Step 1 Respiratory

Front 1

Why does the exp rate increase in restrictive lung disease?

Back 1

There is increased radial traction (fibrosis)

Front 2

In chich do you see dyspnea first chonic bronch or emphy?

Back 2

Ephysema - destroy SA of gas exchange but the v/q is relatively preserved due to concurent cap bed destruction so the ABGs are relatively normal

Front 3

In which due you get early cyanosis

Back 3

Bronchitis bc you have damaged gas exchange but undamaged caps so you have a big v/q mismatch --> polycythemia

Front 4

What is in the conducting zone of?

Back 4

Nose --> term bronchs have smooth muscle in the walls, epi is pseudo strat columnar until it resp bronchs where it loses cilliation and becomes cuboidal.

Front 5

Where is cartilage present?

Back 5

Trachea and bronchi,

Front 6

Where is the respiratory zone

Back 6

resp bronchs, alv ducts, and alveoli participates in gas exchange

Front 7

Where do goblet cells extend to

Back 7

Only to the bronchi!!

Front 8

what is the function of clara cells

Back 8

Non cililated columnar cell with secretory granules. Secrete a component of surfactant, degrade toxins, act as a reserve cell...the also secrete a protein that inbibits PMS as well as PMN mucin production

Front 9

How is surfact released

Back 9

Ca dependent fusion with the mem

Front 10

what is the clearance mech of particles 2 microns or larger? and of particles smaller than 2 microns?

Back 10

1- mucociliary
2- alveolar macros

Front 11

What makes elastase

Back 11

Alv macros

Front 12

What things make up a bronchopulmonary segment

Back 12

Each segment has a tertiary segment bronchus and 2 arteries (pulm art and a bronchial art) in the center, and veins a lymphatics drain along the border

Front 13

How does the pulm artery pressure differ throughout the cardiac cycle?

Back 13

it doesnt, elastic walls maintain pull pressure at a relatively constant level throughout the cardiac cycle

Front 14

What bronch segments provide the greates resistance

Back 14

The medium >2mm airways provide greates while the smaller airways have the least

Front 15

What level does the esophagus go through the dia and what goes wit hit

Back 15

Vagus, T10

Front 16

What level does the IVC go through the dia and what goes wit hit

Back 16

T8, nothing

Front 17

What level does the aorta go through the dia and what goes wit hit

Back 17

T12, azygous, and thoracic duct

Front 18

What are the muscles of insp during exercise

Back 18

Scalene SCM, external intercostals and the normal diaphragm

Front 19

What are the expiration muscles

Back 19

Rectus abdominis, internal and ext obliques, transversus abdominis

Front 20

What controls resp rate

Back 20

1 - central control is in the medulla, has a rhythmic cycling patter of insp and exp
2 - central chemo - in the 4th vent responds to acidity from co2 (co2 crosses BBB)
3- Peripheral chemo - carotid and aortic bodies - sensitive to O2 and CO2

Front 21

Does surfactant inc or dec compliance?

Back 21

Increases it

Front 22

What is the equation for the collapsing pressure

Back 22

P = 2(surface tension)/radius

Front 23

What is the inspiratory capacity

Back 23

IRV + TV

Front 24

What is the equation for alveolar dead space

Back 24

Vd= Vt x (PaCO2 - PeCO2)/PaCO2

Front 25

What is the largest contributor to functional dead space

Back 25

Apex of the lung

Front 26

what is compliance

Back 26

Change in lung volume for a given change in pressure - it is decreased in pulm fibrosis, insufficient surfactant and pulm edema

Front 27

Which Hb form has a low affinity for O2

Back 27

Taut

Front 28

Which has a high affinity

Back 28

Relaxed

Front 29

What things favor the taut Hb form

Back 29

inc Cl, H, CO2, 2,3 BPG, and T....this leads to inc unloading

Front 30

What does Fetal Hb have very little of

Back 30

BPG

Front 31

What do you use after nitrates to treat CN poisoning

Back 31

Thiosulfate..it binds CN forming thiocynaate which is renally excreted

Front 32

What things are diffusion limited

Back 32

O2 (in emphysema and fibrosis), CO, gas cannot equilibrate by the time it reaches the end of the capillary

Front 33

What is normal pulm art pressure

Back 33

10-14,

Front 34

what is the p in pulm htn

Back 34

>/= 25 or >35 with exercise

Front 35

What does pulm HTN result in

Back 35

atherosclerosis, medial hypertrophy and intimal fibrosis of the pulm arteries

Front 36

What is the gene assoc with primary pulm htn

Back 36

BMPR2 - normally inhibits vasc smooth muscle prolif

Front 37

what are some cause of 2 pulm HTN

Back 37

COPD, mitral stenosis (inc R, inc P), recurrent thromboemboli, AI dz (sys sclerosis inflamm) L--> R shunt, sleep apnea, or living at high altitude (hypoxia causes vasocon)

Front 38

WHat is the equation for Pulm vasc resistance

Back 38

PVR = Ppulm art - PLa/CO

Front 39

How do you calc O2 content

Back 39

(O2 binding capacity (1.34) x %sat) + dissolved 02

Front 40

What is the alveolar gas equation

Back 40

PAO2= PIO2 - PaaCO2/R
= 15- - PaCO2/.8

Front 41

What causes increased A-a gradients

Back 41

R--> L Shunting, v/q mismatch, fibrosis

Front 42

What cuases Hypoxemia with a normal A-a

Back 42

High altitude, hypoventilation

Front 43

what is the difference between hypoxemia and hypoxia

Back 43

Hypoxemia - dec paO2
Hypoxia - dec O2 delivery to the tissues

Front 44

What are some causes of hypoxia

Back 44

dec CO
Hypoxemia
Anemia
Cn poisoning
CO poisoning

Front 45

How does the V/Q ratio in the apices of the lungs change with exercise

Back 45

with exercise there is vasocil of the apical caps results in a v/q ratio that approaches 1

Front 46

When does v/q = O, what happens when ppl w/ shunts are put on 100% O2

Back 46

When there is a shunt
Shunt = perfusion but not vent like if the alveoli fill with liquid,
100% O2 --> no change

Front 47

At what rib level is the spleen

Back 47

L 9-11

Front 48

At what rib level is the liver

Back 48

R 8-12

Front 49

At what rib level is the Kidney

Back 49

L 12th rib could go retroperitoneal and hurt the kidney

Front 50

What changes occur in response to high altitude

Back 50

1 - acute inc in ventilation
Chonic inc in ventilation
Inc epo
Inc 2,3 BPG
Cellular changes (inc mitochondria)
Inc renal excretion of bicarb (can augment by use of acetazolamideto compensate for the resp alkalosis)
Chronic hypoxic pulm vasc resis results in RVH

Front 51

What happens to the ABG during exercise

Back 51

No change in PaO2, PaCo2 but inc in venous CO2

Front 52

What embolus can lead to DIC

Back 52

Amniotic fluid

Front 53

What is virchows triad for DVTs

Back 53

Stasis, Hypercoag, endothelial damage

Front 54

What is homans sign

Back 54

dorsiflexion of the foot --> tender calf muscle....DVT!!

Front 55

What are the signs of a PE

Back 55

Resp alkalosis, pleuritic chest pain, friction rub, Inc A-a gradient,

Front 56

What are the signs of obstructive lung disease

Back 56

Obstruction of air flow leads to air trapping in the longs, Airways close prematurely at high lung volumes resulting in ^RV, Dec FVC.
PFTs: Dec FEV1/FVC ratio, V/Q mismatch

Front 57

What is the path of chronic bronch

Back 57

Hypertrophy of the mucus secreting glands in the bronchioles
Reid indez glad depth/total thickness >.5
Productive cough >3 consec months, disease of small airways

Front 58

What are the exam findings in Chronic bronchitis

Back 58

Wheezing, crackles, cyanosis, early onset, (due to shunting)late onset dyspnea

Front 59

What is the path of ephysema

Back 59

Enlargement of the air spaces and dec recoil resulting from destruction of alv walls, dec compliance

Front 60

What are the s/sx of emphysema

Back 60

Pursed lips breathing, dyspnea, dec breath sounds, tachy, late onset hypoxemia due to eventual loss of capilary beds

Front 61

What are the three types of emphysema and their associations

Back 61

1 - centriacinar - smoking (uperlobes just the Rbs_
2- Panacinar - A1AT codominant, lower lobes
3 - Paraseptal - assoc with bullae --> can rupture --> spontaneous pneumothorax (often tall health guys)

Front 62

What is the patho of asthma

Back 62

Hyper responsiveness of the bornchi causes reversible broncho con smooth muscle hypertrophy, cruschmanns spirals (shed epi from muc plugs), and charcot leden crystals

Front 63

what can trigger asthma

Back 63

Viral URI, allergens and stress

Front 64

What are the findings in asthma

Back 64

cough, wheezing, dyspnrea, tachypnea, hypoxemia, dec I/E ratio (longer expiration), pulsus paradoxicus (>10 mmhg bp dec difference on insp), mucus plugging

Front 65

How do NSAIDs cause Asthma

Back 65

Block cox --> leukotrienes inc

Front 66

What is the patho behind bronchiectasis

Back 66

Chronic necrotizing infection of the bronchi --> permanently dilated airways, purulent sputum, recurent infection, HEMOPTYSIS

Front 67

What is bronchiectasis assoc with

Back 67

CF, kartageners, can develop aspergilosis

Front 68

What are the signs of restrictive lung dz

Back 68

Restricted lung expansion causes a dec in lung volumes (dec fvc and TLC),
PFTs - FEV1/FVC ratio >80%

Front 69

What are extrapulmonary causes of Restrictive lung disease

Back 69

Poor musc effort - MG, polio, als
Poor structural apparatus - scoliosis, ank spondy, morbid obesity

Front 70

List some causes of restrictive lung dz

Back 70

ARDS, neonatal rds, pneumoconioses (asbestosis, CWP, silicosis), sarciod, Idiot pathic fibrosis (cycles of injury and healing --> inc collagen) Good pastures, wegners, Eosinophilic granulomatosis (histiocytosis X), drug tox (bleo, busulfan, amiodarone)

Front 71

What pneumoconioses affect the upper lobes

Back 71

silicosis and CWP

Front 72

Where do you see eggshell calcification of the hilar LNs

Back 72

Silicosis

Front 73

what is the path of silicosis

Back 73

Though to disrupt phagolysosome and impair macros, inc succept to TB

Front 74

What do you see in asbestosi

Back 74

Ivory white calcified pleural plaques assoc with an inc incidence of bronchogenic carcinoma

Front 75

The low O2 tension in neonatal RDS puts them at inc risk for what

Back 75

PDA

Front 76

What two things can result from early O2 therapy

Back 76

Bronchopulm dysplasia, retinopathy (due to inc VEGF when you return to room air that causes neovascularization) of prematurity

Front 77

What are the RFs for neonatal RDS?

Back 77

Premat, diabetic mom (inc insulin dec surfactant), cesarean delivery (dec release of feal GCCs)

Front 78

What are some causes of ARDS

Back 78

Trauma, sepsis, shock, gastric aspiration, uremia, acute panc, or amniotic fluid embolysim

Front 79

what is the patho of ARDS

Back 79

diffuse alveolar damage --> inc alv capillary perm --> protein rich leakage into alveoli, results in formatino of intral alveolar hyaline membrane. The initial damage is due to neutrophilic substances that are toxic to the alveolar wall, activation of the clotting cascade or oxy derived free rads
**Refractory to O2 therapy, NORMAL capillary wedge pressure
CO2 can get out put O2 cannot get in

Front 80

What is the criteria for sleep apnea

Back 80

Pt stops breathing for at least 10s repeatedly during sleep

Front 81

What is the diff between central and obstructive sleep apnea

Back 81

Central - no resp effort, Obst resp effort against an obstructed airway

Can lead to pulm HTN and arrhytmias, and polycythemia

Front 82

What are the signs and causes of superior vena cava syndrome

Back 82

Cant drain...get conjunctival ?, dyspnea, cough, edema, HA, prominent superficial veins, cyanosis, veins of the upper limb fail to empty when limb is raised.
Causes: bronchogenic carcinoma, NHL

Front 83

What are some of the complics of Lung Ca

Back 83

SPHERE
Superioir vena cava synd
Pancoasts tumor
Horners syndrome
Endocrine (paraneoplastic)
Recurrently laryngeal sx (hoarse)
Effusions (Pleural or pericardial)

Front 84

What are some of the sx of lung ca

Back 84

Cough, hemoptysis, bronch obstruction, weezing, pneumonic 'coin lesions' on xray, or non calcified nodule on CT. Mets to lung is the most common often from breast colon prostate and bladder.

Front 85

What are common sites of mets from the lungs

Back 85

adrenals, brain (see epilipsey), bone, liver

Front 86

Where is SCC located, what hormone assoc

Back 86

Hilar mass, central, see PTHrP release, keratin pearls

Front 87

What lung cancer is not linked to smoking

Back 87

Bronchioalveolar

Front 88

Where is adenocarcinoma found

Back 88

Peripheral, Presents like pneumonia can result in hypertropic osteoarthropathy, see clara --> type II pneumocytes multiple densityes. Mucin production

Front 89

SCC

Back 89

Central, highly malig, ACTH, ADH, lambert eaten, inoperable. See neuroendocrine kulchitsky cells (dark blue)

Front 90

Large cell carc

Back 90

Hihgly anaplastic undiff tumor, poor prog, Pleiomorphic giant cells with leuko fragments in cyto.

Front 91

Carcinoid tumor

Back 91

early onset <40, serotonin causes fibrous depositis in R heart valves can lead to tricuspid insufficiency, pulm stenosis, and RHF

Front 92

What histo do you see in mesothelioma

Back 92

Psammoma body, can get hemorrhagic pleural effusions

Front 93

Bronchopneumonia

Back 93

Multiple small foci in the lungs, air bronchograms caused by S, aureus, klebs H flu, S pyogenes alveoli fill up patchy distribution with >1 lobe

Front 94

What can lead to an abscess

Back 94

Obstruction or aspiration of oropharyngeal contents often due to S. aureus or anaerobes

Front 95

What can cause a transudative pleural effusion

Back 95

CHF, nephrotic, hepatic cirrhosis

Front 96

what does a lymphatic pleural effusion have

Back 96

Inc TGs