Respiratory System Practice Quiz For Um/Fau

This one is probably debatable, as I gave every patient at least one condition that causes decreased mucociliary transport. I picked D as the correct answer because of the graph in Dr. Fischer's lecture that shows mucociliary transport lowest in smokers with bronchitis. Also, patient D has 3 strikes against him/her (age, bronchitis, smoking).

Due to immunosuppression, PPD can have false negative in AIDS pts so it doesn't rule out TB

A: Multi-drug resistant TB is becoming a significant problem
B: Minimum treatment time is 6 months
C: Cavitation indicates active infection, so poor prognosis
D: I am sure that many believe this, but I haven't seen any RCT's on this topic yet
E: These two drugs are the most important parts of TB treatment (assuming no resistance is likely)

High PCO2 and low pH means that it is a resp. acidosis. HCO3 is elevated as a normal compensatory response.

The correct answer is "Upper airway filtering, Cough and Sneeze reflexes, mucociliary escalator." These are physical defense systems of the lung that help to protect against foreign particles and pathogens. The upper airway filtering refers to the nose and throat filtering out larger particles before they reach the lungs. The cough and sneeze reflexes help to expel irritants and pathogens from the respiratory tract. The mucociliary escalator is a mechanism where tiny hair-like structures called cilia move mucus and trapped particles out of the lungs. These physical defense systems work together to prevent harmful substances from entering and causing damage to the lungs.

Chronic Lung Disease, also known as Bronchopulmonary dysplasia, is a condition that primarily affects premature infants who require mechanical ventilation and oxygen therapy. It is characterized by lung inflammation, which can be caused by mechanical injury from the ventilator, oxygen toxicity due to prolonged exposure to high levels of oxygen, and increased susceptibility to infections and sepsis. Therefore, all of the options mentioned in the question - mechanical injury, oxygen toxicity, infection and sepsis, and inflammation - are seen in Chronic Lung Disease.

Squamous cell carcinoma is the most common type of cancer in the head and neck. It arises from the squamous cells that line the mucosal surfaces of the head and neck, such as the mouth, throat, and voice box. Risk factors for this type of cancer include tobacco and alcohol use, as well as infection with certain types of human papillomavirus (HPV). Squamous cell carcinoma can present with symptoms like a sore throat, difficulty swallowing, or a lump in the neck. Treatment options include surgery, radiation therapy, and chemotherapy.

The response to alkalosis is hypoventilation, which means that the lungs decrease the rate and depth of breathing. This leads to a decrease in the amount of oxygen in the blood, resulting in hypoxemia. In contrast, in a metabolic acidosis, the lungs can compensate by increasing the rate and depth of breathing to eliminate excess carbon dioxide and increase blood pH. Therefore, it is more difficult for the lungs to compensate for a metabolic alkalosis than a metabolic acidosis.

Pneumothorax would show hyperresonance to percussion and decreased tactile fremitus. Egophany, whispered pq, dullness to percussion, and increased tactile fremitus all indicate consolidation, not pneumothorax.

This slide shows the 'onion skin' appearance of grade 3 pulmonary HTN. The lumen is completely blocked but there is no fibrinoid necrosis.

Alveolus is

Coughing is a reflex action that helps to clear the airways of irritants or mucus. The phases of coughing involve different actions of the respiratory muscles. The expiratory phase refers to the forceful exhalation of air during a cough. The compressive phase refers to the compression of the airways to generate a strong cough. The inspiratory phase refers to the inhalation of air before the cough. However, the term "expressive" does not correspond to any specific phase of coughing. It does not describe any action or component of the coughing process.

Light's criteria for an exudate are one or more of the following:
Pleural fluid protein/serum protein > 0.5
Pleural fluid LDH/serum LDH > 0.6
Pleural fluid LDH > 2/3 the upper limits of the normal serum LDH
Additional criteria include: Pleural fluid protein > 2.9 g/dL
Pleural fluid cholesterol > 45 mg/dL (does not by itself provide a definitive diagnosis of an exudate)

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in children. Bronchiolitis is an infection that affects the small airways in the lungs, causing inflammation and difficulty breathing. RSV is highly contagious and spreads through respiratory droplets. It is most common in infants and young children, especially during the winter months. RSV can cause symptoms such as coughing, wheezing, fever, and difficulty feeding. It is important to note that while other viruses like parainfluenza, rhinovirus, adenovirus, and coronavirus can also cause bronchiolitis, RSV is the most common culprit.

A: polysaccharide capsule is main virulence factor, B: sputum commonly contaminated with H. flu, D: commonly seen in COPD

Pressure controlled ventilation is a mode of mechanical ventilation where the inspiratory pressure is set and the ventilator delivers a constant pressure during inspiration. While pressure controlled ventilation allows for control of inspiratory pressure level and I:E ratio, it has the disadvantage of being unable to directly control minute ventilation. Minute ventilation is the amount of air that is moved in and out of the lungs in one minute and is determined by both the tidal volume and the respiratory rate. In pressure controlled ventilation, the minute ventilation is indirectly controlled by adjusting the inspiratory time and respiratory rate, but it is not directly controlled like in volume controlled ventilation.

Indications for ventilation: RR>35, TV10mmHg, refractory hypoxemia

Sarcoidosis presents similarly to PCP, but has systemic involvement including skin nodules, Coccidiomycosis is unlikely due to lack of exposure, MAC is uncommon in HIV patients and more often presents with extrapulmonary symptoms, S. pneumo is unlikely due to the slow onset and interstitial infiltrates.

Irregular spiculated masses are highly suspicious for cancer.

Correct matchings are as follows:
Group 1 PAH: Pulmonary Arterial Hypertension
Group 2 PH: Pulmonary hypertension with left heart disease
Group 3 PH: Pulmonary hypertension associated with lung diseases and/or hypoxemia
Group 4 PH: Pulmonary hypertension due to chronic thrombotic and/or embolic disease
Group 5 PH: Miscellaneous or caused by inflammation, obstruction, or extrinsic compression

If PaO2/FiO2 ratio is 200, it is ALI. This patient's ratio is 250, so it is ALI.

Headache is not one of the common constitutional symptoms of reactivation TB. Reactivation TB commonly presents with symptoms such as anorexia, fever, unintentional weight loss, and night sweats. While headaches can occur in some cases of TB, they are not considered one of the common constitutional symptoms.

Latent TB will test positive on PPD test, they are at increased risk of active TB, they are not contagious, and do not usually show symptoms.

Sinusitis and bronchitis can occur at any CD4, CMV usually occurs at

The angiogram shows a PE, and since the patient is hemodynamically unstable, thrombolytics are indicated unless there is a contraindication in order to prevent cardiac arrest. Heparin does not help dissolve an already existing clot.

A: rare, B: 20-50% positive, C: splits IgA, D: vaccine prevents 25 most common serotypes

This vignette is supposed to describe idiopathic pulmonary hypertension. Current thoughts on IPH indicate that there is some genetic predisposition but that a 'second hit' is needed, much like in cancer. IPH is also associated with low NO and prostacyclin levels, and high endothelin levels.

Laryngomalacia is a floppy airway during inspiration due to cartilage underdevelopment. It resolves on its own usually.

Organism is Staph aureus.
A: sputum usually neg, blood usually pos, C: Cat and Coag positive, D: Typical presentation of Legionella, E: Typical of Mycoplasma

This EKG shows signs of RVH: Right axis deviation, p pulmonale, and R/S ratio of >1

This CT shows mesothelioma. Asbestos exposure is the major risk factor for this disease, but smoking in conjunction with exposure accelerates the disease process.

In patients with PE, you see:
Impaired gas exchange (hypoxemia)
Increased pulmonary vascular resistance (vascular obstruction)
Alveolar hyperventilation (hypocarbia)
So…most likely ABG: alkalemic pH, low pO2, low pCO2 (respiratory alkalosis)

A: MRSA is common, C: It's the opposite, effective against negs not pos, D: AZ binds to 50S. E: Doxy binds to 30 S

Tracheoesophageal fistula can present with polyhydramnios, frothing at the mouth, coughing, cyanosis, respiratory distress, and gets worse with feeding. It is diagnosed by inability to pass an NG tube, which shows up as a coiled tube on x-ray.

Normal pH with abnormal PCO2 and HCO3 means that there are at least 2 disturbances. Since PCO2 is low there is a respiratory alkalosis, and since the bicarb is low, there is a metabolic acidosis (of the increased anion gap variety).

Coccidiomycosis is the endemic fungus in the SW US. Blasto is more common in the SE US, and Cryptococcus is seen in big cities with a lot of pigeons around. Aspergillus is possible, but not as likely considering the vignette and the lack of any distinctive x-ray changes. It is unlikely to be bacterial because repeated rounds of antibiotics did nothing for his symptoms.

This is a vocal cord nodule, which is the result of repetitive trauma. All three treatments mentioned above will help reduce symptoms and prevent recurrence.

Subacute and prolonged symptoms and streaky infiltrate are suggestive of either Mycoplasma or Chlamydophila. Patient also denies symptoms that are unique within the pneumonias to either Legionella (diarrhea) or Mycoplasma (myalgia, arthralgia). Chlamydophila is more common in 65-79 age range, and is gram-negative.

D-dimer can only rule out PE if the pre-test probability is low. Since this patient has a high probability of PE, the results of the test do nothing to rule out or in PE. The student would have known this had he gone to the regional campus and paid attention in Dr. L's class.

The four T's of anterior mediastinal masses: Thyroid, Terrible lymphoma, Thymoma, Teratoma. This image is actually a thyroid goiter.

The vignette describes a classic presentation of Cystic Fibrosis. A,C,D, and E are all seen in CF patients.

Pneumonia is more likely to cause type 1 hypoxemic respiratory failure.