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Respiratory

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1. What lobes are affected in silicosis
Dec in the FEV1/FVC
Both highest in the base
Upper lobes
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

2. What are the 9 interstitial lung diseases

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3. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
RALS - righ anterior - left superior
Ratio from apex to base becomes more uniform
Acute/chronic inc in vent
FRC - inward pull of lung balanced by outward pull of chest wall

4. What are the potential TX for sleep apnea
Hyaline membrane disease
Weight loss - CPAP - surgery
Dec - due to lactic acidosis
PVR = (PpulmA - PleftA)/CO

5. At what PaO2 does cyanosis begin
Centriacinar
<60
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Lowered

6. What are fat emboli associated with
4 polypeptide subunits - 2 alpha and 2 beta
Tissue hypoxia from dec O2 sat and dec O2 content
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Long bone fractures and liposuction

7. Why do pts with emphysema exhale through pursed lips
Inc airway pressure to prevent airway collapse during exhalation
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
N- terminus - carbaminohemoglobin
TB - apex

8. What area of the lung is the largest physiologic contributor of fxnal dead space
N- terminus - carbaminohemoglobin
Apex of healthy lung
Deoxygenated blood - elastic walls
Defect in coagulative cascace proteins

9. What is surfactant made of...
Dipalmatoyl phosphatidylcholine
Dipalmatoyl phosphatidylcholine - decreases surface tension
Inc airway pressure to prevent airway collapse during exhalation
Hypertrophy of mucus secreting glands in the bronchioles

10. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
0 - negative - prevents pneumothorax
Type II cells
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Lower portion of right inferior lobe

11. What direction does an increase in metabolic need shift the O2 dissociation curve
Ratio from apex to base becomes more uniform
Right
Steroids to mom - artificial surfactant and thyroxine to neonate
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

12. What is another name for neonatal RDS
More indolent
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Dec dec in FEV1 - dec in FVC
Hyaline membrane disease

13. What is central sleep apnea
Prematurity - maternal RDS - cesarean delivery
No respiratory effort
Elastase
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

14. What does decreased PAO2 do
PA02 = 150 - PACO2/0.8
Hyaline membrane disease
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

15. What organisms cause a bronchoPNA and What are the characteristics
Tight jxns
Repeated cycles of lung injury and wound healing with inc collagen
C3 - 4 - 6 - phrenic nerve - referred to shoulder
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

16. What is early onset hypoxemia from in chronic bronchitis
CT angio
Loss of elastic fibers
Tissue hypoxia from dec O2 sat and dec O2 content
Shunting

17. What are the causes of hypoxemia
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Chest pain - tachypnea and dyspnea

18. What cells in the lung produce surfactant and What does it do
Viral - URIs - allergens and stress
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

19. Define inspiratory reserve volume (IRV)
Airway obstruction (shunt) 100% O2 does not improve PO2
Air in excess of tidal volume that moves into lung on maximal inspiration
Shed epithelium from mucus plugs
Pleural effusion

20. What renal changes occur at high altitude and What are they compensating for
Lowered
IRV + TV + ERV + RV
Inc excretion of bicarb to compensate for respiratory alkalosis
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

21. What does the conducting zone consist of...
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
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
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

22. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Prematurity - maternal RDS - cesarean delivery

23. Where does lung cancer met to...
Drainage
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals

24. What changes in lung volunes occur as a result of restrictive lung disease
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Dec in lung volumes - FVC - TLC
Methylene blue
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

25. What happens to V/Q ratio in COPD
Mismatch
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Ratio from apex to base becomes more uniform
Right

26. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Inc shear stress leading to endothelial injury
Positive cooperativity and negative allostery - unlike myoglobin

27. What does the law of Laplace state about tendency of alveoli to collapse
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Upper lobes
On expiration as radius dec

28. Define inspiratory capacity (IC)
IRV + TV
Shed epithelium from mucus plugs
L/S > 2 = lecithin/sphingomyelin
Ratio from apex to base becomes more uniform

29. What changes at high altitude can result in RVH
Upper lobes
Ratio from apex to base becomes more uniform
Inc
Chronic hypoxic vasocxn

30. Why is endothelial damage a risk factor for DVT
CT angio
Pa > PA > Pv
Exposed collagen fibers provides impetus for clotting cascade
Hypoxic vasocxn

31. Which muscles are involved in quiet breathing and What part of respiration do the control
TB - apex
Inspiration by diaphragm - expiration is passive
Opposites
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

32. What are the associations with bronchiectasis

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33. What kind of connection exists between endothelial cells in the capilaries
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Inc O2 consumption
Tight jxns
Inoperable - responsive to chemotherapy

34. What organism causes a lobar PNA and What are the characteristics
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Dec - due to lactic acidosis
Brings air in and out - warms - humidifies - filters

35. Susceptibility to what infection is increased in silicosis and why
TB - silica disrupt phagolysosomes and impair MACS
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Squamous cell carcinoma - keratin pearls and intracellular bridges
Fe 2+

36. What do PFTs show in restrictive lung disease
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Apex of healthy lung
FEV1/FVC > 80%
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

37. What is used to treat CN poisoning and why
Dec cross sectional area of pulm vasc bed
Inc resistance leading to inc pressure
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
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

38. Lung absecss often reults From what organisms
S. aureus or anaerobes
Positive cooperativity and negative allostery - unlike myoglobin
Inc EPO leading to erythrocytosis
Long bone fractures and liposuction

39. What is the V/Q ratio at the apex and base of the lung
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Hyaline membrane disease
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

40. How does left to right shunt cause pulm HTN
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Inc shear stress leading to endothelial injury
FRC - inward pull of lung balanced by outward pull of chest wall
Hypoxic vasocxn

41. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Carcinoid - carcinoid
Dec in the FEV1/FVC
Squamous cell carcinoma - keratin pearls and intracellular bridges
Zone 3

42. What causes primary pulm HTN
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Positive cooperativity and negative allostery - unlike myoglobin
Centriacinar
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

43. What is the pathology of bronchiectasis
Persistently low O2 tension
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Dec - because physiologic shunt dec O2 extraction from ratio

44. What are the lab/study findings in adenocarcinoma of the lung
Inc due to inc CO
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Clara cells - type II pneumocytes; multiple densitites on CXR
Inc resistance leading to inc pressure

45. What is a typical tidal volume
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Dec
500mL
Repeated cycles of lung injury and wound healing with inc collagen

46. How many lobes does each lung have - and What is the lingula
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
TB - apex
Airways close prematurely resulting in inc RV and dec FVC
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

47. What changes occur to pulm blood flow during exercise
Carcinoid - carcinoid
Heparin
Inc due to inc CO
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

48. What layers must CO2 and O2 traverse to complete gas exchange
Dipalmatoyl phosphatidylcholine
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Prematurity - maternal RDS - cesarean delivery
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

49. What is a consequence of pulm HTN
Dorsiflexion of food leads to tender calf muscle
No change - but inc venous CO2 content
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

50. How does mitral stenosis cause pulm HTN
IRV + TV + ERV + RV
Inc resistance leading to inc pressure
Apex of healthy lung
Dec - because physiologic shunt dec O2 extraction from ratio

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Respiratory

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