Bases Loaded
(Worth a bonus 100 points)
Fomepizole is the agent of choice for which acidosis:
A. Isopropyl alcohol toxicity
B. Methanol induced acidosis
C. Salicylate induced acidosis
D. Metabolic acidosis of CKD
E. Alcoholic ketoacidosis
B) Fomepizole is an alcohol dehydrogenase inhibitor, is the agent of choice in methanol induced acidosis (aka ethylene glycol induced acidosis), and has the advantage of a predictable decline in ethylene glycol levels.
All of the following are accessory muscles for forced inspiration except…
A) Sternocleidomastoid
B) External Intercostals
3) Internal Intercostals
4) Serratus Anterior
Answer: Internal Intercostals
Mathematically, compliance is defined as a change in ___ over a change in ___.
A- ventilation: time
B- alveolar ventilation: time:
C- elastic recoil: pressure
D- volume: pressure
E- surface tension: radius
D- volume: pressure. Mathematically, Compliance = ∆V/∆P. Compliance is easily understood when thinking in terms of inhalation. In pathology where air is able to easily flow into the lungs without a great change in pressure, there is high compliance (obstructive disease) vs. pathology where a great increase in pressure is required to change the volume in the lung when inspiring, being a decreased compliance (restrictive disease).
Non Sequitur:
Which of the following is NOT a characteristic of obstructive pulmonary diseases?
A) Increased secretions
B) Destruction of parenchyma
C) Inflammation of airways
D) Decreased compliance
Answer D) Decreased compliance
What category of chronic interstitial lung disease does sarcoidosis belong to?
A. fibrosing
B. granulomatous
C. eosinophilic
D. smoking related
B) Granulomatous
Sarcoidosis is a granulomatous chronic interstitial lung disease
Pregnancy is associated with which acid-base disturbance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
B) Progesterone in pregnancy stimulates the respiratory center and causes hyperventilation and therefore causes respiratory alkalosis
Which of the following is NOT a major diaphragmatic ligament?
A) Medial arcuate ligament
B) Lateral arcuate ligament
C) Posteroinferior arcuate ligament
D) Median arcuate ligament
Answer:
Posteroinferior arcuate ligament
Decreased alveolar ventilation will have what impact on PCO2 and PO2 in the blood at the alveoli compared to functional alveolar ventilation?
A- increased, increased
B- increased, decreased
C- increased, no change
D- no change, increased
E- no change, no change
F- no change, decreased
G- decreased, no change
H- decreased, increased
I- decreased, decreased
B- increased, decreased. When alveolar ventilation is decreased, there will be less gas exchange. Thus, less CO2 will be offloaded and less O2 will be picked up, resulting in increased PCO2 and decreased PO2.
Question 1: Immunotherapy can be utilized as a treatment for which lung cancers:
A. Pneumoconiosis
B. alpha-1 antitrypsin deficiency
C. newborn respiratory distress syndrome
D. cystic fibrosis
A) Pneumoconiosis
Pneumoconiosis is a lung disease that is due to inhalation of certain mineral and organic dusts encountered; it now includes organic and inorganic particulates and chemical fumes and vapors.
Non Sequitur:
Which of the following is the best initial treatment for management of COPD?
A) Tiotropium bromide
B) Albuterol
C) Montelukast
D) Fluticasone
Answer: Tiotropium Bromide
Name the correct positioning of your finger pads for superior mesenteric ganglion inhibition.
A) Below the xiphoid
B) Above the umbilicus
C) Midpoint between the xiphoid and umbilicus
D) Below the manubrium
A) Below the Xiphoid
A patient with COPD comes in for PFTs, what are you likely to find in their results?
A) Decreased FEV1 and Increased FVC
B) Decreased FEV1 and FVC
C) Increased FEV1 and FVC
D) Increased FEV1 and Decreased FVC
Answer: Decreased FEV1 and FVC
Question 2: The most common primary lung cancer is:
Answer: D - from First Aid 2021 ed. Pg. 709
What is the most common pneumoconiosis?
A. asbestosis
B. silicosis
C. fibrosis
D. coal workers’ pneumoconiosis
B) Silicosis
Silicosis is the most common pneumoconiosis in the world and is caused by crystalline silica.
Which of the following causes of metabolic acidosis is associated with a normal anion gap?
A. Diabetes mellitus
B. Diarrhea
C. Starvation
D. Chronic renal failure
E. Lactic acidosis
Answer B) Diarrhea results in a loss of bicarbonate, but this is compensated by an increase in chloride concentration, which leads to a normal anion gap (hyperchloremic) metabolic acidosis.
How do pressures in the thorax change during forceful expiration?
A) Intrapleural pressure becomes more negative
B) Intrapleural pressure is equal to atmospheric pressure
C) Intrapleural pressure becomes highly positive
D) Intra-alveolar pressure becomes negative
Answer: Intrapleural pressure becomes highly positive
What relationship will accumulation of mucous have on airway resistance and airway compliance?
A- increased, increased
B- increased, decreased
C- increased, no change
D- no change, no change
E- decreased, no change
F- decreased, increased
G- decreased, decreased
B- increase, decrease. Mucous build-up, such as in some chronic bronchitis or bronchiectasis will result in narrowed airways. Smaller airways result in increased turbulence and resistance. Thus, more pressure will be required to achieve the same change in volume when mucous constricts the airways, leading to a decreased compliance.
Question 3: A 30-year-old male is seen for follow-up of a chest x-ray finding. The patient was in a minor car accident and received a chest x-ray in the emergency room. A 0.7 cm, regular, round nodule was seen in the periphery of the right lung. He has no significant past medical history. He is an occasional smoker and emigrated from Mexico eight years ago. Vital signs and exam are within normal limits. Which of the following is the most likely underlying cause of the nodule?
Answer: A.
Explanation:
Answer A (correct answer): Young patients that present with pulmonary nodules are more likely to have benign etiologies than malignant. In addition, a person who presents without symptoms is more likely to have a benign lesion than a malignant one. The most common cause of a benign pulmonary nodule is a granuloma, which is typically formed after infection with fungi or tuberculosis.
Management of pulmonary nodules is outside of the scope of Step 1. In general, however, pulmonary nodules are better visualized by CT scan. Lesions with low risk for malignancy (<0.8 cm in size, young age) are typically followed with serial imaging. Larger, higher-risk lesions (>0.8 cm, older age, smoking history) may require biopsy or PET scan for further workup. The important takeaway is that small nodules in people under 40 are typically benign.
Answer B (incorrect answer): Pulmonary hamartomas are benign proliferations of lung tissue. These are the second most common cause of benign pulmonary nodules.
Answer C (incorrect answer): Malignancy would be expected in someone with significant risk factors including age >60 and a long smoking history. Neoplastic processes are unlikely in a younger person with a nodule as an incidental finding.
Answer D (incorrect answer): Bacterial pulmonary abscesses can present as nodules, but are unlikely in someone that is asymptomatic.
Answer E (incorrect answer): Traumatic lesions include pulmonary contusions which can occur after chest trauma. These present as irregular, patchy opacities on x-ray, not a focal nodule.
Which disease is this describing: hypersensitivity from the inhalation of organic dust containing antigens made up of spores of thermophilic bacteria, fungi, animal proteins, or bacterial products.
A. asbestosis
B. COPD
C. hypersensitivity pneumonitis
D. silicosis
C) hypersensitivity pneumonitis
Hypersensitivity pneumonitis is hypersensitivity from the inhalation of organic dust containing antigens made up of spores of thermophilic bacteria, fungi, animal proteins, or bacterial products. Examples include farmer’s lung and pigeon breeder’s lung
Which of the following sets of lab values demonstrate metabolic alkalosis with respiratory compensation?
A. pH – 7.5; HCO3- - 26; PCO2 - 46
B. pH – 7.3; HCO3- - 23; PCO2 - 36
C. pH – 7.6; HCO3- - 28; PCO2 - 38
D. pH – 7.4; HCO3- - 24; PCO2 - 40
E. pH – 7.5; HCO3- - 26; PCO2 - 38
Answer: A
Explanations:
B = metabolic acidosis with respiratory compensation
C = Respiratory alkalosis with metabolic compensation
D = Normal values
E = Metabolic alkalosis without compensation
Pick the correct pairing of vertebral levels and its organ for the organ’s viscerosomatic reflex.
A) Heart – T4-T5
B) Pancreas – T5-T11
C) Small Intestine – T4-T8
D) Prostate – T9-L1
B) Pancreas, T5-T11
In the lungs, an increase in surface tension will ___ compliance and will ___ collapsing pressure.
A- increase, increased
B- increase, decrease
C- increase, not change
D- not change, not change
E- decrease, not change
F- decrease, increase
G- decrease, decrease
F- decrease, increase. This question tests knowledge of the function of surfactant. Surfactant increases lung compliance by decreasing water surface tension, helping to prevent lung collapse (makes it easier to change lung volume with lower pressure - i.e., less work to breathe). Clinically relevant in premature babies who have low lung compliance due to decreased surfactant production (neonatal respiratory distress syndrome).
A 70-year-old woman presents for follow-up of a lung biopsy. The patient was recently hospitalized for suspected pneumonia after a right middle lobe infiltrate was seen on chest x-ray. After she did not improve on antibiotic therapy, a lung biopsy was performed. Pathology is shown in the image below. Which of the following is the most likely type of cancer?
Answer: E. Bronchoalveolar carcinoma
Explanation:
Answer E (correct answer): This patient’s clinical presentation and pathology are consistent with bronchoalveolar carcinoma, a subtype of adenocarcinoma. This cancer typically presents in nonsmokers with a lobar consolidation on x-ray that can mimic pneumonia. The malignancy is derived from goblet cells, club cells, or type II pneumocytes. The characteristic pathology finding is a single layer of malignant columnar cells growing along the alveolar septa. There is no invasion, so this type of malignancy is sometimes considered “adenocarcinoma in situ.” With proper treatment, the prognosis is excellent because invasion has not occurred.
Answer A (incorrect answer): Small cell carcinoma derives from neuroendocrine cells and appears as clusters of highly basophilic cells.
Answer B (incorrect answer): Squamous cell carcinoma is a malignant proliferation of squamous cells. Pathology demonstrates intercellular desmosomes (intercellular “bridges”) and keratin pearls.
Answer C (incorrect answer): Large cell carcinoma is poorly differentiated and appears as a cluster of large, anaplastic cells.
Answer D (incorrect answer): Bronchial carcinoid tumors show clusters of basophilic neuroendocrine cells.
Which genotypes is sarcoidosis associated with?
A. HLA-DQ5
B. HLA-B8
C. HLA-A9
D. HLA-D2
B) HLA-B8
Genotypes HLA-B8 and HLA-A1 are associated with sarcoidosis.