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Respiratory

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1. Where are ventilation and perfusion highest in the lung - respectively
Person stops breathing for at least 10 seconds repeatedly during sleep
FRC - inward pull of lung balanced by outward pull of chest wall
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Both highest in the base

2. What causes neonatal RDS
Surfactant def leading to inc surfact tension and alveolar collapse
Lobar PNA
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

3. What kind of connection exists between endothelial cells in the capilaries
Persistently low O2 tension
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Acute/chronic inc in vent
Tight jxns

4. What are the 9 interstitial lung diseases

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5. What happens to lung volumes in obstructive lung disease
<75
Inc
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

6. What are mucus secretion swept out by
Airway obstruction (shunt) 100% O2 does not improve PO2
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Ciliated cells

7. Which lung is the more common site for an inhaled foreign body and why
Inc 2 -3- DPG - righward shift
Right lung - right main stem bronhus is wider and more vertical
Lungs collapse inwards and chest wall spring out
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

8. 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
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
Bronchial obstruction - toward side of lesion
RV + ERV - volume in lungs after nl expiration
Opposites

9. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Person stops breathing for at least 10 seconds repeatedly during sleep
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Opposites
Weight loss - CPAP - surgery

10. What is the formula for A- a gradient - and What is it normally
Deoxygenated blood - elastic walls
PAO2 - PaO2 = 10-15 mmHg
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Air that moves into lung with each quiet respiration

11. How does recurrent thromboemboli cause pulm HTN
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Lung cancer
Dec cross sectional area of pulm vasc bed
Inoperable - responsive to chemotherapy

12. What is the pathology of emphysema
Repeated cycles of lung injury and wound healing with inc collagen
Air in excess of tidal volume that moves into lung on maximal inspiration
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

13. In what cells do you find lamellar bodies
Type II cells
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

14. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Dec dec in FEV1 - dec in FVC
Respiratory bronchioles - clear debris in alveoli - bronchi
Bronchial obstruction - toward side of lesion
High alveolar pressure compresses capillaries

15. What are the SPHERE of complications in lung cancer
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Right
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Mismatch

16. In COPD - what happens to airways at high lung volumes
Clara cells - type II pneumocytes; multiple densitites on CXR
Inc to meet O2 demand
Airways close prematurely resulting in inc RV and dec FVC
It binds to Hb -

17. At What terminal does CO2 bind the globin molecule
N- terminus - carbaminohemoglobin
Inc production
RALS - righ anterior - left superior
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

18. What is the presentation of lung cancer

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19. What is the cycle of idiopathic pulmonary fibrosis
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
S. aureus or anaerobes
Repeated cycles of lung injury and wound healing with inc collagen
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

20. What is the formula for oxygen delivery to tissues
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
CO x O2 content of blood
Zone 3

21. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

22. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Upper lobes
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

23. What does the respiratory zone consist of and What is its fxn
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Inc mitochondria
Dec - no change
Elastic properties

24. What is fetal hemoglobin made of and why does it have a higher affinity for O2
Chest pain - tachypnea and dyspnea
500mL
Dipalmatoyl phosphatidylcholine - decreases surface tension
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

25. What is surfactant made of...
More indolent
Dipalmatoyl phosphatidylcholine
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Lowered

26. What is hemoglobin composed of...
Long bone fractures and liposuction
4 polypeptide subunits - 2 alpha and 2 beta
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

27. How does autoimmune dz cause thromboemboli
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Acetazolamide - inhibits CA and acidifies the blood
Shed epithelium from mucus plugs
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

28. What is the pathology of asthma

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29. What do PFTs show in restrictive lung disease
FEV1/FVC > 80%
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
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

30. What kind of space is in the conducting tree and what kind of muscle exists there
Anatomic dead space and smooth muscle
Alchoholics or epileptics
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

31. In which zone of the lung is Pa > Pv >PA
Tissue hypoxia from dec O2 sat and dec O2 content
Zone 3
RV + ERV - volume in lungs after nl expiration
4 polypeptide subunits - 2 alpha and 2 beta

32. What kind of pleural plaques are the result of asbestosis
Prostaglandins - histamine - ACE - kallikrein
Ivory white calcified pleural plaques
Hypoxic vasocxn
Dec

33. A carcinoma in the apex of the lung can cause what syndrome and What is the tumor called

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34. What are clara cells What is their morphology and What do they do
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Hypertrophy of mucus secreting glands in the bronchioles

35. At what PaO2 does hypoxemia begin
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
<75
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Repeated cycles of lung injury and wound healing with inc collagen

36. What TX is the mother given before delivery - and what TXs are given to the infant
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Steroids to mom - artificial surfactant and thyroxine to neonate

37. What lab ration indicates fetal lung maturity
Tension pneumo - away from lesion
Inc 2 -3- DPG - righward shift
Clara cells - type II pneumocytes; multiple densitites on CXR
L/S > 2 = lecithin/sphingomyelin

38. Which structures perforate the diaphragm and where
Dorsiflexion of food leads to tender calf muscle
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Coal miner's - silicosis - abestosis

39. Why is endothelial damage a risk factor for DVT
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Inc resistance leading to inc pressure
Exposed collagen fibers provides impetus for clotting cascade
Fe 2+

40. What is the equation for physiologic dead space
FRC - inward pull of lung balanced by outward pull of chest wall
Inc excretion of bicarb to compensate for respiratory alkalosis
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

41. What changes occur to pulm blood flow during exercise
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
FEV1/FVC > 80%
Inc due to inc CO
Respiratory bronchioles - clear debris in alveoli - bronchi

42. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Apex of healthy lung
C3 - 4 - 6 - phrenic nerve - referred to shoulder
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Inc to meet O2 demand

43. What happens as a result of hypoxia in sleep apnea
Surfactant
RV + ERV - volume in lungs after nl expiration
Inc EPO leading to erythrocytosis
Prematurity - maternal RDS - cesarean delivery

44. What changes in lung volunes occur as a result of restrictive lung disease
20.1 mL O2 /dL
Dec in lung volumes - FVC - TLC
L/S > 2 = lecithin/sphingomyelin
On expiration as radius dec

45. At what lung volume is system pressure atmospheric and why
Dipalmatoyl phosphatidylcholine - decreases surface tension
FRC - inward pull of lung balanced by outward pull of chest wall
Inc airway pressure to prevent airway collapse during exhalation
Type II cells

46. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Pleural effusion
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
4 polypeptide subunits - 2 alpha and 2 beta

47. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
RALS - righ anterior - left superior
Surfactant
Metastasis - breast - colon - prostate - bladder -
Inc resistance leading to inc pressure

48. What are the histological findings in asbestosis and what occupations are associated
FRC - inward pull of lung balanced by outward pull of chest wall
Lungs collapse inwards and chest wall spring out
Lobar PNA
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

49. What increases the risk of PDA in neonatal RDS
L/S > 2 = lecithin/sphingomyelin
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Persistently low O2 tension
Trachea and bronchi

50. What is used to treat methemoglobin
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Retinopathy of maturity
Methylene blue
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

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