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?}}