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Flashcards in Respiratory Deck (147):
1

What is the most common cause of lobar pneumonia in adults?

Streptococcus pneumoniae

2

Unvaccinated child with paroxysmal cough and inspiratory whoop - diagnosis?

Whooping cough caused by bordetella pertussis

3

Why does bordetella cause hypoglycemia?

Toxin activates islets of Langerhans

4

What is the most common cancer arising from scarred lung?

Adenocarcinoma

5

What are tumors that arise peripherally and cause coin lesions?

Adenocarcinoma, bronchioloalveolar carcinoma, large cell carcinoma

6

What acid-base disturbance does acute salicylate poisoning lead to?

Respiratory alkalosis

7

How does hyperventilation affect cerebral blood flow and cerebral vascular resistance?

Decreased cerebral blood flow
Increased cerebral vascular resistance

Because decreased levels of CO2 cause cerebral vasoconstriction

8

What would a biopsy of tissue infected with Histoplasma show?

2-5 micrometer yeast with a thin cell wall but no real capsule

9

What should you think of if you see an immunosuppressed patient with owl's eye inclusion bodies in cells?

CMV

10

What lab values will change when giving supplemental oxygen to a patient with pulmonary diseaese?

Increase PAO2, PaO2, A-a gradient

Will NOT change lung diffusion capacity

11

Why does the abdominal wall move inward on inspiration with a diaphragmatic injury?

Contraction of the intercostal muscles during inspiration results in the diaphragm being sucked upward (negative pressure in the pleural space) and the abdominal wall being sucked inward

12

What happens to pulmonary vessels at high altitude?

Vasoconstriction (decreased diameter) due to hypoxia

13

What PO2 level decreases in anemic patients?

Mixed venous PO2

14

What should be at the top of your differential for a unilateral pleural effusion?

Bacterial infection

15

What respiratory infection should you suspect among infants in the winter months?

RSV

16

How do you treat an RSV infection?

Palivizumab - antibody directed against the fusion protein of RSV

17

What antibiotic inhibits translocation of the growing peptide chain along the mRNA?

Macrolide

18

Why are asthmatic patients at increased risk of oral candidiasis?

Use of inhaled corticosteroids

19

Presentation: bilateral hilar adenopathy, history of nonspecific joint inflammation, cutaneous symptoms

Diagnosis?

Sarcoidosis

20

How is CFTR regulated?

Gated by ATP hydrolysis and involves regulation by protein kinase A phosphorylation

21

Presentation: history of asthma, sudden onset shortness of breath, altered breath sounds

What should you suspect?

Pneumothorax

22

How does pneumothorax look on X ray?

Radiolucency

23

What is a chylous effusion?

Exudative effusions (pleural fluid protein to serum protein > 0.5, pleural to serum LDH > 0.6) with high lipid content, most commonly related to trauma and malignancy

24

How does the vagus nerve affect the lungs?

Bronchoconstriction leading to increased airway resistance and work of breathing

25

What fungus, at body temperature, is a spherule filled with endospores?

Coccidioides

26

What is the mechanism of action of aminoglycosides?

Inhibit the initiation of protein synthesis by binding to and distorting the structure of the prokaryotic 30s ribosomal subunit

27

What medications target synthesis of the fungal cell wall?

Echinocandins (e.g. caspofungin and micafungin) inhibit synthesis of the polysaccharide glucan, an essential component of the fungal cell wall

28

What happens to diffusing capacity (DLCO) in emphysema patients?

Decreases

29

What is Cheyne Stokes respiration?

Cyclic breathing in which apnea is followed by gradually increasing tidal volumes and then decreasing tidal volumes until the next apneic period

30

When is rifampin used as monotherapy?

For prophylaxis against Neisseria meningitidis

31

Presentation: Recurrent sinopulmonary and GI tract infections, anaphylactic response to transfused blood products

Diagnosis?

IgA deficiency (most common primary immune deficiency)

32

Which TB drug can adversely affect the eye?

Ethambutol can cause optic neuritis (presents in conjunction with decreased visual acuity, central scotoma, color blindness)

33

How does N-acetylcysteine help CF patients?

Mucolytic agent - it cleaves the disulfide bonds within mucus glycoproteins (loosens thick sputum)

34

What are the most common bacterial infections (secondary pneumonia) that superimpose over influenza infection?

Strep pneumo > Staph > H. flu

35

What does it mean if mycobacterium can grow in parallel chains?

These are serpentine cords meaning the mycobacterium has cord factor meaning it is a virulent strain

36

Why is expiratory flow rate increased in restrictive lung disease?

Expiratory flow rate is increased due to decreased lung compliance (increased elastic recoil) and increased radial traction exerted on the conducting airways by the fibrotic lung

37

Which TB drug requires an acidic environment?

Pyrazinamide (works best within phagolysosomes)

38

If a patient has tracheal PO2 that does not match alveolar PO2, what is that indicative of?

Should equilibrate in normal conditions because O2 is a perfusion limited gas so in this case it means there's poor perfusion

39

Where does the recurrent laryngeal nerve travel relative to the aorta?

Goes beneath the arch of the aorta (but above the pulmonary artery) through the aorticopulmonary window

40

How does sarcoidosis affect the elasticity of the lung?

Increases it (as do other restrictive lung diseases)

41

What acid-base disturbance does acute salicylate poisoning lead to?

Respiratory alkalosis

42

What is on your differential for an interstitial pneumonia that responds to macrolides?

Mycoplasma pneumoniae or legionella

(If it didn't respond to macrolides, you would think of viral etiologies)

43

What responds more quickly to changes in PCO2 - peripheral or central chemoreceptors?

Peripheral

44

Assuming normal PO2 of 100 mm Hg, what would you expect in terms of oxygen bound to hemoglobin in a patient with 75% of normal hemoglobin (anemic)?

Arterial blood has 75% as much oxygen bound to hemoglobin because Hb is 100% saturated with oxygen at 100 mm Hg

45

How would you differentiate between histoplasmosis and blastomycosis on histology?

Histoplasmosis - tiny oval forms within macrophages

Blastomycosis - larger, round budding yeast forms in tissues

46

Is strep pneumo alpha, beta, or gamma hemolytic?

Alpha

47

What is the most common form of lung cancer?

Bronchogenic adenocarcinoma

48

Post influenza bacterial pneumonia with cavitary lesions - likely cause?

Staph

49

What antibiotic would be contraindicated in treating a patient for H. influenza if that patient was also on anticoagulants?

Macrolides because they inhibit CYP 450 and would potentiate the effects of warfarin

50

What is the mechanism of action of macrolides?

Bind to the P site of the 50s ribosomal subunit and interfere with bacterial protein synthesis

51

What acid base disturbance does heroin overdose lead to?

Acute respiratory acidosis from hypoventilation

52

How can you differentiate between SCID and DiGeorge?

DiGeorge is a type of SCID but in terms of picking an answer:

DiGeorge - look for classic findings like facial abnormalities, hypoparathyroidism, cardiac defects

SCID - more severe immune dysfunction

53

Why is someone with a seizure disorder at increased risk of lung abscess?

Aspiration of oropharyngeal contents (e.g. mouth flora like peptostreptococcus, fusobacterium)

54

What is the effect of ether (and other organic solvents) on viruses?

Can dissolve the lipid bilayer that makes up the outer viral envelope - leads to loss of infectivity

55

If a foreign body becomes lodged in the piriform recess, what nerve can it damage?

Internal laryngeal (branch of vagus that is involved in the cough reflex)

56

What bacteria is the most likely cause of pneumonia in a patient with GI symptoms, neurological symptoms, and recent exposure to contaminated water (e.g. cruise ships or hotels)?

Legionella pneumophila

57

What is the most common laboratory abnormality seen with Legionella?

Hyponatremia

58

Neutrophils fail to turn blue upon nitroblue tetrazolium exposure - what does this mean?

Chronic granulomatous disease - patients cannot reduce nitroblue tetrazolium because they have a genetic defect resulting in NADPH oxidase deficiency

59

What kind of organisms are neutrophils in chronic granulomatous disease bad at killing?

Not effective at killing catalase positive organisms

60

What vitamin deficiencies are associated with cystic fibrosis?

A, D, E, K

Because these are fat soluble vitamins and pancreatic insufficiency inhibits fat absorption

61

Lung abscess is a common complication of what disease?

Aspiration pneumonia

62

Histology: round yeast with doubly refractive walls and broad based budding?

Blastomyces

63

What do you worry about injuring above the clavicle and just lateral to the sternal manubrium?

Apex of the lung or the pleura (think pneumothorax)

64

What three cytokines help raise the ESR through a systemic inflammatory response?

IL-1, IL-6, TNF-alpha

Stimulate hepatic production of acute phase reactants like fibrinogen

65

What is another name for phosphatidylcholine?

Lecithin

66

Describe how lecithin vs. sphingomyelin levels in the amniotic fluid change during pregnancy.

Sphingomyelin - fairly constant

Lecithin - approximately equal to sphingomyelin until 3rd trimester and then shoots up

An L:S of 2:1 is a marker for healthy lung maturation

67

For an autosomal recessive disease, what is the chance that an unaffected individual with unaffected parents (but who are both carriers) with be a carrier for the disease?

2/3

68

What test is carbolfuchsin dye used for?

Acid fast

69

What does acid fast stain stain for?

Mycolic acid

70

What do we use to treat IL-12 deficient patients?

IFN-gamma (helps promote Th1 response which they have trouble doing without IL-12

71

What fungal infection can complicate asthma?

Aspergillus fumigatus

72

How can bronchioalveolar lavage fluid be used to diagnose sarcoidosis?

High CD4/CD8 ratio is diagnostic of sarcoidosis

73

What is pyridoxine?

Vitamin B6

74

What drug is pyridoxine related to?

Isoniazid

75

When is pulmonary vascular resistance lowest?

At functional residual capacity (after normal tidal volume)

76

Describe how airway frictional resistance changes as you move from the larger bronchi to the smaller ones. Where does it reach its maximum?

Most of the airway resistance comes from the first ten generations of bronchi (maximum at generations 2-5) vs. very little from the smallest ones

77

What is the typical mechanism of resistance against streptomycin?

Altered structure of bacterial ribosomal proteins because streptomycin (like other aminoglycosides) work by inactivating the 30s subunit

78

What do you need to know in order to PCR sequence a segment of DNA?

The sequence of the flanking regions

79

Why does chloride shift into erythrocytes in venous vs. arterial blood?

In venous blood, erythrocytes are carrying carbon dioxide which gets converted to H+ and bicarbonate from carbonic anhydrase. The bicarbonate diffuses out into the plasma and so chloride shifts into the RBC to maintain electroneutrality.

80

What is the primary virulence factor of strep pneumo?

Polysaccharide capsule that inhibits phagocytosis

81

What part of the respiratory system is particularly affected by chronic rejection in lung transplantation?

Small airways - bronchiolitis obliterans syndrome

82

Does small cell or squamous cell lung cancer stain positive for chromogranin?

Small cell

83

What would you expect as an acid-base disturbance from chronic exposure to high altitude?

Respiratory alkalosis (due to hyperventilation) with decreased bicarbonate as renal compensation

84

What cytokine is important for the formation of a granuloma?

IFN-gamma

85

What receptors can be pharmacologically targeted for asthma?

1. Leukotrienes - LTC4, LTD4, LTE4
2. Acetylcholine

86

What does the pneumococcal vaccine contain?

Capsular polysaccharides

87

What causes the tissue damage that allows a lung abscess to form?

Lysosomal enzymes released from neutrophils and macrophages

88

Pain upon inspiration in the neck and shoulder region is coming from what nerve?

Referred pain from phrenic nerve (C3 - C5)

Likely due to irritation of the pleura

89

Which RNA polymerase synthesizes the vast majority of rRNA from within the nucleolus?

RNA polymerase I

90

Where is the most highly oxygenated blood in fetal circulation?

Umbilical vein which empties directly into the IVC via the ductus venosus

91

Why is the mucus dehydrated in CF?

CFTR isn't working --> inhibits Cl secretion --> drives Na reabsorption --> dehydrates the mucus

92

Which antifungals bind ergosterol in the fungal cell membrane?

Polyenes (amphotericin B and nystatin)

93

What are the major toxicities of theophylline overdose?

Abdominal pain, vomiting, seizures

94

For a naked RNA virus to induce the host cell's own machinery to synthesize proteins, does it have to be positive or negative?

Positive - meaning it is acting directly as mRNA

95

What is the difference between t-test and ANOVA?

T-test: compare the difference between the means of 2 groups

ANOVA (analysis of variance): compare the difference between the means of 2 or more groups

96

Aside from histamine, what other mast-cell specific enzyme is released in excess during anaphylaxis?

Tryptase

97

What is the intrapleural pressure at FRC?

-5 cm H2O

98

What is arterial PaCO2 a direct indicator of?

Alveolar ventilation

99

Is blastomyces or aspergillus more likely to cause chronic pneumonia in an immunocompetent host?

Blastomyces

100

What is cromolyn?

Mast cell stabilizing agent - inhibits mast cell degranulation

Nedocromil is another mast cell stabilizing agent

101

In a patient with lobar pneumonia, if the lung is pale but has fragments of RBCs, is it in red hepatization or gray hepatization?

Gray

102

Histology: well differentiated lung tumor with composed of tall, columnar cells that line the alveolar septa without evidence of vascular or stromal invasion

Diagnosis?

Bronchioloalveolar carcinoma

103

Why is capillary wedge pressure normal in acute respiratory distress syndrome?

One of the minor diagnostic criteria = absence of cardiogenic pulmonary edema

104

How does the body get rid of strep pneumo?

Bacterial clearance via spleen (encapsulated organism)

105

How does the influenza vaccine work?

Composed of inactivated viral components that increases host circulating antibodies against hemagglutinin so that the virus has trouble entering cells

106

What kind of epithelium is found in the oropharynx, laryngopharynx, anterior epiglottis, upper half of the posterior epiglottis, and vocal folds?

Stratified squamous epithelium

107

What TB drug must be processed by mycobacterial catalase-peroxidase for the drug to be activated within the bacteria?

Isoniazid

108

What is the difference between central vs. peripheral chemoreceptors and what they respond to?

Central - senses CO2 levels to regulate respiratory drive

Peripheral - senses O2 levels in severe cases of hypoxia

109

What is the most common cause of acute epiglottitis and why do we not see it much anymore?

H influenza type B

Decreased because of vaccine

110

Normal PaO2 and % sat, but low O2 content.

What is this suggestive of?

Anemia (e.g. chronic blood loss)

111

Is strep pneumo bile sensitive or bile resistant?

Bile sensitive

112

What is another way to describe aspergilloma?

Colonizing aspergillosis

113

What is a common cause of bilateral absence of vas deferens?

Cystic fibrosis

114

What category of drugs will only reverse vagally-mediated bronchoconstriction?

Antimuscarinics (e.g. ipratropium)

115

What happens during the first week of exposure with TB?

Intracellular bacterial proliferation

116

What are hamartomas composed of?

Disorganized cartilage, fibrous and adipose tissue

117

What is the Reid index?

Ratio of the thickness of the mucous gland layer to thickness of the bronchial wall between respiratory epithelium and cartilage

118

What can be used as prophylaxis in patients at risk for MAC?

Weekly azithromycin

119

What is mucicarmine stain used for?

Stains the polysaccharide capsule of cryptococcus neoformans

120

Which viruses exhibit a form of replication in which they produce a polyprotein product that is later cleaved by a viral protease to produce functional, individual proteins?

Single-stranded, positive sense, linear, non-segmented RNA viruses (e.g. Picornaviruses like echovirus)

121

How far down (rib number) do the lungs go on the mid axillary line?

Rib 9

122

What is the best lab value for helping to determine the cause of metabolic alkalosis?

Urinary Cl - it will be decreased if the cause is loss of hydrogen ions from the body (e.g. vomiting) and increased if the cause is diuretics/primary hyperaldosteronism

123

Describe what happens to pH, PaO2, PaCO2, plasma HCO3 in the setting of pulmonary embolism.

Hypoxemia leading to hyperventilation which leads to increased pH (respiratory alkalosis), decreased PaCO2, decreased PaO2 (hypoxemia), and decreased HCO3 (to account for the loss of H+ to increase the pH)

124

Oral thrush, interstitial pneumonia, and severe lymphopenia during the first year of life suggest vertical transmission of what?

HIV

125

How can vertical transmission of HIV be reduced?

Maternal prophylaxis during pregnancy with the nucleoside analog zidovudine (ZDV, AZT) - a retroviral reverse transcriptase inhibitor

126

Why are patients with silicosis at increased risk of TB infection?

Disruption of macrophage phagolysosomes by internalized silica particles

127

What happens if a patient has a defect in antibody class switching?

Hyper-IgM

128

What would you give in terms of medication to an alcoholic with a lung abscess?

Clindamycin - covers both the gram positive strep pneumo pneumonia as well as anaerobes that likely cause the abscess from aspiration

129

What medication would you consider giving to a child/infant with severe RSV infection?

Ribavirin

130

What does amphotericin B bind to?

Ergosterol in fungal cell membranes but can also bind to cholesterol in human cell membranes (causing most of its toxicities)

131

What drug can assist patients with cessation of tobacco use by reducing withdrawal cravings and attenuating the rewarding effects of nicotine?

Varenicline - partial agonist of nicotinic acetylcholine receptors

132

Why is the pO2 in the left atrium lower than that in the pulmonary capillaries?

Deoxygenated blood from the bronchial arteries mixes with oxygenated blood in the pulmonary veins

133

What vaccines use diphtheria toxoid as their protein carrier?

1. Strep pneumo
2. Neisseria meningitidis
3. H flu

134

What is a common cause for legionella outbreak in a hospital setting?

Colonization of the hospital water system (e.g. humidification system, air conditioning, water-based cooling system)

135

What protects bacteria from osmotic stress?

Peptidoglycan wall

136

What 3 class of antibiotics disrupts the bacterial peptidoglycan wall?

1. Penicillins
2. Cephalosporins
3. Vancomycin

137

Histology: Large spherule filled with endospores?

Coccidioides

138

Deletions or additions of a number of base pairs not in a multiple of 3 indicates what kind of mutation?

Frameshift

139

Antibodies to polyribitol ribose phosphate (PRP) carry protection against?

H flu type B (PRP is in its capsule)

140

What is the difference between TB and sarcoid on biopsy?

TB - caseating granulomas, acid-fast bacilli
Sarcoidosis - noncaseating granulomas

141

What are the 2 most common causes of SVC syndrome?

1. Lung cancer
2. non-Hodgkin lymphoma

142

The green discoloration of pus or sputum during bacterial infections is associated with the release of what?

Myeloperoxidase from neutrophil azurophilic granules - myeloperoxidase is a heme containing pigmented molecule

143

Pneumoconiosis with egg-shell calcifications of hilar nodes and birefringent particles surrounded by dense collagen fibers?

Silicosis

144

Why does mycoplasma pneumoniae infection cause anemia?

Cold agglutinins - the body lyses some of its own RBC's as the antibodies against mycoplasma share some of the antigens

145

What component of inflammatory exudate is most important for inducing rapid neutrophil locomotion?

LTB4

146

What are the 4 major causes of hypoxemia (low PaO2)?

1. Alveolar hypoventilation
2. V/Q mismatch
3. Diffusion impairment
4. Right to left shunting

147

How can you distinguish alveolar hypoventilation from the other causes of hypoxemia?

Hypoventilation shows normal A-a gradient