Respiratory

Front 1

pt exhibits an extended epiratory phase. What is the dz process?

Back 1

obstructive lung dz

Front 2

tall, thin male teenagesr has abrupt-onset dyspnea and left sided chet pain. There is hyperresonant percussion on the affected side, and breath sounds are diminished. What is the dx?

Back 2

spontaneous pneumothorax

Front 3

young wife is concerned about his wifes inability to conceive and her recurrent URIs. She has dextrocardia. Which of her proteins is defective?

Back 3

dynein (Kartagener's)

Front 4

pseudocolumnar ciliated cells extend to _______ bronchioles

Back 4

respiratory

Front 5

goblet cells extend only to the ________ bronchioles

Back 5

terminal

Front 6

this type pneumocytes line the alveoli (97% of the aveolar surfaces)

Back 6

type I cells

Front 7

this type pneumocytes secrete pulmonary surfactant (dipalmitoyl phosphatidylcholine), which decrease the alveolar surface tension.

Back 7

type II cells

Front 8

These cells also serve as precursors to type I cells and other type II cells. They proliferated during lung damage

Back 8

type II cells

Front 9

mucus secretions are swept out of the lungs toward the mouth by these cells

Back 9

ciliated cells

Front 10

a lecithin-to-sphingomyelin ratio of this in amniotic fluid is indicative of fetal lung maturity

Back 10

>2.0

Front 11

image p. 409- gas exchange barrier

Back 11

--

Front 12

each bronchopulmonary segment has a tertiary (segmental) bronchus and 2 of these in the center; veins and lymphatics drain along the borders

Back 12

arteries (bronchial and pulmonary

mneu:arteries run with airways

Front 13

the right lung has this many lobes

Back 13

3

Front 14

the left lung has this many lobes

Back 14

2

Front 15

what is the homologue of the right middle lobe

Back 15

lingula

Front 16

which is the more common site foir inhaled foreign body owing to the less acute angle of the main stem bronchus

Back 16

right lung

Front 17

The relation of the pulmonary artery to the bronchus at each lung hilus is described as this

Back 17

RALS--
Right Anterior, Left superior

Front 18

image lung rlations p. 410

Back 18

--

Front 19

Stuctures perforating diaphram:
IVC
Esophagus, vagus (2 trunks)
aorta (red), thoracic duct (white), azygous vein (blue

Back 19

T8
T10
T12

Front 20

what is the diaphram innervatd by

Back 20

phrenic nerve (C3,4,5)

Front 21

pain from the diaphram can be referred here

Back 21

shoulder

Front 22

what are the mm of respiration in quiet breathing

Back 22

inspiration-diaphram
expiration-passive

Front 23

what are the mm of respiration in exercise

Back 23

expiration-external intercostals, scalene muscles, sternomastoids

inspiration-rectus abdominis, internal and external obliques, transversus abdominis, internal intercostals

Front 24

in high altitude respiration will ____

Back 24

increasie

Front 25

in high altitude erythropoietin will ____

Back 25

increase leading to increase in HCT & HGB

Front 26

in high altitude 2,3-DPG will ______

Back 26

increase

DPG binds to HGB so that HGB releases more O2

Front 27

in high altitude this cellular changes occurs _____

Back 27

increase in mitochondria

Front 28

in high altitude there is an increased renal excretion of this

Back 28

bicarbinate
(compinsatig for respiratory alkalosis)

Front 29

in high altitude chronic hypoxic pulmonary vasoconstriction will result in this cardiac change

Back 29

RVH

Front 30

this is produced by type II pneumocytes, it decreases alveolar surface tension, and inceases compliance

Back 30

surfactant

Front 31

surfactant or dipalmitoyl phosphatidylcholine (lecithin) is deficient in this neonatal syndrome which occurs often in premies

Back 31

neonatal RDS

Front 32

give 4 other important lung products

Back 32

prostaglandins
histamine
Angiotensin converting enzyme (ACE)
kallikrein

Front 33

how do ACE inhibitors cause cough

Back 33

increase bradykinin which causes cough and causes angioedema

Front 34

Kallikrein activates what?

Back 34

bradykinin

Front 35

what is the collapsing pressure of alveola

Back 35

2 (tension)/radius

Front 36

this describes the air in lung after maximal expiration

Back 36

residual volume (RV)

Front 37

this describes air that can still be breathed out after normal expiration

Back 37

expiratory reserve volume (ERV

Front 38

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

Back 38

tidal volume (TV)

Front 39

this describes air in excess of tidal volume that moves into lung on maximal inspiration

Back 39

Inspiratory reserve volume (IRV

Front 40

vital capacity (VC)=

Back 40

TV+IRV+ERV

Front 41

Functional reserve capacity (FRC)=

Back 41

RV+ERV
(volume in lungs after normal expiration)

Front 42

Inspiratory capacity (IC)=

Back 42

IRV + TV

Front 43

Total lung capacty(TLC)=

Back 43

IRV+TV+ERV+RV

Front 44

vital capacity is everything but this

Back 44

residual volume

Front 45

image p. 411- lung volumes

Back 45

--

Front 46

image p. 412- Oxygen-HGB dissociation curve

Back 46

--

Front 47

when a curve shifts to this direction there is a decreased affinity of hgb for O2 (facilitates unloading of O2 to the tissue)

Back 47

right

Front 48

an increase in all factors (except pH) causes a shift of the curve to the ______

Back 48

right

Front 49

an decrease in all factors (except pH) causes a shift of the curve to the ______

Back 49

left

Front 50

right shift --CADET face RIGHT - stands for

Back 50

CO2
Acid/Altitude
DPG (2,3-DPG)
Exercise
Temperature

Front 51

pulmonary circulation is normally a _____ resistance, ____ compliance system

Back 51

low
high

Front 52

PO2 & PCO2 exert opposite effects on pulmonary and systemic circulation. A decrease in PaO2 causes this

Back 52

hypoxic vasoconstriction that shifts blood away from the poorly ventilated regions of the lung to well ventilated regions of the lung

Front 53

what is a consequence of pulmonary hypertension

Back 53

cor pulmonale and subsequent right ventricular failure

Front 54

what is a physical exam finding of cor pulmonale and subsequent right ventricular failure

Back 54

jugular venous distension, edema, hepatomegaly

Front 55

Is this perfusion limited or diffusion limited?
O2 (normal health), CO2, N2O. Gas equilibrates early along the lenght of the capillary. Diffusion can be increased only if blood flow increases.

Back 55

perfusion limited

Front 56

Is this perfusion limited or diffusion limited?
O2 (exercise, emphysema, fibrosis), CO. Gas does not equilibrate by the time blood reaches the end of the capillary

Back 56

diffusion limited

Front 57

image p. 412 pulmonary circulation

Back 57

--

Front 58

Determination of physiologic dead space (VD)=

Back 58

VT x [(PaCO2-PeCO2)/PaCO2

PaCO2=arterial PCO2,
PeCO2=expired air PCO2

Front 59

image p. 413-V/Q mismatch

Back 59

--

Front 60

ideally, ventilation is matched to perfusion in order to achieve adequate gas exchange. V/Q=

Back 60

1

Front 61

Both ventilatio and perfusion are greater at this part of the lung.

Back 61

base of the lung

Front 62

at the apex of the lung V/Q=

Back 62

3 (wasted ventilation)

Front 63

at the base of the lung V/Q=

Back 63

0.6 (wasted perfusion

Front 64

during this, there is an increase in cardiac output and therefore a vasodilation of apical capillaries resulting in a V/Q ratio that approaches 1

Back 64

exercise

Front 65

certain organisms thrive in high O2 and flurish at the apex of the lung. Give an example of such an organism

Back 65

TB

Front 66

when V/Q =0 this is happening

Back 66

there is an airway obstruction(shunt)

Front 67

when V/Q =infinity

this is happening

Back 67

there is a blood flow obstruction (physiologic dead space

Front 68

CO2 is transported from the tissue to the lungs in 3 forms. What are they

Back 68

1) Bicarbinate (90%)
2) bound to hgb as carbinohemoglobin (5%)
3) dissolved CO2 (5%)

Front 69

what is the haldane effect?

Back 69

in lungs, oxygenation of hemoglobin promotes dissociation of CO2 from hgb

Front 70

what is the bohr effect

Back 70

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

Front 71

image CO2 transport p. 413

Back 71

--

Front 72

alveolar-arterial O2 difference=

Back 72

[(A-a)Do2]<10 mmHg

Front 73

this dz results from an obstruction of air flow, resulting in air trapping in the lungs

Back 73

COPD

Front 74

what will PFTs show with COPD

Back 74

decreased FEV1/FVC ratio

Front 75

this type of COPD manifests with a productive cough for >3consecutive months in 2 or more years. There is a hypertrophy of mucus-secreting glands in the bronchiles (Reid index >50%)

Back 75

chronic bronchitis ("Blue Bloater")

Front 76

what PE findings might you find with chronic bronchitis

Back 76

wheezing, crackles, cyanosis

Front 77

what is the leading cause of chronic bronchitis

Back 77

smoking

Front 78

this type of COPD manifests with enlargement of air spaces and decreased recoil resulting from destruciton of alveolar walls.

Back 78

emphysema ("pink puffer")

Front 79

smoking causes this type of emphysema

Back 79

centriacinar emphysema

Front 80

alpha 1 antitrypsin deficiency causes this type of deficiency

Back 80

panacinar

Front 81

alpha 1 antitrypsin deficiency also causes this

Back 81

liver cirrhosis

Front 82

in emphysema there is increased activity of this enzyme

Back 82

elastase

Front 83

what are some PE findings in emphysema

Back 83

dyspnea, decreased breath sounds, tachycarida, decreased inspiration/expiration ratio

Front 84

this form of COPD is caused by bronchial hyperresponsiveness that causes reversible bronchostrinction.

Back 84

asthma

Front 85

name some triggers for asthma

Back 85

viral URIs, allergins, and stress

Front 86

give some findings in asthma

Back 86

cough, wheezing, dyspnea, tachypnea, hypoxemia, decrease I/E ratio, pusus paradoxus, Curschmann's spirals, smooth muscle hypertrophy, mucous plugging

Front 87

this form of COPD is caused by chronic necrotizing infection of bronchi resulting in dilated airways purulent sputum, recurrent infections, hemoptysis. Associated with bronchial obstruction, CF, poor ciliary motility, and Kartagener's syndrome

Back 87

Bronchiectasis

Front 88

in this dz, restricted lung expansion causes decreased lung volumes (decreased VC and TLC)

Back 88

restrictive lung dz

Front 89

what will PFTs show with restrictive lung dz

Back 89

FEV1/FVC ratio > 80%

Front 90

give 2 types of restrictive lung dz that result from poor breathing mechanics (extrapulmonary)

Back 90

1) poor muscular effort - polio, myasthenia gravis
2) poor structural apparatus --scoliosis, morbid obesity

Front 91

give 4 types of restrictive lung dz that result from interstitial lung diseases (pulmonary)

Back 91

1)adult respiratory distress syndrome (ARDS)
2)neonatal rspiratory distress syndrome (hyaline membrane dz)
3) pneumoconioses (coal miner's silicosis, asbestosis)
4) sarcoidosis
5) idiopathic pulmonary fibrosis
6) Goodpasture's syndrome
7) Wegener's granulomatosis
8) eosinophilic granulomas

Front 92

describe the physical exam findings of bronchial obstruction
BS:
Resonance:
Fremitus:
Tracheal Deviation:

Back 92

BS: absent/decreased over affected area
Resonance:↓
Fremitus:↓
Tracheal Deviation: toward side of lesion

Front 93

describe the physical exam findings of pleural effusion BS:
Resonance:
Fremitus:
Tracheal Deviation:

Back 93

BS: ↓ over effusion
Resonance:dullness
Fremitus:↓
Tracheal Deviation: NA

Front 94

describe the physical exam findings of pneumonia
BS:
Resonance:
Fremitus:
Tracheal Deviation:

Back 94

BS: may have bronchial BS over the lesion
Resonance: dullness
Fremitus: ↑
Tracheal Deviation: NA

Front 95

describe the physical exam findings of pneumothorax
BS:
Resonance:
Fremitus:
Tracheal Deviation:

Back 95

BS:↓
Resonance: hyperresinant
Fremitus: absent
Tracheal Deviation: away from side of lesion

Front 96

image p. 415-obstructive vs. restrictive dz

Back 96

--

Front 97

obstructive lung volumes are ____ normal

Back 97

> (↑TLC,↑FRC,↑RV)

Front 98

restrictive lung volumes are ___ normal

Front 99

in both obstructive and restrictive lung dz, these are reduced

Back 99

FEV1 & FVC

Front 100

in obstructive or restrictive lung dz is FEV1 more dramatically reduced resulting in a decreased FEV1/FVC ratio

Back 100

obstructive lung dz

Front 101

this syndrome causes immotile cilia due to a dynein arm defect. It results in male and female infertility (sperm immobile), bronchiectasis, and recurrent sinusitis (bacteria and particles not pushed out); associated with situs inversus

Back 101

Kartagener's syndrome

Front 102

this is caused by diffuse pulmonary interstitial fibrosis caused by inhaled asbestos fibers

Back 102

asbestosis

Front 103

asbestosis increase the risk of these 2 malignancie

Back 103

mesothelioma and bronchogenic carcinoma

Front 104

asbestosis and smoking greatly increases the risk of this malignancy

Back 104

bronchiogenic cancer (smoking is not additive with mesothelioma)

Front 105

ivory-white pleural plaques and ferruginous bodies are often seen in the lungs of people with asbestosis. What are ferruginous bodies

Back 105

asbestos fiber coated with hemosiderin

Front 106

asbestosis is often seen in these 2 professions

Back 106

shipbuilders and plumbers

Front 107

this syndrome in neonates results from a surfactant deficiency leading to increased surface tension, resulting in alveolar collapse.

Back 107

neonatal respiratory distress syndrome

Front 108

surfactant is made by these pneumocytes most abundantly after 35th week of gestation

Back 108

type II pneumocytes

Front 109

what is the lecithin-to-sphingomyelin ratio in the amniotic fluid (measure of lung maturity) in neonatal respiratory distress syndrome

Back 109

<1.5

Front 110

what is surfactant

Back 110

dipalmitoyl phosphatidylcholine

Front 111

what is the treatment for neonatal respiratory distress syndrome

Back 111

maternal streroids before birth; artificial surfactant for infant

Front 112

what is the leading cause of cancer death

Back 112

Lung CA

Front 113

these are bronchogenic carcinomas that arise CENTRALLY

Back 113

squamous cell carcinoma
small cell carcinoma

mneu: Small Squamous Center

Front 114

these 2 forms of lung cancer have a clear link to smoking

Back 114

squamous cell carcinoma
small cell carcinoma

mneu: S & S from Smoking

Front 115

squamous cell carcinoma sometimes produces this peptide

Back 115

PTH-related peptide

Front 116

small cell carcinoma sometimes produces these hormones

Back 116

ADH, ACTH

Front 117

small cell carcinoma sometimes produces this syndrome

Back 117

Lambert-Eaton syndrome

Front 118

this lung cancer often presents with cough, hemoptysis, bronchial obstruction, wheezingg, pneumonic "coin" lesion on x-ray

Back 118

small cell carcinoma

Front 119

what are the bronchogenic carcinomas that arise peripherally

Back 119

1) adenocarcinoma (most common)
2)bronchioalveolar carcinoma
3) large cell carcinoma

Front 120

is bronchioalveolar carcinoma thought to be related to smoking

Back 120

No

Front 121

Lung CA can cause a SPHERE of complictions. name them

Back 121

Superior vena cava syndrome
Pancoast's tumor
Horners syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (horseness)
Effusions (pleural or paricardial)

Front 122

this type of lung tumor causes flushing, diarrhea, wheezing, and salivation

Back 122

carcinoid tumor

Front 123

symptoms such as siezure, bone fracture, jaundice or hepatomegly may be a sign that lung cancer has done this

Back 123

metastesized

Front 124

this is a carcinoma that occurs in the apex of lung and may affect cervical sympathetic plexus, causing Horner's syndrome

Back 124

pancoast's tumor

Front 125

what is horner's syndrome

Back 125

ptosis, miosis, anhidrosis

Front 126

this type of pneumonia involves intra-alveolar exudate which develops into consolidation. It may involve the entire lung.

Back 126

lobar pneumonia

Front 127

what organism is usually implicated in lobar pneumonia

Back 127

pneumococcus most frequently

Front 128

this type of pneumonia involves acute inflammatory infiltrates from bronchioles into adjacent alveoli. There is a patchy distribution involving >/=1 lobes

Back 128

bronchopneumonia

Front 129

what organism is usually implicated in bronchopneumonia

Back 129

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

Front 130

this type of pneumonia involves diffuse patchy inflammation localized to interstitial areas at alveolar walls. Distribution involves >/=1 lobes

Back 130

intertitial (atypical) pneumonia

Front 131

what organism is usually implicated in intertitial (atypical) pneumonia

Back 131

viruses (RSV, adenoviruses), mycoplasma, legionella, chlamydia

Front 132

the lipoxygenase pathway yields thses

Back 132

Leukotrienes

mne: L for lipoxygenase and leukotriene

Front 133

LTB4 is this

Back 133

neutrophil chemotactic agent

Front 134

LTC4,D4, and E4 fuction in this

Back 134

bronchoconstriction, vasoconstriction, constrictionof smooth mm, andincreased vascular permeability

Front 135

PGI2 does this

Back 135

inhibits platelet aggregation and promotes vasodilation

mneu: Platelet-Gathering Inhibitor

Front 136

image p. 417 arachidonic acid products

Back 136

--