respiratory

Question 1

alpha 1 antitrypsin deficiency is due to

Answer 1

mutation of Pi gene on chromosome 14

Question 2

exposure to asbestos fibers causes which one of the following X ray findings?

A. pleural blebs

B. Diffuse interstitial pulmonary fibrosis w/ irregular or linear opacities at the bases of the lungs

Answer 2

B

Question 3

pt hx of working in shipyards or manufacturing insulation

this is pathognomoic for exposure to?

Answer 3

asbestos

Question 4

pt has hx silicosis exposure and has silicotic nodules of varying sizes scattered throughout the lungs

now presents with FEVER.

what should you do?

Answer 4

PPD test for TB

TX if + = isonizid

if pt has negative sputum culture and negative chest xray then give isonizid for 9 months.

Question 5

construction

stone masonry

mining

sandblasting

**ceramics

all increase risk of

Answer 5

silicosis

Question 6

usual interstitial pneumonia

is also called?

Answer 6

idiopathic pulmonary fibrosis

its the most common and lethal usual interstitial pneumonia

• dypnea, cough,

no hx of infection, drugs or occupational exposure

coarse crackles and rales

Question 7

whats the pathology of restrictive lung disease caused by

sarcoidosis

Answer 7

exaggerated immune response w/ accumulation of lymphocytes and macrophages

Question 8

on the boards

breath sounds –> bronchial

percussion note –> dull

tactile fremitus –> increased

diagnosis?

Answer 8

lobar pneumonia

Question 9

on boards

pt with typical pneumonia

in the right lower lobe.

now complaining of shoulder pain with coughing

what is the cause of these symptoms

Answer 9

pneumonia involving the diaphragmatic pleura

Question 10

tx of streptococcus pnenumonia

Answer 10

doxycycline,

or

azithromycin

or

clarithromycin

Question 11

if pt has typical pneumonia caused by streptococcus pneumoniae

and has a comorbidity

how do you tx

Answer 11

admit (inpatient

levofloxacin IV

or

ceftriaxone + azithromycin

Question 12

pneumonia caused by legionella pneumophila

is diagnosed by

Answer 12

urinary antgen (radioimmunoassay)

Question 13

aspiration of endogenous oropharyngeal flora polymorphic gram + organism

Answer 13

aspriation pneumonia

Question 14

a pt with a clenched fist injury

(pt hit someone else in the mouth)

what microbe could be infected his hand

Answer 14

peptostreptococcus

Question 15

pneumonia clues for the boards

nursing home

Answer 15

klebsiella

Question 16

pneumonia clues for the boards

COPD pt

Answer 16

moraxella

or

H influ

Question 17

pneumonia clues for the boards

cattle, sheep, farmer

Answer 17

Q fever

Question 18

pneumonia clues for the boards

Birds

Answer 18

C. Psittacosis

Question 19

pneumonia clues for the boards

hunter

Answer 19

tularemia

Question 20

pneumonia clues for the boards

bat caves in mississippi, ohio river valleys

Answer 20

histoplasmosis

Question 21

pneumonia clues for the boards

California, arizona

Answer 21

Coccidiomycosis

(sarcoid like)*

Question 22

pneumonia clues for the boards

Chicago

(bone lesions)

Answer 22

blastomycosis

Question 23

pneumonia clues for the boards

Homosexual

Answer 23

P jiroveci P

Question 24

pneumonia clues for the boards

headache, diarrhea, and delirium confusion

Answer 24

legionella

(water cocolers, CXR worse

Question 25

pneumonia clues for the boards acute infection with HIV results in Reactivation of what latent infection

Answer 25

**TB**

Question 26

on boards what do these presentations represent? pt with severe injury to the chest wall or illegal abortion in underserved area. that now has emboli

Answer 26

**air embolism** due to **bubbling of air into the circulation**

Question 27

pts with hereditary pulmonary htn with mutations of **bone morphogenetic protein receptor type II (BMPR-II)** what is the cause of the pulm htn

Answer 27

**BMPR-II function** to **inhibit** **proliferation of vascular smooth muscle tissue** doesnt work anymore

Question 28

bronchoalveolar carcinoma arises from

Answer 28

**clara cells**

Question 29

how does large cell carcinoma of the lung cause gynecomastia

Answer 29

excessive secretion no **B - HCG --\>** high levels of estrogen and painful gynecomastia (breast enlargement) in males

Question 30

pt long hx of smoking, pt in ER brought by family bc he is confused his Na is 118. (normal 140) whats the cause

Answer 30

**SIADH --\> hyponatremia --\> confusion** ## Footnote (hes not losing Na - remember Na level on the electrolyte panel is not telling you about the Na in body but its telling you about how much water is in body. if high Na = pt dehydrated, if na is low = overhydrated) in small cell carcinoma.

Question 31

on boards **ataxia** in pt with long hx of smoking what is your diagnosis

Answer 31

**small cell carcinoma** (paraneoplastic syndrome) causing cerebellar (purkinje cell) degeneration/ **_subacute cerebeller degeneration_** due to **autoimmune.**