Respiratory

Question 1

What are the symptoms of a tension pneumothorax?

Answer 1

low bp, fast pulse, respiratory effort, hypoxia, hyperresonance to percussion, and absence of breath sounds

Question 2

What inhibits neutrophil elastase?macrophage?

Answer 2

serum alpha1 antitrypsin

tissue inhibitors of metalloproteinases

Question 3

What are the primary cell lines in stable COPD?

Answer 3

Neutrophil, macrophages, and CD8+ T cells- These cells release proteases that damage lung tissue and have impaired phagocytic activity

Question 4

Where does S. Aureus colonize?

Answer 4

Anterior Nares

Question 5

Describe the symptoms seen with SCID

Answer 5

SCID encompasses many mutations that lead to T and B cell deficiencies, leading to severe viral and bacterial infections, candidiasis, persistent diarrhea, failure to thrive, and thymic aplasia

Question 6

Describe CVID

Answer 6

hypogammaglobulinemia with B and T cell dysfunction that is not as severe as SCID

Question 7

What is the histopathology of Mesothelioma?

Answer 7

Nodular or smooth plerual thickening and pleural effusions

Abundant tonofilaments and long, slender microvilli

Question 8

What is the most common cause of croup?

Answer 8

parainfluenza virus

Question 9

Where in the respiratory tree is airway resistance greatest?

Answer 9

In the medium sized bronchi (generations 2-5)

Question 10

How can you differentiate between MAC and M TB?

Answer 10

MAC grows well at 41 C

Question 11

What is deficient in CGD? How is it tested?

Answer 11

Deficiency in NADPH Oxidase

Tested by dihydrorhodamine flow cytometry and nitroblue tetrazolium test

Question 12

What is the treatment for oral thrush in an immunocompetent patient?

Answer 12

Nystatin, a topical antifungal

Question 13

What are the labs in Allergic bronchopulmonary aspergillus (fumigatus)?

Answer 13

Hypersensitivity reaction- high IgE, eosinophilia, and IgE + IgG antibodies to aspergillus. Reccurent can lead to transient pulm infiltrates and proximal bronchiectasis

Question 14

What is the formula for distending pressure?

Answer 14

P=2T/r

Question 15

What is the respiratory issue associated with pancreatitis?

Answer 15

ARDS

Question 16

What is the role of eosinophils against parasites?

Answer 16

antibody-dependent cell-mediated toxicity

IL-5 from mast cells or Th2 causes eosinophils to proliferate

Question 17

Symptoms associated with obstructive sleep apnea

Answer 17

Morning headaches, daytime sleepiness, obesity, high blood pressure. Can lead to PAH and right heart failure

Question 18

What does M. Pneumo need to grow?

Answer 18

cholesterol

Question 19

What pathogen likes to invade old lung cavities?

Answer 19

Aspergillus fumigatus- forms aspergilloma, a radiopaque structure that shifts when the patient changes position

Question 20

What are the symptoms of lingual thyroid?

Answer 20

dysphagia, dysphonia, dyspnea

Question 21

What is the mechanism of action of Cromoglycates?

Answer 21

Inhibit mast cell degranulation

Question 22

What is the mechanism of action of Montelukast/Zafirlukast?

Answer 22

Leukotriene D4 receptor antagonist

Question 23

What is the MOA of Zileuton?

Answer 23

Lipoxygenase inhibitor

Question 24

What is the MOA of Omalizumab

Answer 24

Antibody to IgE Fc portion

Question 25

What does carbolfuchsin stain for?

Answer 25

Acid-fast stain for mycolic acid in nocardia and mycobacteria

Question 26

What neuroendocrine markers can be positive in small cell carcinoma?

Answer 26

neuron-specific enolase, chromogranin, and synaptophysin

Question 27

What causes the CFTR channel to open?

Answer 27

binding of 2 ATP

Question 28

Which catalase positive organisms most commonly cause infection in patients with CGD?

Answer 28

S. Aureus, Burkholder Cepacia, Serratia Marsescen, Nocardia, Aspergillus (BANASS)

Question 29

What causes oxygen induced hypercapnea?

Answer 29

1. Hyperoxia (to high oxygen content) reverses vasoconstriction and increases dead space 2. Increased arterial O2 leads to decreased Hgb affinity for CO2--> CO2 offloading and increased serum levels 3. High flow O2 leads to decreased chemoreceptor signaling--> decrease respiratory rate and minute ventilation

Question 30

What is the hallmark of asbestos exposure on chest imaging?

Answer 30

pleural thickening with calcifications (especially between the 6th and 9th ribs. (calcified lesions, pleural plaques)

Question 31

What part of the lung is most affected by chronic lung transplant rejection?

Answer 31

The small airways--> bronchiolitis obliterans- inflammation and fibrosis of the bronchiolar walls leads to narrowing and obstruction of the bronchioli.

Question 32

What is the clinical triad of fat embolism syndrome?

Answer 32

neurological abnormalities, petechial rash, and hypoxia

Question 33

What keeps gram positive organisms from being destroyed by variations in tonicity?

Answer 33

peptidoglycan wall

Question 34

What are the symptoms of selective IgA deficiency?

Answer 34

Airway and Gi infections, Autoimmune disease, Atopy, Anaphylaxis to blood transfusions

Question 35

What are the symptoms of superior vena cava syndrome?

Answer 35

dyspnea, cough, and swelling of the face, neck, and UE. Dilated collateral veins may be seen in upper torso. Lung cancer, non-hodgkin lymphoma

Question 36

What is the major virulence factor for H Flu?

Answer 36

The capsule, which is composed of the polymer polyribosylribitol phosphate- binds factor H and prevents phagocytosis and complement mediated lysis