Pulmonary and Asthma Quiz

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Questions and Answers

What condition is typically indicated by a high CO2 level (normal range 33-44 mmHg)?

Ventilatory insufficiency (correct)

Pulmonary embolism

Hyperventilation syndrome

Bronchospasm

What is the mechanism of action of Bosentan in the treatment of pulmonary hypertension?

Vasoconstriction

Vasodilation (correct)

Inhibition of neutrophil recruitment

Bronchodilation

What is a significant side effect of Methotrexate?

Hyperkalemia

Hypoglycemia

Pulmonary fibrosis (correct)

Smooth muscle contraction

What is the role of inhaled corticosteroids like Fluticasone in asthma management?

Prevention of recurrence of asthma episodes Signup and view all the answers

Which medication is known to be a short-acting b2-agonist used for asthma?

Levalbuterol Signup and view all the answers

Which of the following is a potential consequence of prolonged use of oral prednisone in asthma treatment?

Cushing syndrome Signup and view all the answers

What is the effect of leukotriene receptor antagonists on airway constriction?

They inhibit airway constriction Signup and view all the answers

What distinguishes Zileuton from leukotriene receptor antagonists?

It is a lipoxygenase inhibitor Signup and view all the answers

What is Pemberton sign indicative of?

Worsening flushing and neck vein congestion when raising the arms Signup and view all the answers

Which cancer is most commonly associated with hypertrophic osteoarthropathy?

Adenocarcinoma of the lung Signup and view all the answers

Which symptom is NOT associated with carcinoid syndrome?

Severe abdominal pain Signup and view all the answers

What is the initial step in diagnosing a carcinoid tumor?

Measurement of urinary 5-HIAA Signup and view all the answers

What occupational exposure is primarily linked to mesothelioma?

Asbestos exposure Signup and view all the answers

Which of the following findings is indicative of asbestosis on a pulmonary biopsy?

Ferruginous bodies Signup and view all the answers

What is a common characteristic of bronchogenic carcinoid tumors?

Secrete serotonin or serotonin-like derivatives Signup and view all the answers

Which of the following best describes the relationship between adenocarcinomas and hypercoagulable states?

They can lead to hypercoagulable states due to tissue factor release Signup and view all the answers

What does FEV1 measure?

Amount of air exhaled forcefully in one second Signup and view all the answers

Which ratio is utilized to differentiate between obstructive and restrictive lung diseases?

FEV1 to FVC Signup and view all the answers

What is the definition of Residual Volume (RV)?

Air remaining after maximal exhalation Signup and view all the answers

What occurs in the case of pathologic shunts that affects arterial oxygen levels?

High fraction of blood bypassing normal V/Q areas. Signup and view all the answers

Which lung volume term reflects the volume of air remaining after a normal exhalation?

Functional Residual Capacity Signup and view all the answers

In dead space conditions, why does administered oxygen improve oxygenation?

Ventilation remains normal, allowing contact with more blood overall. Signup and view all the answers

What does a high A-a gradient indicate?

There is an actual lung pathology affecting gas exchange. Signup and view all the answers

In which condition is the diffusion capacity of the lungs for carbon monoxide (DLCO) typically increased?

Asthma Signup and view all the answers

What characterizes the primary change in perfusion in cases of dead space?

Primary decrease in perfusion. Signup and view all the answers

What is Tidal Volume (TV) defined as?

Total air inhaled plus exhaled during normal breathing Signup and view all the answers

What physiological response occurs due to hypoxic vasoconstriction in shunts?

Redirection of blood flow away from hypoxic areas. Signup and view all the answers

Which statement is true regarding obstructive lung disease?

Involves conditions such as asthma and COPD Signup and view all the answers

What characterizes Expiratory Reserve Volume (ERV)?

Additional air that can be exhaled after normal exhalation Signup and view all the answers

What is a common cause of low arterial oxygen levels without lung pathology?

Respiratory depression from certain drugs. Signup and view all the answers

In the context of A-a gradient assessment, what does a normal gradient indicate?

The patient has low respiratory rates. Signup and view all the answers

What distinguishes between dead space and shunt conditions?

The degree of hypoxic vasoconstriction. Signup and view all the answers

What is the primary goal when managing a patient on a ventilator regarding FiO2?

To keep it as low as possible to minimize free radical damage Signup and view all the answers

Which of the following tidal volumes is considered ideal for a patient on a ventilator?

400-500 mL Signup and view all the answers

What should be considered if a patient has an arterial pO2 of 40 mm Hg and a FiO2 of 100%?

Increase PEEP to help reduce FiO2 requirements Signup and view all the answers

What is a consequence of decreased CO2 levels in terms of cerebral perfusion?

Decreased cerebral perfusion Signup and view all the answers

What antibiotic combination is recommended for treating ventilator-acquired pneumonia?

Vancomycin and ceftazidime or cefepime Signup and view all the answers

What condition is characterized by low T3 levels in a patient unable to be weaned off the ventilator?

Euthyroid sick syndrome Signup and view all the answers

Which of the following is an important management step in addressing increased intracranial pressure?

Intubation and hyperventilation Signup and view all the answers

Which of the following statements regarding respiratory rate and cerebral perfusion is correct?

Decreasing respiratory rate causes increased CO2, enhancing cerebral perfusion Signup and view all the answers

What is the trend of FEV1/FVC ratio in restrictive lung diseases?

It is increased due to radial traction effects. Signup and view all the answers

When comparing lung volumes in a healthy 70-year-old versus a 20-year-old, which changes are expected?

Residual Volume increases in the older individual. Signup and view all the answers

Which of the following statements about lung compliance is accurate?

In restrictive lung diseases, compliance decreases. Signup and view all the answers

What characterizes the expiratory component of the flow-volume loop in obstructive lung diseases?

It has a scooped-out or concave shape. Signup and view all the answers

How does the diffusion capacity (DLCO) differ in asthma compared to other obstructive lung diseases?

DLCO is generally higher in asthma. Signup and view all the answers

What happens to Total Lung Capacity (TLC) in restrictive lung conditions?

TLC is typically decreased. Signup and view all the answers

Which of the following conditions is associated primarily with decreased compliance of the lungs?

Pneumoconioses. Signup and view all the answers

What is the expected impact of lifelong inhalation of particulates on lung health?

It leads to a slow-onset condition resembling COPD. Signup and view all the answers

Study Notes

Lung Volume Terminology

FEV1: Forced Expiratory Volume in 1 second. The amount of air forcefully exhaled in one second after a maximal inspiration.
FVC: Forced Vital Capacity. The total volume of air that can be maximally exhaled following a maximal inspiration.
FEV1/FVC Ratio: Ratio used to distinguish between obstructive and restrictive lung diseases.
TLC: Total Lung Capacity. The maximum amount of air that can be inhaled after a normal exhalation.
TV: Tidal Volume. The amount of air inhaled and exhaled during normal breathing.
IRV: Inspiratory Reserve Volume. The additional amount of air that can be inhaled after a normal inhalation.
IC: Inspiratory Capacity. The total amount of air in the lungs following maximal inspiration.
ERV: Expiratory Reserve Volume. The additional amount of air that can be exhaled after a normal exhalation.
FRC: Functional Residual Capacity. The volume of air remaining in the lungs after a normal exhalation.
RV: Residual Volume. The volume of air remaining in the lungs after a maximal exhalation.
DLCO: Diffusion capacity of the lungs for carbon monoxide. A measure of how well gas exchange is occurring across the pulmonary capillaries and reflects the extent of gas exchange.

Obstructive vs Restrictive Lung Disease

Obstructive Pattern: Characterized by difficulty exhaling air due to narrowed airways. Examples include asthma and chronic obstructive pulmonary disease (COPD).
- FEV1: Decreased
- FVC: Decreased
- FEV1/FVC Ratio: Decreased (<70%)
- TLC: Usually normal or increased (due to air trapping)
- IC: and IRV: Normal
- ERV: Normal
- FRC: Usually increased (due to air trapping)
- DLCO: Usually normal or slightly decreased (variable depending on specific cause)
Restrictive Pattern: Characterized by a reduced lung capacity due to problems with lung expansion. Examples include pulmonary fibrosis and certain chest wall conditions.
- FEV1: Decreased
- FVC: Decreased
- FEV1/FVC Ratio: Normal or slightly increased
- TLC: Decreased
- IC and IRV: Decreased
- ERV: Decreased
- FRC: Decreased
- DLCO: Decreased

Flow-Volume Loops

Obstructive: Expiratory portion of the flow-volume loop is scooped out/concave. This is because of airflow obstruction, which reduces the flow rate throughout exhalation.Inspiratory flow rate is relatively preserved, but overall size of the loop is reduced due to less volume in the lungs on maximum inspiration.
Restrictive: Loop is smaller and more symmetric; overall size of the loop is reduced due to a decreased volume in the lungs on maximum inspiration.

Shunt vs Dead Space

Shunt: Reduced ventilation relative to perfusion. Shunt is characterized by a reduction in the amount of oxygenated blood that reaches the lungs. The most HY scenarios on USMLE involve abnormal blood flow bypassing the alveoli entirely. Often indicated by a decreased arterial oxygen level despite normal/adequate inspiratory capacity.
Dead Space: Increased ventilation relative to perfusion. Dead space is characterized by air entering the lungs without delivering oxygen to the blood. It is a HY point that USMLE likes to focus on cases of pulmonary embolism and alveolar dead space, which refers to regions of lung tissue receiving ventilation but not oxygen exchange. In these cases, the arterial oxygen level is also decreased.

Alveolar-Arterial (A-a) Gradient

High A-a gradient: The difference between the expected partial pressure of oxygen in the alveoli and the actual partial pressure of oxygen in the arteries is high. This often signifies a problem with gas exchange in the lungs. Typical reasons for a hyperinflated A-a gradient on USMLE are reduced ventilation due to hypoventilation or pulmonary pathologies.
Normal A-a gradient: The difference between the expected and actual partial pressure of oxygen in the alveoli and arteries appears normal, typically between 5-10 mmHg. Often indicative of normal ventilation, with sufficient oxygen delivery.

HY Pulmonary/Respiratory Tract Cancers

Small Cell Bronchogenic Carcinoma: Typically occurs centrally in the lung, presents as a small basophilic cell, and is strongly associated with smoking. A HY point for the USMLE is that it is associated with paraneoplastic syndromes (SIADH, Cushing syndrome, Lambert-Eaton syndrome...).
Squamous Cell Carcinoma: Arises centrally in the lung, frequently associated with smoking. Noteworthy for potential cavitation (cavity/hole) formation.
Adenocarcinoma: This type of lung cancer is typically peripheral in location and is more common in female nonsmokers in USMLE vignettes. Associated with high yield presentations, but not necessarily central lungs (such as hilar or mediastinal masses).

Atelectasis: Collapsed lung tissue, often a concern post-surgery or trauma. Causes reduced breath sounds, dullness to percussion, and decreased tactile fremitus. Can be caused by obstruction distal to lung tissue leading to loss of perfusion.
Flail Chest: Result of multiple rib fractures, leading to paradoxical chest wall movement.
Pulmonary Contusion: Bruising of lung tissue, often from blunt trauma.
Diaphragmatic Rupture: Common complication of trauma, often indicated by diaphragmatic movement on CXR.
Pneumothorax: Air in the pleural space. Classified as either simple, tension or open. Often involves decreased breath sounds and hyperresonance to percussion.
Pleural Effusion: Fluid in the pleural space, typically associated with increased lung disease and heart failure. Often noted on X-ray as dullness to percussion.

Pneumonia: Lung infection (bacterial, viral, or fungal). Possible symptoms include fever, cough, shortness of breath, and chest pain.
**Pleurisy:**Inflammation of the pleura, the membranous lining of the lungs. Pain typically worsens with deep breaths.
**Pneumonia:**Lung infection may be caused by a variety of factors, presenting in many different ways depending on the specific pathogen.
**Empyema:**Pus in the pleural space (purulent pleural effusion); a complication of pneumonia.

Systemic Sclerosis (Scleroderma): Chronic autoimmune disease leading to widespread fibrosis and hardening of tissues, frequently involving the lungs. Characterized by limited or diffuse forms. It is noteworthy for its association with pulmonary hypertension, so high yield for both Step 1 and 2CK forms.
Sarcoidosis: Chronic inflammatory disease characterized by the presence of non-caseating granulomas, predominantly affecting the lungs. Hypersensitivity/autoimmune response. Noteworthy for high yield presentations including an elevated vitamin D level, even though it may be present within normal range in USMLE vignettes.

Pulmonary Hypertension: Increased blood pressure in the pulmonary arteries, often a consequence of other underlying conditions (like PPH).
Pulmonary Edema: Fluid buildup in the lungs. A high yield presentation that can occur in a number of different contexts (like heart failure or infections like pneumonia).
ARDS (Acute Respiratory Distress Syndrome): Often occurring as a secondary complication to other medical complications. Noteworthy for cases that occur <6 hours post-transfusion, with the cause TRALI (transfusion related acute lung injury).
TRALI (Transfusion-related acute lung injury): Non-cardiogenic pulmonary edema, occurring within six hours of transfusion.
TACO (Transfusion-associated circulatory overload): Cardiogenic pulmonary edema, occurring more than six hours after transfusion.

Lung Cancers

Bronchogenic Carcinoma: A general term for cancers arising in the bronchi, leading to problems with oxygen exchange.
Small Cell Lung Cancer: A rapidly growing type of lung cancer most frequently central, associated with poor prognosis.
Squamous Cell Carcinoma: Highly associated with a smoking history.
Adenocarcinoma: Also frequently associated with smoking.

Other Respiratory Conditions

Bronchiectasis: Chronic dilation of the bronchi. Can result from infections or other chronic conditions.
Asthma: Characterized by reversible airway obstruction.
Epiglottitis: Severe, potentially life-threatening inflammation of the epiglottis.
Bacterial Tracheitis: Infection of the trachea.
Pertussis (Whooping Cough): Highly contagious bacterial infection characterized by cough that can be severe and persistent.
Pleurisy/Pleuritis: Pain in the chest that worsens during breathing.
Pneumonia: Infection leading to inflammation of the alveoli.
Croup: Swelling of the larynx and trachea, commonly seen in children.
Tuberculosis (TB): Infectious disease caused by a type of bacterium.
Chronic Obstructive Pulmonary Disease (COPD): Characterized by chronic airway obstruction and difficulties with airflow. A commonly seen presentation is with increased CO2 levels.
Hot Tub Lung: Caused by inhaling contaminated water.
Foreign Body Aspiration: Objects obstructing airways.

Congenital or Childhood Respiratory Conditions

Congenital Diaphragmatic Hernia: Bowel or other abdominal organs herniate into the chest cavity; this is a critical condition for infants causing difficulty breathing.
Tracheoesophageal Fistula (TEF): An abnormal connection between the trachea and esophagus.
Choanal Atresia: Congenital closure of the nasal airway passages.

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Description

Test your knowledge on pulmonary conditions, asthma management, and related medications. This quiz covers key concepts such as the effects of CO2 levels, mechanisms of drugs like Bosentan, and the impact of corticosteroids. Enhance your understanding of respiratory diseases and their treatments.