6-08 Resp

Front 1

PFTs in COPD:

Back 1

dec FEV1, inc FVC ==> dec FEV1/FVC ratio

Front 2

extent of ciliated mucosal epithelium in respiratory tract

Back 2

nose to terminal bronchioles

Front 3

what protects alveoli from inhaled particles?

Back 3

ciliated epithelium -> mucociliary clearance

Front 4

pathogenesis of centriacinar emphysema

Back 4

oxidative injury to resp bronchioles --> PMN recruitment --> elastase, proteinase, cathepsin, and MMPs released , along with oxygen free radicals which --| alpha1antitrypsin ==> protease-antiprotease imbalance --> acinar wall destruction

Front 5

clearance of differnt sized particles from resp tract

Back 5

10-15 um: trapped in URT; 2-10um: mucociliary xport; <2um (eg dust): phagocytosed by macrophages --> cytokine rleases --> tissue injury, inflammation --> fibrosis ==> PNEUMOCONIOSIS

Front 6

3 causes of pulmonary hypertension

Back 6

1) hypoxic vasocnstriction (eg following COPD); 2) volume overload (left heart, eg in decomensated cadiac disorder); 3) idiopathic dysfunction of the endothelium --> impaired apoptosis --> inc wall thickness

Front 7

most common cause of lung abscess

Back 7

aspiration of oropharyngeal contents (fusobacterium, peptostreptococcus, bacteroides); a/w LOC (EtOH, seizures, anesthesia)

Front 8

clinical triad of fat embolism syndrome

Back 8

1) hypoxemia (fat emoblus in lungs); 2) petechial rash (thrombocytopenia /petechiae from platelet adherence to and coating of fat microglobules; 3) neuro abnormalities (microinfarctions of brain tissue)

Front 9

role of type II pneumocytes

Back 9

1) secrete surfactant (dec alveolar surface tension); 2) presurcors of type I cells (proliferate during lung damage)

Front 10

which lung more common for inhaled foreing bodies?

Back 10

right lung (right main stem bronchus has less acute angle)

Front 11

lobes of each lung

Back 11

R: sup, middle, inf; L: sup, inf, Lingula, + space for heart

Front 12

relation of pulm artery to bronchus at each lung

Back 12

RALS (Right Anterior; Left Superior)

Front 13

where do structures perforate the diaphragm?

Back 13

"I 8 10 EGGS AT 12": T8: IVC; T10: EsophaGus + vaGus; T12: Aorta, Azygous, Thoracic duct

Front 14

muscles of forced inspiration (3)

Back 14

external intercostals, scalene muscles, SCM

Front 15

muscles of forced expiration

Back 15

"abs" + internal intercostals

Front 16

diffusion limited

Back 16

equilibrium not reached by the time blood reaches end of capillary -- seen in exercise, emphysema, fibrosis, and with CO

Front 17

calculating physiologic dead space

Back 17

V_D = V_T * (1 - PeCO2/PaCO2) = V_T * ( (PaCO2 - PeCO2)/PaCO2 )

Front 18

changes in v/q with exercise

Back 18

exercise --> vasodilation of apical arteries --> V/Q approaches 1

Front 19

three methods of CO2 transport from tissue to lungs

Back 19

1) as Bicarb (converted by CA) (90%); 2) bound to Hb as carbaminohemoglobin(5%); 3) dissolved CO2 (5%)

Front 20

how does Hb unload CO2 in lungs?

Back 20

Haldane effect: oxygenation of hemoglobin --> release of CO2

Front 21

how does O2 get unloaded in the tissues?

Back 21

tissues build up acid form metabolism; inc H+ --> shifts Hb curve to right --> unloading of O2 (Bohr effect)

Front 22

how to calc A-a gradient

Back 22

Aa gradient = PAO2 - PaO2; PAO2 = PiO2 - PACO2/R = 150 - PACO2/0.8

Front 23

causes of emphysema

Back 23

smoking (centriacinar) and alpha1-antitrypsin deficiency (panacinar + liver cirrhosis [accumulation of unreleased A1AT])

Front 24

emphysema vs bronchitis

Back 24

EMPHYSEMA: "pink puffer," decreased breath sounds, tachycardia, dec I/E ratio; BRONCHITIS: "blue bloater," wheezing, crackles, cyanosis

Front 25

findings in asthma

Back 25

wheezing, dec I/E ratio, pulsus paradoxus, Curschmann spirals, smooth muscle hypertrophy, mucous plugging

Front 26

what causes bronchiectasis?

Back 26

chronically infected/dilated bronchi/airways, often b/c of bronchial obstruction, CF, poor cilia motility, and Kartagener's syndrome

Front 27

PFTs in obstructive vs restrictive lung disease

Back 27

OBSTRUCTIVE: dec FEV1/FVC ratio; RESTRICTIVE: dec FEV1 and lung volumes (VC, TLC, FVC), but FEV1/FVC ratio > 80%

Front 28

causes of interstitial lung disease (8)

Back 28

ARDS, NRDS, IPF, Sarcoidosis, Pneumoconioses, Goodpasture, Wegener's, Eosinophilic Granuloma

Front 29

in what population do you see asbestosis?

Back 29

plumbers and shipbuilders

Front 30

pathologic findings in asbestosis

Back 30

Ferruginous bodies in lung (asbestos fibers coated in hemosiderin) + ivory-white plaques

Front 31

pathogenesis of NRDS

Back 31

surfactant deficiency --> inc surface tension --> atalectasis (alveolar collapse)

Front 32

tx for NRDS

Back 32

maternal steorids beore birth, artificial surfactant for infant

Front 33

central bronchogenic carcinomas

Back 33

squamos cell, small cell

Front 34

peripheral bronchogenic carcinomas

Back 34

1) ADENOCARCINOMA (most common); 2) BRONCHIOALVEOLAR (no smoking link); 3) LARGE CELL (undifferentiated)

Front 35

where do lung tumors met to?

Back 35

Brain (seizures), Bone (fractures), Liver (jaundice, hepatomegaly)

Front 36

complications from lung cancer

Back 36

SPHERE (SVC compression/invasion, Pancoast tumor, causes Horner syndrome (cervical sympathetic plexus dysfunction), Endocrine (paraneoplastic), Recurrent laryngeal symptoms (hoarseness), Effusions (pleural or pericardial)

Front 37

lobar pneumonia: bugs and characteristics

Back 37

pneumococcus; lobar consolidation (can be of whole lung)

Front 38

bronchopneumonia: bugs and characteristics

Back 38

S. aureus, H.flu, Klebsiella, S.pyogenes; patchy distribution, acute inflam infiltrates from bronchioles to alveoli

Front 39

interstitial (atypical) pneumo: bugs and characteristics

Back 39

viruses (RSV, adeno), mycoplasma, legionella, chlamydia; diffuse patchy inflam, localized to interstitla areas at alveolar walls

Front 40

PFTs in asthma vs emphysema

Back 40

both COPD so both have dec FEV1/FVC, inc TLC; however, EMPHYSEMA causes destruction of alveoli and adjoining capillary beds --> DECREASED DLCO, while ASTHMA INCREASE DLCO due to increased pulmonary blood volumes

Front 41

how to rule out asthma?

Back 41

METHACHOLINE: muscarinic agonist --> causes bronchioconstriction (sensitive but not specific)

Front 42

extrinsic vs intrinsic asthma

Back 42

extrinsic (atopic, allergic) asthma caused by Type I hypersensitivity to inhaled / ingested allergens, begins in childhood; INTRINSIC asthma is a/w chronic bronchitis, exercise, and cold-induced asthma; occurs in ADULT life, no a/w allergy

Front 43

pathogenesis of ARDS

Back 43

diffuse alveolar damage --> NEUTROPHILS --> leaky alveolar capillaries --> protein-rick fluid in alveoli ==> intra-alveolar hyaline membrane

Front 44

chronic lung rejection

Back 44

causes bronchiolitis obliterans -- lyphocytic inflam, necrosis, and fibrosis of small airways ==> eventual occlusion of bronchiolar lumen

Front 45

MCC meconium ileus

Back 45

CF

Front 46

MCC death in CF

Back 46

cardiorespiratory complications (pneumonia, bronchiectasis, cor pulmonale) -- 80%

Front 47

embryologic origin of diaphragm

Back 47

Some Parts Build Diaphragm (Septum Transversum, Pleuroperitoneal folds, Body Wall, Dorsal mesentary of the esophagus)

Front 48

cheyne-stokes breathing

Back 48

caused by pontine dysfunction, a/w drug OD, hypoxia, CNS depression, CHF, inc intracranial pressure

Front 49

hyaline membranes

Back 49

eosinophlic membranous structures lining alveolar wall; characteristic of both ARDS and NRDS

Front 50

common description of pt with spontaneous PTX

Back 50

tall, slender men 20-40 yo

Front 51

bronchial obstruction vs pneumothorax: tracheal deviation

Back 51

both have tracheal deviation; in PTX, trachecial deviation AWAY from lesion; in bronchial OBSTRUCTION, tracheal devation TOWARD lesion

Front 52

increased Reid index

Back 52

chronic BRONCHITIS (persistent irritation --> hyperplasia of goblet cells and submucosal glands)

Front 53

what does "blue bloater" mean

Back 53

BRONCHITIS: blue = cyanosis, bloater = peripheral edema from pulmHTN and RV overload (cor pulmonale)

Front 54

what does "pink puffer" mean

Back 54

EMPHYSEMA: pink = not cyanotic (PaO2 ~ nl); puffer = hypervent

Front 55

3 MCC hemoptysis

Back 55

TB, malignancy, Goodpasture

Front 56

honeycomb lung

Back 56

idiopathic pulmonary fibrosis

Front 57

silicosis seen in what occupations?

Back 57

mining, stone cutting, glass production (inhaled silica dust --> macrophages -> alveolar damage, scarring)

Front 58

immune response in typical vs atypical pneumo

Back 58

TYPICAL: PMNs, fibrin, RBCs (sputum = bac + PMNs); ATYPICAL: T cells and macrophages (intracellular orgs --> no sputum)

Front 59

pneumo in dairy workers

Back 59

coxiella burnetti

Front 60

fungal ball of hyphae in preexisting lung cavity

Back 60

aspergilloma (aspergillus)

Front 61

most common location of TB

Back 61

PRIMARY: upper lower lobe or lower upper lobe; SECONDARY: apical

Front 62

rifampin interactions with other drugs

Back 62

rifampin INDUCES p450, so it REDUCES HALF LIFE of: {oral contraceptives, warfarin, digitoxin, ketoconazole, propanalol, prednsione}

Front 63

causes of viral rhinitis

Back 63

Rhinovirus, coronavirus, adenovirus, parainfluenza virus

Front 64

mech of action of streptomycin

Back 64

same as aminoglycosides (--| initiation of ribosomal complex)

Front 65

reid index

Back 65

(thickness of mucous gland layer) / (thickness of bronchial wall between resp epithelium and bronchial cartilage) ==> measure of MUCOUS GLAND ENLARGEMENT, increased in CHRONIC BRONCHITIS

Front 66

MCC cause and site of lung abscess

Back 66

cause: aspiration; site: right lung (right bronchus is straighter than left), lower lobe if standing during aspiration, posterior if supine

Front 67

immune response to TB

Back 67

macrophage phagocytosis --> Ag presentation to CD4+ TH1 cells --> stim macrophages --> kill M.TB, form Langerhans giant cells

Front 68

most common side effect of inhaled steroids

Back 68

oral candidiasis (risne mouth to prevent)

Front 69

epithelium of respiratory tree

Back 69

pseudostratified ciliated columnar until respiratory bronchioles --> simple cuboidal ciliated until alveoli --> no cilia in alveolar sacs / terminal alveolar ducts

Front 70

chronic obstructive disease with recurrent resp infections

Back 70

chronic bronchitis

Front 71

sweating in CF vs normal person

Back 71

in normal people, CFTR makes sweat hypotonic (pulls Na/Cl back from isotonic sweat); this creates hypertonic volume loss in which ECF loss is compensated for by redistribution from ICF; in pts with CF, lack of CFTR causes secretion of isotonic sweat --> exclusively extracellular volume contraction --> hypovolemia, severe hypotension

Front 72

minute ventilation vs alveolar ventilation

Back 72

minute ventilation includes dead space, alveolar ventilation does not

Front 73

source of gastrin, location

Back 73

G cells in stomach/duodeneum

Front 74

common locations of gastrinoma (zollinger-ellison syndrome)

Back 74

pancreas (MEN I), duodenum