pulm

Question 1

lecthin:sphingomyelin ratio (what is considered normal (or less risk))

Answer 1

• indicator of lung development and surfactant production

- >2

Question 2

surgery? non-small cell vs small cell cancer

Answer 2

surgery in NSCC, chemo in SCC

Question 3

mesothelioma high risk in what population (also, what stain)

Answer 3

• people exposed to asbestos
• shipbuilders and plumbers
• prussian blue, hemosiderin surrounding fibers

Question 4

keratin pearls and intercellular bridging

Answer 4

-squamous cell lung cancer

Question 5

emphysema (MOA of reduced oxygenation)

Answer 5

• neutrophil elastase activity increased by smoking
• destruction of alveoli
• decreased ability of oxygen to diffuse across damaged walls
• obstructive lung disease

Question 6

situs inversus (associated with…) (kartagener’s syndrome)

Answer 6

• complete reversal of organs, due to ciliary dyskinesia
• assoc with: bronchiectasis and chronic sinusitis
• sperm can’t swim!

Question 7

basilar hyperlucency (associated with)

Answer 7

-emphysema

Question 8

alpha 1 anti-trypsin (pathophys, and associated disease)

Answer 8

• defective protein misfolded, decreased activity leads to increase elastase activity –> destruction of alveoli
• panacinar emphysema
• hepatic cirrhosis

Question 9

legionella (what does it cause, how is it transmitted, what are the symptoms, what does the gram stain look like?)

Answer 9

• common cause of community acquired pneumonia
• not transmitted person to person, but through water sources
• acute onset high fever and pneumonia
• neutrophils and no organisms on stain

Question 10

common cold caused by what… (name 3 most common and structure (RNA, DNA, dsDNA etc)

Answer 10

• rhinovirus (50%), corona virus (10%), RSV (10%)

- single stranded RNA (rhino naked, corona enveloped)

Question 11

drug that can induce asthma (and associated weird symptom)

Answer 11

• aspirin

- nasal polyp

Question 12

most common cause of pink eye

Answer 12

• adenovirus (naked icosahedral dsDNA)

- self-limited

Question 13

bordella purtussis grows on…

Answer 13

bordet-gengou agar

Question 14

tennis racquet cells are pathognomonic for…. (and cell markers)

Answer 14

• langerhans cell histiocytosis

- S-100 and CD1a

Question 15

name of drug given to premature babies with insufficient surfactant

Answer 15

-phosphatidylcholine

Question 16

nuerotoxic SE of INH…

Answer 16

• burning/tingling in fingers, due to decreased B6

- supplemental B6 can improve symptoms

Question 17

erythema nudism is an extra pulmonary manifestation of… (also in a GI condition…)

Answer 17

• sarcoid

- crohns

Question 18

oral candidiasis in asthma due to… (fix it by…)

Answer 18

• inhaled corticosteroids

- rinsing mouth

Question 19

pancoasts tumor

Answer 19

• tumor of the apex of the lung, compressing superior cervical sympathetic ganglion
• results in horner’s syndrome
• smoking is risk factor

Question 20

air crescent sign (name pathogen, and physical form)

Answer 20

• pulmonary aspergillosis

- 45 degree branching septate hyphae, rare fruiting bodies

Question 21

most common malignancy associated with exposure to asbestos? second?

Answer 21

• brochogenic carcinoma

- mesothelioma

Question 22

what are club cells? what do they do (2 things)

Answer 22

• cells responsible for producing protein component of surfactant
• responsible for CYP450 dependent oxidase activity which detoxifies inhaled materials

Question 23

most common cause of atypical pneumonia? what is the difficulty in identifying this organism

Answer 23

• mycoplasma pnuemonia

- takes weeks to culture, use cold agglutinin test

Question 24

eosinophilia in sputum sample… (NAACP)

Answer 24

-neoplasm, allergic, asthma, collagen vascular diseases, parasites

Question 25

sputum of asthma patients contains... (3 things)

Answer 25

- eos - curshmanns spirals - charcot-leyden crystals

Question 26

thumbprint sign... (indicative of what condition... causative organism?)

Answer 26

- epiglottitis | - h.flu

Question 27

hypercalcemia of malignancy is most often due to...

Answer 27

-squamous cell lung cancer

Question 28

what is dipalmitoyl phophatidylcholine and what cell makes it?

Answer 28

-surfactant, type II pneumocytes

Question 29

type II pneumocytes have two main jobs, name them.

Answer 29

- produce surfactant | - proliferation after lung damage

Question 30

what cells make ADH, serotonin, calcitonin etc in the lungs?

Answer 30

-bronchial cells of kulchitsky

Question 31

what viral illness precedes lobar pneumonia in an otherwise healthy individual? (and structure of virus)

Answer 31

-influenza... enveloped, segmented, single-stranded RNA

Question 32

leading cause of death for CF pts

Answer 32

-pseudomonas

Question 33

panacinar vs centriacinar emphysema

Answer 33

- pan: alpha-1-antitrypsin | - centri: smoking

Question 34

wheezing localizing respiratory problems to....

Answer 34

-bronchioles

Question 35

OSA causes... that leads to compensatory....

Answer 35

- respiratory acidosis | - increased HCO3 absorption by kidney

Question 36

things are most likely to lodge in the...

Answer 36

right main bronchus

Question 37

zeill-nielson stain

Answer 37

TB (and other mycobacterium)

Question 38

nocardia asteroides (presents like... but can be differentiated by... tx with...)

Answer 38

- TB, but with more brain abscesses, typically in immunocompromised pts. - also acid fast (but weakly), however, gram positive filaments - tx with sulfas

Question 39

which bug belongs to which medium: - bordet-gengou - chocolate agar with factors V and X - tellurite - theyer-martin

Answer 39

- bordet-gengou.... purtussis - chocolate agar with factors V and X... H. influenza - tellurite.... diphtheria - theyer-martin.... gonorrhea

Question 40

anatomy of lung... where is the horizontal fissure located

Answer 40

-just behind the 4th rib

Question 41

lung exam: if you have decreased breath sounds, you think it could be one of two things... to distinguish those you do a tactile fremitus/egophony– what are the two main things you're distinguishing between

Answer 41

- decreased breath sounds = less air... consolidation or effusion - increased fremitus/egophony, consolidation - no increased fremitus/egophony, effusion

Question 42

genetics of CFTR (chromosome number and specific mutation), and end result

Answer 42

- deletion at F508 on chromosome 7 - misfolded CFTR protein, channel which is important for secreting Cl- in GI and respiratory tracts as well as reabsorbing Cl- from sweat is not transported to membrane - thick mucous in GI and respiratory, and elevated Cl- in sweat

Question 43

disease that comes in two phases, first somewhat nonspecific symptoms, second with hemorrhagic mediastinitis, bloody pleural effusions and mediastinal widening on CXR (probably a stem with a farm and sheep)

Answer 43

-bacillus anthracis, or 'wool sorters disease'

Question 44

smoker with large hilar mass with cavitation makes you think... which is associated with...

Answer 44

- squamous cell carcinoma | - PTHrP, elevated calcium in the blood

Question 45

allergic rhinitis is an example of which type of immune reaction... it causes...

Answer 45

- type I | - angioedema due to IgE mediated release of histamine from mast cells and basophils

Question 46

honeycomb pattern? name disease and common phenotype.

Answer 46

- desquamative interstitial pnemonia | - middle aged, smoker, gradual onset, restrictive pattern

Question 47

what is a syncytium?

Answer 47

-a multinucleated cell formed by fusion of nearby cells, ala RSV

Question 48

what is the chloride shift?

Answer 48

when the body gets hypercapnic, increased CO2 gets picked up by RBC's, carbonic anhydrase converts it to bicarb which is extruded into blood for Cl-

Question 49

histamine 1 vs histamine 2 receptors

Answer 49

- histamine 1 receptors are located in nasal and bronchial mucosa, implicated in seasonal allergies - histamine 2 receptors are located in stomach and affect GI acid secretion