Pulmonary

Front 1

The systolic/diastolic blood pressure of the pulmonary circulation

Back 1

25/8 mmHg

Front 2

The pulmonary circulatory system has ______ pressure and resistance than the systemic circulation

Back 2

lower

Front 3

The property of pulmonary blood vessels that allows vessels to expand and dilate, allowing for large volume increases without increasing pressure

Back 3

compliance

Front 4

The pressure across the capillary walls in the lungs

Back 4

transmural pressure = (intravascular pressure - alveoli pressure)

Front 5

Increases in lung volume ____________ resistance in alveolar vessels and _____________ resistance in extra-alveolar vessels

Back 5

increase, decrease

Front 6

The point at which total pulmonary circulation resistance is lowest

Back 6

end of expiration

Front 7

The mechanism used by the lungs to shift circulation to better ventilated alveoli

Back 7

hypoxic vasoconstriction

Front 8

The levels that define pulmonary hypertension (arteriole pressure)

Back 8

25mmHg at rest, 35mmHg when exercising

Front 9

Simplified Poiseuille's equation

Back 9

pressure change = resistance x flow

Front 10

Point at which pulmonary edema occurs

Back 10

When pulmonary capillary pressure exceeds 25 mmHg

Front 11

A condition that occurs due to damage to the lung tissue (via toxins, bacteria, or inflammation) that reduces the pressure threshold for pulmonary edema (by increasing capillary permeability)

Back 11

adults respiratory distress syndrome (ARDS)

Front 12

Formula for inspired O2

Back 12

PO2(tracheal) = (Ptotal - PH2O) x 0.21

(Note that normally PH20 = 47 mmHg)

Front 13

The alveolar PO2

Back 13

105 mmHg

Front 14

The alveolar PCO2

Back 14

40 mmHg

Front 15

The typical tissue PO2

Back 15

40 mmHg

Front 16

The typical tissue PCO2

Back 16

46 mmHg

Front 17

The type of alveolar dead space caused by disruptions to blood flow / gas exchange

Back 17

respiratory dead space

Front 18

Increasing alveolar ventilation (hyperventilation) ___________ the partial pressure of CO2

Back 18

decreases

Front 19

The three components of lung vital capacity

Back 19

1. tidal volume

2. inspiratory reserve volume

3. expiratory reserve volume

Front 20

The air that cannot be moved out of the lungs physiologically

Back 20

residual volume

Front 21

The procedure used to directly measure pulmonary artery pressures

Back 21

pulmonary artery catherization (Swan Ganz)

Front 22

ventilation formula

Back 22

total minute ventilation = tidal volume x respiratory rate

Front 23

normal total minute ventilation

Back 23

5-6 liters/min

Front 24

The cells of the lung that secrete surfactant

Back 24

type II alveolar epithelial cells

Front 25

The major muscles of inspiration

Back 25

scalenes and external intercostals

Front 26

The major muscles of expiration

Back 26

internal intercostals and abdominal muscles

Front 27

The formula/test used to assess airway resistance

Back 27

FEV1/FVC (should be above 70%)

Front 28

In restrictive lung disease, the FVC is ________ and the FEV1 is __________

Back 28

low, normal

Front 29

The major component of surfactant

Back 29

DPPC

Front 30

compliance forumla

Back 30

compliance = (delta volume) / (delta pressure)

Front 31

Boyle's law formula

Back 31

P1V1=P2V2

Front 32

Any disease that increases airway resistance

Back 32

obstructive lung disease

Front 33

low pitched wheezing noises on physical exam

Back 33

rhonchi

Front 34

A decrease in CO2 partial pressure ________ smooth muscle tone of the airways

Back 34

increases

Front 35

An obstructive respiratory disease where alveoli (and thus elastic recoil) are destroyed

Back 35

emphysema

Front 36

The major factor that causes the inability to exhale normally in emphysema

Back 36

loss of elastic recoil

Front 37

Pulmonary diseases that are characterized by decreased distensibility of lungs, pleura, or chest wall

Back 37

restrictive lung disease

Front 38

The mechanism of measuring lung volume that is not accurate for patients with obstructive lung disease

Back 38

helium dilution test

Front 39

gas diffusion formula

Back 39

~ [area x diffusion coefficient x (pressure difference)] / thickness of membrane

Front 40

The test used to test gas diffusion of lung

Back 40

CO diffusion test

Front 41

The formula for dissolved gas amount

Back 41

amount that dissolves = solubility coefficient x partial pressure

Front 42

oxygen diffusion is normally ______________ limited

Back 42

perfusion

(diffusion limitation is abnormal)

Front 43

Increases in temperature shift the Hb binding curve to the ____________

Back 43

right

Front 44

Increasing pH shifts the Hb binding curve to the ________

Back 44

left

Front 45

Increasing PCO2 shifts the Hb binding curve to the __________

Back 45

right

Front 46

2,3DPG (indicates increased glycolysis) shifts the Hb binding curve to the __________

Back 46

right

Front 47

The fetal hemoglobin curve is shifted to the ______

Back 47

left

Front 48

Formula that relates ventilation and arteriole CO2 partial pressure

Back 48

Va = K(VCO2/PaCO2)

Front 49

Normal value range for alveolar-arterial oxygen gradient

Back 49

0-10 mmHg

Front 50

oxygen content formula

Back 50

CaO2 = 1.34(Hgb)(oxygen saturation) + 0.003(PaO2)

Front 51

Key sign of hypoventilation

Back 51

increased PaCO2 with normal A-a gradient

Front 52

Key sign of a shunt

Back 52

High A-a gradient that does not respond to oxygen

Front 53

Normal PaCO2 value range

Back 53

35-45 mmHg

Front 54

PaCO2 formula

Back 54

VCO2/VA

(CO2 production / alveolar ventilation)

Front 55

The part of the brainstem that is largely responsible for rhythmic, autonomic breathing

Back 55

medulla

Front 56

The term for normal, quiet breathing

Back 56

eupnea

Front 57

The term for dyspnea at rest while supine

Back 57

orthopnea

Front 58

The classic pattern of breathing seen in someone with metabolic acidosis

Back 58

Kussmaul breathing

(rapid and deep pattern)

Front 59

The respiratory neuron group in the medulla responsible for inspiration

Back 59

dorsal respiratory group (DRG)

Front 60

The part of the VRG (medulla) that acts as a respiratory rhythm generator

Back 60

Botzinger complex

Front 61

Part of the pons that results in deeper and more frequent breaths

Back 61

apneustic center

Front 62

Part of the pons that inhibits the DRG and halts inspiration

Back 62

pnemotaxic center

Front 63

Receptors in alveoli and small airways that respond to interstitial edema

Back 63

J receptors

Front 64

Hormone that suppresses appetite and stimulates ventilation

Back 64

leptin

Front 65

Sleep pattern of extreme responses to hyper and hypoventilation

Back 65

Cheynes-Stokes respiration

Front 66

Bronchodilator that increases calcium efflux to induce bronchial smooth muscle relaxation

Back 66

Beta-2 agonist

Front 67

The mechanism of beta agnoist action

Back 67

receptor --> increase cAMP --> PKA --> calcium efflux

Front 68

Three most common beta-2 agnoists

Back 68

1. albuterol

2. salmeterol

3. fomoterol

Front 69

The short action "rescue inhaler" beta 2 agonist

Back 69

albuterol

Front 70

The two long-acting beta 2 agonist bronchodilators

Back 70

salmeterol & formoterol

Front 71

The major short acting anti-cholinergic bronchodilator

Back 71

ipratropium

Front 72

The 2 major long acting anti-cholingeric bronchodilators

Back 72

tiotropium & umeclidinium

Front 73

The mechanism of action of anticholinergic bronchodilators

Back 73

block muscarinic receptors to block

Front 74

The type of bronchodilator indicated for COPD

Back 74

anticholinergic

Front 75

The mechanism of action of montelukast

Back 75

inhibits LTF4 formation

Front 76

the mechanism of action of zileuton

Back 76

blocks formation of all leukotrienes

Front 77

anti-tussive that draws free water into airway

Back 77

guaifenesin

Front 78

non-opiate anti-tussive that is not particularly effective

Back 78

dextromethorphan

Front 79

genetic disorder that causes emphysema (without smoking / environmental risk factors)

Back 79

alpha-1-antitrypsin deficiency

Front 80

The cells responsible for early bronchospasm

Back 80

mast cells & macrophages

Front 81

Mechanism of late phase bronchospasm

Back 81

Cytokine and chemokine mediated inflammation

Front 82

endogenous bronchodilators

Back 82

catecholines

Front 83

The mechanism of exercise induced bronchoconstriction

Back 83

reduced water content --> increased tonicity --> irritation and bronchospasm

Front 84

antibody therapeutic that blocks mast cell degranulation (used for intractable asthma)

Back 84

omalizumab

Front 85

A condition characterized by dilation and destruction of bronchial walls, retention of mucus, and increased incidence of infections

Back 85

bronchiectasis

Front 86

The chloride channel protein affected in cystic fibrosis

Back 86

CFTR

Front 87

The primary physiological characteristics of bronchiestasis

Back 87

1. mucus hypersecretion

2. epithelial hyperplasia

3. airway hyperreactivity & bronchoconstriction

4. loss of elastic recoil

Front 88

The main pathogen of concern in CF patients

Back 88

Pseudomonas aeruginosa

Front 89

The bronchodilator sometimes used in CF patients

Back 89

beta 2 agonists

Front 90

The CFTR potentiator drug that works in patients with a specific gene mutation

Back 90

Ivacaftor

Front 91

PAO2 formula

Back 91

(FiO2)(Pb - PH20) - PaCO2/0.8

Front 92

The typical fraction of inspired oxygen at sea level

Back 92

0.21

Front 93

The barometric pressure at sea level

Back 93

760 mmHg

Front 94

The vapor pressure of water at sea level

Back 94

47 mmHg

Front 95

The A-a (Alveolar-arterial) oxygen gradient formula

Back 95

(FiO2)(Pb-PH20) - [(PaO2 + PaCO2)/0.8]

Note: (FiO2)(Pb-PH20) usually equals 150

Front 96

Normal A-a gradient value

Back 96

0

Front 97

When determining whether V/Q mismatch or a shunt is responsible, what do you look at?

Back 97

Response to oxygen. If PaO2 is <500mmHg after 100% oxygen, then a shunt is responsible.

Front 98

The pH change seen in chronic hypercapnia

Back 98

0.03 units pH per 10mmHg rise in PaCO2

Front 99

The two major sources of innervation for the parietal pleura

Back 99

intercostal nerves and phrenic nerve

Front 100

The collapse of a segment of lung

Back 100

atelectasis

Front 101

The general mechanism of pleural transudate formation

Back 101

changes in pressure (hydrostatic or osmotic) in pleural space or pleural blood vessels

Front 102

Effusion that leaks into the pleural space

Back 102

transudate

Front 103

Pleural effusion caused by disruption to pleural membranes

Back 103

exudate

Front 104

The sterile exudate form of pneumonia-caused pleural effusion

Back 104

parapneumonic effusion

Front 105

The infected exudate form of pneumonia-caused pleural effusion

Back 105

empyema

Front 106

A type of pleural effusion caused by disruption of the thoracic duct

Back 106

chylothorax

Front 107

Interstitial diseases caused by inhaling inorganic dust

Back 107

pneumoconioses

Front 108

Interstitial disease caused by immune reaction to organic molecules

Back 108

hypersensitivity pneumonitis

Front 109

The pathogenesis of asbestosis

Back 109

macrophages incompletely phagocytose asbestos fibers

Front 110

Cancer of the pleura

Back 110

mesothelioma

Front 111

The pneumoconiosis that increases risk for TB, due to effect on alveolar macrophages

Back 111

silicosis

Front 112

partially alveolated bronchiole

Back 112

respiratory bronchiole

Front 113

bronchiole that does not open in alveoli

Back 113

membranous bronchiole

Front 114

defining feature in lung slide of bronchiole

Back 114

cartilage

Front 115

The kind of emphysema that is not caused by smoking. Occurs more frequently in lower lobes.

Back 115

panlobular emphysema

Front 116

The pathophysiology of ARDS

Back 116

Inflammatory response (to infection such as pneumonia or pancreatitis) causes edema of capillary-alveoli interface

Front 117

The kind of WBCs seen in hypersensitivity pneumonia

Back 117

CD8+ lymphocytes

Front 118

The major anticholinergic bronchodilator

Back 118

ipratropium

Front 119

The kind of pulmonary hypertension that increases the PCWP

Back 119

venous pulmonary hypertension

Front 120

The most common gene mutated in hereditary pulmonary hypertension

Back 120

BMPR-II

Front 121

The three major medications given to treat pulmonary hypertension (WHO group 1)

Back 121

1. NO increase (Ricoiguat)

2. Endothelin antagonist

3. Prostacyclin

Front 122

The types of interstitial lung diseases that lead to a "ground glass" appearance on CT

Back 122

infectious or inflammatory

Front 123

The type of interstitial lung disease that leads to honeycombing

Back 123

fibrotic

Front 124

Interstitial disease that results in inter-alveolar macrophages. Related to smoking.

Back 124

DIP

Front 125

Pulmonary disease characterized by stellate lesions and Birbeck granules. Heavily correlated with smoking.

Back 125

PLCH (pulmonary langerhans cell histiocytosis)

Front 126

A fibrotic lung disease with both temporal and spatial heterogeneity. Restricted to interstitia

Back 126

UIP (usual interstitial pneumonia)

Front 127

Disease that causes poorly formed granulomas and neutrophil infiltration of interstitia

Back 127

hypersensitivity pneumonitis

Front 128

Interstitial lung disease that is not related to smoking

Back 128

COP (cryptogenic organizing pneumonia)

Front 129

pulmonary vascular resistance formula

Back 129

PVR = (mean pulmonary arterial pressure -PAWP) / cardiac output

Front 130

Major form of inflammation-caused alveolar edema

Back 130

ARDS

Front 131

The tend of non-small cell lung cancer that tends to be locally invasive (not metastatic), grow around the hilum, and secrete PTH.

(100% of patients have history of smoking.)

Back 131

squamous cell

Front 132

The most common form of non-small cell lung cancer that tends to metastasize. Typically located in periphery.

Back 132

adenocarcinoma

Front 133

The kind of lung cancer that is more likely to be systemic

Back 133

small cell lung cancer

Front 134

Type of lung cancer that causes hypercalcemia

Back 134

squamous cell carcinoma

Front 135

Common paraneoplastic syndrome that causes hyponatremia

Back 135

SIADH

Front 136

Cancer characterized by keratin pearls and intercellular bridges

Back 136

squamous cell carcinoma

Front 137

minute ventilation equation

Back 137

VE = (tidal volume) x (respiratory rate)

Front 138

dead space equation

Back 138

VD/VT = (PaCO2 - PECO2) / PaCO2

Front 139

blood oxygen carrying capacity formula

Back 139

CaO2 = 1.34 (Hgb) (SaO2) + 0.003(PaO2)

Front 140

Starlings law for pulmonary capillary fluid balance

Back 140

= (difference in hydrostatic pressure) - (difference in oncotic pressure)

Front 141

Stretch receptors (of tracheobronchial tree) that prevent hyperinflation

Back 141

Hering-Breuer

Front 142

Interstitial lung disease with ground glass opacities & pigmented alveolar macrophages. Only occurs in smokers.

Back 142

DIP

Front 143

ILD that has pneumonia like presentation and has alveolar infiltrates. Responds to steroids.

Back 143

crypogenic organizing pneumonia (COP)

Front 144

Form of ILD that is an immune response to organic particles

Back 144

hypersensitivity pneumonitis

Front 145

The defining PaO2 for hypoxemia

Back 145

< 60 mmHg

Front 146

The defining PaCO2 for hypercapnia

Back 146

> 45 mmHg

Front 147

The four necessary criteria for ARDS

Back 147

1. acute onset

2. abnormal CXT or CT (bilateral opacities)

3. respiratory failure not fully explained by fluid overload or CHF

4. hypoxemia