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Respiratory

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1. Define expiratory reserve volume (ERV)
Steroids to mom - artificial surfactant and thyroxine to neonate
Type II cells
No respiratory effort
Air that can still be breathed out after nl expiration

2. What cells make surfactant and At what week is produced most abundantly
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Inc O2 consumption
Type II pneumocytes - after week 35
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

3. What changes in lung volunes occur as a result of restrictive lung disease
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Dec in lung volumes - FVC - TLC
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Respiratory bronchioles - clear debris in alveoli - bronchi

4. What does decreased PAO2 do
Dec release of fetal glucocorticoids
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Persistently low O2 tension
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

5. What is Homan's sign
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Dorsiflexion of food leads to tender calf muscle
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Right shift - favors taut - low affinity for O2 - O2 unloading

6. What happens to diffusing capacity in interstiial lung diseases
Inspiration by diaphragm - expiration is passive
IRV + TV + ERV + RV
Lowered
Both highest in the base

7. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Positive cooperativity and negative allostery - unlike myoglobin
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Pleural effusion
Dipalmatoyl phosphatidylcholine

8. What is positive cooperativity of hemoglobin refer to...
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Upper lobes
Chroniclly tired
TB - silica disrupt phagolysosomes and impair MACS

9. What is the ideal V/Q ratio and why
TB - silica disrupt phagolysosomes and impair MACS
RALS - righ anterior - left superior
Matched - =1 adequate gas exchange
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

10. What do PFTs show in restrictive lung disease
Prematurity - maternal RDS - cesarean delivery
FEV1/FVC > 80%
Inc
Inc mitochondria

11. What is the formula for oxygen delivery to tissues
CO x O2 content of blood
Methylene blue
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

12. What changes in CO2 occur during exercise
Person stops breathing for at least 10 seconds repeatedly during sleep
Inc production
PAO2 - PaO2 = 10-15 mmHg
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

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

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14. What is the pathology of chronic bronchitis
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Tight jxns
Hypertrophy of mucus secreting glands in the bronchioles
Type II cells

15. Why is endothelial damage a risk factor for DVT
Air that can still be breathed out after nl expiration
Hypertrophy of mucus secreting glands in the bronchioles
Chest pain - tachypnea and dyspnea
Exposed collagen fibers provides impetus for clotting cascade

16. What is the pathology of ARDS
Steroids to mom - artificial surfactant and thyroxine to neonate
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Air in excess of tidal volume that moves into lung on maximal inspiration
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

17. Where are ventilation and perfusion highest in the lung - respectively
Dec - due to lactic acidosis
Tension pneumo - away from lesion
Acetazolamide - inhibits CA and acidifies the blood
Both highest in the base

18. What changes in EPO occur at high altitude
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Dec in the FEV1/FVC
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

19. What does a V/Q ratio of 0 indicate
Everything but RV - TV + IRV + ERV
It binds to Hb -
Airway obstruction (shunt) 100% O2 does not improve PO2
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

20. What happens to lung volumes in restrictive lung disease
Dec
Inc due to inc CO
Centriacinar
Right lung - right main stem bronhus is wider and more vertical

21. What is the initial damage of ARDS caused by
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Steroids to mom - artificial surfactant and thyroxine to neonate
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

22. What causes secondary pulm HTN
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
High alveolar pressure compresses capillaries
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

23. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Drainage
Centriacinar
Positive cooperativity and negative allostery - unlike myoglobin
Lobar PNA

24. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Upper lobes
Respiratory bronchioles - clear debris in alveoli - bronchi
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
CO - 200x

25. Define total lung capcaity
Upper lobes
IRV + TV + ERV + RV
More indolent
Opposites

26. Where do 95% of PE arise from
Methylene blue
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Weight loss - CPAP - surgery
Deep leg veins

27. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with 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
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

28. What is a potential test for asthma
Methacholine challenge
Both highest in the base
No respiratory effort
Person stops breathing for at least 10 seconds repeatedly during sleep

29. What kind of connection exists between endothelial cells in the capilaries
Pleural effusion
In between perfusion limited and diffusion limited
Tight jxns
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

30. What changes occur to PaO2 and PaCO2
Weight loss - CPAP - surgery
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
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
No change - but inc venous CO2 content

31. What changes in ventilation rate occur during exercise
Brings air in and out - warms - humidifies - filters
Retinopathy of maturity
Ratio from apex to base becomes more uniform
Inc to meet O2 demand

32. What lab ration indicates fetal lung maturity
In between perfusion limited and diffusion limited
Brings air in and out - warms - humidifies - filters
Deoxygenated blood - elastic walls
L/S > 2 = lecithin/sphingomyelin

33. What are the findings in asthma
CO x O2 content of blood
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Superior portion of right inferior lobe
Surfactant

34. Susceptibility to what infection is increased in silicosis and why
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
TB - silica disrupt phagolysosomes and impair MACS
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
High alveolar pressure compresses capillaries

35. What are potential triggers for asthma
Lobar PNA
Dipalmatoyl phosphatidylcholine - decreases surface tension
Dec cross sectional area of pulm vasc bed
Viral - URIs - allergens and stress

36. What is used to treat CN poisoning and why
Air in lung after maxmimal expiration - cannot be measured on spirometry
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
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
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

37. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
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
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Apex of healthy lung
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

38. Which pts are at risk for apriation PNA
<60
Opposites
Airway obstruction (shunt) 100% O2 does not improve PO2
Alchoholics or epileptics

39. What increases the risk of PDA in neonatal RDS
Incr - right - dec - left
Respiratory bronchioles - clear debris in alveoli - bronchi
Persistently low O2 tension
IRV + TV + ERV + RV

40. What changes at high altitude can result in RVH
Long bone fractures and liposuction
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Chronic hypoxic vasocxn

41. What organism thrives in high O2 and where in the lung does it flourish
FRC - inward pull of lung balanced by outward pull of chest wall
Respiratory bronchioles - clear debris in alveoli - bronchi
It binds to Hb -
TB - apex

42. How does left to right shunt cause pulm HTN
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Superior portion of right inferior lobe
Tight jxns
Inc shear stress leading to endothelial injury

43. What organisms cause a bronchoPNA and What are the characteristics
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Dipalmatoyl phosphatidylcholine
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

44. What is pulmonary surfactant made of - and What does it do
More indolent
Coal miner's - silicosis - abestosis
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Dipalmatoyl phosphatidylcholine - decreases surface tension

45. Define inspiratory reserve volume (IRV)
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Inc excretion of bicarb to compensate for respiratory alkalosis
High alveolar pressure compresses capillaries
Air in excess of tidal volume that moves into lung on maximal inspiration

46. What layers must CO2 and O2 traverse to complete gas exchange
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Chest pain - tachypnea and dyspnea
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

47. Chronic bronchitis is a disease of what kind of airways
Inc shear stress leading to endothelial injury
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Dec in lung volumes - FVC - TLC
Small airways

48. What is a typical tidal volume
500mL
In between perfusion limited and diffusion limited
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Lobar PNA

49. 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
Centriacinar
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Heparin

50. What happens to arterial PO2 in chronic lung disease and why
Lobar PNA
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Dec - because physiologic shunt dec O2 extraction from ratio

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