Respiratory

Question 1

Type 1 pneumocytes

Answer 1

line alveoli

for gas exchange

Question 2

Type 2 pneumocytes

Answer 2

produce surfactant
proliferate during lung damage
precursor to pneumocytes I and II

Question 3

Expiratory muscles

Answer 3

abs

internal intercostals

Question 4

Hysteresis

Answer 4

difference b/t inspiration and expiration Vol/P graph

due to overcoming surface tension in inspiration

Question 5

Functional reserve capacity

Answer 5

after normal expiration

chest wall expansion=lung elasticity

Question 6

Bohr effect

Answer 6

oxygen more readily released by Hb with increased 2,3-BPG, H+, Cl-, CO2, temp

Question 7

Methemoglobin

Answer 7

ferric iron bound (Fe3+)
does not readily bind oxygen
tx with methylene blue

Question 8

Pulmonary hypoxia

Answer 8

causes vasoconstriction (unlike other tissues)

Question 9

Primary PAH

Answer 9

BMPR2 gene inactivating mutation

PAH over 25mmHg

Question 10

Secondary PAH

Answer 10

from COPD or recurrent thromboemboli

Question 11

Cor pulmonale

Answer 11

RVH and cyanosis

Question 12

V/Q mismatches

Answer 12

V/Q=0, airway obstruction

V/Q=infinity, infarct/no blood flow

Question 13

V/Q values of the lung

Answer 13

ideal=1
apex of lung is higher (less blood flow)
base of lung is low (more blood flow)
overall base has more V and Q though

Question 14

Haldane effect

Answer 14

RBC’s release CO2 when increased O2 present (in lungs)

Question 15

High altitudes on blood chemistry

Answer 15

decreased PCO2 (hyperventilation)
increased RBC’s/EPO
increased 2,3-BPG (increased oxygen release)

Question 16

Virchow’s triad and Homan’s sign

Answer 16

Stasis
hypercoagulability
endothelial damage
all for DVT
Homan's-dorsiflexion of foot causes pain=DVT

Question 17

DVT treatment

Answer 17

heparin for acute

warfarin for long term

Question 18

Sign of pulmonary emboli

Answer 18

hypoxemia
CNS sx
petechial rash

Question 19

Obstructive lung disease characteristics

Answer 19

barrel chest (increased residual volume)
increased FEV1/FVC ration

Question 20

Chronic bronchitis

Answer 20

COPD with emphysema
hypertrophy of mucous glands
hypercapnea/wt gain (blue bloaters)
productive cough over 3 mo for over 2 years

Question 21

Emphysema

Answer 21

pink puffers
pursed lips/erythematous
increased lung compliance

Question 22

Centriacinar emphysema

Answer 22

increased proteases

from smoking

Question 23

Panacinar emphysema

Answer 23

decreased antiprotease (A1AT deficiency)

Question 24

Paraseptal emphysema

Answer 24

giant bullae

spontaneous pneumothorax in young males

Question 25

Asthma characteristics

Answer 25

Curschmann spirals (mucus plugs) Charcot Leyden crystals (eosinophil breakdown) hyperresponsiveness smooth muscle hypertrophy

Question 26

Bronchiectasis characteristics

Answer 26

chronic necrotizing bronchi infection permanently dilates airways assc with Cystic fibrosis/Kartagener's syndrome/allergic bronchopulmonary aspergillosis

Question 27

Restrictive lung disease characteristics

Answer 27

decreased lung volume normal FEV1/FVC caused by fibrosis/damage to lungs Sarcoidosis/Goodpasture's/Wegener's

Question 28

Anthracosis

Answer 28

upper lungs | assc with coal miners

Question 29

Silicosis

Answer 29

increased TB/bronchogenic carcinoma sandblasting/foundry work disruption of macrophages fibrosis/upper lungs

Question 30

Asbestosis

Answer 30

lower lungs calcified pleural plaques increased mesothelioma/carcinoma golden-brown fusiform rods (asbestos bodies)

Question 31

Neonatal respiratory distress syndrome

Answer 31

tx with corticosteroids before birth decreased surfactant risk of PDA with low oxygen levels risk with maternal DM

Question 32

Acute respiratory distress syndrome

Answer 32

ARDS intra alveolar hyaline membrane ROS damage lungs triggered by traumatic event

Question 33

Obstructive sleep apnea

Answer 33

assc with obesity HTN hypoxia causes increased EPO/RBC production

Question 34

Resorption atelectasis

Answer 34

airway obstruction | deviates toward obstruction

Question 35

Compression atelectasis

Answer 35

air/fluid in pleural space | deviates away

Question 36

Contraction atelectasis

Answer 36

fibrotic, irreversible lung damage | prevents full expansion

Question 37

Lung cancer

Answer 37

most common is metastatic (breast,colon,prostate) | coin lesion on x-ray

Question 38

Adenocarcinoma of lungs

Answer 38

nonsmoking females | K-RAS mutation

Question 39

SSC of lungs

Answer 39

hilar mass cavitation/cigarettes/hypercalcemia keratin pearls

Question 40

Small cell carcinoma of lung

Answer 40

undifferentiated Lambert-Eaton assc myc oncogene mutation Kulchitsky cells (dark blue cells)

Question 41

Mesothelioma

Answer 41

assc with asbestos hemorrhagic pleural effusions pasammoma bodies

Question 42

SVC syndrome

Answer 42

impaired blood drainage from head | assc with malignancy or indwelling catheters

Question 43

Lobar pneumonia

Answer 43

Strep pneumo Klebsiella bacterial

Question 44

Interstitial pneumonia

Answer 44

viral/intracellular origin mycoplasma/legionella/chlyamydia influenza/RSV/adenovirus

Question 45

Cause of lung abscesses

Answer 45

S. aureus anaerobes (Bacteroides/fusobacterium) air fluid levels on CXR

Question 46

Transudate cause

Answer 46

CHF | cirrhosis

Question 47

1st gen H1 blockers

Answer 47

diphenhydramine/dimenhydrinate/chlorpheniramine cross BBB cause sedation and antimuscarinic effects

Question 48

Theophylline

Answer 48

``` inhibits phosphodiesterase (bronchodilates) can cause cardio/neurotoxicity ```

Question 49

MOA of ipratoprium

Answer 49

blocks muscarinic receptors | prevents bronchoconstriction

Question 50

1st line for long term asthma

Answer 50

corticosteroids

Question 51

Use of antileukotrienes (montelukast/zileutin/zafirlukast)

Answer 51

aspirin induced asthma | long term asthma if steroids contraindicated

Question 52

MOA of omalizumab

Answer 52

anti IgE Ab | allergic asthma when steroids do not work

Question 53

Bosetan MOA

Answer 53

antagonizes endothelin 1 receptor decreases pulmonary resistance for PAH