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Respiratory

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1. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Steroids to mom - artificial surfactant and thyroxine to neonate
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Gland depth/total thickness of broncial wall - >50%
More indolent

2. What kind of pleural plaques are the result of asbestosis
Inc O2 consumption
Ivory white calcified pleural plaques
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Ratio from apex to base becomes more uniform

3. How happens to the proton from the rxn the created bicarb
Dipalmatoyl phosphatidylcholine - decreases surface tension
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
It binds to Hb -
PAO2 - PaO2 = 10-15 mmHg

4. What are fat emboli associated with
Form of hemoglobin bound to CO in place of O2 - causes dec O2 binding capacituy with a left shift in the O2 hemoglobin dissociation curve - dec unloading in tissues
Long bone fractures and liposuction
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Lowered

5. What is a consequence of pulm HTN
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Dec in the FEV1/FVC

6. What are the subtypes of pneumoconioses

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7. What is the fxn of the conducting zone
Dec in lung volumes - FVC - TLC
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Brings air in and out - warms - humidifies - filters
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

8. What is a lung abscess and What does usually result from
Airway obstruction (shunt) 100% O2 does not improve PO2
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Viral - URIs - allergens and stress
Inspiration by diaphragm - expiration is passive

9. What causes secondary pulm HTN
Heparin
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

10. At What terminal does CO2 bind the globin molecule
N- terminus - carbaminohemoglobin
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Steroids to mom - artificial surfactant and thyroxine to neonate

11. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Bronchial obstruction - toward side of lesion
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Small airways

12. What are the risk factors for neonatal RDS
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Prematurity - maternal RDS - cesarean delivery
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

13. What is a potential test for asthma
High alveolar pressure compresses capillaries
Methacholine challenge
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Dorsiflexion of food leads to tender calf muscle

14. Define functional residual capacity (FRC)
Brings air in and out - warms - humidifies - filters
Hyaline membrane disease
Both highest in the base
RV + ERV - volume in lungs after nl expiration

15. What are the findings of chronic bronchitis
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
RV + ERV - volume in lungs after nl expiration
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

16. What kind of connection exists between endothelial cells in the capilaries
Tight jxns
Tension pneumo - away from lesion
TB - silica disrupt phagolysosomes and impair MACS
Dipalmatoyl phosphatidylcholine - decreases surface tension

17. What is virchow's triad
Stasis - hypercoagulability - endothelial damage
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

18. What happens to diffusing capacity in interstiial lung diseases
PAO2 - PaO2 = 10-15 mmHg
Lowered
Hypertrophy of mucus secreting glands in the bronchioles
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

19. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Drainage
PA02 = 150 - PACO2/0.8
Tension pneumo - away from lesion
Dec in the FEV1/FVC

20. What is the pathology of chronic bronchitis
Hypertrophy of mucus secreting glands in the bronchioles
Inc due to inc CO
Inc airway pressure to prevent airway collapse during exhalation
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

21. What is the pathology of ARDS
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Centriacinar
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Inoperable - responsive to chemotherapy

22. What findings are associated with emphysema
Repeated cycles of lung injury and wound healing with inc collagen
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Coal miner's - silicosis - abestosis
Prematurity - maternal RDS - cesarean delivery

23. What changes in V/Q throughout the lung during exercise
Ratio from apex to base becomes more uniform
Drainage
Chronic hypoxic vasocxn
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

24. Why is cesarean delivery a risk factor for neonatal RDS
Dec release of fetal glucocorticoids
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Positive cooperativity and negative allostery - unlike myoglobin
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

25. What does decreased PAO2 do
Trachea and bronchi
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Milky fluid with inc TGs

26. What is the alveolar gas equation
Form of hemoglobin bound to CO in place of O2 - causes dec O2 binding capacituy with a left shift in the O2 hemoglobin dissociation curve - dec unloading in tissues
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Shed epithelium from mucus plugs
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

27. What organism thrives in high O2 and where in the lung does it flourish
Inc to meet O2 demand
Inc O2 consumption
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
TB - apex

28. What are the findings in asthma
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
In between perfusion limited and diffusion limited
Form of hemoglobin bound to CO in place of O2 - causes dec O2 binding capacituy with a left shift in the O2 hemoglobin dissociation curve - dec unloading in tissues

29. What are the 3 reasons for an increased A- a gradient
Respiratory bronchioles - clear debris in alveoli - bronchi
Upper lobes - cor pulmonale - caplan's syndrome
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Pa > PA > Pv

30. Toxicities of what drugs include interstitial lung disease
Bleomycin - busulfan - anmiodorone
IRV + TV + ERV + RV
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Repeated cycles of lung injury and wound healing with inc collagen

31. What happens to V/Q ratio in COPD
Everything but RV - TV + IRV + ERV
Mismatch
Metastasis - breast - colon - prostate - bladder -
Both highest in the base

32. What is the pathology of emphysema
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Pleural effusion

33. What is central sleep apnea
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Inspiration by diaphragm - expiration is passive
No respiratory effort

34. How does sleep apnea or high altitude cause pulm HTN
Zone 3
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Hypoxic vasocxn
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

35. What are the findings associated with sarcoidosis
Defect in coagulative cascace proteins
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Small airways
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

36. What are the potential TX for sleep apnea
Weight loss - CPAP - surgery
Air in excess of tidal volume that moves into lung on maximal inspiration
Hypertrophy of mucus secreting glands in the bronchioles
Alpha1- antitrypsin def - also cirrhosis

37. What is positive cooperativity of hemoglobin refer to...
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Long bone fractures and liposuction
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

38. What is the response for ventilation of high altitude
Acute/chronic inc in vent
Methacholine challenge
Air that moves into lung with each quiet respiration
Steroids to mom - artificial surfactant and thyroxine to neonate

39. What are curschmann's spirals
Inc shear stress leading to endothelial injury
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Methylene blue
Shed epithelium from mucus plugs

40. What are the SPHERE of complications in lung cancer
Apex of healthy lung
Dec - due to lactic acidosis
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Mismatch

41. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Form of hemoglobin bound to CO in place of O2 - causes dec O2 binding capacituy with a left shift in the O2 hemoglobin dissociation curve - dec unloading in tissues
Dec cross sectional area of pulm vasc bed
Right shift - favors taut - low affinity for O2 - O2 unloading
Air that can still be breathed out after nl expiration

42. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Steroids to mom - artificial surfactant and thyroxine to neonate
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
L/S < 1.5
Elastase

43. 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
Retinopathy of maturity
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Inc airway pressure to prevent airway collapse during exhalation

44. What is tha hallmark finding of COPD
Inc O2 consumption
Inc due to inc CO
Dec in the FEV1/FVC
Lobar PNA

45. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
FRC - inward pull of lung balanced by outward pull of chest wall
Pleural effusion
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

46. What are the various causes of ARDS
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
CT angio
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

47. What changes in lung volunes occur as a result of restrictive lung disease
Dec - due to lactic acidosis
Dec in lung volumes - FVC - TLC
Hypertrophy of mucus secreting glands in the bronchioles
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

48. What lab ration indicates fetal lung maturity
L/S > 2 = lecithin/sphingomyelin
Hypertrophy of mucus secreting glands in the bronchioles
Gland depth/total thickness of broncial wall - >50%
Air that can still be breathed out after nl expiration

49. What happens as a result of hypoxia in sleep apnea
Ivory white calcified pleural plaques
Nitrates to oxidize hemoglobin to methemoglobin Which binds CN allowing cyto C oxidase to fxn - use thiosulfate to bind this cyanide forming thiocynate - which is renally excreted
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Inc EPO leading to erythrocytosis

50. What happens to lung volumes in restrictive lung disease
Bleomycin - busulfan - anmiodorone
Ciliated cells
Dec
Dec cross sectional area of pulm vasc bed

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