SYTM 5504 Week 1 Practice Questions
[1FG] Which of the following statements concerning terminal bronchioles is true? (A) They are part of the conducting portion of the respiratory system. (B) They function in gas exchange. (C) They do not contain ciliated cells. (D) They have cartilage plates present in their walls. (E) They do not contain secretory cells.
(A) They are part of the conducting portion of the respiratory system. ???
[1AB] A 27 year old woman with a goiter comes to the hospital for surgical treatment. The surgeon must ligate the superior laryngeal artery before surgically resecting the goiter, so care must be taken to avoid injury to which of the following nerves? (A) External laryngeal nerve (B) Internal laryngeal nerve (C) Superior laryngeal nerve (D) Hypoglossal nerve (E) Vagus nerve
(B) Internal laryngeal nerve ???
[1FG] True statements about asthma include which one of the following? (A) It is due to a loss of lung elasticity. (B) It eventually causes the lungs to expand and leads to a barrel chest. (C) It is associated with difficulty expiring air from the lungs. (D) It may be helped by gene therapy using recombinant α1 antitrypsin. (E) It is usually not associated with inflammation.
(C) It is associated with difficulty expiring air from the lungs. ???
[1AB] A 38 year old man has had thyroid surgery to remove his papillary carcinoma. The external laryngeal nerve that accompanies the superior thyroid artery is damaged during the surgery. This injury could result in a severe impairment of function of which of the following? (A) Relaxing the vocal cords (B) Rotating the arytenoid cartilages (C) Tensing the vocal cords (D) Widening the rima glottidis (E) Abducting the vocal cords
(C) Tensing the vocal cords External laryngeal nerve innervates cricothyroid muscle, which tenses, adducts, & elongates vocal cords. Anterior part of muscle tenses vocal cord, while posterior part relaxes it. All other muscles of larynx that move vocal cords are innervated by recurrent laryngeal nerve.
[1FG] The trachea possesses which one of the following components? (A) Irregular cartilage plates in its wall (B) Skeletal muscle in its wall (C) An epithelium containing only two cell types (D) A thick basement membrane underlying its epithelium (E) Bowman glands in its lamina propria
(D) A thick basement membrane underlying its epithelium ???
[1FG] Characteristics of olfactory epithelium include which one of the following? (A) It is located in the inferior region of the nasal cavity. (B) It is classified as simple columnar. (C) It has an underlying lamina propria containing mucous glands (D) It has modified cilia, which act as receptors for odor. (E) It is unable to regenerate.
(D) It has modified cilia, which act as receptors for odor. ???
[1FG] Which of the following statements concerning respiratory bronchioles is true? (A) No gas exchange occurs in them. (B) They do not have alveoli forming part of their wall. (C) They contain goblet cells in their lining epithelium. (D) They are included in the conducting portion of the respiratory system. (E) Ciliated cells comprise a portion of their lining epithelium.
(E) Ciliated cells comprise a portion of their lining epithelium. ???
[1E] A prenatal ultrasound revealed polyhydramnios, and at birth, the baby had excessive fluids in its mouth. What type of birth defect might be present, and what is its embryological origin? Would you examine the child carefully for other birth defects? Why or why not?
A, B, & D ???
[1CD] A 65-year-old male with pleural effusion is undergoing thoracentesis. To puncture the lung, the physician should insert the needle at the midaxillary line between which of following two ribs? A. 7th and 9th B. 1st and 3rd C. 9th and 11th D. 5th and 7th E. 3rd and 5th
A. 7th and 9th ???
[1HIJ] Q. The apex of the upright human lung compared with the base has: A. A higher PO2 B. A higher ventilation C. A lower pH in end capillary blood D. A higher blood flow E. Smaller alveoli
A. A higher PO2 ???
[1NO] A young man is struck in the chest area during a game of pickup basketball. He shows immediate signs of chest soreness and difficulty breathing but is otherwise alert. He is taken to an urgent care center where he is diagnosed with atelectasis and is treated with an incentive spirometer, which is sufficient to reverse breathing difficulties and fully re-inflate his lungs. What would be the expected result from extended atelectasis? A. A reduced arterial PO2 due to ventilation/perfusion ratio that approaches zero in the affected alveoli B. An increased arterial PO2 due to an increase in ventilation/perfusion ratio in the affected alveoli C. An increase in physiologic dead space D. A reduced arterial PCO2 due to ventilation/perfusion that approaches zero in the affected alveoli
A. A reduced arterial PO2 due to ventilation/perfusion ratio that approaches zero in the affected alveoli In shunting, V/Q approaches 0. Venous blood enters arterial system w/o oxygenation, causing hypoxemia. In anatomic shunting, blood bypasses lungs & alveoli completely, e.g. intra-cardiac shunting & pulmonary AVMs. In physiologic shunting, blood goes to alveoli that don't work so non-ventilated alveoli are perfused, e.g. atelectasis. However, increased RR from decreased O2 will not increase PaO2, since alveoli that are working are already at full oxygen exchange capacity. However, hyperventilation will keep CO2 levels normal. Shunting will not correct w/ 100% oxygen.
[1KL] An 8-year-old boy is brought to the office by his mother because of a 3-day history of fever, sore throat, and itchy red eyes. He just returned from a week-long summer camp that included hiking trips and swimming lessons. His temperature is 102.9°F, but other vital signs are within normal limits. Physical examination shows conjunctival injection and discharge and oropharyngeal erythema. The public health department reports an outbreak of similar symptoms among the other campers and camp volunteers. Which of the following is the most likely cause of this patient's symptoms? A. Adenovirus B. Cytomegalovirus C. Epstein-Barr virus D. Influenza virus E. West Nile virus
A. Adenovirus Patient has viral conjunctivitis, whose most common causative pathogen is adenovirus. Adenovirus can also cause URTIs. ???
[1KL] A 20-year-old college student develops fever, severe pharyngitis, hepatosplenomegaly, and posterior cervical lymphadenopathy. The pathogenesis of this syndrome most likely involves a DNA virus infection of which of the following cells? A. B lymphocytes B. Kupffer cells C. Macrophages D. Neutrophils E. T lymphocytes
A. B lymphocytes ???
[1KL] Cody, who is 10 months old, presents with irritability and a purulent ear discharge. Exudate contains Gram-positive cocci. Cervical lymph nodes are moderately swollen. His medical history includes numerous infections after 5 months of age. They include a Staphylococcal skin infection, which responded poorly to antibiotics. Which of the following features describes the most likely microbe of his illness? A. Catalase-negative, α-hemolytic on sheep blood agar B. Catalase-negative, β-hemolytic on sheep blood agar C. Catalase-negative, γ-hemolytic on sheep blood agar D. Catalase-positive, α-hemolytic on sheep blood agar E. Catalase-positive, β-hemolytic on sheep blood agar
A. Catalase-negative, α-hemolytic on sheep blood agar Patient has middle ear infection due to Strep pneumo.
[1KL] A 16-year-old patient presents with painless, purulent discharge from the right ear for the last three days. He reports he had the flu one week ago. He gives no history of seasonal or drug allergies. On examination, the tympanic membrane cannot be visualized. Which of the following ear structures increase the susceptibility of the suspected diagnosis? A. Eustachian tube B. Shape of the ear C. Tympanic membrane D. Length of external canal E. Semi-circular canals
A. Eustachian tube ???
[1KL] A 6-year-old patient presents with pain in the left ear. Pus is drained from the ear and a sample is sent for culture. Gram stain reveals neutrophils and small Gram-negative bacteria. However, the bacteria in the smear are so small that it is difficult to decide whether they are rods or cocci. What information from the lab would allow identification of the organism? A. Growth on blood agar supplemented with X and V factors B. Beta-hemolysis around colonies on sheep blood agar C. Ability to grow in medium containing 6.5% NaCl D. Sensitivity to bacitracin and resistance to optochin E. Positive bile-esculin test
A. Growth on blood agar supplemented with X and V factors ???
[1KL] If Cody (see previous card for details of his life) has an immunodeficiency syndrome, what aspect of the immune system is most likely to be defective? A. IgM/IgG, complement, and neutrophils B. IgE, mast cells, and basophils C. Function of CD4+ T cells D. Proliferation and cytolysis by CD8+ cells E. NK cell function
A. IgM/IgG, complement, and neutrophils Throwback! Encapsulated bacteria like Strep pneumo are dealt w/ using complement system & neutrophils.
[1NO] Concerning the ventilatory response to hypoxia... A. It is the major stimulus to ventilation at high altitude. B. It is primarily brought about by central chemoreceptors. C. It is reduced if the PCO2 is also raised. D. It rarely stimulates ventilation in patients with chronic lung disease. E. It is important in mild carbon monoxide poisoning.
A. It is the major stimulus to ventilation at high altitude.
[1KL] A 3-year-old boy presents with pain in his right ear and purulent discharge from his right eye. His right tympanic membrane is erythematous, opacified, and bulging, and his right eye demonstrates injected conjunctiva and minimal purulent discharge. His sibling has the same condition. Which organism is most likely causative of this patient's condition? A. Streptococcus pneumoniae B. Staphylococcus aureus C. Moraxella catarrhalis D. Haemophilus influenzae E. Streptococcus pyogenes
A. Streptococcus pneumoniae The most common cause of middle ear infections in kids is Strep pneumo. That's all you need to know, apparently.
[1KL] A 23-year-old male presents with fever, sore throat, erythematous rash, and joint swelling. A social history reveals he commonly has sexual relations with other males. His rapid antigen test for Group A beta-hemolytic streptococcus is negative. What is the next best step in the management of this patient? A. Test for HIV and gonorrhea B. Discharge the patient with a prescription for penicillin V C. Recommend the patient use frequent gargles and take acetaminophen D. Obtain a CBC E. Test for measles antibodies
A. Test for HIV and gonorrhea ???
[1HIJ] Which one of the following is higher at the apex of the lung than at the base when a person is standing? A. V/Q ratio B. Blood flow C. Ventilation D. PaCO2 E. Lung compliance
A. V/Q ratio ???
[1AB] A 52 year old woman presents to her primary care physician with ongoing anxiety, weight loss, proptosis, and tremor. She was diagnosed with hyperthyroidism and was treated with methimazole six months ago. Laboratory results are consistent with an ongoing hyperthyroid state. She undergoes thyroidectomy given failure of medical therapy. Following surgery, she complains of a sore throat. Her family notes that she is extremely hoarse and speaks in whispers. The lesion in this patient is most likely localized to which nerve? A. Vagus nerve B. Facial nerve C. Trigeminal nerve D. Greater auricular nerve E. Glossopharyngeal nerve
A. Vagus nerve Vagus nerve gives rise to recurrent laryngeal nerve, which innervates all intrinsic muscles of larynx except cricothyroid, which is innervated by external laryngeal branch of superior laryngeal branch of vagus nerve. On left side, laryngeal nerve recurs around right subclavian artery; on right side, it recurs around aortic arch.
[1NO] A 45-year-old male is involved in a motor vehicle accident and suffers a right femoral shaft fracture. Upon arrival at the hospital, his leg is operated on immediately. On his third hospital day, he becomes agitated and tachypneic, and complains of chest pain. An arterial blood sample is drawn immediately and shows a PaO2 of 65 mm Hg. Which of the following is the most likely mechanism of hypoxemia in this patient? A. Ventilation/perfusion mismatch B. Diffusion impairment C. Hypoventilation D. Left-to-right shunt E. Increased tissue oxygen extraction
A. Ventilation/perfusion mismatch This patient is potentially suffering from pulmonary embolism, which causes V/Q mismatch.
[1KL] A 12-year-old boy presents with acute onset of sore throat, fever to 38.9°C and painful anterior cervical lymphadenopathy. On examination, the pharynx is red and swollen, and the tonsils are covered with yellow-white exudate. The child also has halitosis. What non-suppurative complication is of concern? A: Acute rheumatic fever B: Scarlet fever C: Quinsy D: Ludwig's angina E: Osteomyelitis
A: Acute rheumatic fever ???
[1HIJ] During a normal breathing cycle there are three intervals; at rest before inspiration begins, inspiration, and expiration. Which of the following occurs during the breathing cycle? A: Alveolar pressure becomes greater than atmospheric pressure during expiration B: At rest lung volume is at residual volume C: Intrapleural pressure becomes positive at the end of inspiration D: During expiration intrapleural pressure becomes more negative E: Alveolar pressure becomes positive than atmospheric pressure at mid inspiration
A: Alveolar pressure becomes greater than atmospheric pressure during expiration ???
[1M] A 40-year-old man presents to the family medicine clinic following a minor accident at work. He attributes the accident to daily fatigue, drowsiness and difficulty thinking clearly which has worsened gradually over the past two years. He feels he has not slept well since he started sleeping on the couch after his partner complained about his very loud snoring. What is the most likely cause of the man's condition? A: Collapse of the pharyngeal muscles B: Unilateral blockage of a nasal passage with bone C: Tumor of blood vessels and fibrous tissue in the roof on the nasal cavity D: Infection with Klebsiella rhinoscleromatis E: Necrotizing granulomatous vasculitis
A: Collapse of the pharyngeal muscles Patient has obstructive sleep apnea, which is excessive, loud snoring w/ apnea, i.e. intervals of breath cessation. Most common cause is obesity, but other causes include tonsillar hypertrophy & nasal septum deviation. Pharyngeal muscles collapse due to weight of tissue in neck.
[1HIJ] In comparison to systemic circulation, which of the following is the differentiating feature of pulmonary circulation? A: Lower resistance B: Higher cardiac output C: Higher arterial pressure D: Higher blood flow E: Higher capillary pressure
A: Lower resistance ???
[1HIJ] In an upright lung, which of the following is lower at the base of the lung than at the apex of the lungs? A: Ventilation/Perfusion ratio B: PaCO2 C: Blood flow D: Ventilation E: Volume
A: Ventilation/Perfusion ratio Since blood flow aka perfusion is highest at base, ratio is lowest at base.
[1NO] The total O2 content of blood includes dissolved O2 and O2 bound to Hb. What is the total O2 content of blood in this case? What fraction of total O2 content is O2-hemoglobin? Assume dissolved O2 = (0.3 mL O2 / 100 mL blood), O2 binding capacity of blood is (20.1 mL O2 / 100 mL blood) & percent saturation of Hb by O2 is 98% (though normally, percent saturation of Hb depends on PO2 of blood).
Amount of O2-hemoglobin = O2 binding capacity of Hb * % saturation = (20.1 mL O2 / 100 mL blood) * (0.98) = 19.7 mL O2 / 100 mL blood. Total O2 content of blood = Dissolved O2 + O2-hemoglobin = (0.3 mL O2 / 100 mL blood) + (19.7 mL O2 / 100 mL blood) = 20 mL O2 / 100 mL blood.
[1M] Name the period of breath cessation that might be seen in a sleep study.
Apnea Apnea is discussed on different cards. On another note, choanal atresia is congenital nasal obstruction where there is bony (sometimes membranous) blockage of back of nasal passage. This is due to failure of recanalization of nasal fossae. It affects females more than males. It is also mostly unilateral, esp. on right side, though it can be bilateral. Bilateral choanal atresia is life-threatening since infants are obligate nasal breathers. Choanal atresia is checked for by poking catheter into infant's nasopharynx at birth. Classic presentation is cyanosis upon breastfeeding but pinkness returns upon crying.
[1CD] A 46-year-old patient comes to his doctor's office and complains of chest pain and headache. His computed tomography scan reveals a tumor located just superior to the root of the right lung. Blood flow in which of the following veins is most likely blocked by this tumor? A. Hemiazygos vein B. Arch of the azygos vein C. Right subclavian vein D. Right brachiocephalic vein E. Accessory hemiazygos vein
B. Arch of the azygos vein ???
[1NO] Most of the carbon dioxide transported in the arterial blood is in the form of... A. Dissolved B. Bicarbonate C. Attached to hemoglobin C. Carbamino compounds E. Carbonic acid
B. Bicarbonate
[1KL] A 3-year-old female is brought to the emergency department with a 6-hour history of inspiratory stridor and high fever. The child is anxious, leaning forward, and drooling. Pharyngeal X-ray shows obstruction at level of epiglottis. Which of the following describes the most likely causative agent of her illness? A. Non-capsulated Gram -ve coccobacillus growing on blood agar B. Capsulated Gram -ve coccobacillus growing on chocolate agar C. Non-capsulated Gram +ve bacillus producing AB toxin D. Capsulated Gram +ve coccus sensitive to optochin E. Non-capsulated Gram +ve coccus sensitive to bacitracin
B. Capsulated Gram -ve coccobacillus growing on chocolate agar Patient has epiglottitis to extent that it has caused obstruction of upper airway (life-threatening). Most common cause of epiglottitis is H. influenzae.
[1AB] Which of the following nerves supplies motor innervation to the cricothyroid muscle? A. Right recurrent laryngeal nerve B. External laryngeal nerve C. Internal laryngeal nerve D. Left recurrent laryngeal nerve E. Glossopharyngeal nerve
B. External laryngeal nerve
[1KL] If Cody remained healthy until he was five months old, what is the most likely reason that he did not develop infections before the age of five months? A. Babies of that age range are not exposed to bacteria B. Maternal IgG provided protection C. During the first few months of life, the phagocytic capacity of neutrophils is high but then declines. D. Before 5-6 months, the intestine contains no normal flora. E. Factors H and I are not produced during the first six months of life, so that complement is more active then than later.
B. Maternal IgG provided protection Another throwback! IgG is the placenta god.
[1KL] A 12-year-old boy comes to the clinic because of a bad cold for the past two weeks. His symptoms began with a runny nose which progressed, producing large amounts of dark yellow snot from his nose for the past 7 days. HIs temperature is 101.5°F, pulse is 78/min, respirations are 18/min, and blood pressure is 120/75 mm Hg. Physical examination shows purulent nasal discharge. His lungs are clear to auscultation bilaterally. Sputum culture grows a Gram-negative, aerobic, oxidase-positive diplococcus that is unable to metabolize maltose. Which of the following is the most likely cause of this condition? A. Haemophilus influenzae B. Moraxella catarrhalis C. Neisseria meningitidis D. E. coli E. Streptococcus pneumoniae
B. Moraxella catarrhalis Patient has acute sinusitis, which can be caused by any number of bugs. Distinguishing feature here is Gram-negative diplococcus, which is characteristic of Neisseria meningitidis, Neisseria gonorrhoeae, & Moraxella catarrhalis.
[1M] A 45-year-old man presents with epistaxis. He recently had a stuffy nose with nasal discharge and facial pain over the maxillary sinuses. He also has ear pain and hearing loss. A mass is present superior to the hard palate. What is the most likely diagnosis? A. Nasopharyngeal angiofibroma B. Nasopharyngeal carcinoma C. Laryngeal carcinoma D. Chronic sinusitis
B. Nasopharyngeal carcinoma Nasopharyngeal carcinoma is malignant tumor of epithelial cells of nasopharynx, above soft palate. There is increased incidence in males vs. females. In China, it tends to affect adults, but in Africa, it tends to affect children. It is assoc. w/ EBV. Symptoms include nasal obstruction, epistaxis, nasal discharge, otitis media & hearing loss if there is blockage of Eustachian tube, sinus invasion, & metastasis to cervical lymph nodes.
[1HIJ] In areas of the lung with lower than normal V/Q ratios, the A. Capillary CO2 tension is lower than normal B. Pulmonary vascular resistance is higher than normal C. Alveolar O2 tension is higher than normal D. Water vapor pressure is higher than normal E. Gas exchange ratio is higher than normal
B. Pulmonary vascular resistance is higher than normal ???
[1CD] While performing this procedure, the lower border of the lung will lie at the level of which rib in the MCL? A. Fifth B. Sixth C. Seventh D. Eighth E. Ninth
B. Sixth ???
[1M] A 67-year-old man presents to the family medicine clinic with hoarseness, cough, and stridor. Physical exam reveals multiple enlarged, hard, painless cervical lymph nodes. A biopsy of a mass on the vocal cord reveals squamous cell carcinoma. What are the most likely risk factors? A. Cocaine B. Smoking C. Alcohol D. Screaming
B. Smoking & C. Alcohol Patient has laryngeal carcinoma, which is most likely located on true vocal cords. Risk factors include cigarette smoking & alcohol, which has synergistic effect w/ smoking. Other risk factors include having squamous papillomata & papillomatosis, since this cancer is squamous cell carcinoma. Symptoms include persistent hoarseness, cough, stridor, & painless cervical lymphadenopathy due to metastases. Of course, keratin pearls are seen on histology.
[1KL] A 48-year-old male presents with worsening headache, nasal discharge, and fever for the past 2-3 weeks. He also reveals a history of uncontrolled diabetes. Vital signs include a blood pressure of 150/95 mm Hg, a heart rate of 90/min, respiratory rate of 19/min, oxygen saturation of 97%, and a temperature of 100°F. Physical examination reveals tenderness over cheekbones and forehead. The lungs are clear with normal heart sounds. Sinus discharge grew pure culture of organisms on blood agar. What is the most likely organism responsible for his illness? A Streptococcus viridans B. Streptococcus pneumoniae C. Haemophilus influenzae D. Staphylococcus aureus E. Neisseria meningitidis
B. Streptococcus pneumoniae ???
[1AB] Which of the following muscles form the posterior wall of the laryngopharynx? A. Styloglossus muscle B. Superior pharyngeal constrictor C. Posterior cricoarytenoid muscles D. Palatoglossus muscle E. Palatopharyngeus muscle
B. Superior pharyngeal constrictor In general, pharyngeal constrictor muscles form posterior wall of laryngopharynx & they include superior, middle, & inferior constrictor muscles.
[1NO] A 59-year-old woman comes to the emergency department with an acute onset of shortness of breath. She states to the attending physicians that she recently sustained a fractured fibula in her right leg and has had slightly elevated blood pressure for several years. A lung scan demonstrates a perfusion defect in the lower right lobe. Which of the following occurs if blood flow to the alveolar units in the region of the perfusion defect is totally obstructed by a pulmonary embolism? A. There will be a reduced arterial PO2 due to venous to arterial shunt. B. The PO2 of the alveoli affected by the embolism will be equal to PO2 in the inspired air. C. The anatomical dead space is decreased. D. The ventilation/perfusion of the alveoli in the affected area goes to zero. E. The PO2 of the alveolus will be equal to the mixed venous PO2.
B. The PO2 of the alveoli affected by the embolism will be equal to PO2 in the inspired air. In dead space, V/Q approaches ∞. No hypoxemia is seen in pure dead space since healthy alveoli are supplying oxygenated blood while poorly perfused one aren't contributing at all. However, if enough blood is diverted to alveoli w/ good perfusion (non-pure dead space), V/Q ratio of those alveoli decreases, leading to hypoxemia. Increased CO2 is seen. Dead space will correct w/ 100% oxygen. V/Q mismatch is intermediate state b/w shunting & dead space where some lungs have low V/Q while others have high V/Q. Inadequate ventilation causes reduced oxygenation of blood. Increased RR keeps CO2 levels normal. Mismatch corrects w/ 100% oxygen.
[1NO] Concerning the peripheral chemoreceptors... A. They respond to changes in the arterial PO2 but not pH. B. Under normoxic conditions, the response to changes in PO2 is very small. C. The response to changes in PCO2 is slower than that for central chemoreceptors. D. They are the most important receptors causing an increased ventilation in response to a rise in PCO2. E. They have a low blood flow per gram of tissue.
B. Under normoxic conditions, the response to changes in PO2 is very small.
[1M] A 16-year-old cheerleader comes to the family medicine clinic because of difficulty cheering due to a hoarse voice. What is the most likely diagnosis? A. Laryngeal carcinoma B. Vocal cord nodules C. Recurrent laryngeal papillomatosis D. Nasopharyngeal angiofibroma
B. Vocal cord nodules Vocal cord nodule aka singer's nodule is nodule that arises on true vocal cords due to excessive use. They are composed of degenerative (myxoid) connective tissue & are often bilateral.
[1AB] Image on other side of card is a view of the upper larynx during a laryngoscopic examination. What structure creates the small tubercle indicated by the blanked out label? A. arytenoid cartilage B. cuneiform cartilage C. thyroid cartilage D. corniculate cartilage E. cricoid cartilage
B. cuneiform cartilage Cricoid cartilage articulates w/ thyroid cartilage & its lower border marks end of pharynx & larynx. Arytenoid cartilages sit atop cricoid cartilage, & corniculate cartilage sit on apices of arytenoid cartilages. Cuneiform cartilages lie anterior & superior to corniculate cartilages.
[1KL] Which of the following respiratory viruses has RNA only, for both its genome and replicative intermediate? A: Parvoviruses B: Influenza C: Adenovirus D: EBV E: Cytomegalovirus
B: Influenza ???
[1KL] A 5-year-old boy comes to the pediatrician's office because of a cold. His mother also indicated that he began draining yellowish fluid from his left nostril. He has had a fever and upper respiratory infection symptoms for the past 8 days. On physical examination, mucopurulent exudate was seen coming from the left nostril. Gram stain of this discharge showed cocci in chains of two. What is the most likely organism responsible for his condition? A: Streptococcus pyogenes B: Streptococcus pneumoniae C: Streptococcus viridans D: Corynebacterium diphtheriae E: Bacillus anthracis
B: Streptococcus pneumoniae ???
[1KL] A 17-year-old male patient presents to the hospital with a sore throat. His condition is associated with fever and chills, difficulty in swallowing, and ear pain. The vital sign shows a temperature of 102.2°F, pulse rate 102/min, and respiratory rate of 20 breaths/min. The physical exam reveals a dry tongue, erythematous enlarged tonsils, pharyngeal exudate, and tender cervical lymphadenopathy. Which is the most useful test in establishing a diagnosis in this patient? A: ASO titer B: Throat culture C: C-reactive protein level (CRP) D: Erythrocyte sedimentation rate (ESR) E: Cold agglutinin test
B: Throat culture ???
[1NO] Which of the following statements best describe the characteristics of peripheral chemoreceptors? A: They respond to changes in arterial PO2 but not pH. B: Under normal conditions the response to changes in PO2 is very small. C: The response to changes in PCO2 is similar to central chemoreceptors. D: They are the most important receptors causing an increased ventilation in response to a rise in PCO2. E: They have a low blood flow per gram of tissue.
B: Under normal conditions the response to changes in PO2 is very small. Central chemoreceptors are located in medulla, where it mainly monitors CO2 & pH levels since O2 delivery to brain is fairly stable under normal conditions. It normally exerts strongest control over RR. Peripheral chemoreceptors are located in carotid bodies & aortic arch, where they mainly monitor O2 level. They exert strongest control when there is dramatic decrease in arterial O2 levels. They are weakly sensitive to PCO2 & pH; increased PCO2 & decreased pH actually increases their sensitivity to PO2, while decreased PCO2 & increased pH decreases their sensitivity to PO2.
[1HIJ] Which of the following will occur when a 10-year-old boy inhales a coin which completely blocks air flow in his left lung? A: Ventilation/perfusion (V/Q) ratio in the left lung will increase. B: Ventilation/perfusion ratio in the left lung will be lower than in the right lung. C: Alveolar PO2 in the left lung will be approximately equal to the PO2 in inspired air. D: Alveolar PO2 in the right lung will be approximately equal to the PO2 in venous blood. E: Systemic arterial PO2 will be elevated
B: Ventilation/perfusion ratio in the left lung will be lower than in the right lung. ???
[1KL] A 20-year-old male presents with a 7-day history of fever, myalgia, and malaise. He also complains of a sore throat and difficulty swallowing. He denies any cough or rhinorrhea. He is sexually active with his female partner. He plays for the school soccer team. On exam, he has a temperature of 102.2°F, blood pressure of 110/80 mm Hg, and pulse rate of 106/min. Ora exam reveals mild congestion of pharyngeal arches and enlarged tonsils with whitish exudate. He has anterior and posterior cervical lymphadenopathy. The lungs are clear to auscultation. The cardiovascular exam reveals no murmurs. He has mild splenomegaly. Which of the following recommendations are advised for this patient? A. Start treatment with empiric antibiotics B. Start treatment with glucocorticoids C. Abstain from contact sports until normal D. Avoid sexual intercourse until normal E. Treat with antivirals
C. Abstain from contact sports until normal Patient has infectious mononucleosis, which is caused by Epstein-Barr virus.
[1E] Scientists are studying human lung development by trying to identify which proteins and signaling factors trigger lung bud division and bronchiole branching. Their main focus is particularly around the 20th week of gestation, during which terminal bronchioles branch into respiratory bronchioles and further into alveolar ducts. What phase of embryonic lung development are the scientists studying? A. embryonic B. Pseudoglandular C. Canalicular D. Saccular E. Alveolar
C. Canalicular ???
[1CD] A 21-year-old patient with a stab wound reveals a laceration of the right vagus nerve proximal to the origin of the recurrent laryngeal nerve. Which of the following conditions would most likely result from this lesion? A. Contraction of bronchial muscle B. Stimulation of bronchial gland secretion C. Dilation of the bronchial lumen D. Decrease in cardiac rate E. Constriction of coronary artery
C. Dilation of the bronchial lumen Since vagus nerve is parasympathetic, its lesion will prevent parasympathetic stimulation & result will be sympathetic in nature.
[1KL] A 4-year-old boy is brought to the emergency department with 4 days of barking cough and stridor. He has a temperature of 100.7°F. He is not short of breath or cyanotic. He has no history of asthma and has received all vaccinations. A steeple sign is seen on chest X-ray. What is the likely causative agent? A. Cytomegalovirus B. Coxsackievirus C. Parainfluenza virus D. Herpesvirus E. Streptococcus pyogenes
C. Parainfluenza virus Patient has croup aka laryngotracheal bronchitis, whose hallmark characteristic is steeple sign on chest X-ray. Most common cause of croup is parainfluenza virus.
[1KL] A 23-year-old female presents with a 2-day history of sore throat, cough, and rhinorrhea. She has experienced a low-grade fever for the last 2 days but denies any chills. She smokes a pack of cigarettes daily and consumes 2-3 drinks of alcohol on the weekends and has no other chronic medical conditions. On examination, she has a temperature of 100.4°F, pulse rate of 90/min, and blood pressure of 120/80 mm Hg. Oral exam reveals diffuse erythema of the pharynx and mild tonsillar exudates. Anterior cervical lymph nodes are enlarged. Which of the following symptoms in this patient suggests a viral rather than bacterial etiology of her condition? A. Presence of lymphadenopathy B. Presence of tonsillar exudates C. Presence of cough and rhinorrhea D. Presence of fever E. Presence of headache
C. Presence of cough and rhinorrhea Since bacteria that cause sore throat are limited to the URT, they would not cause cough, rhinorrhea, or conjunctivitis. However, viruses can infect entire RT & produce those symptoms.
[1E] What tissue or cell type originates from lung bud mesenchyme? A. Pseudostratified columnar epithelium B. Epithelial lining of alveolar sac C. Smooth muscle D. Type II cells
C. Smooth muscle ???
[1NO] Concerning the central chemoreceptors... A. They are located near the dorsal surface of the medulla. B. They respond to both the PCO2 and the PO2 of the blood. C. They are activated by changes in the pH of the surrounding extracellular fluid. D. For a given rise in PCO2, the pH of the CSF falls less than that of blood. E. The bicarbonate concentration of the CSF cannot affect their output.
C. They are activated by changes in the pH of the surrounding extracellular fluid.
[1E] What is hyaline membrane disease mainly associated with? A. Oxygen therapy at birth B. Type I pneumocyte development C. Type II pneumocyte development D. Diaphragmatic hernia E. Caesarian delivery
C. Type II pneumocyte development ???
[1HIJ] A patient was tachypneic (respiratory rate 28/min) on examination and intercostal indrawing was observed during inspiration. Spirometry done which reveals tidal volume equals 250 mL. What is the total ventilation volume (in L/min)? A: 5 L/min B: 6 L/min C: 7 L/min D: 8 L/min E: 9 L/min
C: 7 L/min 0.25 L * 28/min = 7 L/min
[1M] What are causes of epistaxis?
Causes include trauma, dry (heated) air, nose picking, foreign object, rhinitis, cocaine, nasopharyngeal angiofibroma, & nasopharyngeal carcinoma. Dry air dries nasal membranes, which become crusted/cracked. Fragile superficial vessels bleed when picked or scratched. In rhinitis, blood vessels dilate & are more vulnerable to injury.
[1M] What drug is associated with a hole in the nasal septum?
Cocaine Intranasal cocaine abuse causes destruction of palate & perforation of nasal septum. Trauma & chemical irritants used to cut cocaine cause severe vasoconstriction to extent that nasal membrane undergo infarction. Cocaine is even used during certain ENT surgeries since it lessens bleeding. There is increased risk of infection due to impaired mucociliary transport & decreased humoral & cell-mediated immunity.
[1KL] A 6-year-old male who recently immigrated to the United States from Asia is admitted to the hospital with dyspnea. Physical exam reveals a gray membrane in the patient's oropharynx along with lymphadenopathy. The patient develops myocarditis and expires on hospital day 5. Which of the following would have prevented this patient's death? A. Increased CD8+ T cell count B. Secretory IgA against viral proteins C. Increased IgM preventing bacterial invasion D. Circulating IgG against AB exotoxin E. Improved IgE release from mast cells
D. Circulating IgG against AB exotoxin Patient has diphtheria ???
[1KL] A 12-year-old male whose family recently emigrated from eastern Europe presents to the emergency room with a fever of 103.5°F, a swollen neck, difficulty breathing, and grayish-white membranes in the oropharynx. Cultures were taken from the pharynx and the bacteria were found to be Gram-positive rods with metachromatic granules. The toxin produced by this bacterium has which of the following mechanisms of action? A. Inhibits G-protein Gi alpha subunit via ADP ribosylation B. Over-activates guanylate cyclase C. Inactivates 60S ribosomal subunit D. Inactivates elongation factor 2 E. Cleaves SNARE proteins
D. Inactivates elongation factor 2 Patient has diphtheria, whose exotoxin inhibits protein synthesis by inactivating (ribosylating) elongation factor 2.
[1AB] This image shows a needle cricothyrotomy, a procedure that can be used to establish a short term emergency airway when other airway establishment procedures (e.g., intubation) have failed or are contraindicated. If performed properly, the tip of the needle will be located A. In the laryngeal vestibule B. Between the false and the true vocal cords C. Immediately posterior to the epiglottis D. Inferior to the true vocal cords E. In the piriform recess
D. Inferior to the true vocal cords Needle will pierce cricothyroid membrane (hence name of procedure), which lies below all vocal cords, just before trachea begins. This is opposed to thyrotomy (thru thyroid cartilage) or superior laryngotomy (thru thyrohyoid membrane).
[1AB] What is the anatomic region located inferior to the vocal folds, and functions to communicate with the lumen of the trachea? A. Laryngopharynx B. Oropharynx C. Ventricles D. Infraglottic cavity E. Vestibule
D. Infraglottic cavity
[1CD] A 75-year-old woman was admitted to a local hospital, and bronchograms and radiographs revealed lung carcinoma in her left lung. Which of the following structures or characteristics does the cancerous lung contain? A. Horizontal fissure B. Groove for superior vena cava C. Middle lobe D. Lingula E. Larger capacity than the right
D. Lingula
[1AB] Lesion to the glossopharyngeal nerve will result in which of the following deficits? A. Loss of function in the palatoglossus muscle B. Loss of function in the palatopharyngeus muscle C. Loss of taste sensation to the anterior two thirds of the tongue D. Loss of function in the stylopharyngeus muscle E. Loss of the efferent limb of the gag reflex
D. Loss of function in the stylopharyngeus muscle ???
[1KL] A 7-year-old male patient is brought to the clinic for evaluation of a sore throat lasting five days. He has no cough during this period. His medical and family history is insignificant. Vitals show a blood pressure of 120/80 mm Hg, temperature 99°F, and pulse is 84 bpm. On physical examination, anterior cervical nodes are palpable and tender. Exudates are seen on the posterior pharyngeal wall. A rapid antigen test came back negative. Which of the following is the next best step in management? A. No treatment required B. Start broad-spectrum antibiotics C. Start antivirals D. Perform throat swab culture E. Gargle with saltwater
D. Perform throat swab culture Gold standard of diagnosing sore throat is throat swab culture. Sensitivity of rapid antigen tests are 70-80%, so false negative could easily have been made. Sensitivity of throat swab culture is 98%.
[1KL] A 16-year-old man comes to the physician because of nausea, headache, blood in his urine, and malaise for 2 days. Three weeks ago, he had severe pharyngitis that resolved spontaneously after several days without antibiotic therapy. His blood pressure is 165/90 mm Hg. Physical examination shows mild peripheral edema. HIs serum creatinine concentration is 2.1 mg/dL. Urinalysis shows: Protein 3+ RBC 40-50/hpf WBC 10-20/hbf RBC casts present Which of the following is the most likely diagnosis? A. Pyelonephritis B. IgA nephropathy C. Malignant hypertension D. Post-streptococcal glomerulonephritis E. Renal stones
D. Post-streptococcal glomerulonephritis ???
[1CD] While performing thoracentesis, lowest level of pleural cavity will lie at level of which rib at end of expiration in MAL? A. Seventh B. Eighth C. Ninth D. Tenth E. Eleventh
D. Tenth ???
[1NO] Concerning the respiratory centers... A. The normal rhythmic pattern of breathing originates from neurons in the motor area of the cortex. B. During quiet breathing, expiratory neurons fire actively. C. Impulses from the pneumotaxic center can stimulate inspiratory activity. D. The cortex of the brain can override the function of the respiratory centers. E. The only output from the respiratory centers is via the phrenic nerves.
D. The cortex of the brain can override the function of the respiratory centers. Examples of this are voluntary hyperventilation or holding one's breath. As for other answer choices, normal rhythmic pattern of breathing originates in brainstem. Expiration is passive during quiet breathing, so neurons wouldn't be firing actively. Impulses from pneumotaxic center inhibit inspiration. Output from respiratory centers includes phrenic nerves & impulses from spinal cord to other accessory muscles.
[1NO] In the blood oxygen tension curve for an apparently healthy individual, which of the following most likely explains the slight decrease in tension between alveolar-capillary blood & arteriole blood? A. Diffusion limitation B. Perfusion limitation C. Wasted ventilation (dead space) D. Venous admixture E. Shift in the Hb dissociation curve
D. Venous admixture Newly oxygenated blood from pulmonary capillaries has PO2 = 104 mm Hg. After it mixes w/ deoxygenated blood from bronchial circulation en route to L atrium, PO2 drops to 100 mm Hg. Then it mixes w/ more deoxygenated blood from cardiac muscle, which lowers PO2 to 95 mm Hg.
[1AB] Which region or space would be most affected if the pharyngeal tonsils (adenoids) were inflamed and significantly swollen? A. valleculae B. laryngopharynx C. oropharynx D. nasopharynx E. oral cavity
D. nasopharynx
[1NO] Given that barometric pressure is 760 mm Hg at sea level and the fractional concentration of O2 in inspired air is 21%, what is the PO2 in dry air at sea level?
Dalton's law states that the partial pressure of a gas = barometric pressure * fractional concentration of the gas. Therefore, PO2 = (760 mm Hg)(0.21) = 159.6 mm Hg.
[1HIJ] If the ventilation perfusion ratio of a lung unit is decreased by partial bronchial obstruction while the rest of the lung is unaltered, the affected lung unit will show: A. Increased alveolar PO2 B. Decreased alveolar PCO2 C. No change in alveolar PN2 D. A rise in pH of end capillary blood E. A fall in oxygen uptake
E. A fall in oxygen uptake ???
[1CD] A thoracic surgeon has entered the right pleural cavity and excised two suspicious lymph nodes at the hilum of the right lung for frozen-section pathological study. These nodes belong to which of the following lymph node groups? A. Parasternal B. paratracheal C. Superior tracheobronchial D. Inferior tracheobronchial E. Bronchopulmonary
E. Bronchopulmonary ???
[1NO] An increase in which of the following increases the O2 affinity of hemoglobin? A. Temperature B. PCO2 C. H+ concentration D. 2,3-DPG E. Carbon monoxide added to the blood
E. Carbon monoxide added to the blood
[1NO] A 65-year-old male with a long history of COPD is brought to the emergency room complaining of shortness of breath, fever, yellow sputum, and lower extremity edema. Physical examination reveals cyanosis, finger clubbing, and bilateral lung wheezes. Which of the following findings is most likely in this patient? A. Normal arterial blood oxygen content B. Normal mixed venous blood oxygen content C. Increased pH of the arterial blood D. Decreased pulmonary arterial resistance E. Decreased cerebral vascular resistance
E. Decreased cerebral vascular resistance Brain has a very high oxygen requirement (20% of all oxygen consumed by body). Since this patient has had long history of COPD w/ signs of chronic hypoxia, it's fair to assume that cerebral vessels are dilated to maximize blood flow.
[1CD] You must remove fluid from the pleural cavity of your patient through thoracentesis. You decide to insert the aspiration needle over the top of a rib, into an intercostal space inferior to the lower border of the lung in the MAL at the end of a normal expiration. Which of the following is the highest level at which this procedure might safely be done without injuring the lung? A. Fourth intercostal space B. Fifth intercostal space C. Sixth intercostal space D. Seventh intercostal space E. Eighth intercostal space
E. Eighth intercostal space ???
[1AB] A 44 year old woman presents to the hospital for planned total thyroidectomy. She was diagnosed three months ago with follicular thyroid carcinoma after her husband noticed a progressive neck mass. The patient undergoes an uncomplicated total thyroidectomy. Eight hours following the procedure, the patient experiences violent coughing shortly after ingestion of water and ice chips. The clinical staff also notes new onset hoarseness when the patient speaks. The patient most likely suffered nerve injury during ligation of which of the following arteries? A. Internal carotid artery B. Thyroidea ima artery C. Ascending pharyngeal artery D. Superior thyroid artery E. Inferior thyroid artery
E. Inferior thyroid artery ???
[1KL] A 20-year-old woman presents with sore throat, mild cough, and a low-grade fever of 5 days duration. A throat swab culture on blood and chocolate agar was negative. A 7-day treatment with augmentin was unsuccessful but responded well to azithromycin. What is the most likely microbial cause of her illness? A. Streptococcus viridans B. Rhinovirus C. Streptococcus pyogenes D. Neisseria gonorrhoeae E. Mycoplasma pneumoniae
E. Mycoplasma pneumoniae Patient has walking pneumonia caused by Mycoplasma b/c treatment w/ beta-lactams was unsuccessful. This indicates resistance or lack of cell wall. Even though viruses are much more likely to cause sore throat than bacteria, response to antibiotics indicates that infection is bacterial.
[1AB] A 62 year old woman presents to the hospital for planned total thyroidectomy. She was diagnosed three months ago with papillary thyroid carcinoma after her husband noticed a progressive neck mass. The patient undergoes an uncomplicated total thyroidectomy. Six hours following the procedure, the patient experiences violent coughing shortly after ingestion of water and ice chips. The clinical staff also notes new onset hoarseness when the patient speaks. The patient's symptoms are most likely due to damage of which of the following nerves? A. Accessory nerve B. External laryngeal nerve C. Internal laryngeal nerve D. Superior laryngeal nerve E. Recurrent laryngeal nerve
E. Recurrent laryngeal nerve ???
[1HIJ] During normal standing position, which of the following best describes the blood flow in the lung? A: Highest at the apex than the base B: Equals at the apex and the base C: Highest at the apex owing to the effects of gravity on arterial pressure D: Lowest at the base because that is where alveolar pressure is greater than arterial pressure E: Highest at the base because that is where the difference between arterial and venous pressure is greatest
E: Highest at the base because that is where the difference between arterial and venous pressure is greatest ???
[1NO] Which of the following best describes the ventilatory response to carbon dioxide? A: It is increased if the alveolar PO2 is raised. B: It depends on only on the central chemoreceptors. C: It is increased during sleep. D: It is increased if the work of breathing is increased. E: It is a major factor controlling the normal level of ventilation.
E: It is a major factor controlling the normal level of ventilation.
[1NO] Hemoglobin has a unique oxygen binding ability causing the sigmoid shape of the hemoglobin dissociation curve. Which of the following causes a right shift of the curve? A: Alkaline blood pH B: Carbon monoxide poisoning C: Decreased 2,3-diphosphoglycerate concentration D: Lower body temperature E: Metabolic acidosis
E: Metabolic acidosis
[1NO] A patient who was diagnosed with type 2 diabetes mellitus and high cholesterol is sent for an exercise stress test. With regard to CO2 during exercise, which of the following physiological process taking place? A: All of the dissolved CO2 become converted to bicarbonate, which binds to hemoglobin B: Bicarbonate travels in the RBCs until it reaches the lung, where it gets exhaled as CO2 C: Carbaminohemoglobin CO2 bound to hemoglobin) becomes the primary CO2 transport carrier D: In the lungs, the acidic environment shifts the hemoglobin-O2 curve to the right and causes the release CO2 from hemoglobin E: More chloride is entering the RBCs peripherally to compensate for increased carbonic anhydrase activity
E: More chloride is entering the RBCs peripherally to compensate for increased carbonic anhydrase activity For CO2, 70% is transported as dissolved HCO3-; 25% is transported as HbCO2, & 5% is dissolved in blood. Carbonic anhydrase in RBC combines CO2 & H2O to form H2CO3, which dissoc. into H+ & HCO3-. While HCO3- redily diffuses out of RBC, H+ remains trapped. Cl- then diffuses into RBC (chloride shift) even out charge. Reverse chloride shift occurs in lungs.
[1E] A newborn begins to produce nonbilious emesis after feeding. This is associated with white frothy nasal and oral secretions which recur after suctioning. Physical examination is significant for abdominal distension with crying. A nasogastric tube is unable to fully pass into the esophagus. A plain chest and abdominal radiograph shows excessive air in the stomach. There is coiling of the nasogastric tube in the blind esophageal pouch. What is the diagnosis?
Esophageal atresia w/ distal tracheoesophageal fistula ???
[1M] The posterior nasal cavity is the most common site of epistaxis. True/False
False 90-95% of nosebleeds involve Kiesselbach's plexus in anterior nasal cavity, which is more accessible. 5-10% involve posterior nasal cavity, which is higher & deeper in nose. It bleeds down back of throat & is more severe.
[1HIJ] Assume that an alveolus is ventilated with room air at sea level and gets mixed venous blood with PvO2 = 40 and PvCO2 = 45. What values would PaO2 & PaCO2 approach if blood flow (but not ventilation) were stopped?
If V/Q ratio is infinity, then PaO2 would rise while PaCO2 would fall until they reach composition of inspired gas. PaO2 = 150 while PaCO2 = 0. ???
[1HIJ] Assume that an alveolus is ventilated with room air at sea level and gets mixed venous blood with PvO2 = 40 and PvCO2 = 45. What values would PaO2 & PaCO2 approach if ventilation (but not blood flow) were stopped?
If V/Q ratio is zero, then PaO2 & PaCO2 must be same as those of mixed venous blood. Therefore, PaO2 = PvO2 = 40 & PaCO2 = PvCO2 = 45. ???
[1M] What are the types of nasopharyngeal carcinoma?
Keratinizing, non-keratinizing, & basaloid squamous cell carcinomas There are three subtypes of squamous cell carcinomas: well-differentiated keratinizing squamous cell carcinoma, non-keratinizing squamous cell carcinoma, & basaloid squamous cell carcinoma. Non-keratinizing type can also be divided into differentiated vs. undifferentiated; undifferentiated, which is most common, has pleomorphic cells & may have background lymphocytes.
[1HIJ] An 18 month old female infant presents to the Emergency department with shortness of breath. She had been eating cereal two hours back when her mother noticed a sudden bout of coughing. On arrival to ER, she was distressed, crying, and coughing erratically. Attending physician took her blood and sent for arterial blood gasses (ABGs). What will be her ABGs look like?
PO2 & O2 percent saturation would be decreased. PCO2 would be increased & pH would be decreased. ???
[1NO] When inspired air enters the trachea, it is saturated with water vapor. What is the PO2 of this humidified tracheal air at sea level, given that water vapor pressure is 47 mm Hg and the fractional concentration of O2 is 21%?
PO2 of humidified air = (Barometric pressure - Water vapor pressure) * (fractional concentration of O2) = (760 mm Hg - 47 m Hg) * (0.21) = 149.7 mm Hg
[1NO] The value for alveolar PO2 (PaO2) is given as 100 mm Hg. Assuming complete equilibration of O2 across the alveolar-pulmonary capillary barrier, what is the value for PO2 in the pulmonary capillary blood? How does this equilibration occur? What is the concentration of dissolved O2 in that blood, given that the solubility of O2 in blood is (0.003 mL O2 / 100 mL blood / mm Hg)?
Since pulmonary capillary blood normally equilibrates almost completely w/ alveolar gas, PO2 in pulmonary capillary blood = PaO2 = 100 mm Hg. This equilibration is achieved via simple diffusion driven by partial pressure difference. Henry's law states that Concentration of dissolved gas = Partial pressure of gas * Solubility of gas. Therefore, Concentration of dissolved O2 = (100 mm Hg)(0.003 mL O2 / 100 mL blood / mm Hg) = 0.3 ml O2 / 100 mL blood.
[1E] A baby born at 6 months' gestation is having trouble breathing. Why?
Surfactant ???
[1M] What are complications of obstructive sleep apnea?
Symptoms of obstructive sleep apnea include apneic episodes, hypoxemia, respiratory acidosis due to CO2 retention, & daytime somnolence, leading to narcolepsy. Complications include pulmonary hypertension, since hypoxemia & respiratory acidosis cause smooth muscle cells in pulmonary vessels to constrict, & secondary polycythemia, since hypoxemia stimulates kidneys to release EPO. Daytime somnolence can also lead to poor food choices, poor exercise, hypertension, heart disease, accidents, & obesity.
[1M] Posterior epistaxis is usually more severe. True/False
True Epistaxis is discussed on other cards. Laryngeal papilloma is benign papillary tumor of the vocal cord. It often pops up as single papilloma in adults, multiple in children. It is caused by HPV 6 & 11, presenting w/ hoarseness. Histologically, it looks like purple cauliflower & branching w/ fibrovascular cores (see picture). This is distinguished from recurrent laryngeal papillomatosis aka juvenile papillomatosis, which involves tons of recurrent papillomata. They are mainly located on larynx but can extend to lung. It affects kids age 2-6 born of moms w/ HPV 6 or 11. It is treated w/ repeat surgical excisions.
[1M] Posterior nasal cavity epistaxis usually bleeds down the back of the throat. True/False
True Epistaxis is discussed on other cards. On another note, nasopharyngeal angiofibroma is benign tumor of fibrovascular stroma of posterolateral wall of roof of nasal cavity. It consists of large blood vessels & fibrous tissue. It targets adolescent males who are fair-skinned & red-headed. It presents w/ profuse epistaxis & is locally aggressive, w/ intracranial extension.
[1M] Nasopharyngeal carcinomas are squamous cell carcinomas. True/False
True Nasopharyngeal carcinomas are discussed on other cards. Granulomatosis w/ polyangiitis aka Wegener's disease is necrotizing granulomatous vasculitis. Immunologic problem causing blood vessels to be inflamed & eventually destroyed, leading to necrosis. These acute necrotizing granulomas of URT create mucosal ulcerations of oral cavity & nasopharynx. It causes chronic relapsing, remitting sinusitis. Avg. patient age is 40, & it affects males more than females.
[1HIJ] Regional variations in pulmonary ventilation (V) and blood flow (Q) are measured in healthy individuals while they stand in the upright position. The results are graphed with the x axis denoting the position along the lung from base to apex. What curve is most likely to be observed?
V/Q would increase exponentially from the base to the apex, while blood flow would decrease linearly from base to apex. ???
