1) {{c1::Rhinitis}} is the inflammation of the nasal mucosa
2) What is the most common cause of rhinitis? {{c1::Rhinovirus}}
3) {{c1::Rhinitis}} presents with sneezing congestion and runny nose (common cold) 4) {{c1::Allergic rhinitis}} is a subtype of rhinitis due to a type {{c2::I}} hypersensitivity reaction (e.g. to pollen) 5) Allergic rhinitis is characterized by an inflammatory infiltrate with {{c1::eosinophils}} (WBC type) 6) Allergic rhinitis is associated with other atopic disorders such as {{c1::asthma}} and {{c2::eczema}} 7) {{c1::Nasal polyps}} are protrusions of edematous inflamed nasal mucosa 8) Nasal polyps are usually secondary to repeated bouts of {{c1::rhinitis}} 9) Nasal polyps are associated with {{c1::cystic fibrosis}} in children 10) Nasal polyps are associated with {{c1::aspirin-intolerant asthma}} in adults 11) {{c1::Aspirin-intolerant asthma}} is characterized by a triad of asthma aspirin-induced bronchospasms and nasal polyps 12) {{c1::Angiofibromas}} are benign tumors of nasal mucosa composed of large blood vessels and fibrous tissues 13) What demographic is classically associated with angiofibroma? {{c1::Adolescent males}} 14) Nasopharyngeal angiofibromas often present with profuse {{c1::epistaxis}} 15) {{c1::Nasopharyngeal carcinoma}} is a malignant tumor of nasopharyngeal epithelium 16) What virus is nasopharyngeal carcinoma associated with? {{c1::Ebstein-Barr Virus (EBV)}} 17) Nasopharyngeal carcinoma is classically seen in {{c1::African}} {{c2::children}} 18) Nasopharyngeal carcinoma is classically seen in {{c1::Chinese}} {{c2::adults}} 19) Biopsy of nasopharyngeal carcinoma usually reveals pleomorphic {{c1::keratin}}-positive epithelial cells in a background of {{c2::lymphocytes}} 20) Nasopharyngeal carcinoma often presents with involvement of {{c1::cervical}} lymph nodes 21) What is the most common cause of acute epiglottitis? {{c1::H. influenzae type B}} 22) Acute {{c1::epiglottitis}} presents with high fever sore throat and {{c2::drooling}} with dysphagia 23) Acute epiglottitis may present with muffled voice and inspiratory {{c1::stridor}} 24) Acute epiglottitis is associated with risk of acute {{c1::airway obstruction}} 25) What is the most common cause of laryngotracheobronchitis (croup)? {{c1::Parainfluenza virus}} 26) {{c2::Laryngotracheobronchitis (croup)}} presents with a hoarse, "{{c1::seal bark}}" cough and inspiratory stridor 27) Vocal cord nodules arise on the {{c1::true}} vocal cords 28) Vocal cord nodules are due to excessive use of vocal cords and are usually {{c1::bilateral}} (uni- or bilateral) 29) Vocal cord nodules are composed of degenerative {{c1::myxoid}} connective tissue 30) {{c1::Vocal cord (Singer's)}} nodules present with hoarseness and resolve with resting of voice 31) {{c1::Laryngeal papilloma}} is a benign papillary tumor of the vocal cord 32) What virus is associated with laryngeal papilloma? {{c1::HPV (strains 6 11)}} 33) Laryngeal papillomas are usually {{c1::single}} lesions in {{c2::adults}} 34) Laryngeal papillomas are usually {{c1::multiple}} lesions in {{c2::children}} 35) Laryngeal papillomas may have {{c1::koilocytic}} change on biopsy 36) Laryngeal papilloma often presents with {{c1::hoarseness}} 37) {{c1::Laryngeal carcinoma}} is a squamous cell carcinoma usually arising from the epithelial lining of the vocal cord 38) The major risk factors for laryngeal carcinoma are {{c1::alcohol}} and {{c1::tobacco}} 39) Laryngeal carcinoma can rarely arise from a laryngeal {{c1::papilloma}} 40) Laryngeal carcinoma often presents with {{c1::hoarseness}}; other signs include cough and stridor 41) {{c1::Pneumonia}} is defined as an infection of the lung parenchyma 42) Pneumonia often occurs when normal defenses are {{c1::impaired}} 43) Viral pneumonia may damage the {{c1::mucociliary escalator}} which consequently predisposes to superimposed bacterial pneumonia 44) Clinical features of pneumonia include productive cough with {{c1::yellow-green}} or {{c2::rusty}}-colored sputum (due to pus and blood respectively) 45) Pneumonia may present with {{c1::decreased}} breath sounds and {{c2::dullness}} to percussion 46) Pneumonia may present with fever chills and {{c1::elevated}} WBC count 47) Pneumonia may present as {{c1::tachypnea}} (respiratory rate) with {{c2::pleuritic}} chest pain 48) Diagnosis of pneumonia is made by {{c1::CXR}} and sputum & blood gram stain/culture 49) {{c1::Lobar}} pneumonia is characterized by consolidation of an entire lobe or lung 50) {{c2::Lobar}} pneumonia is characterized by neutrophils in the air sacs with an {{c1::intra-alveolar}} exudate (location) 51) {{c2::Lobar}} pneumonia is commonly caused by {{c1::Streptococcus pneumoniae}} (95%) and {{c3::Klebsiella pneumoniae}} (5%) 52) Initially lobar pneumonia presents with {{c1::congestion}} on gross imaging due to congested vessels and proteinaceous edema in the alveolar airspaces 53) Following the congestion phase lobar pneumonia presents grossly with {{c1::red hepatization}} due to exudate neutrophils and hemorrhage filling the alveolar air spaces 54) Following red hepatization lobar pneumonia presents grossly with {{c1::gray hepatization}} due to degradation of red blood cells within exudate 55) The final phase of lobar pneumonia is {{c1::resolution}} with regeneration of tissue via type {{c2::II}} pneumocytes 56) {{c1::Streptococcus pneumoniae}} is the most common cause of community-acquired pneumonia 57) {{c1::Klebsiella pneumoniae}} is a cause of pneumonia that most commonly effects the elderly alcoholics and diabetics (due to aspiration) 58) Pneumonia due to Klebsiella pneumoniae is caused by enteric flora that are {{c1::aspirated}} 59) {{c2::Klebsiella pneumoniae}} infection is characterized by a thick mucoid capsule that results in gelatinous '{{c1::currant jelly}}' sputum 60) Klebsiella pneumoniae is often complicated by {{c1::abscess}} formation in the lungs and liver 61) {{c1::Bronchopneumonia}} is characterized by {{c2::scattered patchy}} consolidation centered around {{c3::bronchioles}} 62) Bronchopneumonia is often multifocal and {{c1::bilateral}} (uni- or bilateral) 63) What type of pneumonia is characterized by acute inflammatory infiltrates from bronchioles into adjacent alveoli? {{c1::Bronchopneumonia}} 64) What type of pneumonia is typically caused by S. pneumoniae S. aureus H. influenzae and Klebsiella? {{c1::Bronchopneumonia}} 65) {{c1::Streptococcus pneumoniae}} is the most common cause of secondary pneumonia 66) Pneumonia due to Staphylococcus aureus is often complicated by {{c1::abscess}} formation or {{c2::empyema}} (pus in the pleural space) 67) {{c1::Haemophilus influenzae}} {{c2::Moraxella catarrhalis}} and {{c3::Legionella}} are common causes of pneumonia superimposed on {{c4::COPD}} 68) {{c1::Pseudomonas aeruginosa}} is a common cause of pneumonia in {{c2::cystic fibrosis}} patients 69) {{c1::Legionella pneumophila}} is a cause of pneumonia that is transmitted from {{c2::water}} sources 70) {{c1::Legionella pneumophila}} is a cause of pneumonia in immunocompromized patients that is best visualized by {{c2::silver}} stain 71) {{c1::Interstitial (atypical)}} pneumonia is characterized by diffuse interstitial infiltrates 72) {{c1::Atypical}} pneumonia is characterized by diffuse patchy inflammation that is localized to {{c2::interstitial}} areas at alveolar walls 73) How many lobes does interstitial (atypical) pneumonia typically involve? {{c1::> 1}} 74) {{c1::Interstitial (atypical)}} pneumonia presents with relatively mild upper respiratory symptoms 75) What type of pneumonia is typically caused by Mycoplasma Chlamydia Legionella and viruses (RSV CMV influenza adenovirus)? {{c1::Interstitial (atypical) pneumonia}} 76) {{c1::Mycoplasma pneumoniae}} is the most common cause of atypical pneumonia in young adults 77) What demographic is commonly affected by Mycoplasma pneumoniae? {{c1::young adults especially those living in close quarters}} 78) One complication of Mycoplasma pneumoniae is autoimmune {{c1::hemolytic anemia}} due to high concentrations of cold agglutinins (IgM) 79) What gram stain is Mycoplasma pneumoniae characterized by? {{c1::No stain (lacks cell wall)}} 80) {{c2::Chlamydia pneumoniae}} is the second most common cause of {{c1::atypical}} pneumonia in young adults 81) {{c1::Respiratory syncytial virus (RSV)}} is the most common cause of atypical pneumonia in infants 82) {{c1::Cytomegalovirus (CMV)}} is a common cause of atypical pneumonia in post-transplant patients on immunosuppressive therapy 83) {{c1::Influenza}} is a common viral cause of atypical pneumonia in the elderly 84) {{c1::Influenza}} virus increases the risk for superimposed bacterial pneumonia (e.g. by S. aureus H. influenzae) 85) {{c1::Coxiella burnetii}} infection is a cause of atypical pneumonia with high fever (Q fever) 86) What demographic is associated with Coxiella burnetii pneumonia? {{c1::Farmers and veterinarians}} 87) Lung {{c1::abscess}} is a localized collection of pus within the parenchyma 88) Lung abscess is often caused by {{c1::aspiration}} of oropharyngeal contents 89) Lung abscess commonly occurs in patients predisposed to {{c1::loss of consciousness}} (e.g. alcoholics epileptics) 90) Lung abscess may occur in patients with {{c1::bronchial obstruction}} (e.g. cancer) 91) Lung abscesses are commonly due to {{c1::anaerobic}} bacteria such as {{c2::Bacteroides}} {{c3::Fusobacterium}} {{c4::Peptostreptococcus}} and Prevotella 92) Lung abscesses may present with {{c1::air-fluid levels}} on CXR which suggests {{c2::cavitation}} 93) What drug is commonly used to treat lung abscesses? {{c1::Clindamycin}} 94) Lung abscess secondary to aspiration is most commonly found in the {{c1::right}} lung (left/right) 95) If a patient is {{c2::upright}} during aspiration an abscess is most likely to form in the {{c1::basal}} segments of the right lower lobe of the lung 96) If a patient is {{c2::lying on their right side}} during aspiration an abscess may form in the {{c1::posterior}} segment of the right {{c3::upper}} lobe of the lung 97) {{c2::Tuberculosis}} is due to inhalation of aerosolized {{c1::Mycobacterium tuberculosis}} 98) Primary TB results in focal caseating necrosis in the {{c1::lower}} or {{c1::middle}} lobes of the lung and {{c2::hilar}} lymph nodes 99) Primary TB classically forms a {{c1::Ghon complex}} which is a calcified granulomatous lesion with hilar lymphadenopathy 100) What symptoms does primary TB typically present with? {{c1::Generally asymptomatic}} 101) Secondary TB typically effects the {{c1::apex}} of the lung due to high oxygen tension 102) Primary tuberculosis may progress to {{c1::miliary}} tuberculosis which is a systemic spread of TB that may lead to multi-organ failure 103) What type of pneumonia may be caused by tuberculosis? {{c1::Tuberculous bronchopneumonia}} 104) Clinical features of secondary TB include fever and night {{c1::sweats}} 105) Clinical features of secondary TB include cough with {{c1::hemoptysis}} and weight {{c2::loss}} 106) Biopsy of tuberculosis reveals {{c1::caseating}} granulomas 107) What stain is Mycobacterium tuberculosis characterized by? {{c1::Acid fast}} 108) Secondary TB may involve the CNS causing {{c1::meningitis}} with granulomas at the {{c2::base}} of the brain 109) Secondary TB may involve the kidneys causing sterile {{c1::pyuria}} 110) Secondary TB may involve the lumbar vertebrae causing {{c1::Pott}} disease 111) Obstructive lung diseases are characterized by obstruction of air flow resulting in air {{c1::trapping}} in lungs 112) {{c2::Obstructive}} lung diseases are characterized by a {{c1::decreased}} FEV1/FVC ratio 113) Obstructive lung diseases are characterized by a(n) {{c1::increased}} total lung capacity 114) Obstructive lung diseases are characterized by a(n) {{c1::increased}} residual volume and functional residual capacity 115) {{c3::Chronic bronchitis}} is defined as a {{c1::productive cough}} lasting > {{c2::3}} months per year for > {{c2::2}} years 116) Chronic bronchitis is highly associated with {{c1::smoking}} (risk factor) 117) Chronic bronchitis is characterized by hypertrophy/hyperplasia of bronchial {{c1::mucinous}} glands 118) {{c3::Chronic bronchitis}} leads to an increased {{c1::Reid}} index which is the thickness of {{c2::mucus glands}} relative to the {{c2::overall bronchial wall}} thickness 119) In chronic bronchitis the Reid index is > {{c1::50}}% (normal is < {{c1::40}}%) 120) Chronic bronchitis is associated with {{c1::cyanosis}} due to early-onset hypoxemia from shunting 121) Chronic bronchitis is associated with {{c1::CO2}} retention (hypercapnia) due to mucus plug trapping 122) What sounds (2) may be heard on respiratory exam in a patient with chronic bronchitis? {{c1::wheezing crackles}} 123) Chronic complications of chronic bronchitis include pulmonary hypertension with progression to {{c1::cor pulmonale}} 124) Chronic bronchitis patients have increased risk of acquiring {{c1::infection}} 125) What effect may chronic bronchitis secondarily have on RBC levels? {{c1::Increased (polycythemia)}} 126) Chronic bronchitis is associated with {{c1::increased}} Paco2 and {{c1::decreased}} Pao2 127) Chronic bronchitis presents with {{c1::productive cough}} due to excessive mucus production and late-onset {{c2::dyspnea}} 128) Emphysema is characterized by {{c1::enlargement}} of air spaces 129) {{c3::Emphysema}} is characterized by the {{c1::destruction}} of {{c2::alveolar air sacs}} 130) Emphysema is characterized by loss of {{c1::elastic recoil}} which inhibits the ability to exhale air from the alveoli (air trapping) 131) Emphysema is characterized by loss of elastic recoil which may lead to airway {{c1::collapse}} during exhalation 132) Emphysema is due to an imbalance of {{c1::proteases}} (e.g. elastase) and {{c1::antiproteases}} (e.g. α1-antitrypsin) 133) Inflammation in the lung normally leads to release of {{c1::proteases}} by {{c2::neutrophils}} and {{c2::macrophages}} 134) {{c1::α1-antitrypsin}} is an enzyme that neutralizes {{c2::proteases (e.g. elastase)}} in the lung 135) Emphysema may be caused by excessive {{c1::inflammation/proteases}} or lack of {{c2::α1-antitrypsin}} 136) The most common cause of emphysema is {{c1::smoking}} 137) {{c3::Smoking}} results in {{c1::centriacinar}} emphysema that is most severe in the {{c2::upper}} lobes of the lung 138) {{c3::α1-antitrypsin deficiency}} results in {{c1::panacinar}} emphysema that is most severe in the {{c2::lower}} lobes of the lung 139) α1-antitrypsin deficiency is due to {{c1::misfolding}} of the mutated protein 140) What liver pathology is associated with α1-antitrypsin deficiency? {{c1::Cirrhosis}} 141) Mutant α1-antitrypsin polymerizes and accumulates in the {{c1::endoplasmic reticulum}} of hepatocytes resulting in liver damage (e.g. cirrhosis) 142) {{c3::α1-antitrypsin}} deficiency is characterized by {{c2::pink/purple}} colored {{c1::PAS}}-positive globules in hepatocytes 143) What is the normal allele for α1-antitrypsin? {{c1::PiM}} 144) What is the most clinically significant mutant allele for α1-antitrypsin? {{c1::PiZ}} 145) What genotype is associated with an asymptomatic phenotype with decreased α1-antitrypsin? {{c1::PiMZ heterozygotes}} 146) PiMZ heterozygotes (α1-antitrypsin) are at significant risk for emphysema if they {{c1::smoke}} 147) What genotype is associated with significant risk for panacinar emphysema and liver cirrhosis (α1-antitrypsin)? {{c1::PiZZ homozygotes}} 148) Clinical features of emphysema include dyspnea and cough with {{c1::minimal}} sputum production (quantity) 149) {{c3::Emphysema}} often presents with {{c1::prolonged}} expiration with {{c2::pursed}} lips 150) Emphysema may present with weight {{c1::loss}} 151) Emphysema is characterized by increased {{c1::AP}} diameter with a flattened {{c2::diaphragm}} on CXR 152) Emphysema may present with {{c1::increased}} lung field lucency on CXR 153) Chronic complications of emphysema include {{c1::hypoxemia}} (due to destruction of capillaries in the alveolar sac) with eventual cor pulmonale 154) {{c1::Asthma}} is defined as bronchial hyperresponsiveness with reversible airway bronchoconstriction 155) Asthma is most often due to {{c2::allergic stimuli}} (type {{c1::I}} HSR) but may also be triggered by viral URIs and stress 156) Asthma is often associated with {{c1::allergic rhinitis}} {{c2::eczema}} and a family history of {{c3::atopy}} 157) Asthma most commonly presents in {{c1::childhood}} (age group) 158) Pathogenesis of asthma involves allergens inducing a TH{{c1::2}} phenotype in CD4+ T cells of genetically susceptible individuals 159) Asthma pathogenesis: TH2 cells secrete IL-{{c1::4}} which mediates class switching to {{c2::IgE}} 160) Asthma pathogenesis: TH2 cells secrete IL-{{c1::5}} which attracts {{c2::eosinophils}} 161) Asthma pathogenesis: TH2 cells secrete IL-{{c1::10}} which stimulates TH2 cells and inhibits TH1 cells 162) Re-exposure to an allergen in asthmatics leads to IgE-mediated activation of {{c1::mast}} cells 163) In an asthmatic response mast cells release preformed {{c1::histamine}} granules (early-phase reaction) 164) In an asthmatic response mast cells lead to generation of leukotrienes {{c1::C4}} {{c1::D4}} and {{c1::E4}} (early-phase reaction) 165) In an asthmatic response inflammatory mediators especially {{c1::major basic protein}} from eosinophils damages cells and perpetuates bronchoconstriction (late-phase reaction) 166) One clinical feature of {{c3::asthma}} is a productive cough with {{c1::spiral}}-shaped mucus plugs known as {{c2::Curschmann spirals}} 167) One clinical feature of {{c3::asthma}} is a productive cough with {{c2::eosinophil}}-derived crystals known as {{c1::Charcot-Leyden}} crystals 168) Asthma is associated with bronchial smooth muscle {{c1::hypertrophy}} 169) Clinical diagnosis of asthma may be aided with {{c1::spirometry}} (PFTs) and {{c2::methacholine}} challenge 170) Asthma classically presents with episodic cough dyspnea and {{c1::wheezing}} (lung sound) 171) Asthma may present with {{c1::tachypnea}} (respiratory rate) 172) Which form of lung disease is associated with pulsus paradoxus? {{c1::obstructive::restrictive or obstructive?}} 173) Asthma may present with a(n) {{c1::decreased}} inspiratory/expiratory ratio 174) Asthma may cause excessive production of mucus with resultant mucus {{c1::plugging}} 175) Asthma may present with {{c1::peribronchial cuffing}} on CXR 176) Severe unrelenting asthma attacks can result in {{c1::status asthmaticus}} and death 177) {{c1::Bronchiectasis}} is defined as the permanent dilatation of bronchioles and bronchi 178) Bronchiectasis is due to chronic {{c1::necrotizing}} inflammation or {{c2::obstruction}} which results in permanently dilated airways 179) {{c1::Bronchiectasis}} is an obstructive lung disease that may be caused by cystic fibrosis 180) Which obstructive lung disease may be caused by Kartagener syndrome? {{c1::Bronchiectasis}} 181) Bronchiectasis is associated with bronchial {{c1::obstruction}} such as a tumor or foreign body 182) Bronchiectasis is associated with poor {{c1::ciliary}} motility (e.g. smoking Kartagener syndrome) 183) Bronchiectasis is associated with {{c1::allergic bronchopulmonary aspergillosis}} which is a hypersensitivity reaction to Aspergillus 184) Which obstructive lung disease may be caused by allergic bronchopulmonary aspergillosis? {{c1::Bronchiectasis}} 185) Allergic bronchopulmonary aspergillosis is usually seen in individuals with {{c1::asthma}} or {{c2::cystic fibrosis}} 186) Bronchiectasis may present with dyspnea and cough with {{c1::hemoptysis}} 187) Bronchiectasis is associated with recurrent infections and {{c1::foul}}-smelling {{c2::purulent}} sputum 188) Bronchiectasis may cause digital {{c1::clubbing}} 189) Complications of bronchiectasis include secondary {{c1::(AA) amyloidosis}} and hypoxemia with cor pulmonale 190) Which obstructive lung disease is associated with secondary (AA) amyloidosis? {{c1::Bronchiectasis}} 191) Generally obstructive lung diseases increase risk for chronic hypoxic pulmonary vasoconstriction with subsequent {{c1::cor pulmonale}} 192) {{c1::Restrictive}} lung diseases are characterized by a FEV1/FVC ratio {{c2::>}} 80% 193) Restrictive lung diseases are characterized by a {{c1::decreased}} total lung capacity 194) Restrictive lung diseases are characterized by a {{c1::decreased}} residual volume and functional residual capacity 195) Restrictive lung diseases are most commonly due to {{c1::interstitial}} diseases of the lung 196) {{c1::Idiopathic pulmonary fibrosis}} is fibrosis of the lung interstitium with unknown cause 197) {{c1::Idiopathic pulmonary fibrosis }} is likely related to cyclical lung injury with {{c2::TGF-β}} from injured pneumocytes inducing increased collagen deposition and fibrosis 198) Idiopathic pulmonary fibrosis presents clinically with progressive {{c1::dyspnea}} cough and digital {{c2::clubbing}} 199) Idiopathic pulmonary fibrosis is initially seen on CT in {{c1::subpleural}} patches 200) {{c2::Idiopathic pulmonary fibrosis}} eventually results in diffuse fibrosis with end-stage '{{c1::honeycomb}}' lung on CT 201) What is the treatment for idiopathic pulmonary fibrosis? {{c1::Lung transplant}} 202) {{c1::Pneumoconioses}} are a subset of {{c3::restrictive}} lung diseases characterized by interstitial fibrosis due to {{c2::occupational}} exposure 203) Pneumoconioses requires chronic exposure to small particles that are {{c1::fibrogenic}} 204) Pneumoconioses are due to release of {{c2::fibrogenic}} factors from {{c1::alveolar macrophages}} that have engulfed foreign fibrogenic particles 205) Coal workers' pneumoconiosis results from prolonged {{c1::coal (carbon) dust}} exposure 206) {{c2::Coal workers' pneumoconiosis}} is also known as "{{c1::black lung}} disease" 207) Mild exposure to carbon (e.g. pollution) results in {{c1::anthracosis}} which is an asymptomatic condition characterized by collections of carbon- laden macrophages 208) Coal workers' pneumoconiosis most commonly effects the {{c1::upper}} lobes of the lung 209) {{c1::Coal workers' pneumoconiosis}} is characterized by macrophages laden with {{c2::carbon}} causing inflammation and fibrosis 210) {{c2::Silicosis}} is a pneumoconiosis that results from prolonged {{c1::silica}} exposure 211) Silicosis is seen in {{c2::sandblasters}} silica miners and {{c1::foundries}} 212) Silica may impair {{c1::macrophages}} and disrupt {{c1::phagolysosome}} formation increasing susceptibility to {{c2::TB}} 213) What pneumoconiosis has an increased risk for TB? {{c1::Silicosis}} 214) Silicosis presents with fibrotic nodules in the {{c1::upper}} lobes of the lung 215) Silicosis may present with "{{c1::eggshell}}" calcification of the {{c2::hilar}} lymph nodes 216) Berylliosis results from prolonged {{c1::beryllium}} exposure 217) {{c1::Berylliosis}} is a pneumoconiosis that is seen in {{c3::miners}} and workers in the {{c2::aerospace}} and electronic manufacturing industries 218) Berylliosis most commonly effects the {{c1::upper}} lobes of the lung 219) Berylliosis is characterized by a {{c1::granulomatous}} histology and therefore is occassionally responsive to treatment with {{c2::steroids}} 220) {{c1::Berylliosis}} is a pneumoconiosis that presents with {{c2::noncaseating granulomas}} in the lung hilar lymph nodes and systemic organs 221) Berylliosis increases risk for {{c1::lung}} cancer 222) Asbestosis results from prolonged exposure to {{c1::asbestos}} fibers 223) Asbestosis is commonly seen in {{c1::construction}} workers {{c2::shipyard}} workers and {{c3::plumbers}} 224) {{c1::Asbestosis}} is associated with increased risk for {{c2::lung carcinoma}} and {{c2::mesothelioma}} (cancers) 225) Which is more common in individuals exposed to asbestos: lung (bronchogenic) carcinoma or mesothelioma? {{c1::Lung carcinoma}} 226) {{c1::Asbestosis}} presents with "Ivory white", calcified supradiaphragmatic and pleural plaques 227) Asbestosis lesions may contain {{c1::Asbestos (ferruginous)}} bodies which are golden-brown fusiform rods resembling dumbbells 228) Asbestos bodies may be found in an alveolar septum sputum sample often obtained by {{c1::bronchoalveolar lavage}} 229) Asbestos bodies contain {{c1::iron}} and thus may be visualized using a {{c1::Prussian blue}} stain 230) Asbestosis most commonly effects the {{c1::lower}} lobes of the lung 231) {{c1::Caplan}} syndrome is a combination of {{c2::rheumatoid arthritis}} and {{c2::pneumoconiosis}} with intrapulmonary nodules 232) Sarcoidosis is a systemic disease characterized by widespread {{c1::noncaseating}} granulomas 233) What demographic is associated with sarcoidosis? {{c1::African American females}} 234) Sarcoidosis is likely due to CD{{c1::4}}+ T-cell response to an unknown antigen 235) Granulomas due to sarcoidosis often have characteristic {{c1::stellate}}-shaped inclusions ('{{c2::asteroid}} bodies') within giant cells 236) Granulomas due to sarcoidosis may have {{c1::Schaumann}} bodies which are calcium and protein inclusions inside of giant cells 237) Granulomas due to sarcoidosis most commonly involve the {{c1::hilar}} lymph nodes and the {{c1::lung}} leading to {{c2::restrictive}} lung disease 238) What eye pathology is associated with sarcoidosis? {{c1::Uveitis}} 239) What skin pathologies are associated with sarcoidosis? {{c1::Cutaneous nodules}} {{c2::Erythema nodosum}} {{c3::Lupus Pernio}} 240) Sarcoidosis is associated with {{c1::lupus pernio}} which are skin lesions on the face resembling lupus 241) Sarcoidosis may involve the salivary and lacrimal glands which mimics {{c1::Sjogren}} syndrome 242) Sarcoidosis is associated with {{c1::Bell palsy}} a type of facial paralysis 243) Sarcoidosis is associated with {{c1::hypercalcemia}} due to increased {{c2::1α-hydroxylase}} activity in epithelioid histiocytes 244) Sarcoidosis is associated with elevated serum levels of the enzyme {{c1::angiotensin converting enzyme (ACE)}} 245) What is the treatment for sarcoidosis? {{c1::Steroids (if symptomatic)}} 246) What are the most common presenting symptoms (2) of pulmonary sarcoidosis? {{c1::Dyspnea Cough}} 247) Sarcoidosis is associated with {{c1::elevated}} CD{{c2::4}}+/CD{{c2::8}}+ ratio in bronchoalveolar lavage fluid 248) Sarcoidosis is often asymptomatic except for enlarged {{c1::lymph nodes}} 249) Sarcoidosis may be visualized on CXR as {{c1::bilateral hilar lymphadenopathy}} and coarse reticular opacities 250) {{c1::Hypersensitivity pneumonitis}} is an autoimmune reaction that generates {{c2::granulomas}} in response to inhaled organic antigens (e.g. pigeon breeders lung) 251) Hypersensitivity pneumonitis is a mixed type {{c1::III}}/{{c1::IV}} hypersensitivity reaction 252) Hypersensitivity pneumonitis is often seen in {{c1::farmers}} and those exposed to {{c2::birds}} 253) Hypersensitivity pneumonitis presents with {{c1::fever}} cough and dyspnea hours after exposure; resolves with removal of exposure 254) Hypersensitivity pneumonitis can lead to interstitial fibrosis and {{c1::restrictive}} lung disease with chronic exposure to the inhaled antigen 255) The normal mean pulmonary artery pressure is between {{c1::10}} and {{c1::14}} mmHg 256) Pulmonary hypertension is defined as a mean pulmonary artery pressure > {{c1::25}} at rest 257) Pulmonary hypertension is characterized by {{c1::atherosclerosis}} of the pulmonary trunk 258) Pulmonary hypertension is characterized by {{c1::smooth muscle (medial)}} {{c2::hypertrophy}} of pulmonary arteries 259) Pulmonary hypertension is characterized by {{c1::intimal}} {{c2::fibrosis}} of pulmonary arteries 260) {{c1::Plexiform}} lesions are small vascular channels that may be seen with severe long standing pulmonary {{c2::hypertension}} 261) Pulmonary hypertension leads to RV {{c1::hypertrophy}} with eventual {{c2::cor pulmonale}} 262) Pulmonary hypertension may present with exertional {{c1::dyspnea}} and {{c2::right}}-sided heart failure 263) What demographic is classically associated with primary pulmonary hypertension? {{c1::Young adult females}} 264) Heritable {{c3::pulmonary hypertension}} can be due to {{c1::inactivating}} mutations of the {{c2::BMPR2}} gene 265) The BMPR2 gene normally inhibits {{c1::vascular smooth muscle}} proliferation 266) What is the prognosis of heritable pulmonary hypertension? {{c1::Poor prognosis}} 267) The cause of primary pulmonary arterial hypertension (PAH) is often {{c1::idiopathic}} 268) Secondary pulmonary hypertension due to Lung Disease may arise due to {{c1::damage / inflammation}} of lung parenchyma (e.g. COPD / Interstitial lung disease) or {{c2::hypoxic pulmonary vasoconstriction}} (e.g. obstructive sleep apnea high altitude) 269) Secondary pulmonary hypertension due to Heart Disease may arise due to increased {{c1::volume}} in the pulmonary circuit (e.g. left heart failure congenital heart disease) 270) Secondary pulmonary hypertension due to Chronic {{c1::Thromboemboli }} may arise with recurrent pulmonary {{c1::embolism}} or {{c2::microthrombi}} 271) Another type of secondary pulmonary hypertension may arise due to {{c1::multifactorial}} causes such as hematologic systemic and metabolic disorders 272) Acute {{c2::(aka Adult) respiratory distress syndrome (ARDS)}} is caused by diffuse alveolar damage with impairment of the {{c1::alveolar- capillary}} interface 273) Damage to the alveolar-capillary interface leads to {{c1::increased}} alveolar-capillary permeability 274) In ARDS leakage of protein-rich fluid leads to noncardiogenic pulmonary {{c1::edema}} (normal PCWP) 275) In ARDS leakage of protein-rich fluid leads to formation of intra-alveolar {{c1::hyaline}} membranes 276) Clinical features of ARDS include hypoxemia and cyanosis with respiratory distress due to a {{c1::thickened}} diffusion barrier 277) Clinical features of ARDS include hypoxemia and cyanosis with respiratory distress due to {{c1::collapse}} of air sacs 278) Acute respiratory distress syndrome presents with a "{{c1::white-out}}" appearance on CXR 279) {{c1::Acute Respiratory Distress Syndrome (ARDS)}} is a clinical syndrome characterized by acute onset respiratory failure with bilateral lung opacities and no evidence of HF/fluid overload 280) ARDS is a diagnosis of exclusion with the following criteria (ARDS) - Abnormal chest x-ray - Respiratory failure within {{c1::1 week}} of insult - Decreased {{c2::Pao2 / FIO2}} ratio - Symptoms of respiratory failure are not due to HF/fluid overload 281) The causes of {{c8::acute respiratory distress}} syndrome may be remembered with "SPARTAS" S: {{c1::Sepsis}} P: {{c2::Pancreatitis}}, {{c2::Pneumonia}} A: {{c3::Aspiration}} R: {{c4::uRemia}} T: {{c5::Trauma}} A: {{c6::Amniotic fluid embolism}} S: {{c7::Shock}} 282) In ARDS activation of {{c2::neutrophils}} by proinflammatory cytokines induces {{c3::free radical}} and {{c3::protease}}-mediated damage of {{c1::both type I and II}} pneumocytes 283) Treatment of ARDS includes addressing the {{c1::underlying cause}} 284) Treatment of ARDS includes mechanical ventilation with {{c2::positive end-expiratory pressure (PEEP)}} and most importantly {{c1::low}} tidal volumes 285) Recovery of ARDS may be complicated by {{c1::interstitial fibrosis/scarring}} due to loss of type II pneumocytes 286) {{c2::Neonatal respiratory distress}} syndrome is respiratory distress due to inadequate {{c1::surfactant}} levels 287) Surfactant decreases {{c2::surface tension}} in the lung preventing {{c1::collapse}} of alveolar air sacs after expiration 288) Neonatal respiratory distress syndrome is associated with {{c1::premature}} birth 289) The {{c1::lecithin}}:{{c2::sphingomyelin}} ratio in amniotic fluid is used to screen for {{c3::lung}} maturity 290) As surfactant production is increased (fetal lung maturation) {{c1::lecithin}} levels {{c2::increase}} while {{c1::sphingomyelin}} levels {{c2::remain constant}} 291) What lecithin:sphingomyelin ratio is indicative of adequate surfactant production? {{c1::> 2}} 292) What lecithin:sphingomyelin ratio is predictive of NRDS? {{c1::< 1.5}} 293) Neonatal respiratory distress syndrome is associated with {{c1::C-section delivery}} due to decreased stress-induced release of fetal {{c2::glucocorticoids}} 294) Neonatal respiratory distress syndrome is associated with {{c1::maternal diabetes}} due to increased levels of fetal {{c2::insulin}} 295) What is the effect of increased fetal insulin on surfactant production? {{c1::Decreased surfactant production}} 296) NRDS presents with {{c1::increased}} respiratory effort after birth 297) NRDS may present with {{c1::tachypnea}} (respiratory rate) with use of accessory muscles and grunting 298) Neonatal respiratory distress syndrome is associated with diffuse granularity of the lung with a "{{c1::ground-glass}}" appearance on CXR 299) NRDS increases risk for persistence of a {{c1::patent ductus arteriosus}} due to persistently {{c2::low}} O2 tension (hypoxemia) 300) What GI pathology is associated with neonatal respiratory distress syndrome due to hypoxemia? {{c1::Necrotizing enterocolitis}} 301) In patients with neonatal respiratory distress syndrome {{c2::supplemental O2}} therapy increases the risk for {{c1::free radical}} injury 302) {{c1::Retinopathy of prematurity}} is an eye complication associated with {{c2::supplemental O2}} therapy in NRDS patients (due to neovascularization) 303) {{c1::Bronchopulmonary dysplasia}} is a respiratory complication associated with {{c2::supplemental O2}} therapy in NRDS patients 304) {{c1::Intraventricular hemorrhage}} is a CNS complication associated with {{c2::supplemental O2}} therapy in NRDS patients 305) What treatment may be used to treat neonatal respiratory distress syndrome before birth? {{c1::Maternal steroids}} 306) What treatment may be used to treat neonatal respiratory distress syndrome after birth? {{c1::Artificial surfactant for the infant}} 307) One test for fetal lung maturity is the {{c2::surfactant}}:{{c1::albumin}} ratio in the amniotic fluid 308) One test for fetal {{c1::lung}} maturity is the foam stability index test 309) {{c1::Lung}} cancer is the most common cause of cancer mortality in the U.S. 310) The average age of presentation for lung cancer is {{c1::60}} years old 311) The key risk factors for lung cancer are {{c1::cigarette smoke}} {{c2::radon}} and {{c3::asbestos}}; family history is also a risk factor 312) {{c1::Polycyclic aromatic hydrocarbons}} and {{c2::arsenic}} are particularly mutagenic carcinogens found in cigarette smoke 313) Lung cancer risk is directly related to the duration and the amount of smoking which is measured in '{{c1::pack-years}}' 314) {{c1::Radon}} is formed by radioactive decay of uranium which is present in soil 315) Radon accumulates in closed spaces such as {{c1::basements}} 316) {{c1::Radon}} is responsible for most of the public exposure to ionizing radiation 317) {{c1::Radon}} exposure is the 2nd most frequent cause of lung carcinoma in the U.S. 318) Increased risk of lung cancer is seen in {{c1::uranium}} miners due to increased exposure to radon 319) Presenting symptoms of lung cancer are non-specific and include cough hemoptysis weight {{c2::loss}} and post-obstructive {{c1::pneumonia}} 320) Lung cancer often presents on CXR with a "{{c1::coin}}-lesion" or on CT with a non-calcified nodule 321) One benign cause of a 'coin-lesion' on CXR is {{c1::granuloma}} (e.g.TB or fungus) 322) One benign cause of a 'coin-lesion' on CXR is {{c1::bronchial hamartoma}} which is benign tumor of {{c2::lung tissue}} and {{c2::cartilage}} 323) Lung carcinoma is classically divided into two categories: {{c1::small cell carcinoma}} (15%) and {{c1::non-small cell carcinoma}} (85%) 324) {{c1::Small}} cell carcinoma of the lung is usually not amenable to surgical resection and is thus treated with {{c2::chemotherapy +/- radiation}} 325) {{c1::Non-small}} cell carcinomas of the lung usually do not respond well to chemotherapy and are thus treated upfront with {{c2::surgical resection}} 326) {{c1::Small (oat) cell}} lung carcinoma arises from {{c2::neuroendocrine (Kulchitsky)}} cells which are small dark blue cells 327) What demographic is associated with small (oat) cell carcinoma? {{c1::Male smokers}} 328) Small (oat) cell carcinoma is {{c1::centrally}} located 329) Small cell carcinoma is characterized histologically by {{c1::poorly}} differentiated small cells and is thus {{c1::very}} aggressive 330) {{c2::Small (oat) cell}} lung carcinoma may produce the anterior pituitary hormone {{c1::ACTH}} leading to {{c1::Cushing syndrome}} 331) {{c2::Small (oat) cell}} lung carcinoma may produce the posterior pituitary hormone {{c1::ADH}} leading to {{c1::SIADH}} 332) {{c3::Small (oat) cell}} lung carcinoma may produce antibodies against {{c1::presynaptic Ca2+ channels}} causing {{c2::Lambert-Eaton myasthenic}} syndrome 333) {{c3::Small (oat) cell}} lung carcinoma may produce {{c2::antibodies}} against {{c1::neurons}} which may cause paraneoplastic myelitis encephalitis and subacute cerebellar degeneration 334) Small (oat) cell carcinoma is commonly associated with amplification of the {{c1::myc}} oncogene 335) {{c3::Small (oat) cell}} carcinoma of the lung is characterized by positive staining for {{c1::chromogranin A}} {{c2::neuron-specific enolase}} {{c4::synaptophysin}} and {{c5::NCAM}} (CD56) 336) Squamous cell carcinoma of the lung is {{c1::centrally}} located 337) {{c3::Squamous cell}} carcinoma of the lung is characterized histologically by {{c2::keratin pearls}} and {{c1::intercellular bridges}} 338) {{c1::Squamous cell}} carcinoma of the lung is the most common tumor in {{c2::male smokers}} 339) {{c2::Squamous cell}} carcinoma of the lung may produce {{c1::PTHrP}} leading to hyper-{{c1::calcemia}} 340) Squamous cell carcinoma of the lung commonly presents as a hilar mass arising from the {{c1::bronchus}} 341) Adenocarcinoma of the lung is {{c1::peripherally}} located 342) {{c3::Adenocarcinoma}} of the lung is characterized histologically by a {{c1::glandular}} pattern that often stains positive for {{c2::mucin}} 343) {{c1::Adenocarcinoma}} of the lung is the most common cancer in nonsmokers and female smokers 344) {{c2::Adenocarcinoma}} of the lung is associated with {{c1::hypertrophic osteoarthropathy}} (clubbing) 345) {{c4::Adenocarcinoma}} of the lung is associated with {{c5::activating}} mutations in the {{c1::KRAS}} {{c2::EGFR}} and {{c3::ALK}} genes 346) Large cell carcinoma is characterized histologically by {{c1::poorly}} differentiated large cells 347) Large cell carcinoma of the lung may present histologically with pleomorphic {{c1::giant}} cells 348) {{c2::Large cell}} carcinoma of the lung may secrete the hormone {{c1::β-hCG}} 349) Is large cell carcinoma related to smoking? {{c1::Yes}} 350) Large cell carcinoma of the lung is {{c1::peripherally}} located 351) What is the prognosis of large cell carcinoma? {{c1::Poor}} 352) {{c2::Adenocarcinoma in situ}} is characterized histologically by {{c1::columnar}} cells containing mucus that grow along pre-existing bronchioles and alveoli 353) {{c2::Adenocarcinoma in situ}} is a subtype of adenocarcinoma that typically arises from {{c1::club (Clara)}} cells 354) Is bronchioloalveolar carcinoma related to smoking? {{c1::No}} 355) In regards to lung neoplasias; adenocarcinoma in situ is {{c1::peripherally}} located 356) {{c2::Adenocarcinoma in situ}} of the lung presents similarly to {{c1::pneumonia}} on CXR (hazy infiltrates consolidation) 357) What is the prognosis of bronchioloalveolar carcinoma? {{c1::Excellent}} 358) Bronchial {{c3::carcinoid}} tumor is characterized histologically by nests of {{c1::well}} differentiated {{c2::neuroendocrine}} cells 359) Bronchial carcinoid tumor is characterized by positive staining for {{c1::chromogranin A}} 360) Is bronchial carcinoid tumor related to smoking? {{c1::No}} 361) What is the prognosis of bronchial carcinoid tumor? {{c1::Excellent (low-grade malignancy; rarely metastasizes)}} 362) Bronchial carcinoid tumor classically forms a polyp-like mass in the {{c1::bronchus}} 363) Symptoms of bronchial carcinoid tumor are related to {{c2::mass effect}} or {{c1::carcinoid syndrome}} 364) What does the T of TNM staging for lung cancer represent? {{c1::tumor size and local extension}} 365) What does the N of TNM staging for lung cancer represent? {{c1::spread to regional lymph nodes (hilar and mediastinal)}} 366) What does the M of TNM staging for lung cancer represent? {{c1::metastasis}} 367) The {{c1::adrenal gland}} is a unique site of distant metastasis from lung cancer 368) Lung cancer has a {{c1::low}} 5-year survival rate because the disease often presents {{c1::late}} in its course 369) Which is more common primary lung tumors or metastasis to the lung? {{c1::Metastasis}} 370) Metastasis to the lung usually presents as multiple '{{c1::cannon ball}}' nodules on imaging 371) Does metastasis to the lung typically present as single or multiple lesions? {{c1::Multiple}} 372) Metastasis to the lung is most often from {{c1::breast}} {{c2::colon}} prostate and bladder cancer 373) Common sites of metastasis from lung cancer include the {{c1::adrenal gland}} {{c2::brain}} {{c3::bone}} and {{c4::liver}} 374) Lung cancer is the most common cause of metastasis to the {{c1::brain}} 375) One complication associated with lung cancer is {{c1::pleural effusion}} which is classically seen with {{c2::adenocarcinoma}} 376) {{c1::superior sulcus}} tumor ({{c3::pancoast}} tumor) is any kind of lung carcinoma that occurs in the {{c2::apex}} of the lung 377) Pancoast tumors may cause {{c1::Pancoast}} syndrome which is characterized by shoulder pain Horner syndrome atrophy of hand/arm muscles and edema (due to vascular compression) 378) One complication associated with lung cancer is {{c1::hoarseness}} due to compression of the recurrent laryngeal nerve 379) One complication associated with lung cancer is {{c1::diaphragmatic paralysis}} due to compression of the phrenic nerve 380) One complication associated with lung cancer is {{c1::superior vena cava}} syndrome due to compression of the SVC 381) One complication associated with lung cancer is {{c1::Horner}} syndrome due to compression of the {{c2::superior cervical}} or {{c3::stellate}} ganglia 382) {{c2::Horner}} syndrome is a triad of ipsilateral {{c1::ptosis}} {{c1::miosis}} and {{c1::anhidrosis}} 383) SVC syndrome is characterized by impaired drainage of the upper extremities resulting in {{c1::edema}} and dilated collateral veins in the {{c2::upper torso}} 384) SVC syndrome is characterized by impaired drainage of the head, resulting in "facial {{c1::plethora}}" 385) SVC syndrome is characterized by impaired drainage of the neck resulting in {{c1::jugular venous distention}} 386) SVC syndrome can be caused by {{c1::thromboemboli}} from indwelling central venous catheters 387) SVC syndrome can raise {{c1::intracranial}} pressure (if obstruction is severe) leading to headaches and dizziness 388) {{c1::Pneumothorax}} is defined as the accumulation of air in the pleural space 389) Pneumothorax presents with {{c1::unilateral}} (uni- or bilateral) chest pain and expansion as well as dyspnea 390) Pneumothorax presents with {{c1::decreased}} tactile fremitus on the affected side 391) {{c2::Pneumothorax}} presents with {{c1::hyper}}-resonance on the affected side 392) Pneumothorax presents with {{c1::diminished}} breath sounds on the affected side 393) {{c1::Primary spontaneous}} pneumothorax is due to rupture of apical supleural blebs or cysts 394) What demographic is associated with primary spontaneous pneumothorax? {{c1::Tall thin young males}} 395) {{c1::Secondary spontaneous}} pneumothorax may be due to diseased lung (e.g. bullae in emphysema infections) or {{c2::meconium}} aspiration 396) {{c1::Traumatic}} pneumothorax may be due to iatrogenic causes such as bronchoscopy subclavian line placement thoracentesis barotrauma 397) In {{c2::tension}} pneumothorax the trachea +/- mediastinum shifts {{c1::away from}} the side of collapse 398) {{c1::Traumatic}} pneumothorax is caused by blunt or penetrating trauma 399) {{c1::Tension}} pneumothorax arises when air enters the pleural space but cannot exit 400) Tension pneumothorax needs immediate needle decompression and {{c1::chest tube}} placement 401) {{c1::Mesothelioma}} is a malignancy of the lung {{c2::pleura}} that is highly associated with {{c3::asbestosis}} 402) Mesothelioma presents with recurrent {{c1::pleural effusions}} dyspnea and chest pain 403) Mesothelioma may result in {{c1::hemorrhagic}} pleural effusion (exudative) and pleural thickening 404) What histological finding may be associated with mesothelioma? {{c1::psammoma bodies}} 405) Almost all {{c2::mesotheliomas}} are {{c1::calretinin}} positive which is negative in most carcinomas 406) Is smoking a risk factor for mesothelioma? {{c1::No}} 407) {{c1::Adenocarcinoma}} is the most common cause of primary lung carcinoma (40%) 408) What is the next step if a coin-lesion is identified in a patient on CXR? {{c1::Review previous CXRs and compare}} 409) The three major risk factors for thrombosis are {{c1::disruption in blood flow (stasis)}} {{c2::hypercoagulability}} and {{c3::endothelial cell damage}} ({{c4::Virchow}} triad) 410) The imaging test of choice for deep venous thrombosis is {{c1::compression ultrasound}} 411) {{c1::DVT}} is a blood clot within a deep vein causing swelling redness warmth and pain 412) What lab test is used clinically to rule out DVT (high sensitivity low specificity)? {{c1::D-dimer}} 413) Lower limb {{c3::DVT}} may be associated with {{c1::calf pain}} upon {{c2::dorsiflexion}} of the foot ({{c4::Homan}} sign) 414) {{c1::Unfractioned or LMW heparin}} is used for prophylaxis and acute management of DVT 415) {{c1::Oral anticoagulants (e.g. warfarin)}} are used for treatment and long-term prevention of DVT 416) Most pulmonary emboli arise via a thromboembolus from the {{c3::proximal}} {{c1::deep veins}} of the {{c2::lower}} extremity 417) What is the most common symptom of pulmonary embolus? {{c1::Most often clinically silent}} 418) Pulmonary emboli are usually clinically silent due to the dual blood supply of the lungs via the {{c1::pulmonary}} and {{c2::bronchial}} arteries 419) Pulmonary emboli are usually clinically silent as the embolus is usually {{c1::small}} (size) and self-resolves 420) Pulmonary {{c1::infarction}} due to PE occurs if a large- or medium-sized artery is obstructed in patients with pre-existing {{c2::cardiopulmonary}} compromise 421) Pulmonary infarction due to PE may present with {{c1::pleuritic}} chest pain and pleural effusion 422) Pulmonary infarction due to PE may present with {{c1::tachypnea}} (RR) and {{c2::tachycardia}} (HR) 423) Pulmonary infarction due to PE may present with hemoptysis and sudden-onset {{c1::dyspnea}} and chest pain 424) In a patient with a pulmonary emboli V/Q lung scan shows mismatch due to abnormal {{c1::perfusion}} 425) The V/Q mismatch seen in pulmonary embolism can result in {{c1::hypoxemia}} which causes {{c2::hyper}}-ventilation with consequent respiratory {{c2::alkalosis}} 426) {{c1::Spiral CT (CT pulmonary angiography)}} is the imaging test of choice for pulmonary embolism 427) What may be seen on spiral CT in a patient with a pulmonary embolism? {{c1::Vascular filling defects}} 428) Pulmonary embolism may present with {{c1::elevated}} D-dimer 429) Gross examination of pulmonary infarction due to PE reveals a hemorrhagic {{c1::wedge}}-shaped infarct 430) The wedge-shaped infarct due to pulmonary embolism points {{c1::towards}} the area of occlusion (towards or away) 431) {{c1::Large saddle}} pulmonary emboli may cause sudden death 432) Death from a saddle pulmonary emboli is due to {{c1::electromechanical}} dissociation 433) Pulmonary {{c1::hypertension}} may arise with chronic emboli that are reorganized over time 434) {{c1::Rhinosinusitis (Sinusitis)}} is caused by obstruction of sinus drainage into the nasal cavity causing inflammation and pain over the affected area 435) Rhinosinusitis most commonly effects the {{c1::maxillary}} sinus in adults 436) The maxillary sinus drains into the {{c1::middle}} meatus 437) Rhinosinusitis is most commonly caused by a {{c1::viral}} (bacterial or viral) upper respiratory infection (URI) 438) Superimposed bacterial infection on top of rhinosinusitis is most commonly due to {{c1::S. pneumoniae}} {{c2::H. influenzae}} and {{c3::M. catarrhalis}} 439) {{c1::Epistaxis}} is the medical term for nose bleed 440) Epistaxis most commonly occurs in the {{c1::anterior}} segment of the nostril ({{c2::Kiesselbach}} plexus) 441) Epistaxis may cause life-threatening hemorrhages if they occur in the {{c1::posterior}} segment of the nostril ({{c2::Woodruff's}} plexus) 442) What type of carcinoma are most head and neck cancers? {{c1::Squamous cell carcinoma}} 443) What virus is oropharyngeal carcinoma associated with? {{c1::HPV-16}} 444) {{c1::Field cancerization}} is a process by which a carcinogen damages a wide mucosal area causing multiple tumors 445) Interstitial restrictive lung diseases are characterized by {{c1::decreased}} diffusing capacity 446) Interstitial restrictive lung diseases are characterized by {{c1::increased}} A-a gradients 447) Extrapulmonary restrictive lung diseases are characterized by {{c1::normal}} A-a gradients 448) Extrapulmonary restrictive lung diseases are associated with hypoventilation of {{c1::peripheral}} origin (central or peripheral) 449) Acute respiratory distress syndrome is a cause of {{c1::interstitial restrictive}} lung disease 450) Neonatal respiratory distress syndrome (hyaline membrane disease) is a cause of {{c1::interstitial restrictive}} lung disease 451) What vasculitis may cause interstitial restrictive lung disease? {{c1::Granulomatosis with polyangiitis (Wegener)}} 452) What anti-arrhythmic agent may cause interstitial restrictive lung disease? {{c1::Amiodarone}} 453) What anti-neoplastic agents may cause interstitial restrictive lung disease? {{c1::bleomycin}} {{c2::busulfan}} {{c3::methotrexate}} and procarbazine 454) Interstitial restrictive lung disease may be caused by {{c1::pulmonary Langerhans cell histiocytosis}} (Eosinophilic granuloma) 455) {{c3::Restrictive}} lung disease may be caused by poor structural apparatus such as {{c1::scoliosis}} and {{c2::morbid obesity}} 456) {{c4::Restrictive}} lung disease may be caused by poor muscular effort such as {{c1::polio}} {{c2::myasthenia gravis::paraneoplastic syndrome}} and {{c3::Guillain-Barre}} syndrome 457) In {{c2::obstructive}} lung disease the flow volume loops shifts to the {{c1::left}} 458) In {{c2::restrictive}} lung disease the flow volume loops shifts to the {{c1::right}} 459) {{c1::Sleep apnea}} is defined as repeated (>5x/hr) cessation of breathing > {{c2::10}} seconds during sleep 460) Sleep apnea often presents clinically with daytime {{c1::sleepiness}} 461) Sleep apnea is characterized by a {{c1::normal}} Pao2 and Paco2 during the day 462) Sleep apnea is associated with {{c1::pulmonary hypertension}} due to nocturnal {{c2::hypoxia}} 463) Obstructive sleep apnea is associated with difficult to manage {{c1::systemic hypertension}} due to increased {{c2::sympathetic tone}} 464) Sleep apnea is associated with arrhythmias especially {{c1::atrial fibrillation/flutter}} 465) What effect may sleep apnea secondarily have on RBC levels? {{c1::Increased (polycythemia)}} 466) {{c1::Obstructive}} sleep apnea is caused by respiratory effort against an airway obstruction 467) Obstructive sleep apnea is associated with {{c1::obesity}} loud {{c2::snoring}} with periods of apnea and daytime sleepiness 468) Obstructive sleep apnea may be caused by excess {{c1::parapharyngeal}} tissue in {{c2::adults}} (age group) 469) Obstructive sleep apnea may be caused by {{c1::adenotonsillar}} hypertrophy in {{c2::children}} (age group) 470) Treatment for obstructive sleep apnea includes {{c2::weight loss}} surgery and {{c1::CPAP}} 471) {{c1::Central}} sleep apnea can occur due patients having marginal ventilation when awake (e.g. CNS disease neuromuscular disease severe kyphoscoliosis heavy dose narcotics) 472) {{c1::Obesity hypoventilation}} syndrome is a condition in which severely overweight people fail to breathe rapidly or deeply enough 473) Obesity hypoventilation syndrome is characterized by {{c1::decreased}} Pao2 and {{c1::increased}} Paco2 during sleep 474) Obesity hypoventilation (Pickwickian) syndrome is characterized by {{c1::increased}} Paco2 during waking hours 475) {{c1::Pleural effusion}} is the excess accumulation of fluid between lung pleural layers 476) Pleural effusion causes restricted lung {{c1::inspiration}} (inspiration or expiration) 477) Pleural effusion can be treated with {{c1::thoracentesis}} to remove fluid 478) {{c2::Transudative}} pleural effusion may be caused by increased {{c1::hydrostatic}} pressure (e.g. HF) 479) {{c2::Transudative}} pleural effusion may be caused by decreased {{c1::oncotic}} pressure (e.g. nephrotic syndrome cirrhosis) 480) {{c2::Transudative}} pleural effusion is characterized by {{c1::low}} protein content 481) {{c2::Exudative}} pleural effusion is caused by states of increased {{c1::vascular permeability}} (e.g. malignancy pneumonia trauma collagen vascular disease) 482) Exudative pleural effusions must be drained due to risk of {{c1::infection}} 483) What is empyema? {{c1::Pus in the pleural space}} 484) A {{c2::lymphatic}} pleural effusion is also known as {{c1::chylothorax}} 485) {{c2::Lymphatic}} pleural effusion occurs due to {{c1::thoracic duct}} injury from trauma or malignancy 486) Lymphatic pleural effusion is characterized by a {{c1::milky}}-appearing fluid with increased {{c2::triglycerides}} 487) Pleural effusion presents with {{c1::decreased}} breath sounds (increased or decreased) 488) Pleural effusion presents with {{c1::dullness}} to percussion 489) Pleural effusion presents with {{c1::decreased}} fremitus 490) In large pleural effusions the trachea may deviate {{c1::away from}} the side of the lesion 491) Atelectasis (bronchial / bronchiole obstruction) presents with {{c1::decreased::increased or decreased}} breath sounds 492) Atelectasis (bronchial / bronchiole obstruction) presents with {{c1::dullness}} to percussion 493) Atelectasis (bronchial / bronchiole obstruction) presents with {{c1::decreased}} fremitus 494) In atelectasis the trachea may deviate {{c1::towards}} the side of the lesion 495) Consolidation (lobar pneumonia pulmonary edema) may present with {{c1::bronchial}} breath sounds along with: - {{c2::Ego}}phony - {{c3::Broncho}}phony - Whispered {{c4::Pectoriloquy}} 496) Consolidation (lobar pneumonia pulmonary edema) may present with late inspiratory {{c1::crackles}} 497) Consolidation (lobar pneumonia pulmonary edema) presents with {{c1::dullness}} to percussion 498) Consolidation (lobar pneumonia pulmonary edema) presents with {{c1::increased}} fremitus 499) {{c2::Exudative}} pleural effusion is characterized by {{c1::high}} protein content 500) What is the mode of inheritance of cystic fibrosis? {{c1::Autosomal recessive}} 501) {{c3::Cystic fibrosis}} is due to a defect in the {{c1::CFTR}} gene on chromosome {{c2::7}} 502) Cystic fibrosis most commonly occurs due to a {{c2::frameshift}} deletion of {{c1::Phe508}} 503) What is the most common lethal genetic disease in Caucasians? {{c1::Cystic fibrosis}} 504) The CFTR gene encodes an {{c2::ATP}}-gated {{c1::Cl-}} channel 505) The CFTR Cl- channel {{c1::secretes}} (secretes or absorbs) Cl- in the {{c2::lungs}} and {{c2::GI tract}} 506) The CFTR Cl- channel {{c1::reabsorbs}} (secretes or reabsorbs) Cl- in the {{c2::sweat glands}} 507) The most common CFTR gene mutation (cystic fibrosis) results in a misfolded protein that is retained in the {{c1::RER}} 508) In cystic fibrosis there is {{c1::decreased}} Cl- and H2O secretion in the lungs and GI tract 509) In cystic fibrosis increased intracellular Cl- results in compensatory increased Na+ {{c1::reabsorption}} via epithelial Na+ channels 510) Increased Na+ reabsorption due to decreased Cl- secretion (cystic fibrosis) results in increased {{c1::H2O}} reabsorption 511) Increased H2O reabsorption in CF results in abnormally {{c1::thick}} mucus secreted into the {{c2::lungs}} and {{c3::GI tract}} 512) Increased Na+ reabsorption in cystic fibrosis causes a more {{c1::negative}} transepithelial potential difference (TEPD) 513) Increased {{c2::Cl-}} concentration (> {{c1::60}} meQ/L) in {{c3::sweat}} is diagnostic of cystic fibrosis 514) Cystic fibrosis may present with {{c1::contraction}} (volume) {{c2::alkalosis}} (pH) 515) How does cystic fibrosis effect K+ levels? {{c1::Decreased (hypokalemia)}} 516) What newborn screening blood test is used to screen for cystic fibrosis? {{c1::Immunoreactive trypsinogen}} 517) A(n) {{c1::increased}} immunoreactive trypsinogen may be indicative of {{c2::cystic fibrosis}} 518) What organism is responsible for recurrent pulmonary infections in an infant cystic fibrosis patient? {{c1::Staphylococcus aureus}} 519) What organism is responsible for recurrent pulmonary infections in an adolescent cystic fibrosis patient? {{c1::Pseudomonas aeruginosa}} 520) Chronic bronchitis and bronchiectasis in a cystic fibrosis patient leads to a {{c1::reticulonodular}} pattern on CXR 521) Cystic fibrosis may cause {{c1::pancreatic}} insufficiency resulting in malabsorption 522) Cystic fibrosis may cause malabsorption with {{c1::steatorrhea}} and consequent {{c1::fat-soluble}} vitamin deficiencies 523) Cystic fibrosis may cause {{c1::biliary}} cirrhosis and/or {{c2::liver}} disease 524) Cystic fibrosis may present as {{c1::meconium ileus (10-20% of patients)}} in newborns due to abnormally thick ("inspissated") stool 525) Cystic fibrosis may cause {{c1::infertility}} in men due to congenital bilateral absence of the {{c2::vas deferens}} 526) Is spermatogenesis possible in a patient with cystic fibrosis? {{c1::Yes}} 527) Cystic fibrosis may cause {{c1::subfertility}} in women due to abnormally thick {{c2::cervical mucus}} and amenorrhea 528) Cystic fibrosis may present with {{c1::nasal}} polyps and nail {{c2::clubbing}} 529) Treatment of cystic fibrosis includes replacement of {{c1::pancreatic}} enzymes 530) Treatment of cystic fibrosis includes {{c1::azithromycin}} which is used as an anti-inflammatory agent 531) Treatment of cystic fibrosis includes {{c1::hyper}}-tonic saline which facilitates mucus clearing 532) Treatment of cystic fibrosis includes aerosolized {{c1::dornase alfa (DNase)}} which hydrolyzes DNA in mucus causing decreased viscosity 533) Treatment of cystic fibrosis includes {{c1::albuterol}} a β2 agonist 534) Treatment of cystic fibrosis includes chest {{c1::physiotherapy}} which aids in mucus clearance 535) If a patient is {{c2::supine}} during aspiration an abscess may form in the {{c1::superior}} segment of the right {{c3::lower}} lobe of the lung 536) Which type of lung carcinoma may present with cavitations on CXR? {{c1::Squamous cell carcinoma}} 537) SVC syndrome is commonly caused by malignancy such as: - #1 {{c1::mediastinal mass}} - #2 {{c2::superior sulcus tumor}} 538) What type of upper airway obstruction is depicted by the following flow-volume loop? {{c1::Variable extrathoracic obstruction}} paste- 315048736063489.jpg 539) What type of upper airway obstruction is seen in vocal cord paralysis / dysfunction and laryngeal tumors? {{c1::Variable extrathoracic obstruction}} 540) What type of upper airway obstruction is depicted by the following flow-volume loop? {{c1::Variable intrathoracic obstruction}} paste- 321705935372289.jpg 541) What type of upper airway obstruction is seen in tracheomalacia and bronchogenic cysts? {{c1::Variable intrathoracic obstruction}} 542) What type of upper airway obstruction is depicted by the following flow-volume loop? {{c1::Fixed upper airway obstruction}} paste- 336751205810177.jpg 543) What type of upper airway obstruction is seen in tracheal stenosis extraluminal goiter and mediastinal mass? {{c1::Fixed upper airway obstruction}} 544) Central sleep apnea may be also caused by delayed detection / response to changes in {{c1::PaCO2}} resulting in cyclic ({{c2::cheyne-stokes}}) breathing 545) Central sleep apnea is treated with {{c1::positive airway pressure}} 546) Chronic rhinosinusitis frequently causes {{c1::mucus retention}} cysts in the {{c2::maxillary}} sinus 547) Endothelial dysfunction of the pulmonary vasculature results in increased {{c1::vasoconstrictors}} and decreased {{c1::vasodilators}} 548) Is pulmonary hypertension due to left heart disease usually atleast partially reversible following correction of underlying abnormality? {{c1::yes}} 549) Laryngomalacia presents with {{c2::inspiratory stridor}} during infancy due to collapse of {{c1::supraglottic tissues}} during inspiration 550) Choanal atresia is characterized by congenital obstruction of {{c1::posterior nasal}} passages 551) Infants with {{c1::bilateral::unilateral / bilateral}} choanal atresia can present with upper airway obstruction and cyanosis with feeding 552) Obstruction of the {{c1::brachiocephalic vein}} causes symptoms similar to those seen in SVC syndrome but only on one side of the body 553) The following CXR is highly suggestive of what pulmonary pathology? {{c1::Pneumothorax}} paste-18000207937537.jpg 554) The following CXR is highly suggestive of what restrictive pulmonary pathology in a ~ 50 year old man? {{c1::Idiopathic Pulmonary Fibrosis}} paste-395368919465985.jpg 555) Villous adenomas can cause {{c1::secretory}} diarrhea hypovolemia and electrolyte abnormalities 556) In Crohns disease loss of the innate barrier function of the intestinal mucosa allows intestinal microbes to induce an exaggerated response by the {{c1::adaptive immune system}} resulting in chronic GI inflammation 557) The following CXR is highly suggestive of what pulmonary pathology? {{c3::Primary Pulmonary HTN}} paste-19580755902465.jpg 558) {{c2::Pseudomonas aeruginosa}} is a common cause of malignant {{c1::otitis externa}} whereupon the causative organism can spread into deeper tissues and presents with exquisite ear pain and drainage 559) Histopathology of mesothelioma will show tumor cells with numerous long slender {{c1::microvilli}} and abundant {{c2::tonofilaments}} 560) Grossly mesothelioma most commonly presents with nodular / smooth pleural {{c1::thickening}} 561) Bronchial carcinoid tumor can appear histologically as sheets of uniform cells with a "{{c1::salt and pepper}}" pattern 562) Malignant otitis externa is an emergency that can progress to osteomyelitis of the {{c1::skull base}} 563) Malignant otitis externa is most commonly seen in the {{c1::diabetic}} population 564) Patients with long standing COPD who are administered excessive oxygen can develop {{c1::hypercapnia}} 565) COPD patients with oxygen induced hypercapnia suffer from excess oxygen induced generation of increased {{c1::physiologic dead space}} 566) The most common pulmonary function test indicator of obesity related disease is a reduction in {{c1::expiratory reserve volume}} 567) The reduction of respiratory compliance in obesity is in part due to a reduction in {{c1::chest wall}} compliance due to increased weight 568) The reduction of respiratory compliance in obesity is inpart due to a reduction in {{c1::lung}} compliance due to microatelactasis 569) To compensate for reduced lung compliance obese patients have {{c1::rapid::rate}}-{{c1::shallow::depth}} breathing 570) Progressively weakening diaphragmatic contractions during maximal voluntary ventilation with intact phrenic nerve stimulation indicates either/or: #1 - Pathology of the {{c1::neuromuscular}} junction #2 - abnormally rapid {{c2::diaphragmatic muscle}} fatigue 571) Compression / neuropathy of the phrenic nerve results in {{c1::uniform weak}} inspirations during maximal voluntary ventilation 572) Women who are in the {{c1::postpartum}} period are at particularly high risk of developing myasthenia gravis 573) What flow-volume pattern would diffuse intraalveolar hemorrhage cause? {{c1::Restrictive}} 574) What kind of flow volume pattern would compression atelectasis cause? {{c1::Restrictive}} 575) What flow volume pattern would alveolar hyaline membranes (ARDS) cause? {{c1::Restrictive}} 576) Patients with long-standing COPD have decreased sensitivity to {{c1::PaCO2}} 577) In patients with long standing COPD the main contributor to respiratory drive is arterial {{c1::PaO2}} levels 578) When supplemental oxygen is administered to a patient with chronic COPD the rapid increase in PaO2 can reduce {{c1::peripheral chemoreceptor}} stimulation 579) Infections in the sphenoid or ethmoid sinus may extend to the {{c1::cavernous}} sinus and cause complications 580) Because the facial vein is valveless infections of the face can spread to the {{c1::cavernous sinus}} 581) Patients with {{c1::septal}} deviation are predisposed to rhinosinusitis 582) Rhinosinusitis most commonly effects the {{c1::ethmoid}} sinus in children 583) Patients who develop pulmonary infarction may develop right heart strain that generates a {{c1::S1Q3T3}} EKG finding 584) In chronic bronchitis the DLCO is usually {{c1::normal}} 585) In emphysema the DLCO is usually {{c1::decreased}} 586) In asthma the DLCO is {{c1::normal or increased}} 587) Which cause of crescentic glomerulonephritis may also cause a restrictive lung disease? {{c1::Goodpasture syndrome}} 588) Sarcoidosis may present with a {{c1::rheumatoid arthritis}}-like arthropathy 589) {{c1::Inhalation injury}} is often a complication from smoke inhalation from fires or other noxious substances 590) Inhalation injury results in the development of chemical {{c1::tracheobronchitis}} pulmonary edema and {{c2::pneumon}}itis 591) On physical exam many patients with inhalation injury have singed {{c1::nasal hairs}} 592) Many patients with inhalation injury present secondary to {{c1::burns}} CO inhalation cyanide poisoning or {{c2::arsenic}} poisoning 593) At 18 hours after inhalation injury bronchoscopy will typically show severe {{c1::edema}} congestion of bronchi and {{c2::soot}} deposition 594) At 11 days after inhalation injury bronchoscopy will typically show {{c1::resolution}} 595) Which two pneumoconioses increase the risk for Caplan syndrome? {{c1::Coal worker's pneumonconiosis and Silicosis}} 596) Which two pneumoconioses increase the risk for cor pulmonale? {{c1::Berylliosis and Silicosis}} 597) Bronchial carcinoid tumor is {{c1::peripherally OR centrally}} located 598) One complication associated with lung cancer is {{c1::pericardial effusion}} which can lead to obstructive shock 599) During which phase of the natural history of lobar pneumonia is the exudate composed of mostly bacteria? {{c1::Congestion}} 600) During which phase of the natural history of lobar pneumonia is the exudate composed of fibrin bacteria RBCs and WBCs? {{c1::Red hepatization}} 601) During which phase of the natural history of lobar pneumonia is the exudate composed of WBCs lysed RBCs and fibrin? {{c1::Gray hepatization}} 602) A tension pneumothorax may lead to {{c1::increased}} intrathoracic pressure leading to {{c2::decreased}} cardiac function 603) Patients with prolonged untreated obstructive sleep apnea can develop {{c1::pulmonary hypertension}} and a resultant right heart failure 604) Stimulation of the {{c1::hypoglossal}} nerve can be used as a therapy for obstructive sleep apnea by increasing the {{c2::diameter}} of the oropharyngeal airway 605) Obstructive sleep apnea is due to relaxation of {{c1::pharyngeal muscle tone}} during sleep 606) Tuberculosis can cause cavitary lung lesions due to release of proteases NO and ROS from {{c1::granulomas}} 607) Besides hyaline membranes loss of {{c1::surfactant}} contributes to alveolar collapse in ARDS 608) One multifactorial cause of secondary pulmonary hypertension is due to {{c1::compression}} of the pulmonary vasculature by a tumor 609) Cheyne-Stokes breathing is defined by respirations that oscillate between {{c1::apnea}} and {{c1::hyperapnea}} in response 610) Sleep apnea is diagnosed via {{c1::polysomnography}} where a patient sleeps in a monitored setting and a number of related measurements are taken 611) Digital clubbing is often associated with prolonged {{c1::hypoxia}} 612) Pulmonary alveolar proteinosis is an {{c1::restrictive}} lung disease where proteinaceous material fills the alveoli 613) Primary pulmonary alveolar proteinosis is most commonly due to a defect in {{c1::macrophages}} 614) Cystic fibrosis may present with {{c1::hypo}}natremia 615) Secondhand smoke increases the risk of respiratory tract illnesses in children most significantly {{c1::otitis media}} and {{c2::asthma}} 616) Patients with sarcoidosis may have scattered granulomas in their liver; most commonly affecting the {{c1::portal triads}} 617) A collapsed lung may present as a {{c1::completely opacified hemithorax}} on chest x-ray 618) Complete collapse of a lung usually occurs following {{c1::obstruction}} of a mainstem bronchus 619) {{c1::Nitrogen dioxide (NO2)}} is a toxic production of combustion; and poisoning is seen in firefighters welders and farm silo workers 620) Testing for {{c1::PD-L1}} expression guies immunotherapy in advanced non-small cell carcinomas of the lung 621) An EGFR "driver mutation" is especially common in {{c1::asian::race}} female {{c1::non-smokers::smoking status}} who have adenocarcinomas of the lung 622) Testing for "{{c1::driver mutations}}" in adenocarcinoma of the lung guides systemic therapy in advanced disease 623) 4% of patients with non-small cell lung carcinoma have an {{c2::inversion}} of chromosome 2 that creates an fusion gene between {{c1::EML4}} and {{c1::ALK}} 624) Patients with lung cancers with a EML4-ALK fusion protein are typically seen in young {{c1::non-smokers::smoking status}} 625) Lung cancers with a EML4-ALK fusion protein are typically EGFR {{c1::negative::positive or negative?}} / KRAS {{c1::negative::positive or negative?}}