Fa - Respiratory

Front 1

H1 Blockers- 1st Generation: Mechansim

Back 1

Reversible inhibitor of H1 histamine receptors

Front 2

H1 Blockers- 1st Generation: Examples

Back 2

Diphenhydramine, dimenhydrinate, chlorpheniramine

Front 3

H1 Blockers- 1st Generation: Clinical Uses

Back 3

Allergy, motion sickness, sleep aid

Front 4

H1 Blockers- 1st Generation: Side Effects

Back 4

Sedation, antimuscarinic, anti-α-adrenergic

Front 5

H1 Blockers- 2nd Generation: Examples

Back 5

Loratadine, fexofenadine, desloratadine, cetirizine

Front 6

H1 Blockers- 2nd Generation: Clinical Uses

Back 6

Allergy

Front 7

H1 Blockers- 2nd Generation: Toxicity

Back 7

Far less sedating than 1st Gen b/c less entry into CNS

Front 8

Mediators of Bronchoconstriction (2)

Back 8

1) Inflammation and 2) sympathetic tone

Front 9

Isoproterenol

Back 9

Relaxes bronchial smooth muscle (β2), Adverse (β1)-Tachycardia)

Front 10

Albuterol

Back 10

Relaxes bronchial smooth muscle (β2), Use during acute exacerbation

Front 11

Salmeterol

Back 11

Long acting agent for prophylaxis, Adverse: tremor and arrhythmia

Front 12

Theophylline

Back 12

Bronchodilation by inhibiting phosphodiesterase => decrease in cAMP hydroysis

Front 13

Ipratropium

Back 13

Competetive block of muscarinic receptors, preventing bronchoconstriction; Also for COPD

Front 14

Cromolyn

Back 14

Prevents Mast cell degranulation, only prophylaxis

Front 15

Beclomethasone, Prednisone

Back 15

Inhibit synthesis of cytokines, inactivate NF-κB => lower TNF-α

Front 16

Zileuton

Back 16

5-lipoxygenase pathway inhibitor, blocks conversion of arachidonic acid to leukotrienes

Front 17

Zafirlukast, montelukast

Back 17

Block leukotriene receptor, good for asprin induced asthma

Front 18

Expectorant-Gauifenesin (Robitussin)

Back 18

Remove sputem, large doses needed; Does not suppress cough reflex

Front 19

Expectorant-N-acetylecysteine

Back 19

Mucolytic-can loosen mucous plugs in CF patients. Also used as antidote for acetaminophen overdose

Front 20

Formula for O2 content

Back 20

(O2 binding capacity x % Saturation) + dissolved O2

Front 21

At what amount of deoxygenated Hb does Cyanosis occur?

Back 21

Deoxygenated Hb > 5 g/dl

Front 22

O2 binding capacity

Back 22

20.1 mL O2 / dL

Front 23

Formula for O2 delivery to tissues

Back 23

Cardiac output x O2 content of blood

Front 24

Alveolar Gas Equation

Back 24

PAO2 = PIO2 - (PACO2/R) [Approximation: PAO2=150- PACO2/.8] where R=respiratory quotient=CO2 produced/O2 Consumed

Front 25

List 5 major causes of Hypoxemia (Decreased PaO2)

Back 25

1. High Altitude (normal A-a gradient) 2. Hypoventilation (normal A-a gradient) 3. V/Q mismatch (Inc. A-a gradient) 4. Diffusion defect (inc. A-a gradient) 5. Right to left shunt (Inc. A-a) gradient

Front 26

List 5 major causes of Hypoxia

Back 26

1. Dec cardiac output 2. Hypoxemia 3. Anemia 4. CN poisoning 5. CO poisoning

Front 27

List 2 causes of respiratory ischemia

Back 27

1. Impeded arterial flow 2. Reduced venous drainage

Front 28

What is V/Q at the Apex and base of the lung respectively?

Back 28

Apex V/Q= 3 (wasted ventilation, Inc. dead space), Base V/Q=.6 (wasted perfusion)

Front 29

What is the V/Q in a shunt versus the V/Q with obstructed blood flow?

Back 29

Shunt V/Q = 0, Blood Flow obstruction V/Q= Infinity

Front 30

Which respiratory infection is most common at the Apex of the lung?

Back 30

TB b/c high O2 at apex

Front 31

What is the Haldane Effect?

Back 31

Oxygenation of Hb results in dissociation of H+ from Hb, which results in a shift of the [CO2 + H2O -> H2CO3 -> H+ + HCO3-] equilibrium toward CO2 resulting in CO2 released from RBC

Front 32

What is the Bohr Effect?

Back 32

In peripheral tissue Inc. in H+ from tissue metabolism shifts the O2 dissociation curve to the right, resulting in a release of O2 to tissues.

Front 33

What are the 3 compounds through which CO2 is transported from tissues to the lungs?

Back 33

1. Bicarbonate (90%) 2. Bound to Hb as carbaminohemoglobin (5%) 3. Dissolved CO2 (5%)

Front 34

What are the 7 major responses to high altitude?

Back 34

1. Acute inc. in Ventilation 2. Chronic Inc. in ventilation 3. Inc. EPO production resulting in inc. HCT and Hb 4. Inc. 2,3-DPG 5. Cellular changes (inc Mito) 6. Excretion of Bicarb to compensate for resp alkalosis 7. Chronic Hypoxic pulmonary vasoconstriction results in RVH

Front 35

Which drug can augment renal excretion of bicarbonate in order to compensate for respiratory alkalosis?

Back 35

Acetazolamide

Front 36

What are the 7 major responses to exercise?

Back 36

1. Inc. CO2 production 2. Inc. O2 consumption 3. Inc. Ventilation rate to meet O2 demand 4. V/Q ratio from apex to base becomes more uniform 5. Inc. Pulm Blood flow b/c inc cardiac output 6. dec.. pH during strenuous exercise b/c inc lactic acidosis 7. No Change in PaO2 and PaCO2 but inc in venous O2 content

Front 37

Obstruction of airflow resulting in air trapped in lungs due to airways closing prematurely at high lung volumes

Back 37

COPD

Front 38

What happens to RV, FVC, FEV, FVC, FEV/FCV ratio in COPD?

Back 38

↑RV, ↓FVC, ↓↓FEV ↓FVC ↓FEV/FVC ratio

Front 39

Pathology of Chronic Bronchitis

Back 39

Blue Bloater : Hypertrophy of mucus secreting glands in bronchioles

Front 40

Define Reid index

Back 40

Gland depth/total thickness of bronchiole wall, greater than .5 in COPD and Chronic Bronchitis

Front 41

Diagnosis and Symptoms of Chronic Bronchitis

Back 41

Diagnosis: Productive cough >3 consecutive month in greater than or equal to 2 yrs, Symptoms: Wheezing, crackles, cyanosis, late-onset dyspnea

Front 42

Pathology of Emphysema

Back 42

Enlargement of air spaces and dec... recoil resulting from destruction of alveolar walls b/c of increased elastase activity

Front 43

Cause of centriacinar emphysema

Back 43

Smoking

Front 44

Panacinar emphysema

Back 44

α1 -antitrypsin deficiency

Front 45

Paraseptal emphysema

Back 45

ruptured bullae resulting in spontaneous pneumothorax, MC in otherwise healthy males

Front 46

Signs and symptoms of Emphysema

Back 46

Dec. breath sounds, tachycardia, late-onset hypoxemia b.c loss of capillary beds, early onset dyspnea

Front 47

Curschmann's spirals

Back 47

Asthma

Front 48

Chronic necrotizing infection of Bronchi resulting in permanently dilated airways, purulent sputum , recurrent infections, hemoptysis

Back 48

Bronchiectasis

Front 49

Kartagener's Syndrome

Back 49

autosomal recessive genetic disorder which causes a defect in the action of the cilia lining the respiratory tract , sinuses, eustachian tube, middle ear and fallopian tube

Front 50

Which respiratory disease is associated with Cystic Fibrosis?

Back 50

Bronchiectasis

Front 51

Autoimmune disease which can result in restrictive lung disease

Back 51

Myasthenia Gravis

Front 52

Virus resulting in restrictive lung disease

Back 52

Polio Virus

Front 53

3 Drugs that cause restrictive lung disease

Back 53

Bleomycin, busulfan, amiodarone

Front 54

Name 8 disorders that may result in restrictive lung disease

Back 54

1. ARDS 2. Neonatal RDS, 3. Pneumoconiosis 4. Sarcoidosis 5. Idiopathic Pulmonary Fibrosis 6. Goodpastures Syndrome 7. Wegener's Granulomatosis 8. Eosinophilic Granuloma

Front 55

Surfactant deficiency in neonate

Back 55

Neonatal RDS

Front 56

Treatment of Neonatal RDS

Back 56

Maternal steroids before birth, artificial surfactant

Front 57

Measure of lung maturity in neonate

Back 57

Lecithin-sphingomyelin ratio in amniotic fluid ( <1.5= RDS)

Front 58

Type II Pneumocyte

Back 58

Make surfactant

Front 59

Risk factors for RDS

Back 59

prematurity, cesarean delivery, maternal diabetes

Front 60

Diffuse alveolar damage resulting in inc. capillary permeability and formation of intra-alveolar hyaline membrane

Back 60

ARDS

Front 61

What is the FEV/FVC ratio in obstructive vs. restrictive lung disease?

Back 61

Obstructive < 80% and Restrictive > 80% with dec. TLC

Front 62

Person stops breathing for at least 10 sec repeatedly during sleep

Back 62

Sleep Apnea

Front 63

Treatment of sleep apnea

Back 63

Weight loss, CPAP, surgery

Front 64

Associated with obstructive sleep apnea

Back 64

obesity, systemic/pulmonary hypertension, arrhythmias, loud snoring

Front 65

Central sleep apnea

Back 65

Results from patient repeatedly stop breathing during sleep because the brain temporarily stops sending signals to the muscles that control breathing- often due to pathology affecting brainstem (trauma, encephalitis, stroke)

Front 66

Ferruginous bodies

Back 66

Asbestosis

Front 67

Diffuse Interstitial fibrosis + Lower lung lobes + Inc. risk of Mesothelioma

Back 67

Asbestosis

Front 68

Which professions is asbestosis seen most commonly seen in?

Back 68

Shipbuilders, roofers, plumbers

Front 69

Physical findings of bronchial obstruction

Back 69

1. absent breath sounds over area 2.↓Resonance 3. ↓fremitus 4. tracheal deviation toward side of lesion

Front 70

Physical findings of Pleural effusion

Back 70

1. Breath sounds dec... over effusion 2. dull resonance 3. ↓fremitus

Front 71

Physical findings of Lobar Pneumonia

Back 71

1. Possible breath sounds 2. dull resonance 3. ↑fremitus

Front 72

Physical findings of Tension pneumothorax

Back 72

1. ↓breath sounds 2. Hyperresonant 3. Absent fremitus 4. tracheal deviation away from lesion

Front 73

Complications of Lung Cancer

Back 73

SPHERE: Superior vena cava syndrome, Pancoast's tumor, Horner's syndrome, Endocrine (paraneoplastic-Ex: PTHrP), Recurrent laryngeal symptoms (hoarseness), Effusions (pleural or pericardial)

Front 74

Lung Cancer presentation

Back 74

Cough, Hemoptysis, Bronchial obstruction, wheezing, Pneumonic coin lesion on X-ray

Front 75

What is the most common symptom of a primary lung tumor and mets to the lung respectively?

Back 75

Cough and Dyspnea

Front 76

Lung Squamous Cell Carcinoma

Back 76

Smoking, Central location, Cavitation: Hilar Mass arising from bronchus,

Front 77

What are 3 key features of Lung SCC

Back 77

1. Keratin pearls 2. Intercellular bridges 3. PTHrP activity

Front 78

MC lung cancer in non smokers and females

Back 78

Lung Adenocarcinoma

Front 79

Peripherally located lung cancer developing in site of prior pulmonary inflammation or injury

Back 79

Bronchial Adenocarcinoma

Front 80

Peripherally located lung cancer that grows along airways, not linked to smoking and may present like pneumonia

Back 80

Bronchioloalveolar Adenocarcinoma

Front 81

What are 3 unique characteristics of Lung Adenocarcinomas (both bronchial and bronchioalveolar)

Back 81

Clara cells, Type II Pneumocyte, multiple densities on X-rays

Front 82

Aggressive lung cancer associated with ectopic ACTH or ADH production and Lambert Eaton syndrome

Back 82

Lung Small Cell Carcinoma (oat cell carcinoma)- centrally located

Front 83

Lung cancer that is most responsive to Chemo

Back 83

Lung Small Cell Carcinoma (oat cell carcinoma)

Front 84

Kulchitsky cells (neuroendocrine cells)

Back 84

Lung Small Cell Carcinoma (oat cell carcinoma)

Front 85

Peripherally located highly anaplastic undifferentiated lung cancer that is not very responsive to chemo

Back 85

Lung Large Cell Carcinoma

Front 86

Tumor which excretes serotonin and can cause flushing, diarrhea, wheezing, , salivation

Back 86

Carcinoid Tumor (Flushing, diarrhea, wheezing, salivation = Carcinoid syndrome)

Front 87

Which organs most commonly get mets from the lung?

Back 87

Brain (epilepsy), bone (fracture), Liver (jaundice, hepatomegaly)

Front 88

Tumor which excretes serotonin and can cause flushing, diarrhea, wheezing, and salivation

Back 88

Carinoid tumor (Carcinoid syndrome= flushing, diarrhea, wheezing, salivation)

Front 89

Tumor which causes Horner's syndrome

Back 89

Pancoast's tumor affecting cervical sympathetic plexus

Front 90

Organism associated with lobar pneumonia

Back 90

Pneumococcus

Front 91

Organism associated with bronchopneumonia

Back 91

S. aureus, H. flu, Klebsiella, S. pyogenes: usually involves more than one lobe

Front 92

Organisms associated with Interstitial (atypical) pneumonia

Back 92

Mycoplasma, Legionella, Chlamydia, RSV, Adenovirus,

Front 93

Localized collection of pus within parenchyma, usually from bronchial obstruction (cancer) or aspiration of oropharyngeal contents

Back 93

Lung Abscess- MC S. aureus or anaerobes

Front 94

What are 3 causes of a pleural transudate?

Back 94

CHF, nephrotic syndrome, hepatic cirrhosis (transudate=↓protein)

Front 95

What are causes of a pleural exudate?

Back 95

Malignancy, pneumonia, collagen vascular disease, trauma resulting in inc vascular permeability (exudate=↑protein)

Front 96

What is the conducting zone?

Back 96

Nose, Pharynx, Trachea, Bronchi, Bronchioles, Terminal Bronchioles

Front 97

Where is cartilage present in the conducting zone?

Back 97

Trachea and bronchi

Front 98

What is the function of the conducting zone?

Back 98

Warm, Humidifies, Filters Air

Front 99

What is in the walls of all of the conducting airways?

Back 99

-Smooth Muscle

Front 100

Conducting Zone

Back 100

Anatomic Dead Space

Front 101

What does the respiratory zone consist of? Function?

Back 101

Respiratory bronchioles, alveolar ducts, alveoli Gas Exchange

Front 102

Pseudocolumnar Ciliated cells extend down to where in the respiratory system?

Back 102

Pseudocolumnar to the Respiratory bronchioles

Front 103

Goblet cells extend how far?

Back 103

Goblet to the terminal bronchioles

Front 104

What is the function of Type I Pneumocytes? Epithelum type?

Back 104

Line the alveoli; Squamous

Front 105

What is the function of type II Pneumocytes? Epithelum type?

Back 105

Secrete pulmonary surfactant (3% of pneumocytes are Type II, the rest are type I)
Cuboidal

Front 106

Surfactant is made up of what?

Back 106

Dipalmitoyl Phosphatidylcholine

Front 107

What cells proliferate during lung damage?

Back 107

Type II

Front 108

What cells are precursors to type I cells and type II cells?

Back 108

Type II

Front 109

What are Clara Cells? 3 functions?

Back 109

Nonciliated; columnar with secretory granules.
Secrete component of surfactant, degrade toxins, act as reserve cells

Front 110

What ratio in amniotic fluid indicates fetal lung maturity?

Back 110

2:1 Lecithin: Sphingomyelin

Front 111

Describe each bronchopulmonary segment.

Back 111

Each one has a tertiary (segmental) bronchus and 2 arteries (Bronchial and pulmonary) in the center. Veins and lymphatics drain along the borders.

Front 112

How is Pulmonary Artery Pressure Maintained?

Back 112

Elastic walls in the pulmonary arteries maintain constant levels throughout the cardiac cycle!

Front 113

Right lung has how many lobes?

Back 113

3

Front 114

Left lung has how many lobes?

Back 114

2. Also has lingula. Homologue to right middle lobe

Front 115

To which side does an inhaled foreign body go?

Back 115

Right side

Front 116

Describe the relationship of the pulmonary artery to the bronchus at each lung hilus.

Back 116

RALS- Right Anterior/ Left it is superior

Front 117

From the anterior view describe the whole right and left lobe.

Back 117

Right- Superior lobe separated from middle lobe by horizontal fissure/ Middle from inferior by oblique fissure

Front 118

Describe the posterior view of both lungs

Back 118

They both look exactly the same- you see the oblique fissure from the right side and only the superior and inferior lobes

Front 119

What are the structures perforating the diaphragm and where?

Back 119

T8- IVC
T10- Esophogus, Vagus
T12- Aorta, Thoracic, Azygous (Red, White, Blue)

Front 120

What innervates the diaphragm?

Back 120

Phrenic (C3, C4, C5 keeps the dia[hragm alive. Pain can therefore be referred to the shoulder

Front 121

In quiet breathing what are muscles for inspiration and expiration.

Back 121

Inspiration -- diaphragm; Expiration -- Passive

Front 122

In exercise what muscles mediate inspiration?

Back 122

External intercostals, scalene muscles, sternomastoids

Front 123

In exercise what muscles mediate expiration?

Back 123

Rectus abdominus, internal and external obliques, transversus abdominis, internal intercostals

Front 124

What are five respiratory products and what are their functions?

Back 124

Surfactant - Decrease surface tension in alveoli, Increase compliance, Decrease work of inspiration
Prostaglandins
Histamine - Bronchoconstriction
ACE - Ag I to Ag II, Inactivates Bradykinin
Kallikrein - Activates Bradykinin

Front 125

What is the formula for collapsing pressure?

Back 125

2(Tension)/ Radius

Front 126

Residual Volume

Back 126

Air in lung after maximal expiration

Front 127

Expiratory Reserve Volume (ERV)

Back 127

Air that can still be breathed out after a normal expiration

Front 128

Tidal Volume

Back 128

Air that moves into lung with each quite respiration- generally 500 mL

Front 129

Inspiratory Reserve Volume (IRV)

Back 129

Air in excess of tidal volume that moves in on maximum inspiration

Front 130

Vital Capacity (VC)

Back 130

TV+IRV+ERV

Front 131

Functional Residual Capacity (FRC)

Back 131

RV+ERV- Volume in lungs after normal expiration

Front 132

Inspiratory Capacity (IC)

Back 132

IRV+TV

Front 133

Total Lung Capacity

Back 133

IRV+TV+ERV+RV

Front 134

What is the equation for physiologic dead space?

Back 134

Vd= Vt*((PaCO2-PeCO2)/PaCO2)

Front 135

Oxygen-Hemoglobin Dissociation Curve. What happens to oxygen affinity for hemoglobin when the curve goes to the right?

Back 135

Affinity decreases as you move to the right

Front 136

Oxygen-Hemoglobin Dissociation Curve. What causes a shift to the right?

Back 136

CADET face to the right- CO2, Acid/Altitude, DPG (2,3-DPG), Exercise, Temperature

Front 137

Oxygen-Hemoglobin Dissociation Curve. What causes a shift to the left?

Back 137

A decrease in all of the above things

Front 138

Oxygen-Hemoglobin Dissociation Curve. Where is fetal hemoglobin on the curve vs adult hemoglobin

Back 138

It is to the left b/c it has higher affinity for O2

Front 139

What happens to P50 with a right shift and a left shift?

Back 139

It goes up in a right shift and down in a left shift

Front 140

Pulmonary Circulation is normally a ____ _________, ________ ________ System?

Back 140

Low Resistance, High Compliance

Front 141

Describe what happens with a decrease in alveolar oxygen partial pressure to the pulmonary vasculature?

Back 141

Vasoconstriction to push blood to where there is a high O2 pressure!

Front 142

Describe the principles of diffusion limited and perfusion limited

Back 142

Perfusion limited- gases equilibrate early along the capillary, O2, CO2, N2O
Diffusion limited- gases haven’t equilibrated by the end of the artery- O2, CO2

Front 143

What do you get in normal health?

Back 143

In normal health you have perfusion limited and the only way you can increase it is by increasing blood flow

Front 144

In what conditions do you get the other?

Back 144

You get diffusion limited in emphysema or fibrosis

Front 145

On a graph showing from the start of the capillary to the end of the capillary with respect to equilibrium of gases, what is in between diffusion limited and perfusion limited?

Back 145

Exercise

Front 146

What is a consequence of pulmonary hypertension and what happens?

Back 146

Cor pulmonale and subsequent RHF
Jugular venous distension, hepatomegaly, edema

Front 147

Carbon dioxide has how much of a greater affinity for hemoglobin than does oxygen?

Back 147

50 X

Front 148

What does CO do to the oxygen-hemoglobin dissociation curve?

Back 148

It shifts it to the left

Front 149

What happens to oxygen unloading in tissues?

Back 149

It is decreased (This is b/c the curve is shifted to the left and thus the affinity is increased)

Front 150

What is normal pulmonary artery pressure?

Back 150

10-14 mmHg

Front 151

What is defined as pulmonary hypertension?

Back 151

Above 25 mmHg at rest and above 35 mmHg during exercise

Front 152

What is primary pulmonary hypertension?

Back 152

Unknown

Front 153

What is the prognosis?

Back 153

Poor

Front 154

What is generally the etiology of secondary pulmonary hypertension?

Back 154

COPD; Or a Left to right heart shunt

Front 155

What is the equation for pulmonary vasculature resistance?

Back 155

PVR = P (Pulm Artery)- P (Left Atrium)/ Cardiac Output
This is the same as P=QR except it is R= change in pressure over Q

Front 156

•How do you measure pressure in the left atrium?

Back 156

Pulmonary Wedge Pressure