Resp III

Question 1

NRDS

Answer 1

low surfactant
-alveolar collapse - ground glass on CXR

L:S ratio less than 1.5

risk of PDA, retinopathy, IV hemorrhage, bronchopulmonary dysplasia

Question 2

risk fx NRDS

Answer 2

premature
maternal diabetes - fetal insulin increase
C-section - less release of glucocorticoids

Question 3

tx NRDS

Answer 3

maternal steroid before birth

Question 4

ARDS

Answer 4

acute onset resp failure
-B/L opacities

causes - shock, sepsis, gastric aspiration, acute pancreatitis

diffuse alveoli damage - protein rich - leak to alveoli

formation of intraalveolar hylaine membrane

tx - mechanical ventilation with low tidal volume
-tx underlying cause

Question 5

sleep apnea

Answer 5

repeated stop breathing more than 10 sec during sleep

daytime sleepiness

nocturnal hypoxia
-systemic/pulm HTN, arrhythmia, sudden death

see EPO release - erythropoiesis

Question 6

obstructive sleep apnea

Answer 6

res effort against obstructed airway

with obesity and loud snoring

excess pharyngeal tissue

tx - weight loss, CPAP, surgery

Question 7

central sleep apnea

Answer 7

no resp effort - CNS injury/toxicity

Question 8

pulmonary HTN

Answer 8

greater than 25mmHg at rest

get arteriolosclerosis, medial hypertrophy, intimal fibrosis

death - decompensated cor pulmonale

Question 9

pulmonary arterial HTN

Answer 9

idiopathic

• heritable - BMPR2 - inactivated
• normally inhibit vasc smooth m proliferation

bad prognosis

also with cocaine, amphetamine use, HIV, CT disease, portal HTN, cngenital heart disease

Question 10

pulmonary HTN with left heart disese

Answer 10

systolic/diastolic dysfxn - and valvular disease

Question 11

pulmonary HTN due to lung disease or hypoxia

Answer 11

destruction parenchyma - COPD

hypoxemia vasoconstriction
-sleep apnea/living at altitude

Question 12

chronic thromboembolic PH

Answer 12

recurrent microthrombi

Question 13

tension pneumo

Answer 13

trachea away from side of lesion

hyperresonant on percussion

Question 14

atelectasis

Answer 14

bronchial obstruction

tracheal deviation toward side of lesion

Question 15

transudate

Answer 15

low protein content

increased hydrostatic P and low oncotic P

Question 16

exudate

Answer 16

high protein content

malignancy, pneumona, collagen vasc disease, trauma

drained - risk infetion

Question 17

chylothorax

Answer 17

lymphatic pleural effusion

milky appearing - high triglycerides

thoracic duct injury

Question 18

primary spontaneous pneumothorax

Answer 18

rupture apical bleb or cyst

-tall thin young male

Question 19

secondary spontaneous pneumothorax

Answer 19

barotrauma

or diseased lung - bulla in emphysema/infection

Question 20

traumatic pneumothorax

Answer 20

rib fx or penetrating trauma

Question 21

tension pneumo

Answer 21

when air enter and cannot exit - trachea deviate away from affected side

Question 22

lobar pneumonia

Answer 22

strep pneumo

legionella
klebsiella

intraalveolar exudate - consolidation to lobe

Question 23

bronchopneumonia

Answer 23

strep pneumo
staph aureus
h. flu
klebsiella

acute inflammatory infiltrate

• bronchioles to adjacent alveoli
• patch often with more than 1 lobe

Question 24

interstitial pneumonia

Answer 24

atypical

virus - influenza, CMV, RSV, adenovirus

mycoplasma
legionella
chlamydia

diffuse patchy inflammation - interstitial areas at alveolar walls

diffuse more than 1 lobe

Question 25

lung abscess

Answer 25

aspiration - loss consciousness, alcoholic, epileptic air fluid level anaerobe infection - bacteriode, fusobacterium, peptostreptococcus or staph aureus

Question 26

mesothelioma

Answer 26

malignancy of pleura -asbestosis pleural thickening see psammoma bodies

Question 27

pancoast tumor

Answer 27

superiro sulcus tumor pancoast syndrome - horners, SVC syndrome, sensorimotor deficit, hoarseness

Question 28

SVC syndrome

Answer 28

facial plethora - JVD, edema upper extremities with malignancy - pancoast tumor or thrombosis from indwelling catheters HA, dizzy, risk of aneurysm and rupture cranial arteries

Question 29

lung cancer

Answer 29

leading cause of cancer death cough, hemoptysis, bronchial obstruction, wheezing, coin lesion, etc.

Question 30

lung cancer mets

Answer 30

adrenal brain bone liver

Question 31

lung mets

Answer 31

more common than primary neoplasm from breast, colon, prostate, baldder

Question 32

hoarseness

Answer 32

recurrent laryngeal n compression - with lung cancer

Question 33

oat cell carcinoma

Answer 33

small cell central location paraneoplastic - ACTH - cushing - SIADH - Abs - presynaptic Ca - lambert eaton - amplify myc tx - cannot operate - aggressive - mets before diagnosis - chemotherapy

Question 34

kulchitsky cell

Answer 34

neuroendocrine neoplasm cells of small cell carcinoma chromogranin positive

Question 35

non-small cell cancer of lung

Answer 35

- adenocarcinoma - peripheral - SCC - central - large cell - peripheral - bronchial carcinoid

Question 36

adenocarcinoma of lung

Answer 36

peripheral MC lung cancer nonsmokers - except mets activation KRAS, EGFR, LK hypertrophic osteoarthropathy - clubbing CXR - hazy infiltrate good prognosis glandular pattern - stains with mucin bronchioalveolar subtype - thick alveolar walls

Question 37

SCC of lung

Answer 37

central located hilar mass from bronchus cavitation cigarettes hyperCa - produce PTHrP keratin pearls intercellular bridges

Question 38

large cell carcinoma of lung

Answer 38

peripheral anaplastic undifferentiated poor prognosis less response to chemo -remove with surgery secrete B-hCG pleomorphic giant cells

Question 39

bronchial carcinoid tumor

Answer 39

good prognosis sx - mass effect secrete serotonin - flushing, diarrhea, wheezing nests endocrine cells chromogranin positive