Respiratory

Question 1

What is a chylous effusion? When might you see it?

Answer 1

It is an exudate of chylomicron-rich fluid from the lymphatic duct that drains into the pleura due to damage by a tumor or trauma.

Question 2

What is the most important antibiotic resistance mechanism of pseudomonas aeruginosa?

Answer 2

Mutation of a porin protein that restricts entry of antibiotics into the cell

Question 3

What are three anaerobic species that are commonly aspirated from the oral cavity leading to aspiration pneumonia?

Answer 3

Bacteroides, Fusobacterium, and Peptococcus

Question 4

In what medium does S. aureus cause color change to yellow?

Answer 4

mannitol salt agar

Question 5

What is the most common cause of bronchiolitis in a 6 month old child?

Answer 5

RSV

Question 6

How might one differentiate between lymphoma in the lungs and SCC?

Answer 6

SCC is of neuroendocrine origin, so it often presents with a paraneoplastic syndrome, such as Cushing’s

Question 7

How does pertussis cause hypoglycemia?

Answer 7

Pertussis toxin ADP ribosylates Gi –> increased cAMP –> increased insulin production

Question 8

What is the target for zileuton?

Answer 8

5-lipooxygenase

Question 9

What is the molecule that binds to the CFTR channel, controlling the opening/closing?

Answer 9

ATP

Question 10

What is the mechanism of asprin-induced asthma?

Answer 10

inhibits COX pathway w/out affecting LOX pathway → decreased ratio of prostaglandins:leukotrienes → bronchoconstrction in susceptible patients

Question 11

What is the most common cause of lobar pneumonia?

Answer 11

Streptococcus pneumoniae causes 90-95% of cases. This is an alpha hemolytic organism that colonizes 40-70% of health individuals.

Question 12

Describe the size and capsule of histoplasma capsulatum

Answer 12

small (2-5 um) yeast with thin cell wall but NO capsule

Question 13

Where does cilia end in the respiratory tree?

Answer 13

terminal bronchioles contain cilated cuboidal epithelium–the alveolar ducts and alveoli are not ciliated

Question 14

Where do goblet cells, glands, and cartilage generally stop in the respiratory tree?

Answer 14

at the end of the bronchi – bronchioles are just pseudostratified columnar ciliated epithelium until transitioning at the terminal bronchioles

Question 15

What is the supposed cause of primary spontaneous pneumothorax?

Answer 15

Rupture of apical subpleural blebs, usually in tall, thin males around 20 y.o.

Question 16

What is another name for the lung apex?

Answer 16

Superior sulcus

Question 17

What are the abnormal serum values in sarcoidosis? What findings on bronchiolar lavage would help you differentiate sarcoidosis from hypersensitivity pneumonitis?

Answer 17

↑ ACE and Ca2+; you would see ↑ CD4:CD8 ratio

Question 18

What is an alternative test to the sweat test for CF?

Answer 18

nasal transepithelial potential difference; if more negative than expected, evidence for CF b/c Na+ absorbed (these electrolyte changes occurs in most glands except sweat glands)

Question 19

How does CF → hypovolemia?

Answer 19

NaCl loss in sweat

Question 20

Does changing PaCO2 or PaO2 have more of an effect on cerebral vessel tone?

Answer 20

PaCO2

Question 21

Do panic attacks cause hyper- or hypo- ventillation. How do the neurological symptoms relate?

Answer 21

hyperventilation → ↓ PaCO2 → vasoconstriction → dizziness, weakness, blurred vision

Question 22

What is a quick and dirty HCO3- cutoff that would indicate the kidneys are holding onto bicarb in response to chronic respiratory acidosis? What time limits define acute and chronic respiratory acidosis?

Answer 22

30 suggests chronic

24 hrs chronic (compensation starts kicking in, max at 3-5 d)

Question 23

What are the borders of the lungs at the:

• midclavicular line?
• midaxillary line?
• paravertebral line?

Answer 23

• 7
• 10
• 12

Question 24

What cell secretes proteases and ROS that lead to alveolar wall destruction in emphysema?

Answer 24

neutrophils

Question 25

What is the lining of the vocal cords?

Answer 25

Stratified squamous

Question 26

How does Legionella pneumonia present?

Answer 26

Smoker
high fever
diarrhea/GI symptoms
confusion
slightly productive cough
No gram staining organisms (gram-negative but stains poorly)