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Respiratory
Pathology: Respiratory
| Question | Answer |
|---|---|
| Dyspnea w/ decreased breath sounds, enlargement of air spaces on X-ray. Diagnosis | Emphysema (Pink puffer) loss of elastic tissue → hyperinflation, barrel chest, ↑ A/P to lateral diameter |
| What is the main cause of hypoxia in brochiectasis? | permanent dilation of the airways results in ineffective air acceleration out of the lungs |
| 1. Hypertrophy of the mucus secreting glands in the brochioles. 2. Hypertrophy of airway smooth .muscle | 1. chronic bronchitis 2. asthma |
| Obstructive disorders: 1. Elastance 2. Compliance 3. FVC 4. FEV1 5. FEV1/FVC 6. TLC 7. RV | 1. ↓ 2. ↑ 3. ↓ 4. ↓↓ 5. ↓ 6. ↑ 7. ↑ |
| Restrictive disorders: 1. Elastance 2. Compliance 3. FVC 4. FEV1 5. FEV1/FVC 6. TLC 7. RV | 1. ↑ 2. ↓ 3. ↓ 4. ↓ 5. ↔ or ↑ 6. ↓ 7. ↓ |
| 1. What is the normal function of elastic fibers in the airway? 2. Which pathology is noted for a decrease in elastic fibers? | 1. apply radial traction to help keep airways open 2. emphysema |
| Centriacinar emphysema 1. Site of elastic tissue destruction 2. What is the common cause? 3. Which lobes are usually effected? | 1. distal terminal bronchioles and respiratory bronchioles 2. smoking 3. upper lobes |
| Panacinar emphysema 1. Site of elastic tissue destruction 2. What is the common cause? 3. What is seen on serum protein electrophoresis? 4. Which lobes are usually effected? | 1. entire respiratory unit 2. α1-antitrypsin deficiency 3. absent α1-globulin peak 4. lower lobes |
| Which pathology presents with the following findings on CXR: 1. depressed diaphragm & vertically oriented heart 2. large horizontally oriented heart | 1. emphysema -hyperinflated lungs pushed down diaphragm 2. chronic bronchitis |
| What is the different between the pathogenesis of extrinsic and intrinsic asthma? | 1. extrinsic asthma is a type 1 hypersensitivity rxn caused by allergens 2. intrinsic is a rxn to external objects without IgE antibodies |
| What are the causes of intrinsic asthma (4)? | 1. virus induced respiratory infections 2. aspirin 3. air pollutants, smoke 4. stress, exercise |
| Emphysema or chronic bronchitis 1. cyanosis present 2. ↓ PaCO2 | 1. chronic bronchitis 2. emphysema |
| What are the steps of the initial sensitization to allergens seen in extrinsic asthma? | 1. allergen presented via MHC II to TH2 cells 2. TH2 releases IL-4 & IL-5 3. IL-4 → IgE production 4. IL-5 → eosinophil production |
| After the initial extrinsic asthmatic sensitization, how does a asthmatic reaction occur upon subsequent allergen exposure? | 1. inhaled allergens cross-link IgE antibodies with mast cells 2. mast cells release histamine and leukotrienes |
| 1. What causes Primary ciliary dyskinesia (PCD)? 2. What is the triad of findings frequently observed in PCD? | 1. absent dynein arm on cilia 2. triad of bronchiectasis, sinusitus and situs inversus |
| 1. Primary ciliary dyskinesia is also known as: 2. Why does it cause bronchiectasis? | 1. Kartegener's syndrome 2. failure to clear mucus → chronic infections → bronchiectasis |
| What are the common causes of bronchiectasis? | 1. cystic fibrosis 2. repeat infections 3. primary ciliary dyskinesia 4. allergic pulmonary aspergillosis |
| 1. What is the genetic defect in cystic fibrosis? 2. What is the inheritance pattern? 3. Which ethnicity has the highest incidence? | 1. 3 nucleotide deletion on chromosome 7 that normally codes for phenylalanine 2. autosomal recessive 3. whites |
| How does a defective CFTR affect secretions of sweat glands and lumenal epithelial cells? How does this lead to respiratory infection? | 1. sweat glands unable reabsorb NaCl which is then lost in sweat 2. lumenal epithelial cells unable to secrete Cl- so Na and water retained → ↓secretions & ↓ mucus clearance |
| Primary pulmonary hypertension is due to: | vascular smooth muscle proliferation (from mutation in BMPR2 which usually inhibits vascular smooth muscle proliferation) |
| What are the 3 classes of restrictive lung disorders? | 1. neuromuscular disease (myasthenia gravis) 2. Chest wall disorders (kyphoscoliosis) 3. Interstitial lung disease |
| What 2 pulmonary conditions could cause a tracheal shift to the left? | 1. ↓ volume of ipsilateral lung: spontaneous pneumothorax or atelectasis 2. ↑ contralateral pressure: pleural effusion or tension pneumothorax |
| 1. Hemoptysis followed by renal failure. 2. Pathogenesis of Acute Respiratory Distress Syndrome? 3. Most common cause of ARDS | 1. Goodpastures syndrome 2. inflammation → alveolar-capillary damage → exudation of fluid → pulmonary edema + hyaline membranes 3. Gram-negative sepsis |
| 1. pneumoconiosis + rheumatoid arthritis 2. Which pneumoconiosis has an increased risk for tuberculosis? | 1. Caplan syndrome 2. silicosis (impairs phagolysosome formation by macrophages) |
| 1. Unexplained pleural effusion in young women is usually.. 2. Cyanosis of newborn when breast feeding | 1. Systemic lupus erythematosus 2. choanal atresia; bony septum blocks passage from nose to pharynx |
| Sarcoidosis vs idiopathic pulmonary fibrosis 1. Which has a higher incidence in men? 2. Which has a higher incidence in women? 3. Which has higher incidence in African Americans? | 1. Idiopathic pulmonary fibrosis 2. Sarcoidosis 3. Sarcoidosis |
| What type of hypersensitivity reaction is hypersensitive pneumonitis? | type IV (forms granulomas) |
| 1. What is the normal FEV1/FVC ratio? 2. What is the ratio in restritive lung diseases? | 1. 0.80 2. 1.00 |
| What is the pathogenesis of the pneumoconioses? | small particles get phagocytosed by alveolar macrophages → release inflammatory mediators & initiate fibroblast proliferation w/collagen deposition |
| Silicosis vs Asbestosis 1. What is the fibrosing pattern? 2. What is the site of initial deposition? | 1. Silicosis: nodular fibrosis; upper lobe 2. Diffuse interstitial; lower lobe |
| Pneumoconiosis with: 1. fibrotic opacities not in hilar nodes 2. calcified nodular in hilar nodes 3. diffuse interstitial w/ calcified plaques 4. diffuse interstitial w/ noncaseating granulomas | 1. coal worker pneumoconiosis 2. silicosis 3. asbestosis 4. Berylliosis |
| 1. Define Sarcoidosis 2. What type of granulomas are seen in sarcoidosis? | multisystem granulomatous disease of unknown etiology 2. noncaseating |
| Pathogenesis of sarcoidosis | uknown antigen → ↑CD4/CD8 ratio → cytokine release → granuloma formation |
| 1. Obstructive lung disorder with honeycomb appearance on CXR. 2. Restrictive lung disorder with honeycomb appearance on CXR | 1. bronchiectasis 2. idiopathic pulmonary fibrosis |
| How does Peak Expiratory Flow (PEF) change in restrictive and obstructive lung disease? | both have decreased PEF |
| What is triad asthma? | 1. asthma 2. aspirin sensitivity 3. nasal polyps |
| What causes resorption atelectasis? | airway obstruction by mucus, aspiration of foreign material or centrally located bronchogenic carcimoa prevent air from reaching alveoli |
| What cause compression atelectasis? | air or fluid in the pleural cavity causes small airways to collapse from increased pressure |
| 1. Most common cause of atypical community acquired pneumonia? 2. What is seen on CXR in typical community acquired pneumonia that is not seen in atypical? | 1. mycoplasma pneumoniae 2. consolidation; typical pneumonia has inflammatory infiltrate in the alveolar spaces while atypical has infiltrate in the interstitium |
| 1. Where do the majority of pumonary thromboembolisms originate from? 2. Gold standard for pulmonary embolism diagnosis? | 1. femoral vein 2. pulmonary angiogram |
| What conditions make hemorrhagic infarction more likely in a patient with a pulmonary embolism? | 1. decreased bronchial artery blood flow (e.g. ↓ cardiac output) 2. previously underventilated lung (e.g. COPD) |
| 1. How is pulmonary hypertension diagnosed? 2. What is Cor pulmonale | 1. pulmonary artery pressure > 25 mmHg at rest or >30 mmHg with exercise 2. pulmonary hypertension + right ventricular hypertrophy leading to right sided heart failure |
| 1. How does Goodpasture syndrome usually present? 2. What classification of lung disease is it? 3. What type of hypersensitivity is Goodpastures? | 1. hemoptysis + renal failure 2. restrictive lung disease 3. Type II |
| What are the 5 main causes of secondary pulmonary hypertension | 1. hypoxemia → pulmonary vasoconstriction 2. respiratory acidosis → vasoconstriction 3. loss of pulmonary vasculature → overload of remaining vessels 4. left-to-right cardiac shunt → volume overload 5. backward failure: mitral stenosis or LH failure |
| 1. What is the definition of chronic bronchitis? 2. What is a solitary fibrous tumor? | 1. cough with sputum production for at least 3 months in 2 consecutive years 2. rare tumor, originating in the pleura |
| 1. Lung tumor with least favorable prognosis? 2. Lung tumor with hypercalcemia | 1. small cell 2. squamous cell → paneoplastic syndrome by secretion of PTH |
| 1. Emphysema associated with spontaneous pneumothoraxes 2. alveoli with hyaline membranes | 1. paraseptal 2. acute respiratory diseases |
| Pleural effusion resulting from lymphatic fluid accumulating in pleura cavity. Likely cause | Chylothorax; lymphatic obstruction from non-hodgkins lymphoma |
| Sudden death from a pulmonary embolism occurs from (2) | 1. hypoxemia 2. acute cor pulmonale with right sided heart failure |
| 1. Does atelectasis occur in a pulmonary embolism 2. When CHF or systemic lupus erythematosis produce a pleural effusion, is it an exudate or transudate? | 1. no. airway are not obstructed and lungs to not collapse 2. CHF → transudate; SLE → exudate |
| What type of hypersensitivy reaction is Farmer's lung? | (Hypersensitivity pneumonitis) type III hypersensitivity with immune complexes that deposit on lung tissue and can lead to type IV hypersensitivity with granulomatous inflammation |
| 1. Curshmann spirals or Charcot-Leyden crystals 2. Most common lung cancer | 1. Asthma 2. metastasis from other site |
| Lung tumor that secretes: 1. PTH 2. ADH or ACTH 3. serotonin | 1. squamous cell 2. small cell 3. bronchial carcinoid |
| 1. Coin lesion on CXR in a young patient is most likely 2 things: 2. Lung tumor associated with Eaton-Lambert Syndrome. | 1. bronchial hamartoma or granuloma from fungus/TB 2. small cell carcinoma |
| Peripheral lung tumors | 1. adenocarcinoma 2. some large cell carcinomas |
| Types of emboli | FAT BAT 1. Fat 2. Air 3. Thrombus 4. Bacteria 5. Amniotic Fluid 6. Tumor |
| 1. Most common type of lung cancer 2. Which obstructive lung disorder commonly has cor pulmonale 3. Most common cause of bronchiectasis in the US | 1. adenocarcinoma 2. chronic bronchitis 3. cystic fibrosis |
| 1. Usual cause of lobar pneumonia 2. Usual cause of interstitial pneumonia | 1. Streptococcus pneumonia 2. Mycoplasma pneumonia |
| 1. Non-productive cough: typical or atypical pneumonia? 2. Most common asbestos related tumor? | 1. atypical - inflammation is outside the alveoli, in the interstitium, and can not be coughed up 2. bronchiogenic carcinoma (anywhere along the bronchiole tree) |
| 1. Common gross cause of lung abscess 2. Most common patient with lung abscess | 1. Aspiration of oropharyngeal material 2. alcoholic from loss of gag reflex |
| Restrictive lung disorder caused by smoking | Desquamative interstitial pneumonia |
| Child with nasal polyp | Cystic fibrosis |
| Most common cause of 1. acute epiglottitis 2. laryngotracheobronchitis 3. rhinitis | 1. H influenza type B 2. (croup) parainfluenza virus 3. rhinovirus |
| Which cause of pneuomnia can lead to a cold hemolytic anemia? | Mycoplasma pneumoniae |
| Which section of the lung is colonized: 1. primary tuberculosis 2. secondary tuberculosis | 1. lower lobe and hilar lymph nodes 2. apex of lung |
| 1. What is the normal A1AT allele? 2. Which is the abnormal allele? | 1. PiM 2. PiZ |
| How does chronic bronchitis lead to cor pulmonale? | mucus plugs trap CO2 with ↓O2, leads to global hypoxic vasoconstriction |
| Granuloma in hilar lymph nodes with restrictive lung disease. 1. multiple organ involvement, hypercalcemia 2. aerospace worker | 1. Sarcoidosis 2. Berylliosis |
| What causes fibrosis in idiopathic pulmonary fibrosis? | TGF-β from injured pneumocytes induces fibrosis |
| Plexiform lesion in pulmonary artery biopsy in patient with dyspnea. | Pulmonary hypertension |
| Which two lung tumors stain positive for chromogranin? | Neuroendocrine tumors 1. small cell carcinoma 2. carinoid tumor |
| Lung tumor for intercellular bridges on microscope? | Squamous cell carcinoma ('bridges' are desmosomes between squamous cells seen when cells are pulled apart) |
| Which lung tumor arises from clara cells? | Bronchioloalveolar carcinoma |
| In asthma, which cytokines lead to: 1. IgE production 2. eosinophil production | 1. IL-4 2. IL-5 |
| Which obstructive lung disorder has a decrease diffusion capacity? | emphysema |
Created by:
amichael87
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