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Respiratory

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1. What does pulm HTN result in
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Inc shear stress leading to endothelial injury
No respiratory effort
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

2. What happens to O2 content and O2 sat as Hb falls
Dec - no change
Both highest in the base
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Person stops breathing for at least 10 seconds repeatedly during sleep

3. What is the formula for pulm vasc resistance
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
PVR = (PpulmA - PleftA)/CO
Brings air in and out - warms - humidifies - filters
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

4. In which zone of the lung is PA > Pa > Pv
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Zone 1

5. Other than surfactant - what other important substances are produced by the lungs
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Prostaglandins - histamine - ACE - kallikrein
Inc resistance leading to inc pressure
Bronchial obstruction - toward side of lesion

6. What changes in O2 consumption change during exercise
Mesothelioma - pleura - psammoma bodies
O2 binding x O2 sat + dissolved O2
Inc O2 consumption
Ratio from apex to base becomes more uniform

7. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Lobar PNA
Acetazolamide - inhibits CA and acidifies the blood
Inc excretion of bicarb to compensate for respiratory alkalosis
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

8. What changes occur to pulm blood flow during exercise
Fe 2+
Inc due to inc CO
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
More indolent

9. How does recurrent thromboemboli cause pulm HTN
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Dec cross sectional area of pulm vasc bed

10. What properties determine the combined volumes of the chest wall and lungs
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Elastic properties
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

11. How do you prevent DVT
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
<60
Heparin
Inc due to inc CO

12. What is tha hallmark finding of COPD
Dec release of fetal glucocorticoids
Right
Air in excess of tidal volume that moves into lung on maximal inspiration
Dec in the FEV1/FVC

13. What do type II cells do - What is their morphology - when do they proliferate
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
DIC - especially postpartum
Dec cross sectional area of pulm vasc bed
Dipalmatoyl phosphatidylcholine

14. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Lower portion of right inferior lobe
Ciliated cells
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

15. What is the most common cancerous lesion in the lun
Mesothelioma - pleura - psammoma bodies
Chronic hypoxic vasocxn
Metastasis - breast - colon - prostate - bladder -
Pleural effusion

16. What direction does an increase in metabolic need shift the O2 dissociation curve
It binds to Hb -
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Right

17. What happens to lung volumes in obstructive lung disease
Zone 1
Airway obstruction (shunt) 100% O2 does not improve PO2
Inc
N- terminus - carbaminohemoglobin

18. What kind of course does interstitial PNA follow in comparison to bronchoPNA
4 polypeptide subunits - 2 alpha and 2 beta
More indolent
Elastase
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

19. What is Homan's sign
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Inc due to inc CO
Dorsiflexion of food leads to tender calf muscle
Clara cells - type II pneumocytes; multiple densitites on CXR

20. What is the formula for O2 content
Inc mitochondria
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
O2 binding x O2 sat + dissolved O2
Dipalmatoyl phosphatidylcholine - decreases surface tension

21. What does ACE do
Inc resistance leading to inc pressure
Dec dec in FEV1 - dec in FVC
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
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

22. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
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 to meet O2 demand
Respiratory effort against airway obstruction
Dec - because physiologic shunt dec O2 extraction from ratio

23. What is used to treat CN poisoning and why
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Dec dec in FEV1 - dec in FVC
Metastasis - breast - colon - prostate - bladder -
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

24. What cellular changes occur at high altitude
Inc mitochondria
Air that can still be breathed out after nl expiration
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Dec in lung volumes - FVC - TLC

25. Where do you find type I cells - What is their morphology - and What do they do
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

26. At what lung volume is system pressure atmospheric and why
Milky fluid with inc TGs
FRC - inward pull of lung balanced by outward pull of chest wall
Long bone fractures and liposuction
Shunting

27. What is used to treat methemoglobin
Right shift - favors taut - low affinity for O2 - O2 unloading
Activates bradykinin
Methylene blue
Tight jxns

28. What must occur with a exudate pleural effusion
Acetazolamide - inhibits CA and acidifies the blood
Heparin
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Drainage

29. What is the protein content an exudative pleural effusion and What are the potential causes
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
500mL
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

30. What is the alveolar gas equation
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Small airways
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

31. What is virchow's triad
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Inc mitochondria
Stasis - hypercoagulability - endothelial damage
Dec dec in FEV1 - dec in FVC

32. What findings are associated with emphysema
Carcinoid - carcinoid
Dec dec in FEV1 - dec in FVC
Inspiration by diaphragm - expiration is passive
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

33. What are the 9 interstitial lung diseases

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34. What are the lab/study findings in adenocarcinoma of the lung
Ciliated cells
PAO2 - PaO2 = 10-15 mmHg
Inc airway pressure to prevent airway collapse during exhalation
Clara cells - type II pneumocytes; multiple densitites on CXR

35. What happens to bicarb once it is created in an RBC
RV + ERV - volume in lungs after nl expiration
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Air in lung after maxmimal expiration - cannot be measured on spirometry

36. Define functional residual capacity (FRC)
4 polypeptide subunits - 2 alpha and 2 beta
Dec cross sectional area of pulm vasc bed
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
RV + ERV - volume in lungs after nl expiration

37. What is the formula for oxygen delivery to tissues
Dorsiflexion of food leads to tender calf muscle
CO x O2 content of blood
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

38. In what cells do you find lamellar bodies
Type II cells
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Lowered

39. If you aspirate a peanut while upright - where will it go
Air in lung after maxmimal expiration - cannot be measured on spirometry
PAO2 - PaO2 = 10-15 mmHg
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Lower portion of right inferior lobe

40. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Dec cross sectional area of pulm vasc bed
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
L/S > 2 = lecithin/sphingomyelin
RALS - righ anterior - left superior

41. What is the alveolar gas equation approximation
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Lost with alveolar walls
PA02 = 150 - PACO2/0.8

42. What is pulmonary surfactant made of - and What does it do
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
4 polypeptide subunits - 2 alpha and 2 beta
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Dipalmatoyl phosphatidylcholine - decreases surface tension

43. Tumor secreting serotonin causes a syndrome with flushing - diarrhea - wheezing - salvation; fibrous deposits in the right heart valves may lead to tricuspid insuff - pulmonary stenosis - right heart failure - tumor and syndrome
Carcinoid - carcinoid
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
In between perfusion limited and diffusion limited
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

44. How does autoimmune dz cause thromboemboli
Dec
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Upper lobes - cor pulmonale - caplan's syndrome
N- terminus - carbaminohemoglobin

45. What are mucus secretion swept out by
Ciliated cells
Acute/chronic inc in vent
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
4 polypeptide subunits - 2 alpha and 2 beta

46. What are the potential TX for sleep apnea
Positive cooperativity and negative allostery - unlike myoglobin
Weight loss - CPAP - surgery
CT angio
Long bone fractures and liposuction

47. What is surfactant made of...
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Low resistance and high compliance
<75
Dipalmatoyl phosphatidylcholine

48. What changes in lung volunes occur as a result of restrictive lung disease
Weight loss - CPAP - surgery
Dec in lung volumes - FVC - TLC
Tissue hypoxia from dec O2 sat and dec O2 content
On expiration as radius dec

49. What lung abnl is characterized by absent or decreased breath sounds over affected area - dec resonance - dec fremitus - and which side is the trachea deviated towards
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Dipalmatoyl phosphatidylcholine
Bronchial obstruction - toward side of lesion
Lobar PNA

50. What changes in ventilation rate occur during exercise
RALS - righ anterior - left superior
Anatomic dead space and smooth muscle
Inc to meet O2 demand
Air in lung after maxmimal expiration - cannot be measured on spirometry

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