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Respiratory

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1. What does the respiratory zone consist of and What is its fxn
Dec release of fetal glucocorticoids
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Type II pneumocytes - after week 35
CO - 200x

2. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Bronchial obstruction - toward side of lesion
Zone 1
Matched - =1 adequate gas exchange
Pleural effusion

3. What are the lab/study findings in adenocarcinoma of the lung
Dec - due to lactic acidosis
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Clara cells - type II pneumocytes; multiple densitites on CXR
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

4. Which pts are at risk for apriation PNA
Dec in the FEV1/FVC
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Alchoholics or epileptics
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

5. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Deep leg veins
Trachea and bronchi
On expiration as radius dec

6. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Acute/chronic inc in vent
Right shift - favors taut - low affinity for O2 - O2 unloading
Lobar PNA
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

7. What lab ration indicates fetal lung maturity
Loss of blood flow - impeded arterial flow - reduced venous drainage
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
L/S > 2 = lecithin/sphingomyelin
<60

8. What is the leading cause of cancer death
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Respiratory bronchioles - clear debris in alveoli - bronchi
Tight jxns
Lung cancer

9. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
500mL
Zone 1
CO2 - acid/altitude - DPG - Exercise - Temperature
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

10. What is the course of of pulm HTN
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

11. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Retinopathy of maturity
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Dec - no change

12. What is early onset hypoxemia from in chronic bronchitis
Shunting
Airway obstruction (shunt) 100% O2 does not improve PO2
Metastasis - breast - colon - prostate - bladder -
Type II cells

13. What is an example of hypercoagulability
Defect in coagulative cascace proteins
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Acute/chronic inc in vent
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

14. Why is endothelial damage a risk factor for DVT
Exposed collagen fibers provides impetus for clotting cascade
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Inc O2 consumption
Dipalmatoyl phosphatidylcholine

15. What happens to arterial PO2 in chronic lung disease and why
Dec - because physiologic shunt dec O2 extraction from ratio
Bronchial obstruction - toward side of lesion
Milky fluid with inc TGs
Tight jxns

16. Which has a greater affinity for hemoglobin - CO or O2 and by how much
FEV1/FVC > 80%
Mesothelioma - pleura - psammoma bodies
CO - 200x
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

17. What does kallikrein do
Activates bradykinin
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Lungs collapse inwards and chest wall spring out

18. What are mucus secretion swept out by
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Fe 2+
Ciliated cells

19. What increases the risk of PDA in neonatal RDS
Dec cross sectional area of pulm vasc bed
Bleomycin - busulfan - anmiodorone
Steroids to mom - artificial surfactant and thyroxine to neonate
Persistently low O2 tension

20. Define functional residual capacity (FRC)
RV + ERV - volume in lungs after nl expiration
Small airways
Steroids to mom - artificial surfactant and thyroxine to neonate
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

21. What is the main complication of therapeutic supplemental O2?
Retinopathy of maturity
Heart
Inc resistance leading to inc pressure
Chest pain - tachypnea and dyspnea

22. Where do you find type I cells - What is their morphology - and What do they do
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
It binds to Hb -
N- terminus - carbaminohemoglobin
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

23. What is the pathology of emphysema
Steroids to mom - artificial surfactant and thyroxine to neonate
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Milky fluid with inc TGs

24. How does autoimmune dz cause thromboemboli
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Respiratory bronchioles - clear debris in alveoli - bronchi
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Dec - because physiologic shunt dec O2 extraction from ratio

25. What is the formula for collapsing pressure
P = 2ST/radius
Histiocytosis X - Langerhans cells
Steroids to mom - artificial surfactant and thyroxine to neonate
Inc excretion of bicarb to compensate for respiratory alkalosis

26. What is Homan's sign
Dorsiflexion of food leads to tender calf muscle
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Mismatch
Inc shear stress leading to endothelial injury

27. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Surfactant def leading to inc surfact tension and alveolar collapse
L/S < 1.5
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Squamous cell carcinoma - keratin pearls and intracellular bridges

28. What does the conducting zone consist of...
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Dec

29. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Hyaline membrane disease
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Dipalmatoyl phosphatidylcholine - decreases surface tension
Inc excretion of bicarb to compensate for respiratory alkalosis

30. What is central sleep apnea
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
L/S < 1.5
No respiratory effort

31. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Bronchial obstruction - toward side of lesion
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Exposed collagen fibers provides impetus for clotting cascade

32. What happens to lung volumes in obstructive lung disease
Clara cells - type II pneumocytes; multiple densitites on CXR
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Inc

33. What is the alveolar gas equation
Upper lobes
Inc EPO leading to erythrocytosis
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

34. Lung absecss often reults From what organisms
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
S. aureus or anaerobes
Elastase
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

35. What organisms cause interstitial PNA and What are the characteristics
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Bronchial obstruction - toward side of lesion
Everything but RV - TV + IRV + ERV
Clara cells - type II pneumocytes; multiple densitites on CXR

36. Which lung is the more common site for an inhaled foreign body and why
Right lung - right main stem bronhus is wider and more vertical
Acetazolamide - inhibits CA and acidifies the blood
IRV + TV
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

37. What is the TX for small cell lung cancer
Zone 3
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Inoperable - responsive to chemotherapy
No respiratory effort

38. What does CADET face to the right stand for
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
CO2 - acid/altitude - DPG - Exercise - Temperature
Ratio from apex to base becomes more uniform

39. What doe FAT BAT stand for
Inc 2 -3- DPG - righward shift
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Acute/chronic inc in vent
Air that can still be breathed out after nl expiration

40. What happens to diffusing capacity in interstiial lung diseases
Right lung - right main stem bronhus is wider and more vertical
Lowered
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
<75

41. What is a typical tidal volume
500mL
Squamous cell carcinoma - keratin pearls and intracellular bridges
L/S > 2 = lecithin/sphingomyelin
Respiratory effort against airway obstruction

42. How does sleep apnea or high altitude cause pulm HTN
Hypoxic vasocxn
Pleural effusion
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Zone 3

43. What cells make surfactant and At what week is produced most abundantly
Type II pneumocytes - after week 35
Centriacinar
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

44. What does PFTs show in COPD
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Chroniclly tired
Dec dec in FEV1 - dec in FVC

45. What is the criteria for chronic bronchitis
Productive cough for greater than 3 months in at least 2 years
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Dipalmatoyl phosphatidylcholine
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

46. What is the tendency of the lungs vs the chest wall
Lungs collapse inwards and chest wall spring out
1 g of Hb can bind 1.34 mL of O2 - nl O2 in blood is 15 g/dL - cyansosis when deoxy Hb > 5 g/dL
Type II cells
PAO2 - PaO2 = 10-15 mmHg

47. What is surfactant made of...
Dec - because physiologic shunt dec O2 extraction from ratio
Positive cooperativity and negative allostery - unlike myoglobin
Loss of blood flow - impeded arterial flow - reduced venous drainage
Dipalmatoyl phosphatidylcholine

48. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Elastase
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Mesothelioma - pleura - psammoma bodies

49. What changes in CO2 occur during exercise
Inc resistance leading to inc pressure
Inc production
1 g of Hb can bind 1.34 mL of O2 - nl O2 in blood is 15 g/dL - cyansosis when deoxy Hb > 5 g/dL
Inc due to inc CO

50. What muscles are involved in breathing during exercise and What do they control
Methylene blue
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Airway obstruction (shunt) 100% O2 does not improve PO2
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

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