Respiratory

Front 1

name all the segments of the conducting zone

Back 1

nose, pharynx, trachea, bronchi, bronchioles, and terminal bronchioles

Front 2

where is cartilage present in the lungs?

Back 2

only on the trachea and bronchi

Front 3

What makes up the respiratory zone?

Back 3

consists of respiratory bronchioles, alveolar ducts, and alveoli

Front 4

what is the lower extent of goblet cells?

Back 4

terminal bronchioles

Front 5

name the type of respiratory epithelium.

Back 5

Pseudostratified Ciliated columnar cells (extend to repiratory bronchioles)

Front 6

make up 97% of the alveolar surface. Squamos, thin

Back 6

Type I Pneumocytes

Front 7

Secrete pulmonary surfactant, which decrease the alveolar surface tension

Back 7

type II pneumocytes

Front 8

What makes up surfactant?

Back 8

dipalmitoyl phosphatidylcholine

need Glycine? and Choline + DAG

Front 9

Precusor to type I Pneumocytes

Back 9

type II Pneumocytes

Front 10

nonciliated columnar cells with secretory granules that secrete component of surfactant, degrade toxins

Back 10

Clara Cells

Front 11

what indicates fetal lung maturity by amniocentesis?

Back 11

lecithin: sphingomyelin rate >2.0

Front 12

what is the method for surfactant secretion?

Back 12

constitutive secretion

Front 13

composition of bronchopulmonary segments

Back 13

each one has a tertiary and a segmental bronchus and 2 arteries (bronchial and pulmonary) in the center

Front 14

Right lung has how many lobes?

Back 14

3

Front 15

left lobe composition:

Back 15

2 lobes and Lingula (homologue of right middle lobe)

Front 16

Why is it that aspirated objects go to right lobe?

Back 16

right main stem broncus is wider and more vertical than the left

Front 17

aspirate a peanut. where does it go if you are upright?

Back 17

lower portion of right inferior lobe

Front 18

aspirate a peanut. where does it go if you are supine?

Back 18

superior portion of right inferior lobe

Front 19

relationship of pulmonary artery to the bronchus at each lung hilus

Back 19

RALS

Right anterior,
Left superior

Front 20

level of the horizontal fissure?

Back 20

4thrib

Front 21

what is the level of the horizontal fissre?

Back 21

4th rib

Front 22

what is the level of the oblique fissures and what does it separate?

Back 22

T2

seperates the superior and inferior lobes on both sides

Front 23

level of IVC

Back 23

T8

Front 24

Level of Esophagus

Back 24

T10 (also carries with it 2 vagus trunks)

Front 25

Level that aorta, thoracic duct, and azygous vein pierce the diaphrgam.

Back 25

T12

Front 26

where can diaphragmatic pain be referred to?

Back 26

the shoulder

Front 27

name the muscles of inspiration on exercise.

Back 27

external intercostals, scalene mscles, sternomastoids

Front 28

name the muscles of expiration on exercise.

Back 28

rectus abdominus, internal and external obliques, transversus abdominus, and internal intercostals

Front 29

what does surfactant do?

Back 29

decrease alveolar surface tension, increaes compliance, and decrease work of inspiration

Front 30

What does ACE do in the lung?

Back 30

ACE converts ANG I to ANG II; this inactivates bradykinin

bradykinin in lung --> cough, angioedema

Front 31

what does kallikrein do?

Back 31

activates bradykinin

Front 32

What cannot be measured by spirometry?

Back 32

residual volume and total lung capacity

Front 33

what is a normal tidal volume?

Back 33

500 ml

Front 34

what is the vital capacity equal to?

Back 34

TV + IRV + ERV

Front 35

what is the functional residual capacity equal to?

Back 35

ERV + RV

the amount of air in lungs after a normal expiration

Front 36

normal ratio of FEV1 / FVC:

Back 36

80%

Front 37

vital capacity is everything but the ?

Back 37

residual volume

Front 38

formula to determine physiological dead space

Back 38

Vd = Vt x (PaCO2 - PeCO2) / PaCO2

Front 39

what is the largest contributor to functional dead space?

Back 39

apex of the lung

Front 40

Taut form of Hb, low or high affinity for 02?

Back 40

Low

Front 41

Hemoglobin exhibits what kind of allostery and cooperativity? +/-

Back 41

- allostery
+ cooperativity

Front 42

name some things that cause a right shift in the Hb dissociation curve.

Back 42

increase Cl-, H+, CO2, 2,3- BPG, and increase in temperature favor T form over R form

Front 43

How is CO2 transported in the blood?

Back 43

as Bicarb

Front 44

CO2 (primarily as carbamate) binds to what?

Back 44

AA in globin chain at the N terminus; not to heme

Front 45

What form of hemoglobin does CO2 prefer to bind to?

Back 45

the taut form

Front 46

what does Fe3+ have an increase affinity for?

Back 46

CN-

Front 47

what do you give to treat methemoglobinemia?

Back 47

methylene blue

Front 48

Iron in Hb is normally in what state?

Back 48

Fe2+

Front 49

How do you treat cyanide poisoning?

Back 49

1. give nitrites (which converts Fe2+ --> Fe3+ to bind cyanide)
- this allows cytochrome oxidase to function
2. use thiosulfate to bind the cyanide, which makes thiocyanate, which is RENALLY excreted

Front 50

Carboxyhemoglobin

Back 50

form of Hb bound to CO in place of O2.

causes decrease O2 binding capacity and a left shift in the dissociation curve (decrease O2 unloading in the tissues)

Front 51

why does the Hb dissociation curve have a sigmoidal shape?

Back 51

positive cooperativity

Front 52

which way is fetal Hb shifted on the curve?

Back 52

shifted to the left

Front 53

what pathway synthesizes 2,3 -DPG?

Back 53

Leubering - Rappaport Pathway

Front 54

What does 2,3- DPG do?

Back 54

binds to the Beta chains of Jb and decreases the affinity of Hb for O2

2,3 -DPG increased in adaptation to chronic hypoxemia

Front 55

what is the pressure on the alveoli?

Back 55

P = 2T / R (T= surface tension, R=radius)

Front 56

in what weeks is pumonary surfactant made in utero?

Back 56

weeks 24-35

Front 57

A low PA02 in the lung causes what to vessels?

Back 57

hypoxic vasoconstriction (shift blood away from poorly ventillated areas)

Front 58

Perfusion limited gases:

Back 58

O2 (normally), CO2, N2O,

gas equilibrate early along the length of the capillary

Diffusion can be increased only if blood flow is increased

Front 59

Diffusion Limited

Back 59

O2 in emphysema and fibrosis
CO

Front 60

in what instances is O2 diffusion limited in the lung?

Back 60

emphysema, fibrosis, extreme exercise

Front 61

normal pulmonary arterial pressure = ?

Back 61

10-14 mm Hg

Front 62

What is defined as pulmonary hypertension?

Back 62

>25 mmHg during rest or >35 mmHg during exercise

causes atherosclerosis, medial hypertrophy, and intimal fibrosis of pulm. arteries

Front 63

causes of primary pulmonary hypertension.

Back 63

inactivating mutation in the BMPR2 gene (normally functions to inhibit vascular smooth muscle proliferation); poor prognosis

Front 64

Secondary causes of pulmonary hypertension

Back 64

1. COPD (destroyed lung parenchyma)
2. mitral stenosis (increase resistance --> increase pressure)
3. recurrent thromboemboli (decreases cross-sectional area of pulmonary vascular bed)
4. autoimmune disease (systemic sclerosis, inflammation --> fibrosis)
5. L to right shunt
6. sleep apnea / living at high altitude

Front 65

what is a physical exam finding in pulmonary hypertension?

Back 65

increase sound of P2

Front 66

what can a decrease in NO and an increase in endothelin cause to the pulmonary vaculature?

Back 66

causes endothelial cell dysfx leading to pulmonary hypertension

Front 67

what does chronic hypoxemia / chronic respiratory acidosis due to pulmonary arteries?

Back 67

causes smooth muscle hyperplasia and hypertrophy

Front 68

Formula for Pulmonary vascular resistance =

Back 68

[P (pulm. artery) - P (l. atrium) ] / cardiac output

Front 69

What does Pressure equal to?

Back 69

pressure = flow (Q) x Resistance (R)

Front 70

how does resistance and radius of a vessel relate?

Back 70

Pressure is inversely related to the r^4

Front 71

O2 content of blood = ?

Back 71

(O2 binding capacity x % saturation) + dissolved O2

Front 72

How much O2 can 1 g Hb bind?

Back 72

1.34 mL O2

Front 73

What happens to the following when Hb Falls?

O2 content?
O2 saturation?
arterial PO2?

Back 73

O2 content decreases
O2 saturation stays the same
PO2 stays the same

Front 74

What decreases P02?

Back 74

chronic lung disease because physiologic shunts decrease O2 extraction.

Front 75

know the formula to calculate the A-a gradient

Back 75

PA02 = 150 - PACO2/0.8
PaO2 = given

Front 76

O2 delivery to tissue = ?

Back 76

Cardiac ouput x O2 content of blood

Front 77

Name three things that cause an increaed A-a gradient

Back 77

V\Q mismatch
Diffusion limitation
Right to left shunt (tetrology of fallot)

Front 78

what is the V/Q at the lung apex, middle, and base?

Back 78

Apex = 3
middle = 1
base = 0.6

Front 79

where is ventilation the greatest in the lung?

Back 79

at the base

Front 80

where is perfusion the greatest in the lung?

Back 80

at the base

Front 81

what is the greatest pressure at the apex; alveolar, arterial, or venous?

Back 81

Alveolar > arterial > venous

Front 82

what is the greatest pressure in the middle of the lung?

Back 82

P arterial > alveolar > venous

Front 83

what is the greatest pressure in the base of the lung?

Back 83

arterial > venous> alveolar

Front 84

what is the physiologic site of wasted perfusion?

Back 84

V/Q = 0.6 at the BASE

Front 85

what site of the lung has high PO2 and low PCO2

Back 85

at the apex, due to increase gas exchange

Front 86

where is gas exchange the least in the lung?

Back 86

at the base (increase CO2, decrease 02) due to decrease gas exchange

Front 87

name the three forms CO2 is transported to the lung.

Back 87

1. as Bicarb
2. bound to Hb as carbaminohemoglobin
3. dissolved CO2

Front 88

What is the haldane effect?

Back 88

in lungs, oxygenated Hb promotes dissociation of H+ from Hb. This shifts equilibrium towards CO2 formation, releasing CO2 from lungs.

Front 89

name the physiologic response to high altitude

Back 89

1. increase in ventillation (acute)
2. chronic increase in vent.
3. increase in EPo (causing increase in HCT and Hb)
4. Increase 2,3 DPG (increase O2 release)
5. cellular changes (increase in MT)
6. Increase renal excretion of bicarb to compensate for respiratory alkalosis
7. chronic hypoxic pulmonary vasoconstriction --> RVH

Front 90

How can you augment the renal response to high altitude?

Back 90

acetozolamide increase bicarb excretion in cases of respiratory alkalosis (seen with chronic high altitude)

Front 91

physiologic response to exercise

Back 91

Increase CO2 production
Increase O2 consumption
increase ventillation
V/Q ratio from apex to base becomes more uniform
Increase pulmonary blood flow due to Increase CO
decrease in pH
No change in PaO2 and PaCO2
Increase in venous content of CO2

Front 92

PFT in COPD

Back 92

very decreased FEV1, decrease FVC

causes decrease *FEV1 to FVC ratio*
V/Q mismatch

Front 93

hypertrophy of mucus secreting glands in bronchioles with an increase in Reid Index

Back 93

chronic bronchitis

Front 94

Reid index = ? when is it increased?

Back 94

gland depth / total thickness ; increased in COPD chronic bronchitis

Front 95

what causes wheezing and when is it seen?

Back 95

narrowed terminal bronchioles (due to mucus plugs that trap CO2);

seen in chronic bronchitis

Front 96

emphysema "pink puffer"

Back 96

enlarged of air spaces and decrease recoil resulting from destruction of alveolar walls

Front 97

why do emphysema patients breathe out through pursed lips?

Back 97

it increases airway pressure and prevents airway collapse during exhalation.

Front 98

what type of emphysema does smoking cause?

Back 98

centriacinar

Front 99

what causes panacinar emphysema?

Back 99

alpha 1 antitrypsin deficiency (also liver cirrhosis)

Front 100

what causes paraseptal emphysema?

Back 100

associated with bullae; can rupture--> spontaneous pneumothorax

seen in young, health individuals

Front 101

emphysema findings

Back 101

increase in elastase activity
increase in lung compliance (loss of elastic fibers)
exhale through pursed lips

Front 102

dyspnea, decrease breath sounds, tachycardia, late-onset hypoxemia due to eventual loss of capillary beds (occurs with loss of alveolar walls), early onset dyspnea. Dx?

Back 102

emphysema

Front 103

bronchial hyperresponsiveness leading to reversible bronchoconstriction

Back 103

asthma

Front 104

smooth muscle hypertrophy,
Curschmann's spirals, cough, wheezing, dyspnea, tachypnea, pulsus paradoxus, mucus plugging

Back 104

all seen with asthma

Front 105

chronic necrotizing infection of bronchi

Back 105

bronchiectasis; causes permanently dilated airways, purulent sputum, recurrent infections, hemoptysis

Front 106

name some things that are associated with bronchiectasis.

Back 106

bronchial obstruction, CF, poor ciliary motility, Kartagener's syndrome

Front 107

name a fungal infection seen with bronchiectasis

bacterial= ?

Back 107

aspergillosis

pseudomonas

Front 108

name some causes of Bronchiectasis

Back 108

CF, TB, adenovirus, S. Aureus, H. Influenza, obstruction (due to CA), ciliary dyskinesia, aspergillosis

Front 109

PFT: FEV1 / FVC ratio greater tan 80%

Back 109

restrictive lung disease

Front 110

poor muscular effort, seen in polio, myasthenia gravis can cause what type of lung disease?

Back 110

restrictive lung disease

Front 111

what can scoliosis, morbid obesity, and mesothelioma do to the lungs?

Back 111

cause a restrictive lung disease

Front 112

Pneumoconioses cause what?

Back 112

restrictive lung diseases

Front 113

name some pneumoconioses.

Back 113

coal miner's
silicosis
asbestosis

Front 114

idiopathic pulmonary fibrosis

Back 114

repeated cycles of lung injury and wound healing with increase in collagen

Front 115

Goodpasture's syndrome, Wegener's granulomatosis, eosinophilic granuloma (histiocytosis X)

Back 115

all cause restrictive lung diseaes

Front 116

what are the drugs that can cause a restrictive lung disease?

Back 116

bleomycin, busulfan, amiodarone

Front 117

What are dust cells

Back 117

alveolar macs with anthracotic pigment

Front 118

What is Caplan syndrome

Back 118

CWP with large, cavitating rheumatoid nodules in lung

Front 119

what happens to the lung elasticity in restrictive lung disease?

Back 119

it increases

Front 120

surfactant deficiency leading to increased surface tension, resulting in alveolar collapse. what will be the lecithin to sphingomyelin ratio?

Back 120

the lecithin: sphingomyelin ratio will be less than 1.5 in Neonatal respiratory distress syndrome

Front 121

what vascular abnormality will be likely in a patient with respiratory distress syndrome?

Back 121

patent ductus arteriosus

Front 122

what are the risk factors of neonatal respiratory distress snydrome?

Back 122

prematurity, maternal diabetes (high insulin), cesarean delivery (decrease release of fetal glucocorticoids)

Front 123

how do you treat Neonatal respiratory distress syndrome?

Back 123

steroids prior to birth to mom

artificial surfactant to kid afterwards

Front 124

What increases surfactant (2 things)

Back 124

Cortisol, T4

decreased by insulin

Front 125

Collapsed alveoli lined by hyaline membrane due to protein leak= ?

Back 125

Neonatal respiratory distress snydrome

alveolar collapse on expiration

Front 126

Acute Respiratory Distress Syndrome causes

Back 126

Trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, amniotic fluid embolism

Front 127

Diffuse alveolar damage causes what?

Back 127

increased alveolar capillary permeability leading to protein rich leakage into alveoli = Acute Respiratory Distress Snydrome

Front 128

what causes the initial damage in ARDS?

Back 128

neutrophiic substances toxic to alveolar wall, activation of coagulation cascade, or oxygen derived free radicals

Front 129

Complications of neonatal respiratory distress syndrome

Back 129

Blindness
Permanent small airway damage
intraventricular hemorrhage
patent ductus arteriosus
Necrotizing enterocolitis

Front 130

person stops breathing for at least 10 seconds repeatedly

Back 130

sleep apnea

Front 131

pickwickian syndrome

Back 131

obese, respiratory impairment, somnolence

Front 132

complications of sleep apnea?

Back 132

polycythemia
pulmonary HTN

Front 133

diffuse pulm intersitital fibrosis caused by inhaled asbestos fibers

what are they at increased risk for?

Back 133

mesothlioma

Bronchogenic Carcinoma

Front 134

Ferruginous bodies in lung

Back 134

asbestosi

Front 135

ivory white pleural plaques

Back 135

asbestos

Front 136

what are the primary lobes that asbestos affects?

what about the other pneumoconioses

Back 136

lower lobes = asbestos

upper lobes

Front 137

who gets asbestos

Back 137

shipbuilders, roofers, plumbers

Front 138

smoking and asbestos greatly increase the risk for what?

Back 138

bronchogenic carcinoma

(effect not seen for mesothelioma)

Front 139

Bronchial obstruction:
breath sounds?
resonance?
fremitus?
tracheal deviation?

Back 139

absent / decreased over affected area
resonance decreased
fremitus decreased
toward side of lesion

Front 140

pleural effusion:
Breath sounds
resonance
fremitus

Back 140

decreased breath sounds over effusion
dullness
decreased fremitus

Front 141

Pneumonia (lobar):
Breath sounds
resonance
Fremitus

Back 141

may have bronchial breath sounds
dullness
INCREASE FREMITUS

Front 142

tension pneumo:
breath sounds
resonance?
fremitus
tracheal deviation?

Back 142

decreased
hyperresonant
fremitus absent
trachea deviates away from side of lesion

Front 143

which sinus is mostly effected in sinusitis in adults? Kids?

Back 143

adults: maxillary
kids: ethmoid

Front 144

what fungus cause sinusitis?

Back 144

mucor, aspergillus

Front 145

what type of CA is nasopharyngeal CA?

Back 145

squamos cell CA or undifferentiated CA;

mets to cervical LN

Front 146

LUNG CANCER; most commons

Back 146

adenocarcinoma
squamos cell CA
small cell
large cell
bronchial

Front 147

complications of lung cancer:

Back 147

superior vena cava syndrome
pancoast tumor (causes Horners)
Horners syndrome
Endocrine (paraneoplastic)
recurrent laryngeal symptoms (hoarseness)
Effusions (pleural or pericardial)

Front 148

Squamos cell CA:
associations:
Location:

Back 148

central lesion
smoking associate

Front 149

Hilar mass arising from bronchus. Cavitating. Linked to smoking

Causes PTHrP production

Back 149

squamos cell CA

Front 150

Adenocarcinoma
Types (2):
associations
location

Back 150

Bronchial
Bronchioalveolar

Location: Peripheral

Front 151

neoplastic proliferation of Clara Cells --> type II pneumocytes; multiple densities on chest x-ray

Back 151

AdenoCA of lung

Front 152

Develops at site of inflammation of injury

Not linked to smoking; grows along airway, can present like pneumonia

Back 152

AdenoCA

Front 153

Small cell CA
location?
associations?

Back 153

central
smoking related

Front 154

ectopic ACTH / ADH

Back 154

small cell CA

Front 155

Lambert Eaton Syndrome

Back 155

autoantibodies to Ca Channels; responsive to chemo

seen with SMALL CELL CA

Front 156

Kulchitsky cells

Back 156

small dark blue cells seen in Small CELL CA

Front 157

weakness that comes and goes in lung cancer

Back 157

Lambert Eaton Syndrome (produce antibodies to Ca channels in small cell (oat) cell CA

Front 158

Large Cell CA
Where is it?
histology?

Back 158

peripheral
pleomorphic, anaplastic cells
leukocyte fragments in cytoplasm

Front 159

Secretes seratonin --> flushing, diarrhea, wheezing, salivation

Back 159

Carcinoid tumor (not associated with smoking)

Front 160

site of lung cancer mets

Back 160

Brain (epilepsy)
Bone (fractures)
Liver (jaundice, hepatomegaly)

Front 161

CA that is in apex of lung, affects certical sympathetic plexus--> ptosis, miosis, anhidrosis (ipsilateral)

Back 161

Horner's syndrome due to a lung CA causing Pancoast Tumor

Front 162

What organism causes Lobar pneumonia?

characteristics?

Back 162

pneumococcus mostly

intra-alveolar exudate --> consolidation; may involve entire lung

Front 163

What organism causes bronchopneumonia?

Back 163

s. aureus, H. influenza, S. Pyogenes

acute inflamm. infiltrates from bronchioles into adjacent alveoli; patchy distribution involving 1 or more lobes

Front 164

What organism causes interstitial (atypical) pneumonia

Back 164

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

looks like diffuse patchy infiltrates localized to intersititial areas at alveolar walls; involves 1 or more lobe

more indolent than bronchopneumonia

Front 165

most common cause of lung asbscess?

Back 165

obstruction (CA) or aspiration of pharyngeal contents

s. aureus, anaerobes (Fusobacterium)

can send out septic emboli--> infective endocarditis

Front 166

what causes a transudative pleural effusion?

Back 166

CHF, nephrotic syndrome, hepatic cirrhosis

Front 167

what causes an exudative pleural effusion?

Back 167

malignancy, pneumonia, collagen vascular dz, trauma

needs to be drained due to increase risk of infection

cloudy fluid

Front 168

what causes a lymphatic pleural effusion?

Back 168

milky fluid

increase in triglycerides

Front 169

Dorsal Respiratory group (medullary resp. control center)

Back 169

responsible for inspiration/ rythm of breathing

Front 170

what gives input to the dorsal respiratory group?

what is its output?

Back 170

vagus n., glossopharyngeal n.

phrenic n.

Front 171

What does the ventral respiratory group do?

Back 171

expiration (it's only active during exercise)

Front 172

Aspneustic center.
where is it and what does it do?

Back 172

lower pons;

stimulates inspiration (causes deep prolonged gasp)

Front 173

Pneumotaxic center: where is it and what does it do?

Back 173

upper pons

inhibits inspiration; regulates inspiratory volume and respiratory rate

Front 174

CEntral chemoreceptors in medulla

what is it sensitive to?

Back 174

sensitive to pH of CSF

(due to CO2 crossing brain, which decreases pH)

Front 175

PEripheral chemoreceptors. what are they sensitive to?

Back 175

caroti bodies and aortic bodies

1. decrease in PaO2 (only if very sig)
2. Increase in PaCO2
3. Increase in arterial H+--> stimulation of carotid body peripheral chemoreceptor

Front 176

newborn turns cyanotic on breast feeding, relieved by crying

Back 176

Choanal Atresia; unilateral/bilateral bony septum between nose/pharynx

Front 177

Women with chronic pain, gets nasal polyps. what was she taking?

Back 177

aspirin

increases Leukotrienes C, D, E4 --> bronchoconstriction

Front 178

where are the majority of laryngeal CA located? what type of CA? associations?

Back 178

on true vocal folds
keratinizing squamos cell CA

HPV 6, 11

Front 179

What does an increase in bradykinin cause?

Back 179

Cough and angioedema

Front 180

What is Hb saturation at PO2 of:

100?
40?
25?

Back 180

100 % Hb Sat
75% Hb Sat
50% Hb Sat