Step 1 Respiratory System

Front 1

A patient exhibits an extended expiratory phase; what is the disease process?

Back 1

obstructive lung disease

Front 2

Tall, thin teenage male has abrupt-onset dyspnea, left sided chest pain, reduced breath sounds, and hyperresonace. What happened?

Back 2

Spontaneous pneumothorax

Front 3

Young women can't conceive, suffers from recurrent URI's, and has dextrocardia. What is her problem?

Back 3

Kartagener's syndrome (mutated dynein protein)

Front 4

What is the TLC of a person with these lung volumes: FRC=5, IRV=1.5, IC=2, VC =3.5

Back 4

7

Front 5

Preterm infant has increased lung density on Xray and difficulty breathing. What's wrong, and what could have prevented it?

Back 5

neonatal respiratory distress syndrome. Give mom steroids before birth to increase fetal surfactant production

Front 6

25-year old comatose dude on a ventilator dies from fever, had a pus-filled cavity in his lung. What happened?

Back 6

He aspirated infective material and it led to a lung abscess

Front 7

52-yr-old woman undergoing menopause is tired. What's the dx and has her O2 sat and O2 content changed?

Back 7

anemia due to blood loss. O2 sat is unchanged, O2 content is decreased

Front 8

Patient has hypoxia, but a normal chest X-ray. What's the cause?

Back 8

Pulmonary embolism

Front 9

What disease can a pulmonary embolism mimic?

Back 9

myocardial infarction

Front 10

Patient has hypoxia, and enlarged heart on chest X-ray. What's the cause of the hypoxia?

Back 10

CHF

Front 11

Which anatomical structures are part of the conducting zone of the respiratory tree?

Back 11

everything from the nose/mouth down to the terminal bronchioles. Only moves air, no gas exchange

Front 12

Cartilage is present only in the ________ and _________ of the respiratory tree

Back 12

trachea and bronchi

Front 13

Which anatomical structures are part of the respiratory zone of the respiratory tree?

Back 13

respiratory bronchioles, alveolar ducts, and alveoli. They all exchange gases.

Front 14

What is the lecithin/sphingomyelin ration used for?

Back 14

A value of >2 in the amniotic fluid indicates that the fetus has mature lungs

Front 15

Which cell type lines the alveolar surface, and is thin to facilitate gas exchange?

Back 15

Type 1 pneumocyte

Front 16

Which cells are cuboidal, secrete surfactant, and proliferate when the lung is damaged?

Back 16

Type II pneumocyte

Front 17

Which cells secrete components of surfactant, and also degrade toxins in the respiratory tree?

Back 17

Clara cells

Front 18

Where are the vessels in any given broncho-pulmonary segment?

Back 18

Bronchial and pulmonary arteries run with the bronchus, veins and lymphatics run along the margins

Front 19

If I inhaled a grape, which lung would it end up in and why?

Back 19

Right lung, because the right mainstem bronchus is wider and more vertical than the left one

Front 20

Where are the pulmonary arteries in relation to the mainstem bronchi at the hilum?

Back 20

Right artery is anterior to the bronchus, left artery is superior to the bronchus
(RALS)

Front 21

The fissure between the superior lobe and the middle lobe of the right lung corresponds to what other structure?

Back 21

4th rib

Front 22

At what vertebral level does the IVC penetrate the diaphragm?

Back 22

T8

Front 23

At what vertebral level does the esophagus penetrate the diaphragm?

Back 23

T10

Front 24

At what vertebral level does the aorta penetrate the diaphragm?

Back 24

T12

Front 25

Pain in the diaphragm can feel like pain from....where?

Back 25

Your shoulder

Front 26

Which muscles control breathing during quiet respiration?

Back 26

inspiration - diaphragm
expiration - passive

Front 27

Which muscles control breathing during exercise?

Back 27

inspiration - external intercostals, scalenes, sternomastoids
expiration - abdominals, internal intercostals

Front 28

What 3 things does surfactant do?

Back 28

decrease alveolar surface tension, increase lung compliance, decrease work of inspiration

Front 29

Lung volumes: tidal volume (TV)?

Back 29

air that moves into and out of lungs during a normal, quiet breath

Front 30

Lung volumes: expiratory reserve volume (ERV)?

Back 30

air that can be breathed out after a normal exhalation

Front 31

Lung volumes: Inspiratory reserve volume (IRV)?

Back 31

air in excess of tidal volume that you can breath in on maximum inspiration

Front 32

Lung volumes: Residual volume (RV)?

Back 32

air left in the lung after maximal expiration

Front 33

Lung volumes: Vital Capacity (VC)?

Back 33

TV+IRV+ERV
or, the total amount of usable lung volume

Front 34

Lung volumes: Functional Residual Capacity (FRC)?

Back 34

ERV+RV
or, total air left in the lung after a normal, quiet expiration

Front 35

Lung volumes: Inspiratory capacity (IC)?

Back 35

TV+IRV
or, total amount of air you can breath in after a normal, quiet expiration

Front 36

Lung volumes: Total Lung Capacity (TLC)?

Back 36

IRV+TV+ERV+RV
or, total amount of air that your lungs can hold

Front 37

What is the formula for determining the physiologic dead space?

Back 37

TV x (PA-PE) / PA
TV=tidal volume
PA=arterial pCO2
PE=expired air pCO2

Front 38

In plain english, what does it mean when the oxygen-hemoglobin curve is moved to the left?

Back 38

hemoglobin holds on to oxygen tighter

Front 39

What can cause the oxygen-hemoglobin curve to move to the left?

Back 39

lower temperature, lower pCO2, higher pH, lower 2,3DPG, fetal hemoglobin, resting

Front 40

What can cause the oxygen-hemoglobin curve to move to the right?

Back 40

higher temperature, higher pCO2, lower pH, higher 2,3DPG, exercising

Front 41

In plain english, what does it mean when the oxygen-hemoglobin curve moves to the right?

Back 41

Hemoglobin doesn't hold on to oxygen very tightly; O2 moves into tissues easier

Front 42

The pulmonary circulation is normally a ______-resistance, _______-compliance system

Back 42

low resistance, high compliance

Front 43

Hypoxia (decreased O2) in lung tissue leads to....what?

Back 43

local vasoconstriction, to shunt blood to other places where there is more oxygen

Front 44

What does it mean to say that O2 transport is perfusion-limited in pulmonary capillaries?

Back 44

O2 equilibriates almost instantaneously; to increase diffusion, you must increase blood flow

Front 45

What does it mean to say that in certain disease states, O2 transport is diffusion-limited in pulmonary capillaries?

Back 45

O2 does not equilibriate by the time the blood leaves the capillary due to fibrosis or scarring

Front 46

What are the 2 problems with CO poisining?

Back 46

CO left-shifts the oxyHgb curve (less tissue offloading) and has 50% more affinity to bind to HgB

Front 47

How do you treat CO poisining?

Back 47

100% oxygen

Front 48

Normal pulmonary artery pressure is.....?

Back 48

10-14 mmHg

Front 49

What are the cutoffs for pulmonary hypertension?

Back 49

at rest: >25mmHg
excercise: >35mmHG

Front 50

What causes primary pulmonary hypertension?

Back 50

Nobody knows, and it carries with it a really bad prognosis

Front 51

What causes secondary pulmonary hypertension?

Back 51

COPD, usually, but can also be caused by a L->R shunt

Front 52

How does airway resistance relate to length and radius of the vessel?

Back 52

resistance increases with increased length, decreases a lot with increased radius

Front 53

What is the equation for Pulmonary Vascular Resistance (PVR)?

Back 53

(pulmonary artery pressure - pulmonary wedge pressure) / cardiac output

Front 54

What is the O2 binding capacity in a normal person?

Back 54

20.1 mL oxygen per deciliter

Front 55

What is the equation for total oxygen content of the blood?

Back 55

(O2 binding capacity x %saturation) + dissolved O2

Front 56

What is the formula for oxygen delivery to tissues?

Back 56

cardiac output x blood oxygen content

Front 57

What is the Alveolar Gas Equation?

Back 57

pAO2=pIO2-(pACO2 / R)
pAO2=oxygen in the alveolus
pIO2=oxygen in inspired air
pACO2=CO2 in the alveolus
R=respiratory quotient

Front 58

What can you use as an easier approximation of the Alveolar Gas Equation?

Back 58

PAO2=150-(PaCO2 / 0.8)

Front 59

What is a normal Alveolar-arterial (A-a) gradient?

Back 59

10-15 mmHg

Front 60

What does it mean if the A-a gradient is elevated?

Back 60

hypoxemia due to shunting, V/Q mismatch, or fibrosis

Front 61

How do you calculate the A-a gradient?

Back 61

pAO2-paO2

Front 62

What does a very very small V/Q ratio mean?

Back 62

Shunt. Lots of perfusion, not much ventilation. 100% O2 does NOT improve pO2

Front 63

What does a very very large V/Q ratio mean?

Back 63

Dead Space. Not much perfusion, lots of ventilation. 100% O2 improves pO2

Front 64

Identify the 3 lung zones in terms the V/Q ratio

Back 64

Zone 1 -> V/Q=3, at the apex
Zone 2-> V/Q=1, in the middle
Zone 3-> V/Q=0.6, at the base

Front 65

What are the 3 ways carbon dioxide is transported from tissues?

Back 65

As bicarb (90%)
bound to Hgb (5%)
dissolved in plasma (5%)

Front 66

What are the body's responses to living at high altitude?

Back 66

increased ventilation, increased hematocrit, increased Hgb, increased 2,3DPG, increased bicarb excretion

Front 67

In general, what happens in obstructive lung disease?

Back 67

increased residual volume, decreased vital capacity. decreased FEV1, decreased FEV1/FVC ratio. V/Q mismatch.

Front 68

In plain english, what happens in obstructive lung disease?

Back 68

You breath air in, but the air can't get out. Lung compliance is high, lung elasticity is low

Front 69

What happens in Chronic Bronchitis?

Back 69

hypertrophy of mucus-secreting glands, increase in thickness of small airway walls.

Front 70

what is the timeframe for diagnosing Chronic Bronchitis?

Back 70

productive cough for longer than 3 consecutive months in more than 2 years

Front 71

What happens in emphysema?

Back 71

Destruction of alveolar walls leads to enlarged, floppy airspaces

Front 72

What are some symptoms of Chronic Bronchitis?

Back 72

wheezing, crackles, cyanosis

Front 73

What are some symptoms of emphysema?

Back 73

dyspnea, decreased breath sounds, tachycardia, pursed lips

Front 74

What causes centriacinar emphysema?

Back 74

smoking

Front 75

What causes panacinar emphysema?

Back 75

alpha1-antitrypsin deficiency

Front 76

What's special about paraseptal emphysema?

Back 76

Cause bullae (air bubbles) that can rupture and lead to pneumothorax. Happens in otherwise healthy young males

Front 77

What happens in asthma?

Back 77

bronchi constrict at the drop of a hat. Smooth muscle hypertrophy. Triggered by allergies, stress, viruses.

Front 78

What are some symptoms of asthma?

Back 78

cough, wheezing, dyspnea, tachypnea, hypoxemia, pulsus paradoxus, mucus plugs

Front 79

What happens in bronchiectasis?

Back 79

necrotizing infection that leads to permanently dilated airways.

Front 80

What are some symptoms of bronchiectasis?

Back 80

recurrent infections, purulent sputum, hemoptysis

Front 81

What other syndromes can lead to bronchiectasis?

Back 81

Cystic fibrosis, Kartagener's syndrome, poor ciliary motility

Front 82

In general, what happens in Restrictive Lung Diseases?

Back 82

Lungs can't expand. FEV1/FVC ratio is greater than 80%. reduced total lung volume

Front 83

What two general categories do restrictive lung disease fall into?

Back 83

those due to musculoskeletal problems, and those due to inherent problems with the lung

Front 84

Polio and myasthenia gravis can lead to what kind of lung disease?

Back 84

restrictive lung disease due to poor muscular support

Front 85

Scoliosis and morbid obesity can lead to what kind of lung disease?

Back 85

restrictive lung disease due to structural support issues

Front 86

Give some examples of inherent restrictive lung diseases

Back 86

ARDS, chemical inhalation, sarcoid, goodpasture's, Wegener's, pulmonary fibrosis, hyaline membrane disease

Front 87

What causes neonatal respiratory distress syndrome? (also called hyaline membrane disease, I don't know why)

Back 87

lack of surfactant. Lung alveoli collapse in on themselves

Front 88

What happens in ARDS?

Back 88

injury leads to protein leakage into alveolar space. Neutrophils cause damage, hyaline membranes form

Front 89

What is the normal value for the FEV1/FVC ratio?

Back 89

80%

Front 90

A person has focal absent breath sounds, decreased resonance and fremitus, and his trachea deviates toward the affected side. What's his problem?

Back 90

obstructed bronchus

Front 91

A person has decreased focal breath sounds, dull percussion, decreased fremitus, and no tracheal deviation. What's her problem?

Back 91

pleural effusion

Front 92

A person has normal breath sounds, dull percussion, increased fremitus, and no tracheal deviation. What's their problem?

Back 92

Lobar pneumonia

Front 93

A person has decreased breath sounds, hyperresonant percussion, absent fremitus, and the trachea deviates away from the affected side. What is the problem?

Back 93

pneumothorax

Front 94

Where does Squamous cell carcinoma occur, and what causes it?

Back 94

central tumors in the hilum. You'll see cavitations. Caused by smoking.

Front 95

Where does adenocarcinoma occur, and what kind of cells give rise to it?

Back 95

peripheral sites of prior injury, arises from both type 2 pneumocytes and clara cells. Not linked to smoking

Front 96

Where does Small Cell Carcinoma occur, and what's the pathology?

Back 96

central location, aggressive, undifferentiated. Comes from neuroendocrine cells. Treat with chemo

Front 97

Where does Large Cell Carcinoma occur, and what's the pathology?

Back 97

peripheral location, undifferentiated, poor prognosis. Treat with surgery

Front 98

What kind of tumor can secrete serotonin and cause flushing, diarrhea, wheezing, and salivation?

Back 98

Carcinoid tumor

Front 99

What cancers commonly metastatize to the lung?

Back 99

brain, bone, and liver

Front 100

What tumor occurs in the apex of the lung, and can cause Horner's syndrome?

Back 100

Pancoast's Tumor

Front 101

Which pneumonia presents with intra-alveolar exudate and consolidation on chest X-ray? What organism causes it?

Back 101

Lobar pneumonia, usually caused by pneumococcus

Front 102

Which pneumonia presents with inflammation starting in bronchioles and moving in to the alveoli in a patchy distribution?

Back 102

Bronchopneumonia

Front 103

What organisms commonly cause bronchopneumonia?

Back 103

S aureus, H flu, Klebsiella, S pyogenes

Front 104

Which pneumonia causes diffuse patchy inflammation in the interstitium, leaving the alveoli alone?

Back 104

Interstitial (atypical) pneumonia

Front 105

What organisms commonly cause interstitial pneumonia?

Back 105

RSV, adenovirus, mycoplasma, legionella, chlamydia

Front 106

What organisms are usually found in lung abscesses?

Back 106

S aureus or anaerobes

Front 107

What are the 2 most common causes of lung abscess?

Back 107

bronchial obstruction due to a tumor, or aspirated gastric contents

Front 108

What's the difference between a transudate and an exudate?

Back 108

Transudate has low protein content and is mostly clear, exudate has high protein content and is mostly cloudy

Front 109

What are some common causes of a trandudative pleural effusion?

Back 109

CHF, nephrotic syndrome, hepatic cirrhosis

Front 110

What are some common causes of an exudative pleural effusion?

Back 110

malignancy, pneumonia, collagen vascular disease, trauma

Front 111

how does isoproterenol work and what is it used for?

Back 111

treats asthma by relaxing bronchial smooth muscle. It's a beta-agonist

Front 112

How does albuterol work, and what is it used for?

Back 112

treats asthma by relaxing bronchial smooth muscle. Very fast acting, you inhale it.

Front 113

How does salmeterol work, and what is it used for?

Back 113

treats asthma by relaxing bronchial smooth muscle. Long-acting, used prophylactically

Front 114

how does theophylline work, and what is it used for?

Back 114

treats asthma by inhibiting phosphodiesterase -> increasing bronchodilation. Toxic to heart and nerves.

Front 115

How does ipratropium work, and what is it used for?

Back 115

treats asthma by blocking muscarinic receptors, preventing bronchoconstriction

Front 116

How does cromolyn work, and what is it used for

Back 116

treats asthma by inhibiting mast cell effectors. Prophylaxis only, useless for an acute attack

Front 117

Why do you give corticosteroids (beclomethasone, prednisoe) to people with asthma?

Back 117

they prevent the inflammation that causes the long-term thickening and damage to the bronchial wall

Front 118

how does zileuton work, and what is it used for?

Back 118

treats asthma by blocking the conversion of arachidonic acid into leukotrienes. Reduces inflammation

Front 119

How do zafirlukast and montelukast work, and what are they used for?

Back 119

treats asthma by blocking leukotriene receptors, therefore lessening the inflammatory response

Front 120

What is guaifenesin used for, and what does it do?

Back 120

removes excess phlegm, but does NOT suppress the cough reflex

Front 121

What is N-acetylcysteine, and who is it given to?

Back 121

It's a mucolytic, and is given to CF patients