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Respiratory

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1. What causes neonatal RDS
Zone 3
Dec in lung volumes - FVC - TLC
Surfactant def leading to inc surfact tension and alveolar collapse
DIC - especially postpartum

2. In which zone of the lung is PA > Pa > Pv
Zone 1
Inc
Deep leg veins
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

3. Define physilogic dead space
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Acute/chronic inc in vent
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Hypertrophy of mucus secreting glands in the bronchioles

4. Where does lung cancer met to...
Zone 1
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Dipalmatoyl phosphatidylcholine
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

5. What is hemoglobin composed of...
4 polypeptide subunits - 2 alpha and 2 beta
Acetazolamide - inhibits CA and acidifies the blood
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Drainage

6. What does pulm HTN result in
Inc resistance leading to inc pressure
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Dec release of fetal glucocorticoids
Dec in lung volumes - FVC - TLC

7. What are the SPHERE of complications in lung cancer
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Gland depth/total thickness of broncial wall - >50%
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
No respiratory effort

8. What is the course of of pulm HTN
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Chroniclly tired
Inc due to inc CO
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

9. What is the most common cancerous lesion in the lun
Tight jxns
20.1 mL O2 /dL
Dec release of fetal glucocorticoids
Metastasis - breast - colon - prostate - bladder -

10. At What terminal does CO2 bind the globin molecule
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Ivory white calcified pleural plaques
N- terminus - carbaminohemoglobin

11. What are the associations with bronchiectasis

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12. Where is cartilage present in the respiratory tree
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Trachea and bronchi

13. What are curschmann's spirals
Inc O2 consumption
Upper lobes
Shed epithelium from mucus plugs
Methacholine challenge

14. What is the V/Q ratio at the apex and base of the lung
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Carcinoid - carcinoid
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

15. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Air in lung after maxmimal expiration - cannot be measured on spirometry
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Long bone fractures and liposuction
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

16. What kind of connection exists between endothelial cells in the capilaries
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Deoxygenated blood - elastic walls
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Tight jxns

17. What is obstructive sleep apnea
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Dec in the FEV1/FVC
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Respiratory effort against airway obstruction

18. What are the causes of hypoxemia
Coal miner's - silicosis - abestosis
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

19. 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
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
On expiration as radius dec
Carcinoid - carcinoid
Ivory white calcified pleural plaques

20. Why is endothelial damage a risk factor for DVT
Lungs collapse inwards and chest wall spring out
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
Airways close prematurely resulting in inc RV and dec FVC
Exposed collagen fibers provides impetus for clotting cascade

21. Which pts are at risk for apriation PNA
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Alchoholics or epileptics
Dec - no change
Metastasis - breast - colon - prostate - bladder -

22. What cells in the lung produce surfactant and What does it do
Person stops breathing for at least 10 seconds repeatedly during sleep
Steroids to mom - artificial surfactant and thyroxine to neonate
Right lung - right main stem bronhus is wider and more vertical
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

23. What TX is the mother given before delivery - and what TXs are given to the infant
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Steroids to mom - artificial surfactant and thyroxine to neonate
Inc production
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

24. Other than surfactant - what other important substances are produced by the lungs
Inc production
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
P = 2ST/radius
Prostaglandins - histamine - ACE - kallikrein

25. What findings are associated with emphysema
No change - but inc venous CO2 content
Respiratory bronchioles - clear debris in alveoli - bronchi
Dec in lung volumes - FVC - TLC
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

26. Lung absecss often reults From what organisms
S. aureus or anaerobes
Shed epithelium from mucus plugs
Type II pneumocytes - after week 35
Inspiration by diaphragm - expiration is passive

27. Chronic bronchitis is a disease of what kind of airways
Long bone fractures and liposuction
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Small airways
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

28. Define expiratory reserve volume (ERV)
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Air that can still be breathed out after nl expiration
Surfactant
Lowered

29. What are fat emboli associated with
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
L/S < 1.5
Metastasis - breast - colon - prostate - bladder -
Long bone fractures and liposuction

30. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Type II pneumocytes - after week 35
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
IRV + TV + ERV + RV

31. What are the 3 forms that CO2 is transported from tissues to lungs
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Type II pneumocytes - after week 35
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

32. What are the risk factors for neonatal RDS
Prematurity - maternal RDS - cesarean delivery
High alveolar pressure compresses capillaries
Steroids to mom - artificial surfactant and thyroxine to neonate
Alchoholics or epileptics

33. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Tension pneumo - away from lesion
Ratio from apex to base becomes more uniform
Respiratory bronchioles - clear debris in alveoli - bronchi
0 - negative - prevents pneumothorax

34. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Squamous cell carcinoma - keratin pearls and intracellular bridges
Lungs collapse inwards and chest wall spring out
Dec - no change
Activates bradykinin

35. What is carboxyhemoglobin and What does it cause
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Both highest in the base
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

36. What changes in ventilation rate occur during exercise
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Inc to meet O2 demand
FEV1/FVC > 80%
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

37. What organisms cause interstitial PNA and What are the characteristics
Coal miner's - silicosis - abestosis
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Tension pneumo - away from lesion
Inc 2 -3- DPG - righward shift

38. What is a typical tidal volume
Right lung - right main stem bronhus is wider and more vertical
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
500mL
PVR = (PpulmA - PleftA)/CO

39. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Matched - =1 adequate gas exchange
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Lobar PNA

40. What do PFTs show in restrictive lung disease
Bleomycin - busulfan - anmiodorone
Lower portion of right inferior lobe
FEV1/FVC > 80%
Exposed collagen fibers provides impetus for clotting cascade

41. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

42. What does a V/Q ratio of 0 indicate
N- terminus - carbaminohemoglobin
Airway obstruction (shunt) 100% O2 does not improve PO2
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Coal miner's - silicosis - abestosis

43. What is the protein content in a transudative pleural effusion and What are the potential causes
Dipalmatoyl phosphatidylcholine
Milky fluid with inc TGs
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
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

44. What increases the risk of PDA in neonatal RDS
PVR = (PpulmA - PleftA)/CO
N- terminus - carbaminohemoglobin
Pa > PA > Pv
Persistently low O2 tension

45. How happens to the proton from the rxn the created bicarb
It binds to Hb -
Weight loss - CPAP - surgery
More indolent
FRC - inward pull of lung balanced by outward pull of chest wall

46. Toxicities of what drugs include interstitial lung disease
S. aureus or anaerobes
Bleomycin - busulfan - anmiodorone
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

47. What are the potential TX for sleep apnea
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Hypoxic vasocxn
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Weight loss - CPAP - surgery

48. What is the pathology of asthma

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49. What is occupied in the space that would have been the left middle lobe
Heart
Dipalmatoyl phosphatidylcholine
Dorsiflexion of food leads to tender calf muscle
Anatomic dead space and smooth muscle

50. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
On expiration as radius dec
High alveolar pressure compresses capillaries
Hypertrophy of mucus secreting glands in the bronchioles
Pleural effusion

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