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49 Cards in this Set
- Front
- Back
Dyspnea occurs due to stimulation of what receptors?
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J receptors, causing a decrease in full inspiration
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What is the MC cause of cough with a normal chest xray?
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Postnasal discharge
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What can nocturnal cough be caused by?
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GERD (acid reflux in tracheobronchial tree at night)
Bronchial asthma (d/t bronchoconstriction) |
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Productive cough is typically caused by what problems?
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Chronic bronchitis
Typical bacterial pneumonia Bronchiectasis |
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What drugs can cause cought?
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ACE inhibitors (inhibit degradation of bradykinin; causes mucosal swelling and irritation in tracheobronchial tree)
Aspirin (increase in LT C-D-E4) |
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What are some causes of hemoptysis?
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Chronic bronchitis (MC cause)
Pneumonia, bronchogenic carcinoma TB, bronchiectasis, aspergilloma (fungus living in a cavitary lesion) |
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What are some causes of tachypnea?
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restrictive lung disease
pleuritic chest pain PE w/ infarction (key finding) |
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What diseases cause:
a) Decreased vocal tactile fremitus? b) Absent vocal tactile fremitus? c) Increased vocal tactile fremitus? |
a) Emphysema or asthma with increased AP diameter
b) Atelectasis, fluid, air in pleural space c) Alveolar consolidation (lobar pneumonia) |
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What can cause:
a) Dull percussion? b) Hyperresonant percussion? |
a) Pleural effusion, lung consolidation, atelectasis (no air in alveoli)
b) Pneumothorax, asthma, emphysema |
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What are some causes of crackles?
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pulmonary edema
lobar pneumonia intersititial fibrosis (e.g., sarcoidosis) |
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What are some causes of wheezing?
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Inflammation of segmental bronchi, small airways (e.g., asthma, chronic bronchitis)
Pulmonary edema constricting airway (called cardiac asthma) Pulmonary infarction (release of TXA2, from platelets in embolus causes bronchoconstriction) |
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What are some causes of inspiratory stridor?
What about both inspiratory and expiratory stridor? |
Epiglottitis (h influenzae) and croup (parainfluenza virus)
both is a sign of fixed upper airway obstruction (e.g., from cancer) |
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What are some causes of pleural friction rub?
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pleuritis d/t cancer, infarction, pneumonia, serositis (SLE)
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After how much time is grunting in newborns considered abnormal? What condition is it common in?
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after 24 hours
common in RDS |
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What are some causes of hypoxemia with an increased A-a gradient (>30 mm Hg)?
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Ventilation, perfusion, diffusion defects; right-to-left cardiac shunts
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What are some causes of hypoxemia with a normal A-a gradient (about 5 mm Hg)?
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Depression of respiratory center in medulla (barbiturates, brain injury); upper airway obstruction (epiglottitis h inflluenzae, croup parainfluenza); chest bellows disease (paralyzed diaphragm, ALS w/ degen of anterior horn cells)
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A newborn that becomes cyanotic when breast-feeding but "pinks up" again when crying may have what?
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Choanal atresia - unilateral or bilateral bony septum b/w nose and pharynx, can't breathe through nose
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What is the MC polyp seen in adults w/ a hx of IgE-mediated allergies?
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Allergic polyp
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What is the clinical triad for asthma?
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aspirin (NSAIDs), nasal polyp, asthma
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Which polyps most often occur in women w/ chronic pain syndromes?
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Nasal polyps a/w aspirin and other NSAIDs - drugs block COX leaving the lipoxygenase pathway open
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Nasal polyps in a child should cause you to order what test?
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Sweat test to rule out cystic fibrosis
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Patients with obstructive sleep apnea are at risk of developing what complication?
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pulmonary HTN leading to right ventricular hypertrophy
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Regarding sinusitis, which is the MC sinus involved in
a) adults? b) children? |
a) maxillary
b) ethmoid |
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What is the MC cause of sinusitis?
other causes? |
Viral URI (rhinoviruses)
also could be bacterial URI (MC - s pneumoniae, chronic - anaerobes, systemic fungi Mucor or Aspergillus), deviated nasal septum, allergic rhinitis, barotrauma, or smoking |
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What pathogen is commonly the cause of sinusitis in diabetics?
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Mucor species of systemic fungi
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What is the most sensitive test for sinusitis?
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CT scan
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What virus is a/w the pathogenesis of nasopharyngeal carcinoma?
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Epstein-Barr virus
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A chinese male presents w/ a mass in his nasopharynx and enlarged cervical lymph nodes. Biopsy shows that it is a squamous cell carcinoma. What is the likely dx?
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Nasopharyngeal carcinoma
commonly seen in males, in Chinese and African populations SCC or undifferentiated cancer metastasizes to cervical lymph nodes |
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What are risk factors for laryngeal carcinoma?
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Smoking (MC cause)
Alcohol (synergistic effect w/ smoking) Squamous papillomas and papillomatosis (HPV 6 and 11) |
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A smoker presents w/ persistent hoarseness and cervical lymphadenopathy. A mass is found on the left true vocal cord. Biopsy shows keratinizing squamous cell carcinoma. What's the dx?
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Laryngeal carcinoma
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What causes alveolar collapse in resorption atelectasis?
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lack of air and distal resorption of preexisting air through the pores of Kohn in the alveolar walls
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What is the MC cause of fever 24-36 hrs after surgery?
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Resorption atelectasis
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Surfactant is synthesized by __________ and stored in _______. Synthesis begins in ____ week of gestation.
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type II pneumocytes
lamellar bodies 28th week Phosphatidylcholine is the major component |
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Cortisol and thyroxine (decrease/increase) synthesis of surfactant.
Insulin (decreases/increases) synthesis of surfactant. |
Increase
Decreases |
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What are some causes of respiratory distress syndrome?
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Prematurity, maternal diabetes, C-section
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How can you increase fetal surfactant synthesis when they need to be delivered prematurely?
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Maternal intake of glucocorticoids
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Chest xray of newborn with RDS shows ___________ appearance.
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"ground-glass"
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What are some complications of RDS in newborns?
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blindness and bronchopulmonary dysplasia (d/t O2 therapy)
Intraventricular hemorrhage PDA (d/t persistent hypoxemia) Necrotizing enterocolitis (ischemia allows entry of gut bacteria into wall) Hypoglycemia (d/t excess insulin, can produce seizures and damage to neurons) |
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What is the MC cause of pulmonary edema?
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Left-sided heart failure
other causes: transudate - left heart failure, volume overload, mitral stenosis, nephrotic syndrome, cirrhosis exudate - sepsis, pneumonia, drowning, aspirated gastric contents, heroin, high altitude, ARDS |
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What are the main risk factors for ARDS?
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Sepsis, gastric aspiration and severe trauma w/ shock
also could be diffuse pulm infections (SARS, hantavirus), heroin, smoke, acute pancreatitis, cardiopulmonary bypass, DIC, amniotic fluid or fat embolism |
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Severe hypoxemia, PA wedge pressure <18 mm Hg, and an increased A-a gradient are all indicative of what?
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ARDS
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What is the MC cause of typical community--acquired pneumonia?
MC cause of atypical community-acquired pneumonia? |
streptococcus pneumoniae
mycoplasma pneumoniae |
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MC pathogen causing pneumonia in AIDS?
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Pneumocystis jiroveci
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What organism resides in phagosomes of alveolar macrophages, producing a protein that prevents fusion of lysosomes with phagosome?
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Mycobacterium tuberculosis
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What is the virulence factor of m TB?
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cord factor
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What is the MC extrapulmonary site in TB?
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Kidneys
adrenal involvement may result in Addison's dz |
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TB in the vertebra is called what?
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Pott's disease
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What is the MC type of TB in AIDS?
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MAC (mycobacterium avium-intracellulare complex)
occurs when CD4 count falls below 50 cells/mm3 |
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Hamptom's hump on chest xray is a/w what?
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Pulmonary thromboembolism
wedge-shaped area of consolidation |