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Respiratory

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1. What is an example of hypercoagulability
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Inoperable - responsive to chemotherapy
Defect in coagulative cascace proteins
Mismatch

2. What is pulmonary surfactant made of - and What does it do
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Brings air in and out - warms - humidifies - filters
Dipalmatoyl phosphatidylcholine - decreases surface tension

3. What is early onset hypoxemia from in chronic bronchitis
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Shunting
CO2 - acid/altitude - DPG - Exercise - Temperature

4. What drug therapy is used to augment the changes in bicarb exretion
Acetazolamide - inhibits CA and acidifies the blood
Fe 2+
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Zone 1

5. What is central sleep apnea
Elastase
No respiratory effort
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

6. 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
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
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Inc excretion of bicarb to compensate for respiratory alkalosis

7. What changes in 2 -3 - DPG occur at high altitude
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Respiratory effort against airway obstruction

8. What direction does an increase in metabolic need shift the O2 dissociation curve
Right
Lower portion of right inferior lobe
Viral - URIs - allergens and stress
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

9. What is the formula for A- a gradient - and What is it normally
No respiratory effort
PAO2 - PaO2 = 10-15 mmHg
Type II cells
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

10. What does pulm HTN result in
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Upper lobes
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Alpha1- antitrypsin def - also cirrhosis

11. What are the potential TX for sleep apnea
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
Prematurity - maternal RDS - cesarean delivery
RV + ERV - volume in lungs after nl expiration

12. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Brings air in and out - warms - humidifies - filters
Dipalmatoyl phosphatidylcholine - decreases surface tension
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

13. What changes in O2 consumption change during exercise
Inoperable - responsive to chemotherapy
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
L/S < 1.5
Inc O2 consumption

14. What is the imaging test of choice for PE
Drainage
PVR = (PpulmA - PleftA)/CO
Clara cells - type II pneumocytes; multiple densitites on CXR
CT angio

15. Other than surfactant - what other important substances are produced by the lungs
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Centriacinar
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Prostaglandins - histamine - ACE - kallikrein

16. What is the pathology of asthma

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17. Why is endothelial damage a risk factor for DVT
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Pleural effusion
Exposed collagen fibers provides impetus for clotting cascade
<75

18. What is the tendency of the lungs vs the chest wall
Dipalmatoyl phosphatidylcholine - decreases surface tension
No respiratory effort
Lungs collapse inwards and chest wall spring out
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

19. What does ACE do
IRV + TV
Upper lobes
20.1 mL O2 /dL
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

20. What lobes does Coal Miner's pneumoconioses affect - and What can it result in

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21. What doe FAT BAT stand for
Clara cells - type II pneumocytes; multiple densitites on CXR
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Steroids to mom - artificial surfactant and thyroxine to neonate
Histiocytosis X - Langerhans cells

22. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Air in lung after maxmimal expiration - cannot be measured on spirometry
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Carcinoid - carcinoid

23. What changes in ventilation rate occur during exercise
Inc to meet O2 demand
Carcinoid - carcinoid
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Activates bradykinin

24. What happens with the O2 curve shifts to the right and What does it facilitate
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Steroids to mom - artificial surfactant and thyroxine to neonate
CO - 200x
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

25. What does CADET face to the right stand for
Hypertrophy of mucus secreting glands in the bronchioles
Weight loss - CPAP - surgery
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
CO2 - acid/altitude - DPG - Exercise - Temperature

26. What causes secondary pulm HTN
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Loss of blood flow - impeded arterial flow - reduced venous drainage
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

27. What are the subtypes of pneumoconioses

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28. Define functional residual capacity (FRC)
RV + ERV - volume in lungs after nl expiration
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Lost with alveolar walls

29. 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
PVR = (PpulmA - PleftA)/CO
Bronchial obstruction - toward side of lesion
Inc resistance leading to inc pressure
Dec - due to lactic acidosis

30. Chronic bronchitis is a disease of what kind of airways
Dec
Inc O2 consumption
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Small airways

31. What happens to O2 content and O2 sat as Hb falls
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Dec - no change
Lost with alveolar walls
Dec cross sectional area of pulm vasc bed

32. What is the fxn of the conducting zone
Brings air in and out - warms - humidifies - filters
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Air that can still be breathed out after nl expiration
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

33. What is are the symptoms of a pulmonary embolism
Chest pain - tachypnea and dyspnea
IRV + TV
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Respiratory bronchioles - clear debris in alveoli - bronchi

34. Toxicities of what drugs include interstitial lung disease
Inc to meet O2 demand
Chest pain - tachypnea and dyspnea
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Bleomycin - busulfan - anmiodorone

35. What are the histological findings in asbestosis and what occupations are associated
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Defect in coagulative cascace proteins
Dec - due to lactic acidosis
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

36. What increases the risk of PDA in neonatal RDS
DIC - especially postpartum
Squamous cell carcinoma - keratin pearls and intracellular bridges
Persistently low O2 tension
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

37. What is the main complication of therapeutic supplemental O2?
Retinopathy of maturity
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Alchoholics or epileptics
Inc airway pressure to prevent airway collapse during exhalation

38. What are the risk factors for neonatal RDS
Ratio from apex to base becomes more uniform
Centriacinar
Everything but RV - TV + IRV + ERV
Prematurity - maternal RDS - cesarean delivery

39. What are the causes of hypoxemia
Air in lung after maxmimal expiration - cannot be measured on spirometry
O2 binding x O2 sat + dissolved O2
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

40. In which zone of the lung is PA > Pa > Pv
DIC - especially postpartum
RALS - righ anterior - left superior
Loss of elastic fibers
Zone 1

41. How does recurrent thromboemboli cause pulm HTN
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Dec cross sectional area of pulm vasc bed
Persistently low O2 tension

42. Define tidal volume (TV)
Air that moves into lung with each quiet respiration
Positive cooperativity and negative allostery - unlike myoglobin
Alchoholics or epileptics
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

43. How many lobes does each lung have - and What is the lingula
Lobar PNA
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Acute/chronic inc in vent

44. Define vital capacity (VC)
Right shift - favors taut - low affinity for O2 - O2 unloading
Surfactant def leading to inc surfact tension and alveolar collapse
Everything but RV - TV + IRV + ERV
Respiratory bronchioles - clear debris in alveoli - bronchi

45. Why do pts with emphysema exhale through pursed lips
O2 binding x O2 sat + dissolved O2
Inc 2 -3- DPG - righward shift
Inc airway pressure to prevent airway collapse during exhalation
Coal miner's - silicosis - abestosis

46. What is the protein content an exudative pleural effusion and What are the potential causes
Low resistance and high compliance
Chronic hypoxic vasocxn
Brings air in and out - warms - humidifies - filters
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

47. Define inspiratory capacity (IC)
IRV + TV
Drainage
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Acetazolamide - inhibits CA and acidifies the blood

48. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Upper lobes
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
PA02 = 150 - PACO2/0.8
Right shift - favors taut - low affinity for O2 - O2 unloading

49. What layers must CO2 and O2 traverse to complete gas exchange
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Weight loss - CPAP - surgery
Hypertrophy of mucus secreting glands in the bronchioles
Dipalmatoyl phosphatidylcholine - decreases surface tension

50. What are mucus secretion swept out by
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Ciliated cells
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

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