Pulm MIM

Question 1

Q fever
domestic farm animals/dairy farmer/partruent animals
PNEUMONIA/hepatitis/fever
chronic: (-) culture endocarditis

Answer 1

Coxiella burnetti

Question 2

bird/bat dropping in MW (mississippi, ohio river valleys)
intracellular macs filled w/ fungus
inhaled from the environment
dimorphic fungi
T-cell mediated
PNEUMONIA, chest pain, pericarditis, systematic
Amphotericin B

Answer 2

Histoplasma capsulatum

Question 3

risk factors for drug-resistant STREP PNEUMO in adults

Answer 3

> 65yo
b-lactam/macrolide/fluoroquinolne tx in past 3-6mo
alcoholism/medical comorbidies/ICPs
exposure to children (day care center

Question 4

what prophylaxis drug for h. influenzae

Answer 4

rifampin

Question 5

people who have >5mm TB positive skin test

Answer 5

HIV
live w/ TB infected person
immunocompromised/transplant
CXR has fibrotic changes

Question 6

SHi Moraxella are causes of what (2)

Answer 6

1. otitis media (common infection)

2. acute exacerbation of chronic bronchitis (ACEB)

Question 7

90% viral
if bacterial: GAS, Staph aureus

GAS -> acute rheumatic fever, glomerulonephritis

Answer 7

tonsillitis, pharyngitis

Question 8

pseudomonas
ear -> CNS

purulent otorrhea -> osteomyelitis of mastoid bone, bell’s palsy, meningitis

Answer 8

necrotizing external otitis

Question 9

fungal
nose -> blood -> nasal
broad, nonseptate hyphae with right angle branching inside the vessel
esp in diabetes, ICPs

Answer 9

rhino-cerebral zygomycosis

Question 10

benign polypoid vascular proliferation

adults (trauma, pregnancy) anterior nasal septum

Answer 10

pyogenic granuloma

lobular capillary hemangioma

Question 11

benign vascular/fibrous neoplasm w/ locally destructive tissue
adolescent MALES
lateral/upper posterior nasopharynx
ANTLER-LIKE thin walled vessels w/ collagenous stroma
complete resection essential

Answer 11

Juvenile nasophrayngeal angiofibroma

Question 12

nasal obstruction

Answer 12

Nasopharyngeal carcinoma
olfactory neuroblastoma
rhabdomyosarcoma
sinonasal inflammatory polyps/papillomas/melanoma

Question 13

cystic fibrosis, aspirin intolerance
non-neoplasic inflammation of nasal mucosa
intact epithelium w/ stoma filled w/ eosinophils

Answer 13

sinonasal inflammatory polyps

Question 14

benign neoplasm of sinonasal mucosa (squamous/columnal)
HPV 6,11
inverted (endophytic) harder to resect - higher mortality

Answer 14

sinonasal papilloma

Question 15

malignant tumor of skeletal muscle
most common sarcoma in head/neck of kids 
sarcoma botryoides "grape-like mass" 
t (2;13), t(1;13) 
tadpole cell

Answer 15

rhabdomyosarcoma

Question 16

malignant small round blue cells (rosettes) tumor

unilateral usually in cribiform plate -> damage CN1 -> anosmia

Answer 16

olfactory neuroblastoma

Question 17

EBV (epstein barr virus)
kids in africa
adults in asia
keratinizing (Squamous cell), non-keratinizing, undifferentiated

cervical ALD

keratinizing: not sensitive to radiation, worst prognosis

Answer 17

nansophargyngeal carcinoma

Question 18

granulomatous diseases

Answer 18

Wegener’s: necrotizing
TB: caseating
Sarcoid: non-caseating

Question 19

non-infective vasculitis 
nose, lung, kidneys 
purulent rhinorrhea 
C-ANCA
necrotizing granuloma 
males 

exam Q: sinusitis + bloody urine

Answer 19

Wegener’s granulomatosis

Question 20

EBV associated
africa
highly destructive angiocentric T cell lymphoma

Answer 20

nasopharyngeal carcinoma

extranodal NK-Tcell lymphoma (midline destruction)

Question 21

squamous cell

Answer 21

nasophrayngeal carcinoma (malig)
laryngeal pailloma/papillomatosis (benign) 
laryngeal carcinoma (smoking)

Question 22

benign, exophytic neoplastic growth of squamous cells

adult: single lesion
kids: multiple lesion, high recurrence - HPV 6,11

Answer 22

laryngeal papilloma

Question 23

smoking, alcohol, asbestos
could’ve been progression from laryngeal papilloma
hoarseness
malignant

Answer 23

laryngeal carcinoma

Question 24

most common autoimmune disease in F >50 yo 
destruction of lacrimal/salivary glands 
DRY eye (blurred vision) mouth (dysphagia) 
Igs agains SS-A, SS-B

Answer 24

Sjogren syndrome

Question 25

salivary gland neoplasms

Answer 25

pleomorphic adenoma (benign mixed tumor): most common, benign, epithelial + stomal tissue (myoepithelial) Warthin Tumor: BILATERAL, LYMPHOCYTIC infilatrate, smoking Mucoepidermoid carcinoma: most malignant, t(11;19), fusion gene MECT1-MAML2 mucocytes and epidermoid cells

Question 26

dev lesion of neck

Answer 26

branchial cleft: lateral thyroglossal duct cyst: midline para-ganglioma (carotid body tumor): like pheochromocytoma (perfuse sweating, etc.)

Question 27

smokers, very aggressive centrally located paraneopalstic syndromes (SIADH, Cushing's, Eaton-Lambert syndrome) poorly differentiated small blue cells that are smudged synaptophysin/chromogranin stain positive metastasize to liver/kidneys/adrenal glands

Answer 27

small cell lung cancer

Question 28

central/peripheral/ENDOBRONCHIAL young person w/ recurrent R sided pneumonia not related to smoking surgery is curative well differentiated neuroendocrine cells typical/atypical/malignant

Answer 28

Carcinoid tumors

Question 29

``` most common type of lung cancer in non-smokers "coin" lesions periphrally located F smokers glands/mucin/GLOBET CELLS Erlotininb (Tarceva) EGFR inhibitor lobectomy + chemo (no radiation) ```

Answer 29

adenocarcinoma

Question 30

adenocarcinoma in situa clara cells looks like unresolving pneumonia b/c diffuse (no solid tumor) - ground glass opacity spreads through the airway (not blood stream) not related to smoking

Answer 30

bronchio-alveolar cell carcinoma | the least severe of adenocarcinoma

Question 31

poorly differentiated, prominent nucleoli smoking poor prognosis

Answer 31

large cell carcinoma

Question 32

``` keratin pearls intercellular bridges cavitation intravascular invasion most common in male smokers central/hilar parathyorid hormone-related protein (hyperCa2+) no Avastin ```

Answer 32

squamous cell carcinoma

Question 33

***Chronic bronchitis pathology (4)

Answer 33

mucous gland enlargement (goblet cells, Reid index) chronic inflammation of the airway wall (eosinophils) thick bronchial basement membrane squamous metaplasia, goblet cell hyperplasia

Question 34

emphysema is central bullae | spontaneous pneumothorax: peripheral bullae

Answer 34

.

Question 35

pneumonia/erythemia multiform/bullous myringitis (fluid behind ear drum) no cell wall (sterol in cell membrane) cold agluttinin IgM serology

Answer 35

mycoplasma pneumoniae

Question 36

pneumonia, hoarse voice, pharyngitis, atherosclerosis gm (-) pleomorphic obligate intracellular asymptomatic infection Giemsa stain

Answer 36

chlamydia pneumonia

Question 37

young

Answer 37

sarcoidosis

Question 38

polyarthritis erythema nodosum hilar adenopathy fever acute

Answer 38

Lofgren syndrome sarcoidosis

Question 39

insidious onset, progress relentelssely velcro-like (coarse) crackles PATCHY

Answer 39

.

Question 40

pulmonary embolism from DVT

Answer 40

``` cancer: hypercoag state one leg is swollen sob CT scan should be done lweor lobes 'wedge-shaped' hemorrahgic lesion cause dual blood supply ```