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Pulmonary
FA review Round 1 2020
| Question | Answer |
|---|---|
| Which form of hemoglobin has lower affinity to oxygen? | Deoxyhemoglobin |
| Deoxy or Oxy form of Hb has lower affinity to oxygen? | Deoxyhemoglobin |
| Deoxy or Oxy form of Hb has higher oxygen affinity? | Oxyhemoglobin |
| Deoxy or Oxy form of Hb is found in peripheral tissues predominantly? | Deoxyhemoglobin |
| Which tissue or area is deoxyhemoglobin found predominantly? | Peripheral tissues |
| Which type of hemoglobin is easier or more prompt to release oxygen to needed tissue? | Deoxyhemoglobin |
| On which part is oxyhemoglobin predominant? | Pulmonary capillaries |
| What type of hemoglobin is found predominantly in the Pulmonary capillaries? | Oxyhemoglobin |
| Why is Oxy form of Hb predominant in the Pulmonary capillaries? | It is where he uptake of oxygen is produced |
| What is the cause fo a Congenital Diaphragmatic hernia? | Failure of the pleuroperitoneal canal to close completely, leading to protrusion of viscera into the chest |
| Protrusion of viscera into the chest of a neonate. Most common Dx? | Congenital Diaphragmatic hernia |
| Failure of the pleuroperitoneal canal to close completely during embryogenesis. Dx? | Congenital Diaphragmatic hernia |
| What fails to close completely in Congenital Diaphragmatic hernia? | Pleuroperitoneal canal |
| What is the MCC of death in neonates with Congenital Diaphragmatic hernia? | Pulmonary hypoplasia |
| What pulmonary or respiratory condition is associated with chronic pancreatitis? | Acute Respiratory Distress syndrome (ARDS) |
| ARDS is often associated with which GI condition? | Pancreatitis |
| What are the respiratory effects and signs of ARDS? | 1. Decreased PaO2 / FiO2 ratio 2. CXR --> bilateral infiltrates 3. No clears signs of cardiac dysfunction |
| What substance is produced with vigorous exercise? | Lactic acid |
| How does vigorous exercise cause a decrease in serum pH? | Anaerobic metabolism creates Lactic Acid, lowering the pH in the pulmonary arteries, which carry systemic VENOUS blood to the lungs to be oxygenated |
| Which is the only artery to carry deoxygenated blood? | Pulmonary arteries |
| What type of blood is carried by the Pulmonary arteries? | Deoxygenated blood |
| What is the cause for development of Emphysema? | Destruction of alveolar wall, leading to less available surface area for gas exchange |
| Which obstructive lung disease is characterized by a decreased surface area available for gas exchange? | Emphysema |
| PFTs of a patient with Emphysema: | - Reduced FEV1/ FVC ratio - Increased TLC and RV |
| Which volumes and/or capacities are increased in Emphysema? | TLC and RV |
| Increased or Decreased FEV1/FVC ratio in emphysema? | Decreased |
| The decreased surface area available for gas exchange in Emphysema results in --> | Decreased diffusion of O2 into blood, which then results in blood oxygen content becomes Diffusion-limieted |
| Emphysema causes a person to become: Diffusion-limited or Perfusion limited? | Diffusion-limited |
| What causes the becoming of diffusion-limited oxygen blood content in a person with Emphysema? | The decrease in diffusion of oxygen into blood due to less available surface area for gas exchange. |
| What are the common or typical symptoms and important factor for Altitude sickness? | Nausea, SOB, headache, fatigue, and high altitude |
| What is the pathogenesis of Altitude sickness? | The decrease in atmospheric pressure leads to development of chronic hypoxia and hyperventilation, which lead to Respiratory alkalosis |
| Altitude sickness produces Respiratory Acidosis or Respiratory Alkalosis? | Respiratory alkalosis |
| If Altitude sickness procedures Respiratory acidosis it means that pH and PaCO2? | Increase in blood pH and a decrease in PaCO2 |
| Which condition is compensated, in altitude sickness, by inducing Metabolic acidosis? | Respiratory alkalosis |
| Why is Pulmonary hypoplasia the MCC of death in children with Congenital Diaphragmatic hernia? | Impair growth and inflation of newborn's lungs |
| Other than Congenital diaphragmatic hernia, what is another important cause of Pulmonary hypoplasia? | Oligohydramnios |
| Oligohydramnios and Congenital diaphragmatic hernia, cause: | Pulmonary hypoplasia |
| How is NRDS commonly presented clinically? | Shortly after birth with tachycardia, tachypnea, and cyanosis |
| What does NRDS develops in neonates? | Due to lack of surfactant |
| Approximately until which week of gestation, does the fetus has developed or synthesized enough surfactant for survival? | 35th week |
| What is the function of surfactant? | Reduces surface tension by disrupting the hydrogen bonds between molecules of water, thereby preventing small alveoli from collapsing |
| What does the breakage of H-bonds of water by Surfactant prevent? | Small alveoli from collapse |
| During which two actions of respiration is intrapleural pressure NEGATIVE? | During inspiration and, During Passive Expiration |
| Intrapleural pressure is negative or positive in Inspiration? | Negative |
| Intrapleural pressure is negative or positive in Passive Expiration? | Negative |
| Intrapleural pressure is negative or positive in Forced (active) Expiration? | Positive |
| When is Intrapleural pressure positive? | Only during Forced (active) expiration |
| Which PFT is decreased in both Obstructive and Restrictive lung diseases? | Vital capacity |
| How is Vital Capacity (VC) reduced in Obstructive lung disease? | Due to reduced ability to expire air |
| How is Vital Capacity (VC) reduced in Restrictive lung disease? | Due to decreased ability to inspire air |
| The inability of expiring air normally in a Obstructive lung disease result in : | Decreased Vital Capacity) |
| VC is reduced in Obstructive or Restrictive lung profiles? | Both |
| What is commonly known to stabilize Deoxyhemoglobin? | Increased levels of 2, 3-BPG |
| How does elevated levels of 2, 3-BPG help unload oxygen to peripheral tissues? | It stabilizes deoxyhemoglobin which facilitates O2 unloading in the peripheral tissues |
| What condition stimulates the production of 2, 3-BPG? | High altitude |
| Incrase in 2,3-BPG creates a Right or Left shift of the Oxygen-Hemoglobin dissociation curve? | Right |
| What are the most important clinical manifestations of Methemoglobinemia? | Cyanosis and chocolate-colored blood |
| What are the most common causes of Methemoglobinemia? | Nitrates and Benzocaine |
| How do Nitrates cause Methemoglobinemia? | Induce the change of Fe2+ ----> Fe3+ |
| Condition in which Fe2+ is changed into Fe3+ | Methemoglobinemia |
| What is the treatment for Methemoglobinemia? | Methylene blue and vitamin C |
| What is Tension Pneumothorax? | Life-threatening condition where a penetrating chest wound allows ir to enter the chest but not to exit |
| The increased introduction of air, with no exit available, in a Tension Pneumothorax causes: | Increase in the intrathoracic pressure and causing a cardiopulmonary collapse |
| What condition is known to be caused by traumatic chest wound, allowing air to go into thorax, but no means to get out? | Tension pneumothorax |
| Pleural space pressure is mostly negative or positive? | Negative |
| What is the consequence of Pleural Space pressure, exposed to extremely high atmospheric pressure? | Forcibly collapses the lung, making it difficult for lungs to expand |
| What is an important association or relation of CO, Oxygen, and hemoglobin? | Carbon monoxide binds to Oxygen-sites in hemoglobin with an affinity 250x (times) greater than oxygen |
| What is there result of the extremely higher CO-Hb affinity than O2-Hb affinity? | Decreased Oxygen-carrying capacity of Hb and leftward shift of the O2-Hb dissociation curve |
| What common oxidizing agent may cause Methemoglobinemia? | Dapsone |
| What is an important adverse effect of Dapsone? | Methemoglobinemia |
| What is Mesothelioma? | Malignancy of the pleura associated with Asbestosis |
| Which jobs or activities are associated with Asbestosis expuse? | Roofing, Insulation, Shipbuilding, and Plumbing |
| What are Mesothelioma features? | 1. Hemorrhagic pleural effusions 2. Pleural thickening 3. Histological --> Psammoma bodies |
| How is CO poisoning commonly presented? | Confusion and headache after exposure to fire |
| Which metabolic process is affected by CN poisoning? | Oxidative phosphorylation |
| What is the relation of CN poisoning and oxygen in ATP synthesis? | Oxygen is unable to serve as final electron acceptor in the ETC leading to shut down of Oxidative phosphorylation |
| How is Bronchiectasis clinically presented? | Purulent cough, hemoptysis, rales and rhonchi on auscultation |
| What AR conditions highly associated with Bronchiectasis? | Cystic fibrosis |
| Which Obstructive Lung disease is associated with Cystic fibrosis? | Bronchiectasis |
| Reason for infections in Cystic fibrosis | Stasis of mucus in lungs serve as breeding ground for pathogens |
| What are common findings in Bronchiectasis? | 1. Purulent/bloody sputum 2. Recurrent infections (most commonly P. aeruginosa) 3. Hemoptysis 4. Digital clubbing |
| What is the pathogenesis of Bronchiectasis? | Chronic necrotizing infection of bronchi or obstruction leading to permanently dilated airways |
| What is an important B2-adrenergic receptor agonist? | Albuterol |
| Albuterol is an: | B2-adrenergic receptor agonist |
| What is the MOA of Albuterol? | Activate Gs protein-linked second messengers on smooth muscle tissue |
| Which protein is activated by Albuterol? | Gs protein linked second messenger |
| Which type of drugs are the first line of treatment for acute asthma exacerbation? | B2-adrenergic receptor agonist |
| Albuterol clinical use: | Acute asthma exacerbation |
| Which cytokine is bypassed by the administration of injection so INF-gamma? | IL-12 |
| Which immunodeficiency is treated with exogenous administration of INF-gamma? | IL-12 immunodeficiency |
| What is the essential role of IL-12? | Cell-mediated immune response which would cause secretion of INF-gamma and by TH1 cells |
| What is covered by Medicare Plan A? | 1. Hospital care 2. Skilled nursing facility care 3. Nursing home care 4. Hospice 5. Home health services |
| Is Hospice covered by medicare Plan A? | Yes |
| Enveloped, linear, dsDNA virus which is latent in mononuclear cells | CMV |
| Where is CMV ofen latent for later infection? | Mononuclear cells |
| CMV in Immunocompromised patients | Common cause of pneumonia in immunocompromised, especially those 1-4 moths post-transplant |
| Which pathogen is highly associated with pneumonia after a organ transplant few months back? | CMV |
| What is the cause of X-linked Agammaglobulinemia? | Inherited disease due to dereit in gene coding for Bruton Tyrosine Kinase |
| What enzyme is defective in X-agammaglobulinemia? | Bruton Tyrosine Kinase |
| Bruton Tyrosine kinase is essential for: | Maturation of B cells and its absence causes increase risk of bacterial infections |
| What is the treatment for X-agammaglobulinemia? | IV gamma-globin injections |
| Which condition is treated with IV gamma-globin injections? | X-Agammaglobulinemia |
| What is a common drug used for treatment of chronic asthma? | Zileuton |
| What is the common use for Zileuton? | Chronic asthma |
| MOA of Zileuton: | Inhibition of 5-Lipoxygenase pathway and blocking the conversion of Arachidonic acid to Leukotrienes |
| Leukotrienes are bronchoconstrictors or bronchodilators? | Bronchoconstrictors |
| Which drug is known to stop the conversion of Arachidonic acid into leukotrienes? | Zileuton |
| Which enzyme is inhibited by Zileuton? | 5-Lipoxygenase |
| List of factors that cause a right shift in the Oxygen-Hemoglobin dissociation curve: | 1. Decreased blood pH = increased acidity 2. Increased temperature 3. High-altitude training 4. Increased PaCO2 5. Increased 2,3-BPG |
| A decrease in pH will cause a right or left shift in the O2-Hb dissociation curve? | Right |
| Training at high altitude for sport reasons will cause a right or left shift in the O2-Hb curve? | Right |
| An athlete first arrives the elevated regions of Colorado, what is the body's first compensatory action? | Hyperventilation |
| Is 2, 3-BPG elevated or decreased in High altitude training? | Elevated |
| What is the effect of prolonged exposure to High altitude? | EPO is secreted by cortical and upper medullary cells of the kidney, leading to increased RBC production and therefore hematocrit |
| What is the main advantage or goal for training in a high-altitude location? | Increased production of RBCs due to elevated EPO production, cause improvement in blood oxygen carrying capacity, which reflects with increased endurance |
| How is the severity of asthma measured? | By the number of episodes per week and at night |
| What its the stepwise treatment for asthma? | SABA --> low-dose Inhaled corticosteroids (ICS) --> moderate-dose ICS --> High-dose ICS --> LABA ---> Oral corticosteroids |
| ICS stands for: | Inhaled corticosteroids |
| What is the1st line of treatment of chronic asthma? | Inhaled corticosteroids |
| What is the overall action or goal of corticosteroids in asthma? | Inhibit synthesis of all cytokines |
| Which drugs are known to inhibit synthesis of all cytokines? | Inhaled corticosteroids |
| Specific MOA of ICS: | Inactivate NF-kB, the transcription factor that induces production of TNF-alpha and other inflammatory agents |
| Which Transcription factor is inactivated by ICS? | NF-KB |
| What is the role or function of NF-kB? | Include production of TNF-alpha and other inflammatory agents |
| What is a common practice when using inhaled corticosteroids? | Use a spacer or rinse mouth after fuse to prevent oral thrush |
| A patient with trouble breathing after laying on recent cut grass, refers to use a medication and rinse mouth afterwards. Dx? | Asthma patient treated with ICS |
| What pathogen causes Scarlet Fever? | Streptococcus pyogenes |
| What condition is mediated by a pyrogenic exotoxin? | Scarlet Fever |
| What are the common and classic symptoms of Scarlet fever? | High fever Diffuse, erythematous, rough-texture (sandpaper) rash Strawberry tongue Hx of recent streptococcal pharyngitis |
| A child with a recent bout of strep throat, now presents with rough, diffuse rash all over back and extremities. Dx? | Scarlet fever |
| Important mediators of Anaphylaxis? | C3a, C4a, and C5a |
| In which hypersensitivity would C3a be involved? | Type I hypersensitivity |
| What is the characteristics of anaphylaxis? | Release of vasoactive amines (histamine) that cause hypotension, skin mucosal involvement, respiratory and GI symptoms |
| What is another name for Acid-Fast stain? | Ziehl-Neelsen stain |
| What type of infectious organisms are stained with Ziehl-Neelsen stain? | Mycobacterial infections such as TB |
| What is stained with Periodic Acid-Schiff stain? | Carbohydrate (glycogen) and fungi |
| Which disease may be diagnosed with an Periodic Acid-Schiff stain? | Whipple disease |
| What type of acid-base abnormality is seen with a Panic Attack? | Respiratory alkalosis |
| What is the range of normal ABG pH? | 7.35----7.45 |
| Normal range used for PCO2 in ABGs? | 36 ------ 44 |
| What is the range for HCO3 when reviewing ABGs? | 20------ 28 |
| Is a [HCO3] of 30, is elevated, normal, or decreased? | Elevated |
| A PCO2 of 30, is elevated, normal, or decreased? | Decreased |
| What is the most common cause of community-acquired pneumonia? | Pneumococcal pneumonia |
| What pathogen is known to cause Pneumococcal pneumonia? | Streptococcus pneumoniae |
| alpha-hemolytic, bile soluble, and Optochin sensitive | Streptococcus pneumoniae |
| What causes Kartagener syndrome? | Defect in molecular motor protien Dyenin |
| What is the end result of a defective Dynein protein in Kartagener syndrome? | Immotile cilia |
| What is the triad seen with Kartagener syndrome? | 1. Situs inversus 2. Chronic sinusitis 3. Bronchiectasis |
| Immunodeficiencies are often seen with: | Recurrent pneumonia and URIs |
| What is the MC immunodeficiency? | Selective IgA deficiency |
| IgA helps the prevention of: | Infections at mucosal surfaces, such Giardiasis |
| What is a key vignette Hx factor for Selective IgA deficiency? | Child with preview allergic reaction to blood transfusion |
| An allergic reaction to blood transfusion is a common indicator of which immunodeficiency? | Selective IgA deficiency |
| How is Hantavirus presented clinically? | Severe, sudden onset of Pulmonary Edema |
| Which part of the USA is most affected by Hantavirus? | Southwest |
| What is the natural reservoir of the Hantavirus? | Rodents |
| Which virus has rodents as it natural reservoir? | Hantavirus |
| How is the most common presentation of IL-12 deficiency in a child? | Recurrent or disseminated mycobacterial infection in a child |
| What cells are known to produce or secrete IL-12? | Macrophages |
| When do macrophages secrete IL-12? | After phagocytosis of mycobacterium |
| What is Idiopathic Pulmonary fibrosis? | Restrictive lung disease that result in Collagen deposits and hypoxia |
| What is the typical finding in imaging of Idiopathic Pulmonary fibrosis? | "Honeycombing" |
| What is often found due to the prolonged hypoxia of Idiopathic Pulmonary fibrosis? | Increased levels of EPO, and hematocrit |
| What type of pneumonia is caused by S. aureus? | Postviral lobar pneumonia |
| What is the primary virulence factor of Staph aureus? | Protein A |
| Which pathogen is known to have Protein A as its main virulence factor? | Staph aureus |
| Mild asthma airway remodeling is: | Reversible obstructive airway defect |
| How is the airway remodeling in chronic severe asthma? | Irreversible airway thickening and obstruction atha cannot be entirely reversed with inhaled B2-agonist therapy |
| What is the classical clinical presentation of PE? | Dyspnea and Chest pain |
| What is the best treatment for PE? | Heparin |
| Heparin is the immediate and best treatment for: | Acute PE |
| When is thrombolysis used as therapy for PE? | Massive PE with signs of hypotension and right ventricular dysfunction |
| Anaerobic organism often causative of aspiration pneumonia, in a healthy individual? | Peptostreptococcus |
| A patient with no history of alcoholism, muscle paralysis, or coma, is more likely to develop anaerobic aspiration pneumonia from Klebsiella or Peptostreptococcus? | Peptostreptococcus |
| What are the clinical signs of anaerobe-pneumonia? | 1. Cough productive of foul-smelling sputum 2. Association of poor dentition |
| Poor dentition is often associated with what type of respiratory condition? | Any condition caused by anaerobe organisms such as Peptostreptococcus |
Created by:
rakomi
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