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Pulmonary

FA review Round 1 2020

QuestionAnswer
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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