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Respiratory

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1. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
P = 2ST/radius
Persistently low O2 tension

2. What are the findings of chronic bronchitis
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

3. What is a lung abscess and What does usually result from
Tight jxns
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

4. What is the ideal V/Q ratio and why
FEV1/FVC > 80%
Matched - =1 adequate gas exchange
Inc shear stress leading to endothelial injury
Surfactant def leading to inc surfact tension and alveolar collapse

5. What lung product is deficient in neonatal RDS
Deep leg veins
Surfactant
Long bone fractures and liposuction
Dec cross sectional area of pulm vasc bed

6. What enzyme increases activity in emphysema
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Elastase
Milky fluid with inc TGs
Heparin

7. What kind of connection exists between endothelial cells in the capilaries
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Anatomic dead space and smooth muscle
Tight jxns

8. How does sleep apnea or high altitude cause pulm HTN
S. aureus or anaerobes
Hypoxic vasocxn
Respiratory bronchioles - clear debris in alveoli - bronchi
CO x O2 content of blood

9. What is the TX for small cell lung cancer
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Inoperable - responsive to chemotherapy
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Mismatch

10. What are the 3 reasons for an increased A- a gradient
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Right
Air that can still be breathed out after nl expiration
Ivory white calcified pleural plaques

11. What changes in O2 consumption change during exercise
Inc O2 consumption
Upper lobes - cor pulmonale - caplan's syndrome
Lowered
Heparin

12. Define tidal volume (TV)
Air that moves into lung with each quiet respiration
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Shed epithelium from mucus plugs
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

13. What changes occur to PaO2 and PaCO2
Heart
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
No change - but inc venous CO2 content
20.1 mL O2 /dL

14. What is the appoximate O2 binding capacity
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Inc shear stress leading to endothelial injury
20.1 mL O2 /dL
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

15. What happens with the O2 curve shifts to the right and What does it facilitate
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Pa > PA > Pv
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

16. Where are ventilation and perfusion highest in the lung - respectively
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
4 polypeptide subunits - 2 alpha and 2 beta
P = 2ST/radius
Both highest in the base

17. What does each bronchopulmonary segment have in the center and along its border
Dec in lung volumes - FVC - TLC
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Lowered

18. What is the equation for physiologic dead space
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
500mL
Long bone fractures and liposuction

19. How do you prevent DVT
Acetazolamide - inhibits CA and acidifies the blood
PAO2 - PaO2 = 10-15 mmHg
Heparin
Deoxygenated blood - elastic walls

20. What are the causes of ischemia
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Loss of blood flow - impeded arterial flow - reduced venous drainage
No respiratory effort
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

21. What is the alveolar gas equation
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
FEV1/FVC > 80%

22. What are the findings in asthma
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Hypertrophy of mucus secreting glands in the bronchioles
Metastasis - breast - colon - prostate - bladder -
Air in excess of tidal volume that moves into lung on maximal inspiration

23. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Opposites
Inc shear stress leading to endothelial injury
Dec
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

24. What is the protein content in a transudative pleural effusion and What are the potential causes
Prostaglandins - histamine - ACE - kallikrein
Lobar PNA
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

25. What does CADET face to the right stand for
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
CO2 - acid/altitude - DPG - Exercise - Temperature
Air in excess of tidal volume that moves into lung on maximal inspiration

26. What do PFTs show in restrictive lung disease
IRV + TV + ERV + RV
FEV1/FVC > 80%
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Chroniclly tired

27. Other than surfactant - what other important substances are produced by the lungs
Prostaglandins - histamine - ACE - kallikrein
Dec - no change
Mismatch
Prematurity - maternal RDS - cesarean delivery

28. What properties determine the combined volumes of the chest wall and lungs
Elastic properties
CO - 200x
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Everything but RV - TV + IRV + ERV

29. What does decreased PAO2 do
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Bronchial obstruction - toward side of lesion
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

30. 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
Hypertrophy of mucus secreting glands in the bronchioles
Dec in the FEV1/FVC
Right shift - favors taut - low affinity for O2 - O2 unloading

31. What is the course of of pulm HTN
Prostaglandins - histamine - ACE - kallikrein
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
CT angio
L/S > 2 = lecithin/sphingomyelin

32. What happens in perfusion limited circulatioin and which gases does this apply to...
Histiocytosis X - Langerhans cells
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Bleomycin - busulfan - anmiodorone
Viral - URIs - allergens and stress

33. What reaction and enzyme create bicarb and Where does it happen
On expiration as radius dec
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Ivory white calcified pleural plaques
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

34. What is early onset hypoxemia from in chronic bronchitis
CO - 200x
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Shunting
FEV1/FVC > 80%

35. How is pulmonary circulation characterized in terms of resistance and compliance
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Low resistance and high compliance
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

36. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
CO2 - acid/altitude - DPG - Exercise - Temperature
Air that moves into lung with each quiet respiration
Carcinoid - carcinoid
Pleural effusion

37. What cellular changes occur at high altitude
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Everything but RV - TV + IRV + ERV
Inc mitochondria
CO x O2 content of blood

38. What does ACE do
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Inc due to inc CO
Pleural effusion
Acetazolamide - inhibits CA and acidifies the blood

39. Define functional residual capacity (FRC)
Matched - =1 adequate gas exchange
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Carcinoid - carcinoid
RV + ERV - volume in lungs after nl expiration

40. What causes neonatal RDS
Surfactant def leading to inc surfact tension and alveolar collapse
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Apex of healthy lung
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

41. What are the various causes of ARDS
Respiratory bronchioles - clear debris in alveoli - bronchi
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Lobar PNA
Apex of healthy lung

42. What are curschmann's spirals
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Shed epithelium from mucus plugs
High alveolar pressure compresses capillaries
Surfactant def leading to inc surfact tension and alveolar collapse

43. What kind of course does interstitial PNA follow in comparison to bronchoPNA
Anatomic dead space and smooth muscle
Inc O2 consumption
More indolent
Drainage

44. What happens as a result of hypoxia in sleep apnea
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
O2 binding x O2 sat + dissolved O2
Inc production
Inc EPO leading to erythrocytosis

45. What is the tendency of the lungs vs the chest wall
TB - silica disrupt phagolysosomes and impair MACS
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Lungs collapse inwards and chest wall spring out

46. What is sleep apnea associated with
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Dipalmatoyl phosphatidylcholine
Viral - URIs - allergens and stress

47. Why is there eventual loss of capillary beds in emphysema
RALS - righ anterior - left superior
In between perfusion limited and diffusion limited
Lost with alveolar walls
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

48. What is the nl form of iron in hemoglobin
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Fe 2+
Zone 3

49. Why is cesarean delivery a risk factor for neonatal RDS
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
Dec release of fetal glucocorticoids
Right shift - favors taut - low affinity for O2 - O2 unloading
Right

50. What is pulmonary surfactant made of - and What does it do
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Dipalmatoyl phosphatidylcholine - decreases surface tension
Retinopathy of maturity
Inc

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