Respiratory Path

Question 1

Virchow’s Triad

Answer 1

Stasis
Hypercoag
Endothelial Damage

Question 2

Homan’s Sign

Answer 2

pain with dorsiflexion in calf –> DVT

Question 3

Tx for DVT Acute and Chronic

Answer 3

Acute–Heparin

Chronic–Warfarin

Question 4

Hypoxemia
Neurologic abnormalities
petechial rash

Answer 4

PE triad

Question 5

Amniotic fluid emboli complication

Answer 5

DIC

Question 6

Test of choice for PE

Answer 6

CT pulmonary angiography

spiral CT

Question 7

Imaging for DVT

Answer 7

Ultrasound

Question 8

Hallmark of Obstructive lung disease

Answer 8

Decreased FEV1/FVC ratio

Question 9

Reid Index > 50%
Hypertrophy of mucus glands in lung
productive cough for > 3 months in for 2 years
Cyanosis
Blue bloaters

Answer 9

chronic bronchitis

Question 10

Destruction of alveolar walls
Increased compliance
increased elastase activity
Pt. exhales through pursed lips
Pink Puffers

Answer 10

Emphysema

Question 11

Centriacinar emphysema cause

Answer 11

Smoking

Question 12

Panacinar Emphysema

Answer 12

A1AT Def.

begins in bronchioles

Question 13

Curshman's spirals
Charco-Leyden Crystals
reversible bronchoconstriction
Eosinophils in blood
cough, wheezing
Mucus plugging

Answer 13

Asthma

Question 14

Curshmann’s Spirals

Answer 14

Shed epithelium forms a mucus plug. looks like a spiral

Asthma buzz

Question 15

Charcot-Leyden crystals

Answer 15

breakdown of eosinophils in sputum (asthma)

Question 16

Chronic nectrotizing infection of bronchi –> permanently dilated airways

Answer 16

Bronchiectasis

Question 17

Bronchiectasis associated with

Answer 17

bronchial obst.
poor ciliary motility (smoking, kartagener’s)
CF
Allergic bronchopulmonary aspergillosis

Question 18

Rx induced asthsma

Answer 18

aspirin

Question 19

Restrictive Lung disease findings

Answer 19

Lower Volume
decreased FVC and TLC
FEV1/FVC increased

Question 20

3 types of pneumoconioses

Answer 20

anthracosis
silicosis
asbestosis

Question 21

Coal miner
Upper lung effected
Black Lung

Answer 21

anthracosis

Question 22

Foundries, sandblasting, mines
Lung fibrosis
Upper lobes effected
Eggshell calcification of hilar lymph nodes

Answer 22

Silicosis

Question 23

Silicosis increased risk

Answer 23

Bronchogenic CA

TB

Question 24

Why is there an increased risk of TB with silicosis?

Answer 24

silica disrupts phagolysosomes and impairs macrophages

Question 25

Ivory white calcified pleural plaques Shipbuilding, roofing, plumbing Lower lobes effected Golden-brown fusiform rods

Answer 25

Asbstosis

Question 26

Asbestos bodies

Answer 26

Golden-brown fusiform rods | Look like dumbells

Question 27

Asbestos exposure increased risk

Answer 27

Bronchogenic CA Mesothelioma (less common than broncho but only really seen with asbestos)

Question 28

Premature Newborn Decresaed surfactant --> increased surface tension in lungs collaped alveolar

Answer 28

Neonatal respiratory distress syndrome

Question 29

Test to check surfactant (lung maturity) in utero

Answer 29

lecithin:sphingomyelin ratio > 1.5

Question 30

Neonatal respiratory distress syndrome Tx

Answer 30

maternal steroids artificial surfactant to infant

Question 31

Diffuse alveolar damage (DAD) Intraalveolar hyaline membrane Precipitating factor like trauma, pancreatitis, sepsis, etc.

Answer 31

ARDS

Question 32

what causes the damage initially in ARDS?

Answer 32

release of neutropilic substances toxic to alveolar wall --> activation of coag cascade --> Oxygen free radicals

Question 33

Sleep apnea

Answer 33

cessation of breathing > 10 sec while sleeping Increased Hb --> hypoxia increases EPO daytime somnolence

Question 34

Tx sleep apnea

Answer 34

weight loss CPAP surgery

Question 35

#1 cause of cancer in US

Answer 35

Lung cancer!!!

Question 36

Lung cancer presentation

Answer 36

Coin lesion on X-Ray Non-calcified nodule on CT cough, hemptysis, bronchial obstruction

Question 37

Mets from lung

Answer 37

Adrenals Brain Bone Liver

Question 38

Mets to lung are from

Answer 38

Breast Colon Prostate Bladder

Question 39

``` Peripheral mass in lung NONSMOKER FEMALE Hazy infiltrate on xray Clubbing Thickening of alveolar walls ```

Answer 39

adenocarcinoma

Question 40

``` Central hliar lung mass Cavitation SMOKER MALE Hypercalcemia Keratin Pearls and intercellular bridges ```

Answer 40

Squamous Cell CA

Question 41

``` Central lung mass undifferentiated--very aggressive Endocrine Sx Neuroendocrine cell origin Kulchitsky Cells ```

Answer 41

Small Cell CA (oat cell)

Question 42

Tx Small Cell CA

Answer 42

radiation and chemo no surgery. all other lung CA are surgical excision

Question 43

Peripheral lung mass highly anaplastic undifferentiated tumor Pleomorphic giant cells

Answer 43

Large Cell CA

Question 44

Bronchial Carcinoid Tumor

Answer 44

Excellent prognosis Rare mets Carcinoid Syndrome

Question 45

Small Cell CA mutation

Answer 45

myc oncogene amplification

Question 46

Kulchitsky cells

Answer 46

Dark blue cells seen in small cell CA

Question 47

Adenocarcinoma mutation

Answer 47

activation of k-ras

Question 48

``` Asbestos malignancy of pleura hemorrhagic pleural effusions Pleural thickening PSAMMOMA BODIES ```

Answer 48

Mesothelioma

Question 49

Tumor at apex of lung | Horner's Syndrome

Answer 49

Pancoast Tumor

Question 50

SVC Syndrome

Answer 50

obstruction of SVC decreasing drainage from head JVD UE Edema facial plethora

Question 51

SVC Syndrome causes

Answer 51

Malignancy | Indwelling catheters

Question 52

Why is SVC syndrome an emergency?

Answer 52

increased ICP HA, Dizzy, aneurysm risk

Question 53

Intra-alveolar exudate --> consolidation | may involve entire lung

Answer 53

Lobar pneumonia | entire lobe effected

Question 54

Acute inflammatory infiltrates from bronchioles into adjacent alvoli Patchy distribution > 1 lobe

Answer 54

Bronchopneumonia (lobular)

Question 55

Diffuse patchy inflammation localized to interstitial areas of alveolar walls ≥1 lobe

Answer 55

Interstitial (atypical pneumonia)

Question 56

Lobar pneumonia bugs

Answer 56

S. pneumo | Klebsiella

Question 57

Bronchopneumonia bugs

Answer 57

S. Pneumo S. aureus H. flu Klebsiella

Question 58

Atypical pneumonia bugs

Answer 58

Viruses (flu, RSV, adeno) Mycoplasma Legionella Chlamydia

Question 59

Localized collection of pus within lung parenchyma

Answer 59

lung abscess

Question 60

Types of pleural effusions

Answer 60

Transudate Exudate Lymphatic (chylo)

Question 61

Unilateral chest pain and dyspnea unilateral chest expansion decreased tactile fremitus HYPERRESONANCE

Answer 61

Pneumothorax

Question 62

Air enters but cannot exit thorax Tracheal deviation away from affected side Trauma

Answer 62

Tension Pneumothorax

Question 63

Trachea deviates toward affected side air in pleural space Tall thing young male Due to rupture of apical blebs

Answer 63

Spontaneous pneumothorax