Step 1 First Aid: Respiratory

Front 1

2 functional parts of respiratory tree

Back 1

conducting zone
respiratory zone

Front 2

conducting zone is ___
respiratory zone does ___

Back 2

dead space
gas exchange

Front 3

3 parts of respiratory zone

Back 3

respiratory bronchioles
alveolar ducts
alveoli

Front 4

___ cells comprise 97% of alveolar surface
they are ___ (shape)
the remainder is ___ cells

Back 4

type I pneumocyte
thin
type II pneumocyte

Front 5

type II pneumocytes do ___ (2)
they are ___ (shape) and have ___

Back 5

surfactant secretion
differentiate to type I cells
cuboidal
lamellar bodies

Front 6

___ is an index of fetal lung maturity

Back 6

lecithin:sphingomyelin ratio

Front 7

lecithin:sphingomyelin ratio of ___ indicates mature lungs

Back 7

>2

Front 8

bronchopulmonary segment has ___ (3) in center and ___ (2) peripherally

Back 8

3' (segmental) bronchus
bronchial a.
pulmonary a.
veins
lymphatics

Front 9

R lung has ___ lobes
L lung has ___ lobes

Back 9

3
2 + lingula

Front 10

lobe missing on L

Back 10

middle

Front 11

a peanut aspirated while standing lands in ___

Back 11

lower R inferior lobe

Front 12

a peanut aspirated while supine lands in ___

Back 12

upper R inferior lobe

Front 13

pulmonary a. is ___ with respect to R main bronchus,
and ___ with respect to L main bronchus

Back 13

anterior
superior

Front 14

inferior pleural border at midclavicular line

Back 14

7th rib

Front 15

inferior pleural border at midaxillary line

Back 15

10th rib

Front 16

inferior pleural border at paravertebral line

Back 16

12th rib

Front 17

for paracentesis, puncture ___ with respect to inferior pleural border

Back 17

up to 2 ribs above

Front 18

3 diaphragmatic hiatuses from superior to inferior

Back 18

IVC
esophageal
aortic

Front 19

superior hiatus is ___
inferior hiatus is ___

Back 19

anterior
posterior
(the 3 structures pierce the diaphragm on its posterior aspect,
so more posterior = lower)

Front 20

IVC hiatus is at level ___

Back 20

T8

Front 21

esophageal hiatus is at level ___

Back 21

T10

Front 22

aortic hiatus is at level ___

Back 22

T12

Front 23

___ (2) go through the esophageal hiatus

Back 23

esophagus
vagus

Front 24

___ (3) go through the aortic hiatus

Back 24

aorta
thoracic duct
azygos vein

Front 25

muscles driving inspiration at rest
muscles driving expiration at rest

Back 25

diaphragm
none

Front 26

3 muscles driving inspiration during exercise

Back 26

external intercostal
scalene
SCM

Front 27

5 muscles driving expiration during exercise

Back 27

internal intercostal
rectus abdominis
internal oblique
external oblique
transversus abdominis

Front 28

laplace's law

Back 28

P = 2T/R

where P=collapsing pressure
T=wall tension
R=radius

Front 29

4 basic lung volumes

Back 29

RV (residual)
ERV (expiratory reserve)
V_T (tidal)
IRV (inspiratory reserve)

Front 30

FRC is sum of ___
it is ___

Back 30

RV
ERV
volume of air in lungs after normal expirium

Front 31

IC is sum of ___
it is ___

Back 31

V_T
IRV
total volume which could be inspired after normal expirium

Front 32

VC is sum of ___
it is ___

Back 32

ERV
V_T
IRV
total volume which can be inspired after maximal expirium

Front 33

TLC is sum of ___
it is ___

Back 33

VC
RV
total voluime of air which can be contained in lungs

Front 34

physiologic dead space in terms of V_T

Back 34

V_D = V_T x (P_aCO2 - P_eCO2)/P_aCO2
where P_aCO2 = aterial P_CO2
P_eCO2 = expired P_CO2

Front 35

figure showing compliance plots of chest well and lungs gives ___
this is located at ___

Back 35

FRC
y value for which sum of lungs and chest wall pressures equals 0

Front 36

2 Hb conformations

Back 36

T (taut)
R (relaxed)

Front 37

Hb in T conformation has high/low O2 affinity
this is favored by low/high body temp

Back 37

low
high

Front 38

4 chemicals which increase probability of T conformation

Back 38

Cl-
H+
CO2
2,3-BPG

Front 39

fetal Hb has high O2 affinity because ___

Back 39

it has low 2,3-BPG affinity

Front 40

met-Hb has low affnity for ___ but
high affinity for ___

Back 40

O2
CN-

Front 41

met-Hb is desirable in setting of ___
it is generated by ___ing

Back 41

CN- poisoning
giving nitrites

Front 42

CN-met-Hb complex is bound by ___
this is cleared by ___

Back 42

thiosulfate
kidneys

Front 43

CO poisoning does ___ (2) to Hb

Back 43

left shift O2 binding curve (less unloading)
down-shift O2 binding curve (lower affinity)

Front 44

3 gases with perfusion limited pulmonary exchange

Back 44

O2 (normally)
CO2
N2O

Front 45

2 gases with diffusion limited pulmonary exchange

Back 45

O2 (pathological)
CO

Front 46

diffusion (V_gas) in terms of surface area

Back 46

V_gas = A/T x D_k(P_1 - P_2)

where A=surface area,
T = interface thickness

Front 47

2 situations in which O2 exchange is diffusion limited

Back 47

emphysema
fibrosis

Front 48

diffusion disruption in emphysema

Back 48

low A

Front 49

diffusion disruption in fibrosis

Back 49

high T

Front 50

normal pulmonary a. pressure
pulm HTN is ___ at rest or ___ during exercise

Back 50

10--14
>25
>35

Front 51

gene linked to 1' pulmonary HTN

Back 51

BMPR2

Front 52

BMPR2 does ___

Back 52

inhibits vascular smooth muscle proliferation

Front 53

3 cardiovascular causes of pulmonary HTN
3 pulmonary causes of pulmonary HTN
1 systemic cause of pulmonary HTN

Back 53

mitral stenosis
recurrent emboli
L -> R shunt
OSA
COPD
high altitude living
collagen vascular disease

Front 54

COPD causes pulmonary HTN via ___

Back 54

parenchymal destruction

Front 55

OSA casues pulmonary HTN via ___

Back 55

hypoxic vasoconstriction

Front 56

CVD causes pulmonary HTN via ___ which causes ___

Back 56

intimal fibrosis
medial hypertrophy

Front 57

ohm's law expression for pulmonary vascular resistance (PVR)

Back 57

PVR = (P_PA - P_LA)/CO

where P_PA = pulmonary a. pressure
P_LA = L atrial pressure

Front 58

2 parts of blood O2 content

Back 58

Hb bound
dissolved

Front 59

Hb-bound O2 is determined by ___ (2)

Back 59

binding capacity
% saturation

Front 60

normal binding capacity is determined by ___ (2)

Back 60

Hb binding capacity (constant)
Hb quantity

Front 61

Hb O2 binding capacity

Back 61

1.34 mL/g

Front 62

normal Hb quantity in blood

Back 62

15 g/dL

Front 63

in anemia,
O2 content does ___
Hb does ___
arterial PO2 does ___
O2 sat does ___

Back 63

falls
falls
stays same
stays same

Front 64

alveolar gas equation

Back 64

P_AO2 = P_IO2 - P_ACO2/R

where P_AO2 is alveolar P_O2
P_IO2 is inspired P_O2
P_ACO2 is alveolar P_CO2
R is ratio of CO2 produced per O2 consumed (.8)

Front 65

normal approximation for alveolar gas equation

Back 65

P_AO2 = 150 - P_ACO2/0.8

Front 66

normal A-a gradient

Back 66

10--15 mm Hg

Front 67

3 kinds of oxygen deprivation problems

Back 67

hypoxemia
hypoxia
ischemia

Front 68

hypoxemia means ___
hypoxia means ___
ischemia means ___

Back 68

low P_aO2
low O2 delivery to tissues
low blood flow to tissues

Front 69

2 kinds of causes of hypoxemia

Back 69

high A-a gradient
normal A-a gradient

Front 70

3 causes of hypoxemia with high A-a gradient

Back 70

V/Q mismatch
Diffusion limitation
R-L shunt
(VDRL)

Front 71

2 causes of hypoxemia with normal A-a gradient

Back 71

high altitude
hypoventilation

Front 72

5 causes of hypoxia

Back 72

hypoxemia
ischemia
anemia
CO poisoning
CN poisoning

Front 73

V/Q ratio at apex of lung
V/Q ratio at base of lung

Back 73

3
0.6

Front 74

V/Q -> 0 means ___ is present
100% O2 does/doesn't help

Back 74

airway obstruction (shunt)
doesn't

Front 75

V/Q -> infinity means ___ is present
100% O2 does/doesn't help

Back 75

perfusion defect present
does

Front 76

3 ways CO2 is transported in blood

Back 76

as HCO3-
bound to Hb
dissolved CO2

Front 77

HCO3- accounts for ___% of CO2 in blood

Back 77

90

Front 78

CO2 binds to ___ of Hb
___% of CO2 in blood is Hb bound

Back 78

N terminus
5

Front 79

in lungs ___ does ___ to H+ affinity for Hb
this causes the rxn ___
which causes the rxn ___
the overall effect is ___

Back 79

high O2
lowers
H+ + bicarb -> H2CO3
H2CO3 -> CO2 + H2O (CA)
high O2 in lungs causes CO2 unloading

Front 80

in tissue, ___ does ___ to O2 affinity for Hb
the overall effect is ___

Back 80

high H+
lowers
high H+ causes O2 unloading at tissues

Front 81

in exercise,
___ happens to V/Q ratio
___ happens to P_aO2
___ happens to P_aCO2
___ happens to venous P_CO2

Back 81

becomes more uniform
no change
no change
increase

Front 82

2 causes of fat emboli

Back 82

long bone fx
liposuction

Front 83

amniotic fluid embolism causes ___

Back 83

DIC

Front 84

2 diseases comprising COPD

Back 84

emphysema
bronchitis

Front 85

classical emphysema patient is a ___
with ___

Back 85

pink puffer
barrell chest

Front 86

___ is increased in emphysema
to prevent ___, pts exhale ___ly

Back 86

lung compliance
airway collapse
through pursed lips

Front 87

2 kinds of emphysema

Back 87

centriacinar
panacinar

Front 88

centriacinar emphysema is characteristic of ___

Back 88

smokers

Front 89

panacinar emphysema is characteristic of ___ (2)

Back 89

a1 antitrypsin deficiency
cirrhosis

Front 90

hyperactive enzyme in emphysema

Back 90

elastase

Front 91

classical patient in chronic bronchitis

Back 91

blue bloater

Front 92

histopath derangement in chronic bronchitis

Back 92

reid index > 0.5

Front 93

reid index measures ratio of ___ to ___

Back 93

mucosal thickness
total bronchial wall thickness

Front 94

chronic bronchitis definition

Back 94

productive cough for > 3 m for >= 2 y

Front 95

chronic bronchitis is a disease of large/small airways

Back 95

small

Front 96

2 histopath findings in asthma

Back 96

Charcot-Leyden crystals
Curschmann's spirals

Front 97

Charcot-Leyden crystals mean ___ is present
Curschmann's spirals are ___

Back 97

eosinophilia
shed epithelium

Front 98

in obstructive disease,
FEV1 is ___
FVC is ___
and FEV1/FVC is ___
(normal FEV1/FVC is ___)

Back 98

very low
low
low
80%

Front 99

in restrictive disease,
FEV1 is ___
FVC is ___
FEV1/FVC is ___

Back 99

low
low
>80%

Front 100

test for asthma

Back 100

methacholine challenge

Front 101

in methacholine challenge test, drop of ___ in ___ is diagnostic

Back 101

20%
FEV1

Front 102

eosinophils have ___ nucleus

Back 102

bilobed

Front 103

size of particles which reach terminal airways
these particles can cause ___

Back 103

1-5 uM
pneumoconioses

Front 104

coal miner's pneumoconiosis causes ___ (2)

Back 104

cor pulmonale
Caplan's syndrome

Front 105

Caplan's syndrome has ___ (2)

Back 105

pneumoconiosis
RA

Front 106

immune problem in silicosis
this may increase suscpeptibility for ___

Back 106

defective MQs
TB

Front 107

CXR finding in silicosis

Back 107

hilar eggshell calcification

Front 108

histopath finding in silicosis

Back 108

birefringent particles surrounded by fibrosis

Front 109

CXR finding in asbestosis

Back 109

normally NO hilar adenopathy

Front 110

2 CXR findings in beryliosis

Back 110

irregular opacities
hilar adenopathy possible

Front 111

histopath finding in beryliosis

Back 111

noncaseating granuloma

Front 112

CXR finding in organic dust pneumonitis

Back 112

diffuse nodular infiltrates

Front 113

CXR finding in lung abscess

Back 113

AF level

Front 114

3 causes of lung abscess

Back 114

aspiration
bacterial pneumonia
septicemia

Front 115

lecithin-sphingomyelin ratio commonly falls below ___ in NRDS

Back 115

1.5

Front 116

low P_aO2 in NRDS can cause ___,
but giving supplemental O2 can cause ___

Back 116

PDA
retinopathy of prematurity

Front 117

3 RFs for NRDS

Back 117

prematurity
maternal DM
caesarian section

Front 118

NRDS prophylaxis

Back 118

materal CS

Front 119

NRDS tx (2)

Back 119

artificial surfactant
T4

Front 120

3 triggers for ARDS

Back 120

neutrophilic toxins
activation of coagulation cascade
ROS

Front 121

3 physical exam parameters for lung problems
___ (2) vary together

Back 121

breath sounds
fremitus
percussion resonance
breath sounds
fremitus

Front 122

consolidation as in ___ has ___ breath sounds and fremitus,
and ___ percussion resonance

Back 122

pneumonia
louder
reduced

Front 123

pleural effusion has ___ breath sounds and fremitus,
and ___ percussion resonance
another pathology with these findings is ___

Back 123

reduced
dull
tumor

Front 124

atelectasis has ___ breath sounds and fremitus,
and ___ percussion resonance
another finding is ___

Back 124

reduced
dull
tracheal deviation towards lesion

Front 125

emphysema has ___ breath sounds and fremitus,
and ___ percussion resonance
another pathology with these findings is ___

Back 125

reduced
increased
bronchiectasis

Front 126

tension pneumothorax has ___ breath sounds and fremitus,
and ___ percussion resonance
another finding is ___

Back 126

reduced
increased (hyperresonant)
tracheal deviation away from lesion

Front 127

lung cancer is the ___th cause of cancer death

Back 127

1

Front 128

mets from lung ca commonly go to ___ (4)

Back 128

adrenals
brain
bone
liver

Front 129

2 centrally located lung cancers

Back 129

SCC
SCLC

Front 130

histopath finding in lung SCC

Back 130

keratin pearls

Front 131

electrolyte disturbance associated with lung SCC

Back 131

hypercalcemia

Front 132

SCLC is derived from ___ cells
these are located at ___

Back 132

neuroendocrine Kulchitsky
basal layer of bronchial epithelium

Front 133

4 markers for SCLC cells

Back 133

S100
neuron specific enolase
synaptophysin
chromogranin

Front 134

tx for SCLC (2)

Back 134

chemo
rads

Front 135

3 conditions associated with SCLC

Back 135

ectopic ADH
ectopic ACTH
Lambert-Eaton

Front 136

2 peripherally located lung cancers

Back 136

adenoca
large cell

Front 137

2 kinds of adenoca

Back 137

bronchial
bronchoalveolar

Front 138

bronchoalveolar ca develops from ___ cells

Back 138

type II pneumocytes

Front 139

malignant bronchoalveolar ca cells don't ___

Back 139

invade stroma

Front 140

lung adenoca usually happens at ___

Back 140

site of previous inflammation or injury

Front 141

lung adenoca is the most common ____ (2)

Back 141

NSCLC
lung cancer in non-smokers

Front 142

adenoca appears as single/multiple density on CXR

Back 142

multiple

Front 143

skeletal abnormality in adenoca

Back 143

clubbing

Front 144

large cell lung ca has ___ histology
tx is ___
prognosis is ___

Back 144

anaplastic
surgery
poor

Front 145

2 endocrine problems in large cell lung ca

Back 145

gynecomastia
galactorrhea

Front 146

mesothelioma is the ___th most common cancer associated with asbestos

Back 146

2
(bronchogenic lung ca is #1)

Front 147

2 pneumonia types associated with bacterial pneumonia

Back 147

lobar
bronchopneumonia

Front 148

lobar pneumonia is mostly caused by ___ (2)

Back 148

S. pneumoniae
Klebsiella

Front 149

bronchopneumonia is caused by ___ (4)

Back 149

S. pyogenes
H. influenzae
Klebsiella
SA
(SHiKSA)

Front 150

2 kinds of H1 blockers

Back 150

first generation
2nd generation

Front 151

2nd generation H1 blockers end in ___ or are called ___
they have less ___ (2) SEs because of ___

Back 151

adine
cetirizine
antimuscarinic
sedating
lower CNS penetration

Front 152

2 beta_2 agonists for asthma

Back 152

albuterol
salmetrol

Front 153

albuterol is used for ___
salmetrol is used for ___

Back 153

acute attacks
chronic managment

Front 154

___s are nonselective PDEIs used in asthma
___ is the main example
use is limited because of ___ (2)

Back 154

methylxanthine
theophylline
cardiotoxicity
neurotoxicity

Front 155

theophylline is metabolized by ___

Back 155

CYP

Front 156

3 cardiovascular SEs of theophylline

Back 156

inotropism
chronotropism
pressor

Front 157

3 kinds of complaints in theophylline toxicity

Back 157

GI
arrhythmia
seizure

Front 158

3 GI complaints in theophylline toxicity

Back 158

abdominal pain
diarrhea
vomiting

Front 159

theophylline toxicity tx

Back 159

beta blocker

Front 160

theophylline causes bronchodilation by ___ing (2)

Back 160

potentiating cAMP dilator effect (PDEI)
blocking constrictor effect of adenosine

Front 161

2 phases of asthma attack

Back 161

bronchoconstriction (early)
inflammation (late)

Front 162

3 drugs families which work on early asthma phase

Back 162

beta agonists
antimuscarinics
theophylline

Front 163

1 drug family which works on late asthma phase

Back 163

CS

Front 164

LTs do ___ (2) in asthma

Back 164

bronchoconstriction
chemotaxis

Front 165

___ LTs aka ___ do bronchoconstriction

Back 165

cysteinyl
LTC4/D4/E4

Front 166

___ LTs do chemotaxis

Back 166

LTB4

Front 167

___ is a drug which inhibits LT synthesis by inhibiting ___

Back 167

zileuton
5-lipoxygenase

Front 168

2 drugs which block LT receptor
they are particularly good for ___

Back 168

zafirlukast
motelukast
aspirin-induced asthma

Front 169

what type of cell lines respiratory tree?

Back 169

pseudostratified ciliated columnar cells (to respiratory bronchioles)

Front 170

what type of cells line alveoli?

Back 170

type I pneumocytes (97% of surface area); squamous

Front 171

stem cells of pneumocytes?

Back 171

type II pneumocytes

Front 172

chemical name of surfactant?

Back 172

dipalmitoyl phosphatidylcholine

Front 173

nonciliated columnar cells that degrade toxins in alvioli?

Back 173

Clara cells

Front 174

five compounds secreted by lung?

Back 174

Surfactant, prostaglandins, histamine, angiotensis-converting enzyme, kallikrein (activates bradykinen)

Front 175

what causes cyanosis?

Back 175

more than 5 g/dL of deoxygenated Hb

Front 176

where is V/Q normally >1?

Back 176

at apex of lungs (wasted ventilation)

Front 177

where is V/Q normally <1?

Back 177

at base of lungs (wasted perfusion)

Front 178

why is reactivation TB typically found in apices of lungs?

Back 178

thrives in high O2 found at apex (due to V/Q > 1)

Front 179

imaging test of choice for PE?

Back 179

CT angiography

Front 180

Virchow's triad?

Back 180

1. Stasis, hypercoagubility, endothelial damage

Front 181

Homan's sign?

Back 181

pain in calf with dorsiflexion of foot (sign of DVT)

Front 182

what type of emphysema causes spontaneous pneumothorax in young, healthy males?

Back 182

paraseptal emphysema (associated with bullae)

Front 183

what meds cause restrictive long disease?

Back 183

bleomycin, busulfan, amiodarone

Front 184

ivory white calcified pleural plaques?

Back 184

asbestosis

Front 185

golden-brown dumbbell shaped rods inside macrophages in lungs?

Back 185

asbestos bodies

Front 186

at what point in gestation is surfactant produced?

Back 186

mostly after 35th week

Front 187

what are risk factors for neonatal respiratory distress syndrome?

Back 187

prematurity, maternal diabetes, cesarean delivery

Front 188

mechanism of ARDS?

Back 188

diffuse alveolar damage causes increased capillary permeability and protein-rich leakage into alveoli. Results in formation of intra-laveolar hyaline membrane

Front 189

"coin" lesion on chest x-ray?

Back 189

lung cancer

Front 190

where in lung does squamous cell carcinoma occur?

Back 190

central (hilar mass)

Front 191

in what type of lung cancer do Clara cells differentiate into type II pneumocytes?

Back 191

adenocarcinoma

Front 192

Lambert-Eaton syndrome?

Back 192

autoantibodies against neuromuscular junction calcium channels produced by lung small cell carcinoma; results in decreased ACh being released

Front 193

lung cancer with Psammoma bodies in histology?

Back 193

mesothelioma

Front 194

types of lung cancer most likely causing Pancoast's tumor?

Back 194

squamous cell or small cell carcinomas (peripherally located)

Front 195

most common causes of interstitial (atypical) pneumonias?

Back 195

Viruses (RSV, adenoviruses), Mycoplasma, Legionella, Chlamydia

Front 196

Most common organisms causing lung abscesses?

Back 196

S. aureus, anaerobes

Front 197

mechanism of infertility associated with cystic fibrosis?

Back 197

congenital absence of vas deferens

Front 198

what happens to TLC in COPD?

Back 198

increased due to lung hyperinflation

Front 199

vitamin abnormality seen in sarcoidosis?

Back 199

elevated vitamin D due to increased conversion from inactive form by macrophage