Respiratory

Front 1

ciliated, simple cuboidal

Back 1

bronchioles

Front 2

pseudostratified columnar ciliated epithelium,
goblet cells/mucoserous glands

Back 2

bronchi

Front 3

secrete dipalmitoyl phosphatidylcholine via lamellar bodies

Back 3

aka surfactant

Type II pneumocytes

Front 4

secreted component of surfactant; degrade toxins, act as reserve cells

nonciliated; columnar with secretory granules

Back 4

Clara cells

Front 5

pain from the diaphragm can be referred to the ________

innervated by _____

Back 5

shoulder

C3, C4, C5 (phrenic nerve)

Front 6

quiet breathing (mm used):

inspiration: ___________

expiration: __________

Back 6

insp: diaphragm

exp: passive

Front 7

exercise breathing (mm used):

insp: __________

exp: ___________

Back 7

insp: external intercostals, scalene mm, sternomastoids

exp: internal and external obliques, rectus abdominis, transversus abdominis, internal intercostals

Front 8

histamine

Back 8

increase bronchoconstriction

Front 9

ACE

Back 9

activated angiotensin I > angiotensin II

inactivates bradykinin

Front 10

kallikrein

Back 10

activates bradykinin

Front 11

surfactant

Back 11

decrease alveolar surface tension

increase compliance

decrease work of inspiration

Front 12

law of Laplace: tendency to collapse on expiration as radius _______

Back 12

decreases

Front 13

air that moves into lung with each quiet inspiration, typically 500 mL

Back 13

Tidal volume (TV)

Front 14

everything but the residual volume

Back 14

Vital capacity (VC)

~4.8L

Front 15

RV + ERV

Back 15

Functional Residual Capacity (FRC)

volume in lungs after normal expiration

Front 16

IRV + TV

Back 16

Inspiratory capacity (IC)

Front 17

pulmonary vascular resistance is lowest at ______ because lung is maximally compliant

Back 17

FRC

Front 18

which part of the lung is the largest contributor of functional dead space?

Back 18

apex of healthy lung

(volume of air that does not participate in gas exchange)

Front 19

activation of vagus nerve (efferent activity) > smooth mm _______

Back 19

constriction

+ mucus secretions (c/o ACh from postganglionic parasympathetic neurons acting on muscarinic M3 receptors)

inhibited by tiotropium; ipratropium

Front 20

at FRC, airway and alevolar pressure are ____, and intrapleural pressure is ______ (preventing pneumothorax)

Back 20

0

negative

Front 21

decreased in:
pulmonary fibrosis
insufficient surfactant
pulmonary edema

Back 21

compliance

(change in lung volume for a given change in pressure = dV/dP)

Front 22

fetal hemoglobin has _____ affinity for 2,3-BPG than adult hemoglobin (HbA) and thus has ______ affinity for O2

Back 22

lower

higher

Front 23

T (taut) form of Hb has a ____ affinity for O2

R (relaxed) form of Hb has a _____ affinity for O2

Back 23

low

high (300x)

Front 24

_____ Cl-, H+, CO2, 2,3-BPG, temperature favor T form over R form (with a _____ shift, leading to ______ O2 unloading)

Back 24

increased

right

increased

"When you're relaxed, you do your job better (carry O2)"

Front 25

treatment for cyanide poisoning?

Back 25

1. nitrites (oxidize Hb >> methemoglobin, which binds cyanide, allowing cytochrome oxidase to funciton

2. thiosulfate to bind this cyanide, forming thiocyanate (renally excreted)

Front 26

treatment for methemoglobinemia?

Back 26

methylene blue

Front 27

CO has 200x _____ affinity than O2 for hemoglobin

Back 27

greater

Front 28

perfusion limited -- O2 (normal health), CO2, N2O

Back 28

gas equilibrates early along the length of the capillary; diffusion can be increased only if blood flow increases

Front 29

diffusion limited -- O2 (emphysema, fibrosis), CO

Back 29

gas does not equilibrate by the time blood reaches the end of the capillary

Front 30

pulmonary artery pressure > 25 mmHg or > 35 mmHg during exercise

results in atherosclerosis, medial hypertrophy, intimal fibrosis of pulmonary aa

what is the cause of this primary condition?

secondary condition?

Back 30

pulmonary hypertension

1-- inactivating mutation in BMPR2 gene (typically inhibits vasc smooth muscle proliferation); poor px

2 -- COPD; mitral stenosis; recurrent thromboemboli, AI disease; L--R shunt; sleep apnea or living at high altitude

Front 31

severe respiratory distress >> cyanosis and RVH >> death from decompensated cor pulmonale

Back 31

pulmonary hypertension

Front 32

O2 content of arterial blood ______ as Hb falls, but O2 saturation and arterial PO2 do not

Back 32

decreases

Front 33

Alveolar gas equation

Back 33

PAO2 = (150 - PACO2) / 0.8

Front 34

shunting
V/Q mismatch
fibrosis

Back 34

hypoxemia >> increased A-a gradient

Front 35

impeded arterial flow
reduced venous drainage

Back 35

ichemia
(loss of blood flow)

Front 36

decreased cardiac output
hypoxemia
anemia
cyanide poisoning
CO poisoning

Back 36

Hypoxia
(decreased O2 delivery to tissue)

Front 37

high altitude ( _____ A-a)
hypoventilation ( _______ A-a)
V/Q mismatch ( ___ A-a)
diffusion limitation ( ____ A-a)
Right-to-left shunt ( _____ A-a)

Back 37

Hypoxemia
(decreased PaO2)

nl
nl
increased
increased
increased

(<95-100 mmHg)

Front 38

pulmonary embolism is an example of...

Back 38

dead space

Front 39

apex of lung: wasted _____

base of lung: waster _______

Back 39

apex: ventilation

base: perfusion

both ventilation and perfusion are greater at the base of the lung than at the apex of the lung

Front 40

V/Q >> 0 = ?

Back 40

airway obstruction
(shunt)

100% O2 does not improve PO2

Front 41

V/Q >> infinity = ?

Back 41

blood flow obstruction
(physiologic dead space)

assuming <100% dead space, 100% O2 improves PO2

Front 42

in lungs, oxygenation of Hb promotes dissociation of H+ from Hb

this shifts equilibrium toward CO2 formation; therefore, CO2 is released from RBCs

Back 42

Haldene effect

Front 43

in peripheral tissue, increased H+ from tissue metabolism shifts curve to right, unloading O2

Back 43

Bohr effect

Front 44

CO is transported from tissues in 3 forms:

Back 44

1. bicarbonate
2. carbaminohemoglobin
3. dissolved CO2

Front 45

response to high altitude

Back 45

1.acute increase in ventilation
2.chronic increase in ventilation
3.increased erythropoietin >> increased Hct + Hb (chronic hypoxia)
4. increased 2,3-DPG
5. increased mitochondria
6. increased renal excretion of bicarbonate to compensate for the respiratory alkalosis
7. chronic hypoxic pulmonary vasoconstriction >> RVH

Front 46

response to exercise

Back 46

1. increased CO2 production
2. increased O2 consumption
3. increased ventilation rate to meet O2 demand
4. V/Q ratio from apex to base becomes more uniform
5. increased pulmonary blood flow d/t increased cardiac output
6. decreased pH during strenuous exercise (secondary to lactic acidosis)
7. No change in PaO2 and PaCO2, but increase in venous CO2 content

Front 47

test of choice for imaging PE

Back 47

CT angiography

Front 48

dorsiflexion of foot >> tender calf muscle

Back 48

Homans' sign

Front 49

wheezing, crackles, cyanosis, late-onset dyspnea; productive cough > 3mo

Back 49

chronic bronchitis "blue bloater"

Front 50

hypertrophy of mucus-secreting glands in the bronchioles

Reid index = ?

Back 50

gland depth/total thickness of bronchial wall

in COPD, > 50%

Front 51

increased elastase activity
increased compliance due to loss of elastic fibers

dyspnea, decreased breath sounds, tachycardia, late-onset hypoxemia, early-onset dyspnea

Back 51

Emphysema

"pink puffer"

Front 52

exhale through pursed lips, barrel-shaped chest

Back 52

emphysema

Front 53

associated with bullae >> can rupture >> spontaneous pneumothorax

often in young, healthy males

Back 53

paraseptal emphysema

Front 54

bronchial hyperresponsiveness >> reversible bronchoconstrction

smooth muscle hypertrophy and Curschmann's spirals (shed epithelium from mucous plugs)

Back 54

Asthma

Front 55

eosinophils' major basic protein >> bronchial epithelial damage

increased Th2 cells

Back 55

Asthma

Front 56

chronic necrotizing infection of bronchi >> permanently dilated airways

purulent sputum, recurrent infections, hemoptysis

Back 56

Bronchiectasis

associated with CF, poor ciliary motility, Kartagener's syndrome, aspergillosis

Front 57

interstitial lung diseases:

Back 57

ARDS
neonatal respiratory distress syndrome/hyaline membrane disease
pneumoconioses
sarcoidosis (increased ACE and Ca2+)
IPF
Goodpasture's syndrome
Wegener's granulomatosis
Eosinophilic granuloma (histiocytosis X)
Drug toxicity (bleomycin, busulfan, amiodarone)

Front 58

affects upper lobes
can result in cor pulmonale
dust-laden macrophages
Caplan's syndrome

Back 58

Coal miner's pneumoconioses

Front 59

foundries, sandblasing, mines

affects upper lobes/apices
"eggshell caclification of hilar LNs
birefringent silica particles surrounded by fibrous tissues

Back 59

Silicosis

silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB

Front 60

shipbuilding, roofing, plumbing

lower lobes

"ivory white" calcified pleural plaques

increased incidence of bronchogenic carcinoma and mesothelioma

Back 60

Asbestosis

Front 61

golden-brown fusiform rods (dumbbell-like) inside macrophages

Back 61

Asbestos bodies

Front 62

Berylliosis + hypersensitivity pneumonias >> ?

Back 62

noncaseating granulomas

Front 63

in NRDS, persistently low O2 tension >> risk of PDA

therapeutic supplemental O2 can >> ?

Back 63

retinopathy of prematurity
(increased VEGF > neovascularization with blindness and retinal detachment)

Front 64

diffuse alveolar damage >> increased alveolar capillary permeability >> protein-rich leakage into alveoli >> formation of intra-alveolar hyaline membrane

Back 64

Acute respiratory distress syndrome (ARDS)

d/o trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, or amniotic fluid embolism

Front 65

in ARDS, the initial damage due to _______ substances toxic to alveolar wall, activation of coagulation cascade, or oxygen-derived free radicals

Back 65

neutrophilic

lungs are red, heavy, boggy

increased amylase and lipase

Front 66

FEV1/FVC = < 80%

Back 66

obstructive lung disease

Front 67

FEV1/FVC = >80%; decreased TLC

Back 67

restrictive lung disease

Front 68

no respiratory effort during sleep

Back 68

central sleep apnea

hypoxia >> increased EPO release >> increased erythrocytosis

Front 69

sleep apnea treatment?

Back 69

weight loss, CPAP, surgery

Front 70

absent/decreased breath sounds over affected area

decreased resonance, fremitus

tracheal deviation toward side of lesion

Back 70

Bronchial obstruction

Front 71

decreased breath sounds over area

dullness, decreased fremitus

Back 71

pleual effusion

Front 72

bronchial breath sounds over lesion

dullness

increased fremitus

Back 72

pneumonia (lobar)

Front 73

decreased breath sounds

hyperresonant

no fremitus

trachial deviation away from side of lesion

Back 73

tension pneumothorax

Front 74

coin lesion with popcorn calcification,

made of fat, cartilage, smooth mm, clefts

50-60 yo

Back 74

hamartoma = pulmonary chondroma

Front 75

metastases to lung is common, from breast, ___, prostate, and _____ cancer

Back 75

colon, bladder

sites of metastases -- adrenals, brain (epilepsy), bone (pathologic fracture)
liver (jaundice, hepatomegaly)

Front 76

Superior vena cava syndrome
Pancoast's tumor
Horner's syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (hoarseness)
Effusions (pleural or pericardial)

Back 76

SPHERE of complications with lung cancer

Front 77

PTHrP; keratin pearls and IC bridges

hilar mass, cavitation, smoking

Back 77

Squamous cell carcinoma

(central)

Front 78

most common lung cancer in nonsmokers and females

Back 78

Adenocarcinoma -- bronchial (peripheral)

Front 79

grows along airways, present like pneumonia

can >> hypertrophic osteoarethropathy
tall, columnar cells w/o invasion

Back 79

Bronchioloalveolar adenocarcinoma (peripheral)

+ bronchial type = clara cells >> type II pneumocytes; multiple densities on CXR

Front 80

small dark blue cells

stain with enolase, chromogranin, synaptophsyin

ectopic production of ACTH or ADH

can lead to Lambert-Eaton syndrome

Back 80

Small cell (oat cell) carcinoma
(central)

inoperable; chemotherapy is best

Front 81

pleomorphic giant cells with leukocyte fragments in cytoplasm; poor prognosis

Back 81

Large cell carcinoma
(peripheral)

no chemo; use surgery

Front 82

flushing, diarrhea, wheezing, salivation

fibrous deposits in right heart valves >> tricuspid insufficiency, pulmonary stenosis, right heart failure

Back 82

carcinoid tumor

Front 83

psammoma bodies

long, slender microvilli with abundant tonofilaments >> hemorrhagic pleural effusions, pleural thickening

EM = gold standard

Back 83

mesothelioma

(pleural)

Front 84

occurs in apex/superior sulcus of lungs

rib destruction; atrophy of hand mm, shoulder pain

ptosis, miosis, anhidrosis

Back 84

Pancoast's tumor

with Horner's syndrome d/t affected cervical sympathetic plexus

Front 85

intra-alveolar exudate >> consolidation; entire lung

Lobar

Back 85

Pneumoccocus, Klebsiella

Front 86

acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution

treatment?

Back 86

Bronchopneumonia

S. aureus, H. flu, Klebsiella, S. pyogenes

tx: ceftriaxone

Front 87

diffuse patchy inflammation localized to interstitial areas at alveolar walls

Back 87

Interstitial (atypical) pneumonia

Viruses: RSV, adenoviruses

Mycoplasma, Legionella, Chlamydia

Front 88

stages of lobar pneumonia:

1. congestion (___)
2. red hepatization (___)
3. ____ hepatization (4-6 d)
4. resolution

Back 88

1. 24 hr (red, heavy, boggy)
2. 2-3 d (red, firm; liver-like)
3. gray

Front 89

decreased protein content

due to (3): ???

Back 89

transudate

CHF
nephrotic syndrome
hepatic cirrhosis

Front 90

increased protein content, cloudy

due to: ???

Back 90

exudate

malignancy
pneumonia
collagen vascular disease
trauma

Front 91

milky fluid; increased triglycerides

Back 91

lymphatic pleural effusion

Front 92

diphenydramine, dimenhydrinate, chlorpheniramine

Back 92

reversible inhibition of H1 histamine receptors

Front 93

loratadine, fexofenadine, desloratadine, cetirizine

Back 93

2nd generation H1 histamine blockers

decreased CNS entry -- less sedative

Front 94

isoproterenol

Back 94

nonspecific beta-agonist; relaxes bronchial smooth muscle (b2)

tachycardia

Front 95

albuterol, salmeterol

Back 95

b2-agonists

salmeterol -- longer-acting; tremor, arhythmia

Front 96

inhibits phosphodiesterase, decreases cAMP hydrolysis

blocks adenosine actions

Back 96

theophylline
(methylxanthine)

cardiotoxicity, neurotoxicity

Front 97

competitive block of muscarinic receptors; prevents bronchoconstriction

also used for COPD

Back 97

Ipratropium

Front 98

prevents release of mediators from mast cells

Back 98

cromolyn

Front 99

inhibit synthesis of almost all cytokines

inactivate NF-Kb (TNF-a)

1st line for chronic asthma

Back 99

beclomethasone, prednisone, fluticasone

(corticosteroids)

Front 100

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

Back 100

Zileuton

Front 101

block leukotriene receptors

good for aspirin-induced asthma

Back 101

Zafirlukast, montelukast

Front 102

theophylline's MOA is directly opposite of ________

Back 102

b-agonists
(no cAMP v. cAMP)

Front 103

removes excess sputum, does not suppress cough reflex

Back 103

guaifenesin

Front 104

can loosen mucous plugs in CF by cleaving disulfide bonds within mucus glycoproteins

Back 104

N-acytlcysteine

also an antidote for acetaminophen overdose

Front 105

competitively antagonizes endothelin-1 receptors, decreasing pulmonary vascular resistance

Back 105

Bosentan

for pulmonary hypertension

Front 106

<800 mg/da is okay in asthma/COPD PTs

Back 106

cardioselective B1 blockers

acebutolol
atenolol
esmolol
metoprolol
betaxolol