collagen fibers and dust laden macrophages