Path 15a Flashcards

Which histologic change characterizes chronic bronchitis?

A. Mucinous gland hypertrophy

B. Alveolar septal fibrosis

C. Bronchiolar cartilage hypertrophy

D. Pleural gland atrophy

Patients with chronic bronchitis have an increased risk of developing:

A. Pneumothorax

B. Pulmonary embolism

C. Respiratory infection

D. Pleural effusion

Which structural change characterizes emphysema?

A. Thickened alveolar septa

B. Enlarged air spaces

C. Increased bronchial glands

D. Pleural fibrosis

What happens to lung compliance in pulmonary fibrosis?

A. It increases

B. It remains normal

C. It fluctuates

D. It decreases

Which triad characterizes aspirin-exacerbated respiratory disease?

A. Asthma, eczema, bronchiectasis

B. Asthma, rhinosinusitis, nasal polyps

C. COPD, sinusitis, urticaria

D. Asthma, pneumonia, nasal ulcers

How is asthma defined in these notes?

A. Permanent alveolar enlargement

B. Irreversible airway obstruction

C. Restrictive airway inflammation

D. Reversible bronchoconstriction

Why does chronic bronchitis commonly cause a productive cough?

A. Excessive mucus production

B. Loss of surfactant

C. Alveolar hemorrhage

D. Reduced capillary flow

When does dyspnea typically appear in chronic bronchitis?

A. Before cough develops

B. During childhood

C. Later in disease

D. Only during sleep

Airflow obstruction in obstructive lung disease commonly results in:

A. Pulmonary fibrosis

B. Alveolar edema

C. Air trapping

D. Reduced residual volume

Why can small airways collapse during exhalation in emphysema?

A. Loss of elastic recoil

B. Increased surfactant

C. Bronchial gland enlargement

D. Pleural thickening

What does the Reid index measure in chronic bronchitis?

A. Alveolar wall thickness

B. Bronchiolar smooth muscle thickness

C. Airway lumen diameter

D. Mucus gland/bronchial wall thickness

Emphysema results from an imbalance between which factors?

A. Collagen and elastin

B. Proteases and antiproteases

C. Mucus and surfactant

D. Oxygen and carbon dioxide

What duration of productive cough defines chronic bronchitis?

A. ≥1 month for 3 years

B. ≥6 months for 1 year

C. ≥2 months for 2 years

D. ≥3 months for ≥2 years

Asthma most commonly first presents during:

A. Late adulthood

B. Childhood

C. Pregnancy

D. Old age

Which systemic finding may occur in emphysema?

A. Weight gain

B. Peripheral edema

C. Weight loss

D. Ascites

Smoking classically causes which emphysema pattern?

A. Centriacinar, upper lobes

B. Panacinar, lower lobes

C. Centriacinar, lower lobes

D. Panacinar, upper lobes

What hypersensitivity mechanism causes allergic rhinitis?

A. Type II

B. Type I

C. Type III

D. Type IV

Why may a patient with emphysema develop a barrel-shaped chest?

A. Increased lung volume

B. Decreased residual volume

C. Pleural fibrosis

D. Pulmonary edema

How are residual volume and functional residual capacity affected in obstructive lung disease?

A. Both decrease

B. Both remain normal

C. Both increase

D. Only FRC decreases

α1-antitrypsin deficiency classically causes which emphysema pattern?

A. Centriacinar, upper lobes

B. Centriacinar, lower lobes

C. Panacinar, upper lobes

D. Panacinar, lower lobes

What secondary RBC change may occur in chronic bronchitis?

A. Anemia

B. Leukopenia

C. Polycythemia

D. Thrombocytopenia

Which inflammatory cells release proteases in the lung?

A. Eosinophils and basophils

B. Lymphocytes and plasma cells

C. Mast cells and monocytes

D. Neutrophils and macrophages

Mitral stenosis can raise left atrial pressure and cause:

A. Pneumothorax

B. Pulmonary congestion and hemorrhage

C. Emphysema

D. Bronchial dilation

What happens to the FEV1/FVC ratio in obstructive lung disease?

A. It decreases

B. It increases

C. It remains unchanged

D. It becomes 100%

What happens to lung compliance in emphysema?

A. It increases

B. It decreases

C. It remains unchanged

D. It becomes absent

Which blood-gas pattern is associated with chronic bronchitis?

A. ↓PaCO2 and ↑PaO2

B. ↑PaCO2 and ↓PaO2

C. ↑PaCO2 and ↑PaO2

D. ↓PaCO2 and ↓PaO2

Which presentation is characteristic of emphysema?

A. Hemoptysis with fever

B. Copious purulent sputum

C. Productive cough with edema

D. Dyspnea with minimal sputum

Which collagen type is targeted in Goodpasture syndrome?

A. Type I collagen

B. Type III collagen

C. Type IV collagen

D. Type II collagen

Which lung sounds may occur in chronic bronchitis?

A. Stridor and rub

B. Rhonchi

C. Absent breath sounds

D. Wheezing and crackles

During the early asthmatic response, mast cells release preformed:

A. Leukotrienes

B. Prostaglandins

C. Histamine

D. Collagen

Why does diffusing capacity decrease in pulmonary fibrosis?

A. Increased diffusion-wall thickness

B. Increased alveolar surface area

C. Reduced airway mucus

D. Increased lung compliance

What is the most common cause of emphysema?

A. α1-antitrypsin deficiency

B. Smoking

C. Pulmonary fibrosis

D. Asthma

What structural change occurs in bronchial smooth muscle in asthma?

A. Atrophy

B. Fibrosis

C. Hypertrophy

D. Necrosis

Which Th2 cytokine promotes IgE class switching in asthma?

A. IL-5

B. IL-4

C. IL-8

D. IL-10

Chronic bronchitis can cause pulmonary hypertension that progresses to:

A. Cor pulmonale

B. Mitral stenosis

C. Left heart failure

D. Aortic regurgitation

Asthma is commonly associated with which history?

A. Diabetes and hypertension

B. COPD and smoking

C. Fibrosis and pneumonia

D. Rhinitis, eczema, family atopy

Which mechanisms can cause emphysema?

A. Excess proteases or α1-AT deficiency

B. Increased surfactant or collagen

C. Excess mucus or histamine

D. Reduced elastase or inflammation

What hepatic finding is associated with α1-antitrypsin deficiency?

A. Hemosiderin-filled macrophages

B. Mallory bodies

C. Fatty vacuoles

D. PAS-positive cytoplasmic globules

Which breathing pattern is commonly seen in emphysema?

A. Rapid inspiration

B. Inspiratory stridor

C. Prolonged expiration with pursed lips

D. Cheyne-Stokes breathing

Which eosinophil-derived crystals may appear in asthmatic sputum?

A. Curschmann crystals

B. Charcot-Leyden crystals

C. Calcium oxalate crystals

D. Cholesterol crystals

Loss of elastic recoil in emphysema causes which functional problem?

A. Impaired exhalation and air trapping

B. Increased expiratory recoil

C. Improved airway stability

D. Reduced residual volume

Which exposure is highly associated with chronic bronchitis?

A. Asbestos

B. Smoking

C. Silica

D. Pollen

Which liver pathology is associated with α1-antitrypsin deficiency?

A. Cirrhosis

B. Hepatic adenoma

C. Cholangiocarcinoma

D. Acute hepatitis

Why may patients with chronic bronchitis develop cyanosis relatively early?

A. Alveolar hyperventilation

B. Early hypoxemia from shunting

C. Increased oxygen diffusion

D. Reduced hemoglobin

What happens to functional residual capacity in emphysema?

A. It decreases

B. It remains normal

C. It increases

D. It becomes zero

Which structural change characterizes emphysema?

A. Pleural fibrosis

B. Bronchial gland hypertrophy

C. Septal thickening

D. Destruction of alveolar air sacs

Which eosinophil product contributes to the late-phase asthmatic response by damaging airway cells and perpetuating bronchoconstriction?

A. Major basic protein

B. Histamine

C. IgE

D. Surfactant

What is the major pulmonary function of α1-antitrypsin?

A. Stimulates elastase

B. Neutralizes proteases such as elastase

C. Produces surfactant

D. Activates eosinophils

Which chest X-ray finding may be seen in emphysema?

A. Decreased lung lucency

B. Bilateral infiltrates

C. Increased lung field lucency

D. Pleural calcification

Spiral-shaped mucus plugs in asthmatic sputum are called:

A. Charcot-Leyden crystals

B. Mallory bodies

C. Psammoma bodies

D. Curschmann spirals

Why can chronic bronchitis cause CO2 retention?

A. Mucus plugs trap air

B. Surfactant increases

C. Capillaries are destroyed

D. Alveoli become fibrotic

Which Th2 cytokine attracts eosinophils in asthma?

A. IL-4

B. IL-5

C. IL-10

D. IFN-γ

Which chronic complications may develop in emphysema?

A. Pulmonary fibrosis

B. Pleural effusion

C. Hypoxemia, pulmonary hypertension, cor pulmonale

D. Left ventricular hypertrophy only

What happens to total lung capacity in obstructive lung disease?

A. It decreases

B. It remains normal

C. It becomes fixed

D. It increases

Which chest X-ray findings are characteristic of emphysema?

A. Increased AP diameter and flattened diaphragm

B. Reduced AP diameter and elevated diaphragm

C. Diffuse alveolar infiltrates

D. Enlarged hilar lymph nodes

Re-exposure to an allergen in asthma activates which cells through IgE?

A. Neutrophils

B. Mast cells

C. Macrophages

D. Fibroblasts

Asthma is most commonly triggered by allergic stimuli but may also be triggered by:

A. Hypercalcemia and anemia

B. Renal failure and exercise

C. Viral URIs and stress

D. Liver failure and dehydration

Which leukotrienes are generated by mast cells during the early asthmatic response?

A. LTB4

B. LTE2 and LTB5

C. LTA4 and LTB4

D. LTC4, LTD4, and LTE4

According to these notes, which Th2 cytokines promote Th2 activity while inhibiting Th1 activity?

A. IL-4 and IL-10

B. IL-1 and IL-6

C. IL-5 and IL-8

D. IL-2 and IFN-γ

Which tests can help establish a clinical diagnosis of asthma?

A. Bronchoscopy and biopsy

B. Spirometry and methacholine challenge

C. CT and pulmonary angiography

D. Sputum culture and CBC

Which respiratory-rate abnormality may occur during an asthma attack?

A. Bradypnea

B. Apnea

C. Tachypnea

D. Biot breathing

Pulsus paradoxus is associated with which general form of lung disease in these notes?

A. Restrictive

B. Interstitial

C. Vascular

D. Obstructive

How is the inspiratory/expiratory ratio affected in asthma?

A. Increased

B. Decreased

C. Unchanged

D. Reversed

Excessive mucus production in asthma can result in:

A. Mucus plugging

B. Pleural fibrosis

C. Alveolar hemorrhage

D. Pneumothorax

Which chest X-ray finding may occur in asthma?

A. Honeycombing

B. Pleural plaques

C. Peribronchial cuffing

D. Hilar calcification

A severe, unrelenting asthma attack is called:

A. Bronchiectasis

B. Cor pulmonale

C. Emphysema

D. Status asthmaticus

How is bronchiectasis defined?

A. Permanent airway dilation

B. Reversible bronchoconstriction

C. Alveolar wall destruction

D. Interstitial fibrosis

What underlying processes can produce bronchiectasis?

A. Surfactant loss or edema

B. Necrotizing inflammation or obstruction

C. Pleural fibrosis or effusion

D. Vasculitis or embolism

Which genetic disease can cause bronchiectasis?

A. Marfan syndrome

B. Hemophilia B

C. Cystic fibrosis

D. Sickle cell disease

Which obstructive lung disease may result from Kartagener syndrome?

A. Asthma

B. Emphysema

C. Chronic bronchitis

D. Bronchiectasis

Which type of obstruction can lead to bronchiectasis?

A. Tumor or foreign body

B. Pulmonary edema

C. Pleural effusion

D. Pulmonary embolus

Bronchiectasis is associated with impaired function of which structure?

A. Type II pneumocytes

B. Cilia

C. Pulmonary capillaries

D. Pleural mesothelium

ABPA associated with bronchiectasis represents a hypersensitivity reaction to:

A. Candida

B. Histoplasma

C. Aspergillus

D. Pneumocystis

Allergic bronchopulmonary aspergillosis is most commonly seen in patients with:

A. COPD or fibrosis

B. Pneumonia or TB

C. Emphysema or silicosis

D. Asthma or cystic fibrosis

Which presentation is characteristic of bronchiectasis?

A. Dyspnea, hemoptysis, purulent sputum

B. Dry cough, hemoptysis, dry sputum

C. Stridor, hoarseness, dry sputum

D. Pleuritic pain, hemoptysis, purulent sputum

Which physical finding may develop in bronchiectasis?

A. Cyanosis

B. Digital clubbing

C. Barrel chest

D. Pectus excavatum

Which chronic complications may occur in bronchiectasis?

A. Pneumothorax and fibrosis

B. Lung cancer and edema

C. AA amyloidosis and cor pulmonale

D. Mitral stenosis and emboli

What FEV1/FVC ratio is typical of restrictive lung disease according to these notes?

A. <40%

B. <50%

C. <60%

D. ≥70%

What happens to total lung capacity in restrictive lung disease?

A. It decreases

B. It increases

C. It remains normal

D. It doubles

How are residual volume and FRC affected in restrictive lung disease?

A. Both increase

B. Both decrease

C. RV rises; FRC falls

D. RV falls; FRC rises

Restrictive lung diseases are most commonly caused by diseases involving the:

A. Pleura

B. Airways

C. Lung interstitium

D. Pulmonary arteries

Idiopathic pulmonary fibrosis is best described as:

A. Bronchial dilation

B. Alveolar emphysema

C. Pleural inflammation

D. Interstitial fibrosis of unknown cause

Which mediator promotes collagen deposition in idiopathic pulmonary fibrosis?

A. TGF-β

B. Histamine

C. IL-4

D. Leukotriene C4

Which presentation is characteristic of idiopathic pulmonary fibrosis?

A. Hemoptysis and fever

B. Progressive dyspnea, cough, clubbing

C. Stridor and wheezing

D. Productive cough and cyanosis

Where does idiopathic pulmonary fibrosis initially appear on CT?

A. Central hilar regions

B. Upper airways

C. Subpleural patches

D. Pleural cavities

End-stage idiopathic pulmonary fibrosis produces which CT appearance?

A. Ground-glass

B. Hyperlucency

C. Peribronchial cuffing

D. Honeycomb lung

Which treatments are used for idiopathic pulmonary fibrosis according to these notes?

A. Antifibrotics and lung transplant

B. Antibiotics and steroids

C. Bronchodilators and oxygen

D. Antihistamines and surgery

Pneumoconioses are restrictive diseases involving what pathologic process?

A. Alveolar hemorrhage

B. Occupational interstitial fibrosis

C. Bronchial smooth muscle hypertrophy

D. Pleural infection

Development of pneumoconiosis generally requires chronic exposure to:

A. Large nonfibrogenic particles

B. Viral particles

C. Small fibrogenic particles

D. Water-soluble gases

Which cells release fibrogenic factors after engulfing particles in pneumoconiosis?

A. Type I pneumocytes

B. Eosinophils

C. Mast cells

D. Alveolar macrophages

Coal workers' pneumoconiosis results from prolonged exposure to:

A. Coal dust

B. Silica

C. Asbestos fibers

D. Beryllium

Mild carbon exposure from pollution can cause which asymptomatic condition?

A. Silicosis

B. Anthracosis

C. Asbestosis

D. Sarcoidosis

Which cells accumulate carbon in anthracosis?

A. Neutrophils

B. Type II pneumocytes

C. Macrophages

D. Fibroblasts

Coal workers' pneumoconiosis most commonly affects which lung region?

A. Lower lobes

B. Middle lobes

C. Costophrenic angles

D. Upper lobes

Silicosis results from prolonged exposure to:

A. Silica

B. Coal

C. Asbestos

D. Cotton dust

Which occupations are classically associated with silicosis?

A. Farmers and teachers

B. Sandblasters, miners, foundry workers

C. Bakers and nurses

D. Textile and office workers

Why does silicosis increase susceptibility to tuberculosis?

A. It destroys surfactant

B. It increases mucus production

C. It impairs macrophage phagolysosomes

D. It activates eosinophils

Where are the fibrotic nodules of silicosis most commonly found?

A. Upper lobes

B. Lower lobes

C. Pleural space

D. Middle lobe

Which lymph-node finding is classically associated with silicosis?

A. Caseating necrosis

B. Eggshell calcification

C. Reed-Sternberg cells

D. Noncalcified adenopathy

Berylliosis is classically associated with workers in which industries?

A. Textile and farming

B. Mining and construction

C. Aerospace and electronics

D. Shipbuilding and plumbing

Which lung region is most commonly affected by berylliosis?

A. Lower lobes

B. Costophrenic angles

C. Middle lobes

D. Upper lobes

Berylliosis increases the risk of developing which malignancy?

A. Lung cancer

B. Mesothelioma

C. Colon cancer

D. Thyroid cancer

Which radiographic finding is characteristic of asbestosis?

A. Eggshell hilar calcification

B. Calcified pleural plaques

C. Upper-lobe cavitation

D. Bilateral hilar adenopathy

What do asbestos bodies look like histologically?

A. Pink round globules

B. Stellate inclusions

C. Golden-brown fusiform rods

D. Calcium-filled spheres

How can asbestos bodies be obtained for microscopic examination?

A. Pleural biopsy

B. Blood smear

C. Sputum culture

D. Bronchoalveolar lavage

Which stain can highlight the iron within asbestos bodies?

A. Prussian blue

B. PAS

C. Congo red

D. Silver stain

Which lung region is most commonly affected by asbestosis?

A. Upper lobes

B. Lower lobes

C. Hilar region

D. Apices

Caplan syndrome is the combination of pneumoconiosis with:

A. SLE

B. Scleroderma

C. Rheumatoid arthritis

D. Sjögren syndrome

Sarcoidosis is a systemic disease characterized by:

A. Caseating granulomas

B. Suppurative abscesses

C. Fibrotic plaques

D. Noncaseating granulomas

Which demographic is associated with sarcoidosis according to these notes?

A. African American females

B. Asian males

C. White elderly males

D. Hispanic children

Sarcoidosis is thought to involve which immune response?

A. CD8 response to bacteria

B. CD4+ T-cell response

C. IgE response to pollen

D. Neutrophilic response to fungi

Which stellate-shaped inclusions may be found within sarcoid giant cells?

A. Schaumann bodies

B. Asbestos bodies

C. Asteroid bodies

D. Mallory bodies

Schaumann bodies in sarcoidosis are composed primarily of:

A. Iron and collagen

B. Lipid and glycogen

C. Keratin and calcium

D. Calcium and protein

Sarcoidosis commonly affects the lungs and hilar nodes, producing which type of lung disease?

A. Restrictive lung disease

B. Obstructive lung disease

C. Vascular lung disease

D. Pleural lung disease

Which eye disorder is associated with sarcoidosis?

A. Cataracts

B. Uveitis

C. Glaucoma

D. Retinal detachment

Which skin findings are associated with sarcoidosis?

A. Vesicles and bullae

B. Petechiae and purpura

C. Nodules, erythema nodosum, lupus pernio

D. Psoriasis and eczema

Involvement of the salivary and lacrimal glands in sarcoidosis can mimic:

A. Rheumatoid arthritis

B. SLE

C. Scleroderma

D. Sjögren syndrome

Which cranial nerve disorder is associated with sarcoidosis?

A. Bell palsy

B. Trigeminal neuralgia

C. Horner syndrome

D. Vestibular neuritis

Why can sarcoidosis cause hypercalcemia?

A. Increased PTH secretion

B. Increased 1α-hydroxylase activity

C. Reduced vitamin D activation

D. Increased calcitonin

Which serum enzyme may be elevated in sarcoidosis?

A. Amylase

B. Alkaline phosphatase

C. ACE

D. CK-MB

What is first-line treatment for symptomatic sarcoidosis?

A. Methotrexate

B. Antibiotics

C. Antihistamines

D. Glucocorticoids

What are the most common presenting symptoms of pulmonary sarcoidosis?

A. Dyspnea and cough

B. Hemoptysis and fever

C. Stridor and wheezing

D. Chest pain and syncope

What happens to the CD4+/CD8+ ratio in bronchoalveolar lavage fluid in sarcoidosis?

A. It decreases

B. It increases

C. It remains normal

D. It becomes zero

Sarcoidosis may be asymptomatic except for which common finding?

A. Pleural effusions

B. Cavitary lesions

C. Bilateral hilar lymphadenopathy

D. Pneumothorax

Hypersensitivity pneumonitis develops after exposure to what type of antigen?

A. Inhaled organic antigens

B. Circulating autoantibodies

C. Bacterial endotoxin

D. Heavy metals

Which hypersensitivity mechanisms contribute to hypersensitivity pneumonitis?

A. Type I

B. Types III and IV

C. Type II

D. Types I and II

Hypersensitivity pneumonitis is commonly seen in which exposure groups?

A. Office workers

B. Swimmers

C. Farmers and bird handlers

D. Healthcare workers

With chronic antigen exposure, hypersensitivity pneumonitis can progress to:

A. Interstitial fibrosis B. Centriacinar emphysema

C. Bronchiectasis

D. Pleural effusion

Which vascular change may occur in the pulmonary trunk in pulmonary hypertension?

A. Medial atrophy

B. Arteriosclerosis

C. Venous thrombosis

D. Capillary rupture

What happens to the media of pulmonary arteries in pulmonary hypertension?

A. It becomes calcified

B. It becomes thinner

C. Smooth muscle hypertrophies D

. It disappears

Which intimal change is associated with pulmonary hypertension?

A. Intimal edema

B. Intimal necrosis

C. Intimal calcification

D. Intimal fibrosis

Plexiform lesions are most associated with which condition?

A. Severe longstanding pulmonary hypertension

B. Acute bronchitis

C. Mild asthma

D. Pulmonary edema

Untreated pulmonary hypertension can eventually cause:

A. Left ventricular dilation and aortic aneurysm

B. Right ventricular hypertrophy and cor pulmonale

C. Mitral stenosis and aortic aneurysm

D. Aortic aneurysm and cor pulmonale

Which clinical presentation is typical of pulmonary hypertension?

A. Inspiratory stridor

B. Productive cough

C. Exertional dyspnea with right heart failure

D. Massive hemoptysis only

Which demographic is classically associated with primary pulmonary hypertension?

A. Elderly males

B. Children

C. Middle-aged males

D. Young adult females

Heritable pulmonary hypertension may result from what type of BMPR2 mutation?

A. Inactivating mutation

B. Activating mutation

C. Trinucleotide expansion

D. Mitochondrial mutation

What is the normal effect of BMPR2 on vascular smooth muscle?

A. Stimulates proliferation

B. Inhibits proliferation

C. Causes vasoconstriction

D. Promotes fibrosis

What is the prognosis of heritable pulmonary hypertension according to these notes?

A. Excellent

B. Usually benign

C. Poor

D. Self-limited

How can chronic lung disease cause secondary pulmonary hypertension?

A. Increased surfactant or hypoxic vasoconstriction

B. Left-to-right shunting or hypoxic vasodilation

C. Systemic hypertension or hypoxic vasodilation

D. Parenchymal damage or hypoxic vasoconstriction

How can heart disease cause secondary pulmonary hypertension?

A. Increased pulmonary circuit volume

B. Reduced pulmonary blood volume

C. Loss of surfactant

D. Bronchial obstruction

Chronic thromboembolic pulmonary hypertension can result from:

A. Asthma attacks

B. Recurrent emboli

C. Pleural fibrosis

D. Alveolar edema

ARDS is fundamentally caused by diffuse damage to the:

A. Bronchial cartilage

B. Pleura

C. Pulmonary arteries

D. Alveolar-capillary interface

Damage to the alveolar-capillary interface in ARDS causes:

A. Increased permeability

B. Decreased permeability

C. Reduced blood flow

D. Increased surfactant

Leakage of protein-rich fluid in ARDS causes what type of pulmonary edema?

A. Cardiogenic edema

B. Noncardiogenic edema

C. Hydrostatic edema

D. Lymphatic edema

Protein-rich alveolar fluid in ARDS can form:

A. Asbestos bodies

B. Schaumann bodies

C. Hyaline membranes

D. Curschmann spirals

Why can ARDS cause severe hypoxemia and cyanosis?

A. Increased airway mucus

B. Increased lung compliance

C. Reduced cardiac output

D. Thickened diffusion barrier

Another cause of hypoxemia in ARDS is:

A. Collapse of air sacs

B. Increased alveolar size

C. Excessive elastic recoil

D. Bronchial dilation

Which chest X-ray appearance is classically associated with ARDS?

A. Honeycomb lung

B. White-out appearance

C. Eggshell calcification

D. Hyperlucent apices

Which description best fits ARDS?

A. Chronic respiratory failure with cardiomegaly

B. Unilateral opacity from fluid overload

C. Acute respiratory failure with bilateral opacities and no heart failure

D. Obstruction with increased TLC

In ARDS, activated neutrophils damage which pneumocytes?

A. Type I and Type II pneumocytes

B. Type I only

C. Type II only

D. Club cells

How do activated neutrophils damage lung tissue in ARDS?

A. Histamine release and proteases

B. Free radicals and proteases

C. IgE production

D. Collagen degradation

Recovery from ARDS may be complicated by:

A. Emphysema

B. Bronchiectasis

C. Pleural plaques

D. Interstitial fibrosis

Loss of which cells contributes to fibrosis during ARDS recovery according to these notes?

A. Type II pneumocytes

B. Type I pneumocytes

C. Club cells

D. Goblet cells

What is the lecithin:sphingomyelin ratio used to assess?

A. Placental maturity

B. Fetal lung maturity

C. Fetal kidney function

D. Maternal oxygenation

As fetal surfactant production increases, what happens to lecithin and sphingomyelin?

A. Both decrease

B. Both increase equally

C. Lecithin rises; sphingomyelin stays constant

D. Lecithin stays constant; sphingomyelin rises

Why is C-section delivery associated with neonatal respiratory distress syndrome according to these notes?

A. Increased fetal insulin

B. Increased surfactant breakdown

C. Excess maternal estrogen

D. Reduced stress-induced fetal glucocorticoids

Why does maternal diabetes increase the risk of neonatal respiratory distress syndrome?

A. Increased fetal insulin

B. Decreased fetal glucose

C. Increased fetal cortisol

D. Increased fetal surfactant

What respiratory finding is characteristic of neonatal respiratory distress syndrome after birth?

A. Decreased breathing effort

B. Increased respiratory effort

C. Normal respiration

D. Apnea

Which clinical findings may occur in neonatal respiratory distress syndrome?

A. Bradycardia and apnea

B. Cyanosis without tachypnea

C. Tachypnea, accessory muscle use, grunting

D. Productive cough and wheezing

Which chest X-ray appearance is associated with neonatal respiratory distress syndrome?

A. White-out lung

B. Honeycomb lung

C. Hyperlucent lungs

D. Ground-glass appearance

Why can supplemental oxygen be harmful in neonatal respiratory distress syndrome?

A. Increases free radical injury

B. Causes mucus plugging

C. Causes pulmonary emboli

D. Decreases surfactant production

Which eye complication is associated with supplemental oxygen in premature infants?

A. Uveitis

B. Retinopathy

C. Cataracts

D. Glaucoma

Which respiratory complication is associated with supplemental oxygen in NRDS?

A. Bronchiectasis

B. Pulmonary fibrosis

C. Bronchopulmonary dysplasia

D. Emphysema

Which CNS complication is associated with supplemental oxygen in NRDS according to these notes?

A. Hydrocephalus

B. Meningitis

C. Cerebral edema

D. Intraventricular hemorrhage

What treatment can help prevent NRDS before birth?

A. Maternal glucocorticoids

B. Maternal antibiotics

C. Fetal diuretics

D. Maternal antihistamines

What treatment may be given to an infant with NRDS after birth?

A. Glucocorticoids

B. Artificial surfactant

C. Antibiotics

D. Bronchodilators

Most pulmonary emboli originate from thrombi in the:

A. Pulmonary veins

B. Upper extremity veins

C. Proximal deep leg veins

D. Coronary veins

What is the most common presentation of pulmonary embolism according to these notes?

A. Massive hemoptysis

B. Severe chest pain

C. Syncope

D. Clinically silent

Why are many pulmonary emboli clinically silent?

A. Lungs have dual blood supply

B. Emboli increase surfactant

C. Bronchi dilate around emboli

D. Pleura prevents infarction

Another reason many pulmonary emboli are silent is that they are usually:

A. Septic

B. Small and self-resolving

C. Located in pulmonary veins

D. Associated with pneumonia

When is pulmonary infarction most likely after a pulmonary embolus?

A. Tiny vessel obstruction

B. Normal cardiopulmonary function

C. Large embolus with prior compromise

D. Isolated bronchial obstruction

Pulmonary infarction from PE may cause pleuritic chest pain along with:

A. Transudative edema

B. Pneumothorax

C. Chylous effusion

D. Exudative pleural effusion

Which vital-sign changes may accompany pulmonary infarction from PE?

A. Tachypnea and tachycardia

B. Bradycardia and bradypnea

C. Hypertension and bradycardia

D. Hypothermia and apnea

Which presentation may occur with pulmonary infarction from PE?

A. Chronic dry cough

B. Hemoptysis, sudden dyspnea, chest pain

C. Progressive clubbing

D. Painless peripheral edema

What does a V/Q scan typically show in pulmonary embolism?

A. Matched ventilation defect

B. Excessive perfusion

C. V/Q mismatch

D. Normal perfusion only

A V/Q mismatch from pulmonary embolism can result in:

A. Hypercalcemia

B. Hyperoxia

C. Metabolic alkalosis

D. Hypoxemia

Which laboratory marker may be elevated in pulmonary embolism?

A. D-dimer

B. Troponin

C. ACE

D. Amylase

Which antiarrhythmic drug can cause interstitial restrictive lung disease?

A. Sotalol

B. Amiodarone

C. Adenosine

D. Verapamil

Which structural disorders can cause restrictive lung disease?

A. Asthma and bronchitis

B. Emphysema and bronchiectasi

s C. Scoliosis and morbid obesity

D. PE and pulmonary hypertension

What mechanism produces an exudative pleural effusion?

A. Reduced hydrostatic pressure

B. Increased vascular permeability

C. Increased oncotic pressure

D. Reduced capillary permeability

Why can granulomatous diseases cause hypercalcemia?

A. Increased PTH secretion

B. Reduced vitamin D activation

C. Increased histiocyte 1α-hydroxylase

D. Increased calcitonin secretion

How does pleural-fluid LDH compare with serum in a transudate according to these notes?

A. Much higher

B. Equal

C. Variable

D. Lower

Which occupations are classically associated with asbestos exposure?

A. Shipyard, construction, plumbing workers

B. Farmers, bakers, teachers C

. Miners, sandblasters, farmers

D. Healthcare and office workers

What does the mnemonic “RIB” represent for oxygen toxicity in premature infants?

A. Rickets, infection, bronchitis

B. Retinopathy, IVH, bronchopulmonary dysplasia

C. Respiratory failure, ischemia, bronchospasm

D. Retinopathy, infection, bradycardia

Excessive oxygen administration in longstanding COPD may cause:

A. Respiratory alkalosis

B. Hypocapnia

C. Hypercapnia

D. Metabolic acidosis

According to these notes, why can supplemental oxygen worsen hypercapnia in COPD?

A. Decreases anatomic dead space

B. Increases respiratory rate

C. Increases surfactant breakdown

D. Increases physiologic dead space

Why does obesity reduce chest-wall compliance?

A. Increased weight on chest wall

B. Increased pulmonary surfactant

C. Reduced airway mucus

D. Increased elastic recoil

Why can obesity also reduce lung compliance?

A. Bronchial gland hypertrophy

B. Microatelectasis

C. Alveolar enlargement

D. Pulmonary emboli

Patients with long-standing COPD have reduced sensitivity to changes in:

A. PaCO2

B. PaO2

C. pH

D. Bicarbonate

In long-standing COPD, respiratory drive is described in these notes as depending mainly on:

A. PaCO2

B. PaO2

C. Bicarbonate

D. Hemoglobin

What happens to DLCO in emphysema?

A. Increases markedly

B. Remains normal

C. Becomes immeasurable

D. Decreases

Which pneumoconioses increase the risk of Caplan syndrome?

A. Coal, asbestos, silica

B. Silica, beryllium, cotton

C. Asbestos, talc, iron

D. Coal, beryllium, talc

Besides hyaline membranes, what contributes to alveolar collapse in ARDS?

A. Excess mucus

B. Loss of surfactant

C. Increased elastin

D. Bronchial dilation

Pulmonary alveolar proteinosis is characterized by alveoli filled with:

A. Blood

B. Pus

C. Proteinaceous material

D. Collagen

How is pulmonary alveolar proteinosis classified in these notes?

A. Obstructive

B. Vascular

C. Pleural

D. Restrictive

Primary pulmonary alveolar proteinosis is most commonly due to dysfunction of:

A. Macrophages

B. Neutrophils

C. Fibroblasts

D. Type I pneumocytes

Elevated ACE together with hypercalcemia most strongly suggests:

A. Silicosis

B. Sarcoidosis

C. Asbestosis

D. Emphysema

Which disorder features connective tissue plugs in small airways?

A. Asthma

B. Bronchiectasis

C. Cryptogenic organizing pneumonia

D. Emphysema

Why can cryptogenic organizing pneumonia cause alveolar collapse?

A. Surfactant excess

B. Capillary rupture

C. Pleural fluid

D. Small-airway connective tissue plugs

The radiologic and histologic pattern of idiopathic pulmonary fibrosis is called:

A. Usual interstitial pneumonia

B. Organizing pneumonia

C. Desquamative pneumonia

D. Lipoid pneumonia

In idiopathic pulmonary fibrosis, reticular opacities are most prominent in the: A. Upper lobes B. Hilar regions C. Lower lobes D. Middle lobes

Which interstitial lung disease can produce a cobblestone pleural surface?

A. Sarcoidosis

B. Silicosis

C. Asbestosis

D. Idiopathic pulmonary fibrosis

Which auscultatory finding may occur in emphysema?

A. Diffuse bilateral wheezing

B. Inspiratory stridor

C. Pleural friction rub

D. Bronchial breath sounds

COPD is characterized by what type of airflow obstruction?

A. Fully reversible

B. Irreversible

C. Intermittent

D. Purely restrictive

Which physical exam finding may occur in emphysema?

A. Loud heart sounds

B. Bronchial breathing

C. Diminished heart and lung sounds

D. Inspiratory stridor

What acid-base pattern is described in early emphysema?

A. Respiratory alkalosis

B. Respiratory acidosis

C. Metabolic alkalosis

D. Metabolic acidosis

What acid-base pattern is described in late emphysema?

A. Metabolic alkalosis

B. Metabolic acidosis

C. Respiratory alkalosis

D. Respiratory acidosis

Permanent airway remodeling from recurrent eosinophilic inflammation suggests:

A. Emphysema

B. Chronic asthma

C. Pulmonary fibrosis

D. Bronchiectasis

Bronchiectasis primarily affects which lung regions?

A. Upper lobes

B. Apices

C. Lower lobes

D. Hila

Pleural disease and pleural effusions cause what type of restriction?

A. Intrinsic

B. Interstitial

C. Parenchymal

D. Extrinsic

Idiopathic pulmonary fibrosis is what type of restrictive lung disease?

A. Intrinsic

B. Extrinsic

C. Pleural

D. Neuromuscular

Chronic coal exposure may produce anthracotic pigment in the:

A. Pleura

B. Hilar lymph nodes

C. Alveolar septa

D. Tracheal wall

Advanced asbestosis may produce which fibrotic appearance?

A. Eggshell calcification

B. Ground-glass

C. Honeycombing

D. Cavitation

Sarcoidosis is more commonly associated with which smoking history?

A. Heavy smokers

B. Current smokers

C. Former smokers

D. Nonsmokers

Which lung sounds may be heard in ARDS?

A. Bilateral diffuse crackles

B. Unilateral wheezing

C. Inspiratory stridor

D. Pleural rub only

Which serum marker can help distinguish CHF from ARDS?

A. ACE

B. BNP

C. D-dimer

D. Troponin

Which cardiac findings favor CHF over ARDS?

A. Wheezing and rhonchi

B. Clubbing and cyanosis

C. S3/S4 and JVD

D. Crackles alone

Developmentally, the respiratory system arises from the:

A. Dorsal midgut

B. Ventral hindgut

C. Dorsal foregut

D. Ventral foregut

What epithelium lines the lobar bronchi according to these notes?

A. Ciliated columnar epithelium

B. Simple squamous epithelium

C. Transitional epithelium

D. Stratified squamous epithelium

What causes resorption atelectasis?

A. Pleural air

B. Airway obstruction with oxygen resorption

C. Interstitial fibrosis

D. Pulmonary hypertension

Which can cause resorption atelectasis?

A. Pleural plaques

B. Pulmonary hypertension

C. Mucus, foreign body, tumor

D. Left heart failure, foreign body, tumor

Compressive atelectasis results when the pleural space is expanded by:

A. Fibrosis or air

B. Mucus plugs

C. Bronchial tumors

D. Fluid or air

In compressive atelectasis, the mediastinum shifts:

A. Away from affected lung

B. Toward affected lung

C. Inferiorly

D. Superiorly

What causes contraction atelectasis?

A. Airway mucus

B. Fibrotic restriction of expansion

C. Pleural air

D. Excess surfactant

Hemodynamic pulmonary edema most commonly results from:

A. Right heart failure

B. Reduced oncotic pressure

C. Left-sided CHF

D. Pulmonary embolism

What is the first step of ARDS described in these notes?

A. Hyaline membrane formation

B. Fibroblast proliferation

C. Neutrophil extravasation

D. Endothelial activation with TNF release

What follows endothelial activation in ARDS?

A. Neutrophil adhesion

B. Immediate fibrosis

C. Surfactant overproduction

D. Bronchial dilation

What membrane forms during the next stage of ARDS?

A. Basement membrane

B. Hyaline membrane

C. Fibrous pleural membrane

D. Mucous membrane

What occurs during the fibrotic phase of ARDS?

A. Mast-cell activation

B. Bronchial dilation

C. Fibroblast growth and fibrosis

D. Surfactant accumulation

Which anatomic unit is primarily affected in emphysema?

A. Pleura

B. Bronchus

C. Trachea

D. Acinus

According to these notes, distal acinar emphysema is most associated with:

A. Pneumothorax

B. Pulmonary edema

C. Asthma

D. Bronchitis

Desquamative interstitial pneumonia is characterized by airspaces containing many:

A. Neutrophils

B. Macrophages

C. Eosinophils

D. Mast cells

Pulmonary alveolar proteinosis contains high levels of what substance in alveolar and bronchiolar spaces?

A. Collagen

B. Hemosiderin

C. Surfactant

D. Fibrin

Which gene is most frequently mutated in surfactant dysfunction disorders?

A. CFTR

B. BMPR2

C. SERPINA1

D. ABCA3

Asbestosis increases the risk of which malignancies?

A. Bronchogenic carcinoma and mesothelioma

B. Small-cell carcinoma

C. Mesothelioma and lymphoma

D. Adenocarcinoma and leukemia