Resp Phys

Front 1

FEV1/FVC

Back 1

nl is 0.8
decr in obstructive dz
not decr in restrictive dz

Front 2

Muscles of expiration

Back 2

abdominal muscles compress abdominal cavity
push diaphragm up and push air out of lungs
internal intercostals:
pull ribs dnwd and inwd - ex

Front 3

transmural lung pressure

Back 3

alveolar press minus intrapleural press

Front 4

hysteresis

Back 4

inspiration follows a different curve than expiration.

Front 5

compliance of chest wall lung system

Back 5

At FRC press in lungs is equal to ATM.
Equal negative transmural press by chest wall versus the positive intramural press by lungs

Front 6

Emphysema and compliance

Back 6

lung compliance is incr
thus at the original FRC the tendency for the lung to collapse is much less than that of the chest wall to expand. Thus a higher FRC equilibrium and a barrel chest.

Front 7

Lung fibrosis and compliance

Back 7

Compliance is decr thus FRC will decr and chest wall smaller at equilibrium.

Front 8

Causes of decr lung compliance
(4)

Back 8

Fibrosis
Incr pulm venous press
High expanding pressures
Lack of surfactant

Front 9

Causes of incr lung compliance

Back 9

Emphysema
Age

Front 10

Law of Laplace

Back 10

P = 2T/r

T=surface tension

Front 11

Surfactant

Back 11

Synth by Type II pneumocytes
DPPC
Mature surfactant 2:1 lecithin:sphingomyelin ratio.

Front 12

Lung volumes and airway resistance

Back 12

radial traction exerted on the airways by surrounding lung tiss
High lung vol: great traction and lower resistance (asthmatics learn to breath at high lung vol)
Lower lung vol: less traction, incr airway resistance.

Front 13

Site of highest airway resistance

Back 13

Medium sized bronchi

Front 14

Perfusion limited exchange vs diffusion limited exchange

Back 14

Perfusion limited: N20 and O2 under nl conditions. gas equilibrates early along the length of the capillary
Diffusion limited exchange: CO2 and O2 during strenuous exercise or lung fibrosis. gas does not equilibrate by the time the blood reaches the end of the pulm cap.
diffusion continues as long as the partial pressure gradient is maintained.

Front 15

Adult Hb
Fetal Hb

Back 15

Adult - alpha2/beta2
HbF - alpha2/gamma2 - higher O2 affinity because it binds 2,3 dpg less avidly.

Front 16

O2 content

Back 16

total amount of O2 in the blood. = O2 binding capacity x % sat + dissolved O2.

Front 17

PO2 at 40mmHg (venous blood)
PO2 at 25 mmHg

Back 17

PO2 at 40 mmHg - Hb is 75% saturated - 3/4 heme groups on each Hb has O2 bound.
PO2 at 25 mmHg = P50 = Hb is only 50% saturated.

Front 18

Hb dissociation curve shift to the right

Back 18

Hb affinity for O2 is decr, P50 increases.
Caused by incr CO2, decr pH, incr in temp (during exercise), incr 3-DPG concentration (which binds deoxy Hb) - it is part of the adaptation to chronic hypoxemia.

Front 19

CO and Hb

Back 19

occupied O2 binding sites
decr O2 content of blood
Causes a left shift bc of incr affinity for O2 in remaining binding sites.

Front 20

Cloride shift

Back 20

90% of CO2 is carried as Bicarb in Hb.
CO2 in tissue diffuses into venous plasma then into RBC
In RBC it combines with H20 to form H2CO3 which dissociates via carbonic anhydrase.
HCO3- diffuses out of RBC in exchange for Cl and is transported to the lungs in the plasma.
H+ remains in the RBC and is buffered by deoxyHb (much better than oxyHb. )

In the lungs: bicarb enters RBC in exchange for Cl. Recombines with H+ to form H2CCO3 -> H2O and CO2 and CO2 is expired.

Front 21

Pulm Circ
press, resistance

Back 21

Pressures are much lower in the pulm circ mainly because the resistance is much lower than in the systemic circ.

Front 22

Zone 1 pulm blood flow

Back 22

alveolar press>arterial press>venous press
Q way decr
V decr
V/Q incr

Front 23

Zone 2 pulm blood flow

Back 23

arterial press>alveolar press>venous press

Front 24

Zone 3 pulm blood flow

Back 24

arterial press>venous press>alveolar press
Q way incr
V incr
V/Q decr

Front 25

R->L shunt
L->R shunt

Back 25

R->L shunt: tet of fallot -
shunted blood leads to admix of venous blood in arterial blood.
Can be estimated by having pt breath 100% O2 and measuring degree of dilution of art blood
L->R shunt much more common
Do no lead to a decr in art PO2, PO2 will be elevated on the right side.

Front 26

V/Q ratios

Back 26

>1.0 at the apex
<0.8 in the base
Apex: PO2 is highest and PCO2 is lowest bc gas exchange is more efficient
Base: PO2 is lowest and PCO2 is highest bc gas exchange is less efficient.

Front 27

Lung Stretch rec
Irritant Rec
J rec
Joint and muscle rec

Back 27

Hering Breuer Reflex: when stretch rec in smooth muscle of airways is stimulated by distention of the lungs - decr breathing freq
Irritant: btw airway epith cells - stim by noxious subs
Juxtacapillary rec: alveolar walls close to caps. Engorgement of pulm caps (LVF) stimulates ->rapid shallow breathing
Jt and muscle rec: activated by mvmt of limbs, stim breathing during exercise.

Front 28

V/Q during exercise

Back 28

distribution is more even throughout lung during exercise.

->DECREASE IN DEAD SPACE

Front 29

High Altitude adaptations

Back 29

hypoxemia ->
hyperventilation -> resp alkalosis (tx with acetazolamide)
Incr EPO -> incr O2 capacity and incr O2 content
2,3 DPG incr
PULMONARY VASOCONSTRICTION -> RVH

Front 30

When the O2 dissociation curve shifts right
what happens to p50
how about O2 carrying capacity of Hb

Back 30

Shifts to the right incr P50
has no effect on carrying capacity of Hb that is determined by Hb CONCENTRATION

Front 31

Changes and non changes during strenuous exercise

Back 31

Incr in vent ratematches incr in O2 consumption and CO2 generation - thus mean values for art PO2 and PCO2 do not change
Art pH may change bc of lactic acidosis
Venous PCO2 increases

Front 32

Chest tube

Back 32

inserted through 5th intercostal space in the anterior axillary line.
Tube penetration: skin->superficial fascia->serratus anterior-> external intercostal->internal intercostal-> innermost intercostal -> parietal pleura.

Front 33

Pleuritis

Back 33

visceral pleuritis - no innervation
parietal pleura innervated by intercostal nerves and phrenic C3-C5. Pain may be referred to thoracic wall and root of the neck.

Front 34

Compression of the trachea

Back 34

can occur via enlarged thyroid or an aortic arch aneurysm

Front 35

Bronchogenic ca

Back 35

Adenoca: most common type, peripheral lesions, less ass with smoking
SCC: 2nd most common, strong smoking ass, centrally located lesions, cavitation, may secr PTH
Small Oat cell: Kulchitsky cells of neurocrest origin, ACTH secr, ADH secr

Front 36

Intrathoracic spread of bronchogenic ca sequele

Back 36

Horners
Superior Vena Caval syndrome
Dysphagia
Hoarseness
Paralysis of diagphragm
Pancoast tumor (ulnar nerve pain and horners)

Front 37

Lobar Pneumonia Stages

Back 37

Initial stage: acute congestion, intraalveolar fluid, many bacteria
Early Consolidation: Red hepatization, 2-4 days, consolidation with N/T and fibrin. Lung is red from RBC firm and airless.
Late Consolidation: Gray hepatization, 4-8 days, large amounts of fibrin with decr red and white cells.
Resolution in 8 days.

Front 38

Bronchial Asthma

Back 38

extrinsic (type 1 hs) vs intrinsic
Mucus plugs
whorl like accumulations of epith cells - curschmann spirals
Charcot leyden crystals (crystalloids of eosinophil derived proteins)

Front 39

Chronic Bronchitis

Back 39

Productive cough at least 3 consecutive mos over at least 2 consecutive years.
Linked to smoking and can lead to cor pulmonale
Hyperplasia of mucus secreting submucosal glands

Front 40

Emphysema subtypes
(4)

Back 40

Centrilobular: dilation of resp bronchioles - upper part of lobes
Panacinar: Alpha 1 antitrypsin def, dilation of entire acinus, loss of elasticity
Paraseptal: subpleural blebs
Irregular: inflamm, irreg involvement of acinus with scarring within walls of enlarged spaces.

Front 41

Emphysema cause

Back 41

SMoking - brings in N/T and MP elastase
Alpha1 antritrypsin def:
piZ allele - interferes with hepatic secr - liver damage
homozygous piZZ allele - greatly decr activity, hepatic cirrhosis

Front 42

Kartageners syndrome

Back 42

rare, AR
sinusitis, bronchiectas, situs inversus, male infertility.
Problem with Dynein

Front 43

Restrictive lung dz

Back 43

Interstitial lung dzs:
ARDS, pneumoconioses, Sarcoid, idiopathic pulm fibrosis, SLE, Scleroderma, wegners, goodpastures, Eosinophillic Granuloma

Front 44

Hyaline membrane dz
cause, pulm maturity
Complications

Back 44

neonatal resp distress syndrome
def of surfactant
Surfactant: lecithin incr in 33rd week and sphingomyelin levels stay the same. 2:1 is pulm maturity.
Complications:
Bronchopulm dysplasia from ventilation
PDA, IVH, necrotizing enterocolitis.

Front 45

Coal workers pneumoconiosis

Back 45

Simple: coal macules around bronchioles, MP ingesting coal dust, inconsequeantial
Progressive massive fibrosis: fibrotic nodules, bronchiectasis, pulm HTN, resp failure or RHF

Front 46

Silicosis

Back 46

incr risk for TB

Front 47

Abestosis

Back 47

Diffuse interstitial fibrosis
Ferruginous bodies
hyalinized fibrocalcific plaques of parietal pleura
Predisposes to BRONCHOGENIC CARCINOMA, and MALIGNANT MESOTHELIOMA

Front 48

Sarcoid

Back 48

restrictive lung dz
Intersitial lung dz, enlarged hilar LN, anterior uveitis, erythema nodosum of skin, polyarthritis
Polyclonal hypergammaglobinemia
hypercalcemia and hypercalciuria
Incr serum ACE

Front 49

Idiopathic Pulm fibrosis

Back 49

Chronic inflamm and fibrosis of alveolar wall. Begins with alveolitis-> fibrosis-> ends in distored fibrotic lung filled with cystic spaces - HONEYCOMB lung

Front 50

Eosinophillic Granuloma

Back 50

Interstital lung dz
histiocytic cells, birbeck granules, lung or ribs
Grouped with Hand-Schuller-Christian dz and Letterer-Siew synddrome as variants as histiocytosis X sydnrome

Front 51

secondray Pulm HTN

Back 51

most often COPD
incr pulm blood flow (L->R shunt)
incr resistance (emboli, vasoconstrict from hypoxia)
polycythemia

Front 52

Extrapulm TB

Back 52

TB meningitis, potts dz, paravertebral abcess, psoas abcess

Front 53

Most common lung cancer

Back 53

Cancer mets to lung

Front 54

bronchogenic Ca
survival

Back 54

Smoking
Air pollution
Radiation
Asbestos + Smoking
Exposure to Nickel and Chromates
5yr survival < 10%

Front 55

Chronic Bronchitis
Test?

Back 55

COPD
Marked hyperplasia of bronchial and submucosal glands and bronchial smooth muscle hypertrophy. Quantified by Reid index: ratio of glandular thickness to bronchiolar thickness

Front 56

Most common lobar pneumonia

Back 56

Strep Pneumonia

Front 57

Distinguish btw primary and secondary TB

Back 57

cavitation only in 2'
Apical Lung - 2'
1' ghon complex near hilar LN

Front 58

Carcinoid Syndrome

Back 58

Typically lung or GI can
Flushing, wheezing, recurrent diarrhea, carcinoid heart dz.
Seratonin causing diarrhea

Front 59

PCP
tx and path

Back 59

tx with TMP/SMX
Kills type 2 pneumocytes, damages alveolar epith
serum leaks

Front 60

Aortic Hiatus

Back 60

T12 - aorta, azygous vein, thoracic duct

Front 61

Esophageal Hiatus

Back 61

T10 - esophagus and Vagus

Front 62

Caval Hiatus

Back 62

Inferior vena cava - T8

Front 63

Bohr Effect
Haldane Effect

Back 63

Bohr Effect: incr H+ leads to peripheral O2 unloading
Haldane Effect: oxygenation of Hb in lungs unloads CO2 from Hb.

Front 64

Blue Bloaters

Back 64

Chronic bronchitis
hypertrophy of mucus secr glands
wheezing, crackles, cyanosis

Front 65

Pink Puffers

Back 65

emphysema
dyspnea, decr breath sounds, tachycardia,

Front 66

Treatment for Neonatal ARDS

Back 66

maternal steroids before birth
artificial surfactant for infant

Front 67

Most common places for lung cancer mets

Back 67

Brain, bone, liver

Front 68

Lung Cancer presentation

Back 68

Cough, hemoptysis, bronchial obstruction, wheezing, Pneumonic coin lesion on xray.

Front 69

Pancoast tumor

Back 69

Carcinoma that affects apex of lung - affecting cervical sympathetic plexus -> HORNERS SYNDROME

Front 70

Lobar
Bronchopneumonia
Interstitial

Back 70

Lobar: Intraalveolar exudate, consolidation
S. Pneumococcus
Broncho: Acute inflamm infiltrate from bronchioles into adjacent alveoli
S. Aureus, H. Flu, Klebsiella, S. Pyogenes
Interstitial (atypical):diffuse patchy infiltrate: Mycoplasma, RSV, adenovirus, legionella, chlamydia, coxiella burnetti

Front 71

PGI

Back 71

prostacyclin
decr:
platelet aggregation
vasc tone
bronchial tone
uterine tone

Front 72

PGE, PGF

Back 72

prostaglandins
Incr uterine tone
Decr vasc tone + bronchial tone

Front 73

TXA

Back 73

thromboxane
incr platelet aggregation
incr vasc tone
incr bronchial tone

Front 74

1st gen H1 blocker

Back 74

Diphenhydramine, dimenhydrinate, chlorpheniramine
Tox - sedation, antimuscarinic, anti-alpha-adrenergic

Front 75

2nd gen H1 block

Back 75

Loratadine, fexofenadine, desloratadine
less sedation

Front 76

Bronchial tone
(+)
(-)

Back 76

Bronchial dilation:
incr cAMP
Bronchoconstriction:
Ach + Adenosine

Front 77

Most common cause of laryngeal cancer

Back 77

SCC
cigarette smoking is the most important risk factor

Front 78

Lymphoepithelioma

Back 78

SCC that most freq occurs in the nasopharynx, less commonly in larynx.
Rich in lymphs
Common in China and Africa -
EBV

Front 79

Sqaumous papilloma

Back 79

benign laryngeal neoplasm by HPV 6 +11.

Front 80

Old age and lungs

Back 80

age leads to higher compliance of lungs. Decr elastic recoil.

Front 81

How much can O2 can art blood nl carry?
1gm of Hb
100 ml blood

Back 81

1 gm Hb carries 1.34 g O2
100 ml art blood - carries about 20 ml of O2 at nl Hb of 15g/dl.

Front 82

Esophageal Atresia

Back 82

post deviation of the tracheoesophageal septum.
Feeding causes fluid to spill into trachea and leads to aspiration pneumonia.

Front 83

Strep Pneumoniae virulence

Back 83

Acidic polysacharide capsule. Antibody to specific capsule is necessary for resolution of infection. There are many capsule types.

Front 84

Bordet Gengou Augar

Back 84

used for isolation of Bordatella Pertussis

Front 85

Exudative effusion characteristics

Back 85

one or more of the following:
1. pleural fluid protein/serum protein >0.5
2. PLeural fluid LDH /Serum LDH >0.6
3. Pleural fluid LDH more than 2/3 nl upper limit for serum.

Front 86

Alveolar Ventilation eqn
and what happens to Alveolar PCO2 if you hyperventilate x 4

Back 86

VA= VCO2/PACO2

VA = alveolar ventilation
VCO2 = CO2 production
PACO2 = alveolar PCO2

PACO2 = goes down to 10 mmHG

Front 87

Monoclonal antibody for RSV

Back 87

Palivizumab
directed against the fusion protein of RSV
preventing infection

Front 88

Radial traction
restrictive dz vs obstructive

Back 88

When lung vol decr radial traction decrs -> airway diameter decr.
In interstitial fibrosis the airways are tethered more strongly to lung parenchyma thus airways held open to a greater extent at each lung vol. -incr radial traction.

Front 89

Morbid obesity and respirations

Back 89

peripheral hypoventilation
Pickwickian Syndrome
Press of fatty neck causes intermittant airway obstruction.

Front 90

Rx that binds IgE to inhibit mast cell and basophil rxn

Back 90

Omalizumab - monoclonal abs
Inhibits binding of IgE to high affinity Fc rec on surface of mast and basophils.
Indicated in 12+, moderate to severe persistant asthma
Administered subQ every 2-4 wks

Front 91

Incr surfactant

Back 91

Thyroxine, prolactin, cortisol

Front 92

Gestational Diabetes

Back 92

leads to incr insulin production from baby - decrs surfactant

Front 93

Peripheral hypoventiation causes
vs
Central Hypovent

Back 93

Fatty neck, submersion, suffocation, skeletal abnl (broken rib), trauma, phrenic nerve paralysis, polio, tetanus

Central Hypoven: barbs, opioids, benzos