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Respiratory

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1. Define vital capacity (VC)
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
<75
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Everything but RV - TV + IRV + ERV

2. What is the defect in panacinar emphysema - and what else do you see
Alpha1- antitrypsin def - also cirrhosis
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Squamous cell carcinoma - keratin pearls and intracellular bridges
TB - apex

3. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Right lung - right main stem bronhus is wider and more vertical
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Lowered
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

4. What findings are associated with emphysema
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Positive cooperativity and negative allostery - unlike myoglobin
Low resistance and high compliance
Acute/chronic inc in vent

5. What does PFTs show in COPD
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Dec dec in FEV1 - dec in FVC
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

6. What are curschmann's spirals
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
CO - 200x
Shed epithelium from mucus plugs

7. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Inc 2 -3- DPG - righward shift
CO - 200x
Airways close prematurely resulting in inc RV and dec FVC

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

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9. What are the findings of chronic bronchitis
Ratio from apex to base becomes more uniform
Mesothelioma - pleura - psammoma bodies
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
FRC - inward pull of lung balanced by outward pull of chest wall

10. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Inc 2 -3- DPG - righward shift
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

11. What causes secondary pulm HTN
Carcinoid - carcinoid
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Bleomycin - busulfan - anmiodorone

12. What is Homan's sign
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Fe 2+
Dorsiflexion of food leads to tender calf muscle
Lost with alveolar walls

13. What is a typical tidal volume
Centriacinar
500mL
<75
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

14. Why is cesarean delivery a risk factor for neonatal RDS
Dec release of fetal glucocorticoids
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Dec cross sectional area of pulm vasc bed
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

15. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
IRV + TV + ERV + RV
Inc mitochondria
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
RALS - righ anterior - left superior

16. What reaction and enzyme create bicarb and Where does it happen
Tight jxns
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
500mL
Hyaline membrane disease

17. What do PFTs show in restrictive lung disease
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Metastasis - breast - colon - prostate - bladder -
Inc EPO leading to erythrocytosis
FEV1/FVC > 80%

18. What layers must CO2 and O2 traverse to complete gas exchange
Gland depth/total thickness of broncial wall - >50%
DIC - especially postpartum
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Deoxygenated blood - elastic walls

19. What changes in O2 consumption change during exercise
Inc O2 consumption
Alpha1- antitrypsin def - also cirrhosis
Lost with alveolar walls
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

20. Which pts are at risk for apriation PNA
Alchoholics or epileptics
Elastase
Brings air in and out - warms - humidifies - filters
Lost with alveolar walls

21. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
C3 - 4 - 6 - phrenic nerve - referred to shoulder
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Pa > PA > Pv
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

22. What TX is the mother given before delivery - and what TXs are given to the infant
Steroids to mom - artificial surfactant and thyroxine to neonate
Fe 2+
Alpha1- antitrypsin def - also cirrhosis
0 - negative - prevents pneumothorax

23. What happens with the O2 curve shifts to the right and What does it facilitate
DIC - especially postpartum
Surfactant
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

24. What changes in ventilation rate occur during exercise
Mismatch
L/S > 2 = lecithin/sphingomyelin
Inc to meet O2 demand
CO x O2 content of blood

25. What is the equation for physiologic dead space
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
CO2 - acid/altitude - DPG - Exercise - Temperature
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

26. What does ACE do
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Air that can still be breathed out after nl expiration
Heparin
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

27. What is carboxyhemoglobin and What does it cause
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
Tension pneumo - away from lesion
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Right lung - right main stem bronhus is wider and more vertical

28. What kind of course does interstitial PNA follow in comparison to bronchoPNA
20.1 mL O2 /dL
Dorsiflexion of food leads to tender calf muscle
Dec release of fetal glucocorticoids
More indolent

29. What cells make surfactant and At what week is produced most abundantly
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Dec - due to lactic acidosis
Type II pneumocytes - after week 35
RV + ERV - volume in lungs after nl expiration

30. What lung product is deficient in neonatal RDS
Inc to meet O2 demand
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Surfactant

31. 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
Shunting
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

32. What is used to treat CN poisoning and why
Hypertrophy of mucus secreting glands in the bronchioles
On expiration as radius dec
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
L/S < 1.5

33. What is the leading cause of cancer death
Person stops breathing for at least 10 seconds repeatedly during sleep
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Lung cancer
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

34. What do pulmonary arteries carry - and how are pulm arterial pressures maintained during the cardiac cycle
Deoxygenated blood - elastic walls
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Histiocytosis X - Langerhans cells

35. What does the conducting zone consist of...
Inc production
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Inc shear stress leading to endothelial injury
CO - 200x

36. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Histiocytosis X - Langerhans cells
Right shift - favors taut - low affinity for O2 - O2 unloading

37. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Long bone fractures and liposuction
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
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

38. Define residual volume (RV)
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Air in lung after maxmimal expiration - cannot be measured on spirometry

39. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Exposed collagen fibers provides impetus for clotting cascade
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
CO2 - acid/altitude - DPG - Exercise - Temperature
On expiration as radius dec

40. What are the causes of hypoxia
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Clara cells - type II pneumocytes; multiple densitites on CXR
Dipalmatoyl phosphatidylcholine
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

41. What changes occur to pulm blood flow during exercise
Methacholine challenge
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Inc due to inc CO
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor

42. What is the TX for small cell lung cancer
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Inoperable - responsive to chemotherapy
Dec

43. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
CO2 - acid/altitude - DPG - Exercise - Temperature
Pleural effusion
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Inc

44. What organisms cause a bronchoPNA and What are the characteristics
S. aureus or anaerobes
More indolent
Mismatch
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

45. Where is cartilage present in the respiratory tree
Trachea and bronchi
Methylene blue
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Fe 2+

46. What is an association and potential complication of paraseptal emphysema
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
CO2 - acid/altitude - DPG - Exercise - Temperature
Mismatch

47. Chronic bronchitis is a disease of what kind of airways
Small airways
Ivory white calcified pleural plaques
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Shed epithelium from mucus plugs

48. Why is there eventual loss of capillary beds in emphysema
Weight loss - CPAP - surgery
Lost with alveolar walls
Pleural effusion
On expiration as radius dec

49. At What terminal does CO2 bind the globin molecule
Dorsiflexion of food leads to tender calf muscle
N- terminus - carbaminohemoglobin
Respiratory effort against airway obstruction
Airway obstruction (shunt) 100% O2 does not improve PO2

50. 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
Surfactant def leading to inc surfact tension and alveolar collapse
20.1 mL O2 /dL
Prematurity - maternal RDS - cesarean delivery
Bronchial obstruction - toward side of lesion

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