Pulmonary

Question 1

In the respiratory tree, cartilage and goblet cells extend until where?

Answer 1

Until the end of the bronchi

Question 2

In the respiratory tree, pseudostratified ciliated columnar cells extend until where then become what?

Answer 2

Extend to beginning of terminal bronchioles then transition to cuboidal cells

Question 3

The alveoli consist of what kind of cells?

Answer 3

Simple squamous

Question 4

Elastase is secreted by which pulmonary cells?

Answer 4

Alveolar macrophages

Question 5

What do Type II pneumocytes do?

Answer 5

Secrete surfactant, cuboidal and clustered, precursors to Type I pneumocytes and other Type II cells. Proliferate during lung damage.

Question 6

What do Type I pneumocytes do?

Answer 6

97% of alveolar surfaces, line alveoli, squamous, thin for optimal gas exchange

Question 7

What do Club (Clara) cells do?

Answer 7

Nonciliated low-columnar/cuboidal cells with secretory granules. Secrete a component of surfactant, degrade toxins, and act as reserve cells.

Question 8

What indicates fetal lung maturity?

Answer 8

Lecithin-to-sphingomyelin ration > 2 in amniotic fluid

Question 9

What penetrates the diaphragm at level T8?

Answer 9

Vena cava (8 letters)

Question 10

What penetrates the diaphragm at level T10?

Answer 10

“oesophagus” (10 letters), CN X,

Question 11

What penetrates the diaphragm at level T12?

Answer 11

Aortic hiatus (12 letters), thoracic duct, azygos vein

Question 12

What structures is the diaphragm derived from? (lots of things)

Answer 12

Septum transversum, pleuroperitoneal folds (large portion), dorsal mesentary of esophagus, and muscular outgrowth of lateral body wall

Question 13

What is a normal total lung capacity?

Answer 13

7 L

Question 14

What is a normal tidal volume?

Answer 14

500 mL

Question 15

How do you calculate physiologic dead space?

Answer 15

VD = VT x (PaCO2-PECO2)/PaCO2 “Taco Paco PEco Paco”

Question 16

How do you calculate minute ventilation? (VE)

Answer 16

VE = VT x RR

Question 17

How do you calculate alveolar ventilation? (VA)

Answer 17

VA = (VT-TD) x RR

Question 18

Does the T (taut) form of hemoglobin have low or high affinity for O2?

Answer 18

Low - Taut in Tissues

Question 19

Does the R (relaxed) form of hemoglobin have low or high affinity for O2?

Answer 19

High - Relaxed in Respiratory tract

Question 20

Describe methemoglobin, how does it present?

Answer 20

Oxidized form of Hb (ferric, Fe3+) that does not bind O2 as readily, but has higher affinity for cyanide. May present as cyanosis and chocolate-colored blood.

Question 21

How do you treat methemoglobin?

Answer 21

Methylene blue

Question 22

What is the clinical presentation of cyanide poisoning?

Answer 22

Almond breath, confusion, headache; Cyanide poisons cytochrome C

Question 23

How do you treat cyanide poisoning?

Answer 23

Use nitrites to oxidize Hb to methemoglobin, which binds cyanide, forming thiocyanate which is renally excreted.

Question 24

Describe carboxyhemoglobin

Answer 24

Form of Hb bound to CO instead of O2. Causes less O2 binding capacity with a left shift in dissociation curve. Less O2 unloading in tissues. CO poisoning.

Question 25

Does a curve shift to the right in the oxygen-Hb dissociation curve indicate higher or lower O2 affinity?

Answer 25

Lower

Question 26

Does a curve shift to the left in the oxygen-Hb dissociation curve indicate higher or lower O2 affinity?

Answer 26

Higher

Question 27

What are the factors that affect Hb's affinity for O2?

Answer 27

H+, 2,3-BPG, altitude, temperature, CO2, and exercise

Question 28

Does an increase in all factors shift the curve right or left?

Answer 28

Right

Question 29

What are the consequences of a falling level of Hb?

Answer 29

A decrease of O2 content of arterial blood, but no decrease in O2 saturation or arterial PO2

Question 30

Describe cor pulmonale

Answer 30

Pulmonary HTN causing RV failure (jugular venous distention, edema, hepatomegaly)

Question 31

What is a normal A-a gradient?

Answer 31

10-15 mmHg

Question 32

What is the difference between hypoxemia and hypoxia?

Answer 32

Hypoxemia is low arterial O2, whereas hypoxia is low oxygen delivery to tissues

Question 33

What are the three forms in which CO2 is transported from tissues to the lungs?

Answer 33

HCO3- (90%), Carbaminohemoglobin/HbCO2 (5%), and Dissolved CO2 (5%)

Question 34

What is the purpose of carbonic anhydrase?

Answer 34

CO2 from tissues enters RBC and carbonic anhydrase catalyzes following reaction: CO2 + H2O --> H2CO3

Question 35

Where should thoracentesis be performed?

Answer 35

Between 6-8th ribs along midclavicular line, or between 8-10th ribs along midaxillary line, or between 10-12th ribs along paravertebral line

Question 36

Nasal polyps in children may indicate what disease?

Answer 36

CF

Question 37

Nasal polyps in asthmatic adults may indicate what?

Answer 37

ASA(Aspirin)-intolerant asthma - 10% of asthmatic adults

Question 38

Angiofibromas (benign tumors of nasal mucosa) occur in what patient population?

Answer 38

Adolescent males

Question 39

A PE, specifically fat embolus, presents how?

Answer 39

Hypoxemia, neuro abnormalities, and petechial rash

Question 40

Why can an amniotic fluid pulmonary embolus lead to DIC?

Answer 40

Amniotic fluid is loaded with tissue thromboplastin which activates the coagulation cascade

Question 41

What is the imaging test of choice for PEs?

Answer 41

Spiral CT (CT pulm angiography)

Question 42

Which type of PE usually leads to sudden death?

Answer 42

Saddle embolus

Question 43

What are lines of Zahn?

Answer 43

Interdigitating areas of pink (platelets, fibrin), and red (RBCs) found only in thrombi formed before death. Helps distinguish pre- and postmortem thrombi.

Question 44

What are the 2 most common causes of lobar pneumonia?

Answer 44

S pneumo (95%) and Klebsiella (5%)

Question 45

What is the most common cause of secondary pneumonia?

Answer 45

S aureus

Question 46

CF patients classically develop pneumonia due to which bug?

Answer 46

Pseudomonas

Question 47

What are the most common causes of atypical pneumonia?

Answer 47

Mycoplasma (#1), chlamydia, legionella, RSV (infants), CMV (post-transplant), influenza (elderly), coxiella (farmers and vets; Q fever)

Question 48

Aspiration pneumonia is typically caused by what?

Answer 48

Anaerobic bacteria

Question 49

On spirometry, what is the hallmark of obstructive lung disease?

Answer 49

Reduced FEV1/FVC ratio

Question 50

Which two organs does alpha-1 antitrypsin deficiency affect?

Answer 50

Lung- Emphysema Liver- Misfolded protein accumulates in liver leading to cirrhosis. PiM is normal allele, PiZ is most common mutation. Protein accumulates in ER of hepatocytes and stains PAS-positive.

Question 51

What is the pathogenesis of chronic bronchitis?

Answer 51

Hyperplasia of mucus-secreting glands in the bronchi --> Reid index (thickness of gland layer/total thickness of bronchial wall) > 50% (normal is

Question 52

Who gets centriacinar emphysema?

Answer 52

Smokers

Question 53

Who gets panacinar emphysema?

Answer 53

alpha-1 antitrypsin deficiency

Question 54

Describe the pathogenesis of asthma

Answer 54

A genetic predisposition plus an allergen induces Th2 phenotype of CD4 T cells. These Th2 cells secrete IL-4 (which converts IgG-->IgE), IL-5 (which attracts eosinophils), and IL-10 (which induces Th2 phenotype proliferation)

Question 55

Curschmann spirals and Charcot-Leyden crystals are seen in the sputum of which patients?

Answer 55

Asthmatic patients

Question 56

What are Curschmann spirals and Charcot-Leyden crystals?

Answer 56

Curschmann spirals - shed epithelium forms mucus plugs | Charcot-Leyden crystals - formed from breakdown of eosinophils in sputum

Question 57

The most severe form of an asthma exacerbation is called what?

Answer 57

Status asthmaticus

Question 58

What is bronchiectasis?

Answer 58

Chronic necrotizing infection of bronchi leading to permanently dilated airways

Question 59

Why do patients with sarcoidosis have hypercalcemia?

Answer 59

The non-caseating granulomas contain an enzyme which activates VitD (any disease with many many non-caseating granulomas will present with hypercalcemia)

Question 60

Familial forms of primary pulm hypertension are associated with inactivating mutations of what gene?

Answer 60

BMPR2

Question 61

What are plexiform lesions?

Answer 61

Characteristic vascular change of pulm arteries in pulm HTN

Question 62

In Acute Respiratory Distress Syndrome, what happens to the lung?

Answer 62

Damage to lung-capillary interface results in leakage of proteins into alveoli which reorganize to form hyaline membranes. Hypoxemia and cyanosis develop as a result of thickened membrane.

Question 63

Which lung cancer may produce PTHrP?

Answer 63

Squamous cell carcinoma

Question 64

What is the most common lung cancer in non-smokers?

Answer 64

Adenocarcinoma

Question 65

What is the most common lung cancer in female smokers?

Answer 65

Adenocarcinoma

Question 66

Bronchioloalveolar carcinoma arises from which cell type?

Answer 66

Clara cells

Question 67

Carcinoid tumor arises from which cell type?

Answer 67

Neuroendocrine cells

Question 68

Which lung cancer is chromogranin positive?

Answer 68

Carcinoid tumor (neuroendocrine cells)

Question 69

How does carcinoid tumor classically present?

Answer 69

Polyp-like mass in the bronchus

Question 70

What kind of staging is used for primary tumors of the lung?

Answer 70

TNM staging

Question 71

What is a unique site of metastasis of lung cancer?

Answer 71

Adrenal gland

Question 72

How does sarcoidosis usually present?

Answer 72

Bilateral hilar lymphadenopathy, noncaseating granulomas, and increased Ca and ACE

Question 73

Hypersensitivity pneumonitis is which type of hypersensitivity reaction?

Answer 73

Mixed III/IV reaction

Question 74

What is Caplan syndrome?

Answer 74

Rheumatoid arthritis and pneumoconionses with intrapulmonary nodules

Question 75

"Ivory white" calcified pleural plaques are indicative of what?

Answer 75

Asbestosis (these are not precancerous)

Question 76

Ferruginous bodies are associated with what?

Answer 76

Asbestosis

Question 77

What is anthracosis?

Answer 77

Asymptomatic condition where carbon is trapped in macrophages and hilar lymph nodes

Question 78

What is the pathogenesis of silicosis?

Answer 78

Macrophages respond to silica and release fibrogenic factors, leading to fibrosis. Silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB. Increased risk of bronchogenic carcinoma.

Question 79

What is vasomotor rhinitis?

Answer 79

Chronic nasal discharge that worsens with sudden changes in temperature, humidity, or with exposure to odors or alcohol. Headaches, anosmia, and sinusitis are often reported.

Question 80

What is nasal vestibulitis?

Answer 80

Staphy infection of the internal nares and associated hair follicles. Can cause mucosal edema and nasal congestion.

Question 81

Which drugs can classically cause interstitial lung disease?

Answer 81

Bleomycin, busulfan, amiodarone, methotrexate)