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Flashcards in Respiratory 1 USMLE Deck (127):
1

pt exhibits an extended epiratory phase. What is the dz process?

obstructive lung dz

2

tall, thin male teenagesr has abrupt-onset dyspnea and left sided chet pain. There is hyperresonant percussion on the affected side, and breath sounds are diminished. What is the dx?

spontaneous pneumothorax

3

young wife is concerned about his wifes inability to conceive and her recurrent URIs. She has dextrocardia. Which of her proteins is defective?

dynein (Kartagener's)

4

pseudocolumnar ciliated cells extend to _______ bronchioles

respiratory

5

goblet cells extend only to the ________ bronchioles

terminal

6

this type pneumocytes line the alveoli (97% of the aveolar surfaces)

type I cells

7

this type pneumocytes secrete pulmonary surfactant (dipalmitoyl phosphatidylcholine), which decrease the alveolar surface tension.

type II cells

8

These cells also serve as precursors to type I cells and other type II cells. They proliferated during lung damage

type II cells

9

mucus secretions are swept out of the lungs toward the mouth by these cells

ciliated cells

10

a lecithin-to-sphingomyelin ratio of this in amniotic fluid is indicative of fetal lung maturity

>2.0

11

each bronchopulmonary segment has a tertiary (segmental) bronchus and 2 of these in the center; veins and lymphatics drain along the borders

arteries (bronchial and pulmonary

mneu:arteries run with airways

12

the right lung has this many lobes

3

13

the left lung has this many lobes

2

14

what is the homologue of the right middle lobe

lingula

15

which is the more common site foir inhaled foreign body owing to the less acute angle of the main stem bronchus

right lung

16

The relation of the pulmonary artery to the bronchus at each lung hilus is described as this

RALS--
Right Anterior, Left superior

17

Stuctures perforating diaphram:
IVC
Esophagus, vagus (2 trunks)
aorta (red), thoracic duct (white), azygous vein (blue

T8
T10
T12

18

what is the diaphram innervatd by

phrenic nerve (C3,4,5)

19

pain from the diaphram can be referred here

shoulder

20

what are the mm of respiration in quiet breathing

inspiration-diaphram
expiration-passive

21

what are the mm of respiration in exercise

expiration-external intercostals, scalene muscles, sternomastoids

inspiration-rectus abdominis, internal and external obliques, transversus abdominis, internal intercostals

22

in high altitude respiration will ____

increasie

23

in high altitude erythropoietin will ____

increase leading to increase in HCT & HGB

24

in high altitude 2,3-DPG will ______

increase

DPG binds to HGB so that HGB releases more O2

25

in high altitude this cellular changes occurs _____

increase in mitochondria

26

in high altitude there is an increased renal excretion of this

bicarbinate
(compinsatig for respiratory alkalosis)

27

in high altitude chronic hypoxic pulmonary vasoconstriction will result in this cardiac change

RVH

28

this is produced by type II pneumocytes, it decreases alveolar surface tension, and inceases compliance

surfactant

29

surfactant or dipalmitoyl phosphatidylcholine (lecithin) is deficient in this neonatal syndrome which occurs often in premies

neonatal RDS

30

give 4 other important lung products

prostaglandins
histamine
Angiotensin converting enzyme (ACE)
kallikrein

31

how do ACE inhibitors cause cough

increase bradykinin which causes cough and causes angioedema

32

Kallikrein activates what?

bradykinin

33

what is the collapsing pressure of alveola

2 (tension)/radius

34

this describes the air in lung after maximal expiration

residual volume (RV)

35

this describes air that can still be breathed out after normal expiration

expiratory reserve volume (ERV

36

this describes air that moves into lung with each quiet inspiration, typically 500 mL

tidal volume (TV)

37

this describes air in excess of tidal volume that moves into lung on maximal inspiration

Inspiratory reserve volume (IRV

38

vital capacity (VC)=

TV+IRV+ERV

39

Functional reserve capacity (FRC)=

RV+ERV
(volume in lungs after normal expiration)

40

Inspiratory capacity (IC)=

IRV + TV

41

Total lung capacty(TLC)=

IRV+TV+ERV+RV

42

vital capacity is everything but this

residual volume

43

an decrease in all factors (except pH) causes a shift of the curve to the ______

left

44

right shift --CADET face RIGHT - stands for

CO2
Acid/Altitude
DPG (2,3-DPG)
Exercise
Temperature

45

pulmonary circulation is normally a _____ resistance, ____ compliance system

low
high

46

PO2 & PCO2 exert opposite effects on pulmonary and systemic circulation. A decrease in PaO2 causes this

hypoxic vasoconstriction that shifts blood away from the poorly ventilated regions of the lung to well ventilated regions of the lung

47

what is a consequence of pulmonary hypertension

cor pulmonale and subsequent right ventricular failure

48

what is a physical exam finding of cor pulmonale and subsequent right ventricular failure

jugular venous distension, edema, hepatomegaly

49

Is this perfusion limited or diffusion limited?
O2 (normal health), CO2, N2O. Gas equilibrates early along the lenght of the capillary. Diffusion can be increased only if blood flow increases.

perfusion limited

50

Is this perfusion limited or diffusion limited?
O2 (exercise, emphysema, fibrosis), CO. Gas does not equilibrate by the time blood reaches the end of the capillary

diffusion limited

51

Determination of physiologic dead space (VD)=

VT x [(PaCO2-PeCO2)/PaCO2

PaCO2=arterial PCO2,
PeCO2=expired air PCO2

52

when a curve shifts to this direction there is a decreased affinity of hgb for O2 (facilitates unloading of O2 to the tissue)

right

53

an increase in all factors (except pH) causes a shift of the curve to the ______

right

54

ideally, ventilation is matched to perfusion in order to achieve adequate gas exchange. V/Q=

1

55

Both ventilatio and perfusion are greater at this part of the lung.

base of the lung

56

at the apex of the lung V/Q=

3 (wasted ventilation)

57

at the base of the lung V/Q=

0.6 (wasted perfusion

58

during this, there is an increase in cardiac output and therefore a vasodilation of apical capillaries resulting in a V/Q ratio that approaches 1

exercise

59

certain organisms thrive in high O2 and flurish at the apex of the lung. Give an example of such an organism

TB

60

when V/Q =0 this is happening

there is an airway obstruction(shunt)

61

when V/Q =infinity

this is happening

there is a blood flow obstruction (physiologic dead space

62

CO2 is transported from the tissue to the lungs in 3 forms. What are they

1) Bicarbinate (90%)
2) bound to hgb as carbinohemoglobin (5%)
3) dissolved CO2 (5%)

63

what is the haldane effect?

in lungs, oxygenation of hemoglobin promotes dissociation of CO2 from hgb

64

what is the bohr effect

in peripheral tissue, increased H+ shifts curve to the right unloading O2

65

alveolar-arterial O2 difference=

[(A-a)Do2]<10 mmHg

66

this dz results from an obstruction of air flow, resulting in air trapping in the lungs

COPD

67

what will PFTs show with COPD

decreased FEV1/FVC ratio

68

this type of COPD manifests with a productive cough for >3consecutive months in 2 or more years. There is a hypertrophy of mucus-secreting glands in the bronchiles (Reid index >50%)

chronic bronchitis ("Blue Bloater")

69

what PE findings might you find with chronic bronchitis

wheezing, crackles, cyanosis

70

what is the leading cause of chronic bronchitis

smoking

71

this type of COPD manifests with enlargement of air spaces and decreased recoil resulting from destruciton of alveolar walls.

emphysema ("pink puffer")

72

smoking causes this type of emphysema

centriacinar emphysema

73

alpha 1 antitrypsin deficiency causes this type of deficiency

panacinar

74

alpha 1 antitrypsin deficiency also causes this

liver cirrhosis

75

in emphysema there is increased activity of this enzyme

elastase

76

what are some PE findings in emphysema

dyspnea, decreased breath sounds, tachycarida, decreased inspiration/expiration ratio

77

this form of COPD is caused by bronchial hyperresponsiveness that causes reversible bronchostrinction.

asthma

78

name some triggers for asthma

viral URIs, allergins, and stress

79

give some findings in asthma

cough, wheezing, dyspnea, tachypnea, hypoxemia, decrease I/E ratio, pusus paradoxus, Curschmann's spirals, smooth muscle hypertrophy, mucous plugging

80

this form of COPD is caused by chronic necrotizing infection of bronchi resulting in dilated airways purulent sputum, recurrent infections, hemoptysis. Associated with bronchial obstruction, CF, poor ciliary motility, and Kartagener's syndrome

Bronchiectasis

81

in this dz, restricted lung expansion causes decreased lung volumes (decreased VC and TLC)

restrictive lung dz

82

what will PFTs show with restrictive lung dz

FEV1/FVC ratio > 80%

83

give 2 types of restrictive lung dz that result from poor breathing mechanics (extrapulmonary)

1) poor muscular effort - polio, myasthenia gravis
2) poor structural apparatus --scoliosis, morbid obesity

84

give 4 types of restrictive lung dz that result from interstitial lung diseases (pulmonary)

1)adult respiratory distress syndrome (ARDS)
2)neonatal rspiratory distress syndrome (hyaline membrane dz)
3) pneumoconioses (coal miner's silicosis, asbestosis)
4) sarcoidosis
5) idiopathic pulmonary fibrosis
6) Goodpasture's syndrome
7) Wegener's granulomatosis
8) eosinophilic granulomas

85

describe the physical exam findings of bronchial obstruction
BS:
Resonance:
Fremitus:
Tracheal Deviation:

BS: absent/decreased over affected area
Resonance:↓
Fremitus:↓
Tracheal Deviation: toward side of lesion

86

describe the physical exam findings of pleural effusion BS:
Resonance:
Fremitus:
Tracheal Deviation:

BS: ↓ over effusion
Resonance:dullness
Fremitus:↓
Tracheal Deviation: NA

87

describe the physical exam findings of pneumonia
BS:
Resonance:
Fremitus:
Tracheal Deviation:

BS: may have bronchial BS over the lesion
Resonance: dullness
Fremitus: ↑
Tracheal Deviation: NA

88

describe the physical exam findings of pneumothorax
BS:
Resonance:
Fremitus:
Tracheal Deviation:

BS:↓
Resonance: hyperresinant
Fremitus: absent
Tracheal Deviation: away from side of lesion

89

obstructive lung volumes are ____ normal

> (↑TLC,↑FRC,↑RV)

90

restrictive lung volumes are ___ normal

<

91

in both obstructive and restrictive lung dz, these are reduced

FEV1 & FVC

92

in obstructive or restrictive lung dz is FEV1 more dramatically reduced resulting in a decreased FEV1/FVC ratio

obstructive lung dz

93

this syndrome causes immotile cilia due to a dynein arm defect. It results in male and female infertility (sperm immobile), bronchiectasis, and recurrent sinusitis (bacteria and particles not pushed out); associated with situs inversus

Kartagener's syndrome

94

this is caused by diffuse pulmonary interstitial fibrosis caused by inhaled asbestos fibers

asbestosis

95

asbestosis increase the risk of these 2 malignancie

mesothelioma and bronchogenic carcinoma

96

asbestosis and smoking greatly increases the risk of this malignancy

bronchiogenic cancer (smoking is not additive with mesothelioma)

97

ivory-white pleural plaques and ferruginous bodies are often seen in the lungs of people with asbestosis. What are ferruginous bodies

asbestos fiber coated with hemosiderin

98

asbestosis is often seen in these 2 professions

shipbuilders and plumbers

99

this syndrome in neonates results from a surfactant deficiency leading to increased surface tension, resulting in alveolar collapse.

neonatal respiratory distress syndrome

100

surfactant is made by these pneumocytes most abundantly after 35th week of gestation

type II pneumocytes

101

what is the lecithin-to-sphingomyelin ratio in the amniotic fluid (measure of lung maturity) in neonatal respiratory distress syndrome

<1.5

102

what is surfactant

dipalmitoyl phosphatidylcholine

103

what is the treatment for neonatal respiratory distress syndrome

maternal streroids before birth; artificial surfactant for infant

104

what is the leading cause of cancer death

Lung CA

105

these are bronchogenic carcinomas that arise CENTRALLY

squamous cell carcinoma
small cell carcinoma

mneu: Small Squamous Center

106

these 2 forms of lung cancer have a clear link to smoking

squamous cell carcinoma
small cell carcinoma

mneu: S & S from Smoking

107

squamous cell carcinoma sometimes produces this peptide

PTH-related peptide

108

small cell carcinoma sometimes produces these hormones

ADH, ACTH

109

small cell carcinoma sometimes produces this syndrome

Lambert-Eaton syndrome

110

this lung cancer often presents with cough, hemoptysis, bronchial obstruction, wheezingg, pneumonic "coin" lesion on x-ray

small cell carcinoma

111

what are the bronchogenic carcinomas that arise peripherally

1) adenocarcinoma (most common)
2)bronchioalveolar carcinoma
3) large cell carcinoma

112

is bronchioalveolar carcinoma thought to be related to smoking

No

113

Lung CA can cause a SPHERE of complictions. name them

Superior vena cava syndrome
Pancoast's tumor
Horners syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (horseness)
Effusions (pleural or paricardial)

114

this type of lung tumor causes flushing, diarrhea, wheezing, and salivation

carcinoid tumor

115

symptoms such as siezure, bone fracture, jaundice or hepatomegly may be a sign that lung cancer has done this

metastesized

116

this is a carcinoma that occurs in the apex of lung and may affect cervical sympathetic plexus, causing Horner's syndrome

pancoast's tumor

117

what is horner's syndrome

ptosis, miosis, anhidrosis

118

this type of pneumonia involves intra-alveolar exudate which develops into consolidation. It may involve the entire lung.

lobar pneumonia

119

what organism is usually implicated in lobar pneumonia

pneumococcus most frequently

120

this type of pneumonia involves acute inflammatory infiltrates from bronchioles into adjacent alveoli. There is a patchy distribution involving >/=1 lobes

bronchopneumonia

121

what organism is usually implicated in bronchopneumonia

S. aureus, H. flu, Klebsiella, S. pyogenes

122

this type of pneumonia involves diffuse patchy inflammation localized to interstitial areas at alveolar walls. Distribution involves >/=1 lobes

intertitial (atypical) pneumonia

123

what organism is usually implicated in intertitial (atypical) pneumonia

viruses (RSV, adenoviruses), mycoplasma, legionella, chlamydia

124

the lipoxygenase pathway yields thses

Leukotrienes

mne: L for lipoxygenase and leukotriene

125

LTB4 is this

neutrophil chemotactic agent

126

LTC4,D4, and E4 fuction in this

bronchoconstriction, vasoconstriction, constrictionof smooth mm, andincreased vascular permeability

127

PGI2 does this

inhibits platelet aggregation and promotes vasodilation

mneu: Platelet-Gathering Inhibitor