Respiratory

Question 1

Oxygenation of Hb promotes dissociation of H⁺ from Hb, this shifts equilibrium toward CO₂ formation;therefore, CO₂ is released from RBCs

Answer 1

Haldane effect

• in the lung

Question 2

Increase in H⁺ from tissue metabolism shifts curve to righ,unloading O_2.

Answer 2

Bohr effect

Question 3

interdifitating ares of pink(platelets) and red(RBCs) found ONLY IN THROMBI FORMED BEFORE DEAD

Answer 3

LINES OF ZAHN

Question 4

↓↓FEV/↓FVC<80%

↑RV

V/Q mismatch

Answer 4

Obstructive lung diseases

• chronic bronchitis
  
  • blue bloater
• emphysema
  
  • pink puffer
• Asthma
• bronchiectasia
• lead pulmanry hypertention(>25mmHg)and finally to corp pulmonale (decrease in O2 casues pulmonar vasoconstrctition)

Question 5

Ththickness of gland layer/total thickness of bronchial wall>50%

Answer 5

Reid index

• greater tahn 50% in chronic bronchitis
• productive cough for >3 months per year for > 2 years.

Question 6

dysnea,cough ,minim sputum and purse libs exalation

Answer 6

Emphysema

• exalation through pursed lips to increase airway pressure and prevent airway collapse during respiration.
• decrease lung recoil, increase compliance resulting from destruction of alveolar walls

Question 7

ration of the pulmonary artery yo the blonchus at each lung hilus is described by?

Answer 7

RALS

right anterior

left superior

Question 8

aspirate peanut:

while upright

while supine

Answer 8

• while upright:lower portion of right inferior lobe
• while supine:superior portion of right inferior lobe

Question 9

structures perforatin diaphragm

at T8

at T10

at T12

Answer 9

I (IVC) ate(8) ten(10) eggs(esophagus) at(aorta) twelve(12)

at T8=IVC

at T10=esophagus,vagus

at T12=aorta,thoracic duct,azygos veins

Question 10

air that can still be breathed in after normla inspiration

Answer 10

inspiratory reserve volume

Question 11

air can still be breathed out after normal expiration

Answer 11

Expiratory reserve volume

Question 12

Air in the lungs after maximal expiration

Answer 12

Residual volume

• cannot be mesure by spirometry
• incrased in obstructive lung disease

Question 13

Determination of pysiologic dead space:anatomic dead space +functional dead space in alveoli.

Answer 13

V_D=V_T*PaCO₂-PECO₂/PaCO₂

Question 14

total volume of gas entering the lungs per minute

Answer 14

MINUTE VENTILATION(V_E)

V_E=V_T*RR(respiratoy rate)

Question 15

volumen of gas per unit of time that reaches the alveoli

Answer 15

Alveolar ventilation(V_A)

V_A=(V_T-V_D)*RR

Question 16

Tau HB

Relaxed Hb

Answer 16

• Tau in Tissue has low affinity to O2 leading to increase O2 unloading(curv to the right)
  
  • CL,H+,Co2 and temperature favor tau
• Relaxed Hb high affinity for O2 in the respiratory tract

Question 17

Methemoglobin treatment

Answer 17

Methylene blue

Question 18

Whats Methemoglobyn

Answer 18

It is FERRIC Fe³⁺ hemoglobin that does not bing O₂ readily, but has increase affinity for cyanide.

nitrates cause poisoning by oxidizing Fe⁺² to Fe⁺³

Question 19

Cyanide poisoning treatment(present in nitroprusside)

Answer 19

use nitrites to oxidaze Hb to methemoglobin,which binds cyanide.use thiosulfate to bind this cyanide,foming thiocyanate,which is renally excreted

Question 20

cherry red skin and dead

Answer 20

CO posioning

• carboxyhemoglobin shift curve to the left, decreasing unloading in tissues
• normal pulsoxymeter
• TX:100% O2

Question 21

what does a decrese in PAO2 does to the pulmonary circulation?

Answer 21

↓ in PAO2 causes a hypoxic vasoconstriction

In an effort to shift blood away from poorly ventilated regions of the lung to well-ventilated regions of lung

Question 22

what does an increase in A-a gradient (normal 10-15) means

Answer 22

An incresea in A-a(>15) means Hypoxemia

• shunting
• V/Q mismatch
• intertitial lung disease

Question 23

normal A-a gradient with hypoxemia(decreased PaO2)

Answer 23

• hypoventilation
• High altitude

Question 24

V/Q=0

Answer 24

Airway obstruction(shunt) in shunt 100% does nor improve PO₂

Question 25

V/Q=infinit

Answer 25

blood flow obstruction

Question 26

body response to high altitude(↓PaO₂₎

Answer 26

**ACUTE** causes hyperventilation and respiratory alkalosis. **LATE** ↑erythropoietin ↑2,3BPG (shifh curve to re righ) ↑renal excretion of HCO3(can ve augment by use of acetazolamide) to compensate for the respiratory alkalosis

Question 27

response to exercise by the lung

Answer 27

* V/Q from apex to base becomes uniform * no change on PaO2 and PaO2 * increase venous CO2 and decrese venous O2

Question 28

virshow traid:

Answer 28

* stasis * hypercoagulability * Endothelial damage

Question 29

Sudden onset dysnea,tachypnea,tachycardia, altered mental status, petechial rash.

Answer 29

**_Pulmonary Emboli_** * fat * air(gas) treat with hyperbaric oxygen Caisson´s disease * thrombous * bacteria * amniotic fluid * tumor

Question 30

Answer 30

Curschmann spirals(shed epithelium forms mucus plugs) found in asthma

Question 31

Answer 31

**_Charcot-Leyden crystals_** * formed from breakdown of eosinophils in sputum * found in asthma

Question 32

cough ,foul-smelling sputum,dysnea

Answer 32

**_Bronchiectasis_** associated with bronchial obstruction * kartagener * cystif fibrosis * allergic bronchopulmonary aspergilosis

Question 33

↓FEV/**↓↓**FVC\>80% ↓all lung volumes

Answer 33

**_Restrictive lung disease_** **Poor brething mechanics(normal A-a gradient)** * poor muscular effor-polio,myastenia gravis * poor structural apparatus-scoliosis,morbid obesity **Interstitial lung disease**(pulmonary decrese diffusing capacity,↑A-a gradient)

Question 34

what does acute suplementary O₂ ARDS patients can cause death?

Answer 34

in ARDS patientes respiration is driven by central CO2 concentration, an increase in O2 will decrease CO2 leading to respiratory supression and coma.

Question 35

Answer 35

**_Ferruginous bodies_** * found in asbestosis related to bronchogenic carcinoma and mesothelioma, lower lung. * associated with shipbuilfing,roogin and plumbing.

Question 36

eggshell calcification of hilar lymph nodes

Answer 36

**_Silicosis_** ## Footnote * foundries * sandblasting * mines * silica disrupt phagolysosomes and impari macrophages(susceptibility to TB) * increse risk of bronchogenic carcinoma

Question 37

neonatal respiratoy syndrome risk factor and complications

Answer 37

Risk factors: * prematurity * maternal DM(due to feal increase in insulin, and insulin its an inhibitor of surfactant production dependent on steroids) Complications: * PDA * NEC * supplemental O2(free radical damage) * retinopathy * bronchopulmonar dysplasia

Question 38

damage in BMPR2 with media hypertrophy

Answer 38

primary pulmonary hypertention

Question 39

most common lung cancer in nonsmokesand overall

Answer 39

**adenocarcinoma** * Peripheral * K-ras,EGFR and ALK mutation * associated with clubbing

Question 40

adenocarcinoma of the lung in situ

Answer 40

**_bronchiolovar subtype_** of the adenocarcinoma * CXR:hazy infiltrated similar to pneumonia * apparent thickenin of alveolar walls.

Question 41

caitaiton , cigarret relate and hypercalcemia related lung cancer

Answer 41

**squamos cell carcinoma** ## Footnote produces PTHrP keratin pearls and intercelular bridges

Question 42

lung cancer with these three paraneoplasic syndromes : ACTH ADH Lamber-Eaton

Answer 42

**_small cell(oat cell) carcinoma_** * central * amplified Myc * inoperable:treat with chemo * neuroendocrine neoplasm of kulchitsky cells-\>salt and paper aparience

Question 43

less responsive to chemoteraphy lung cancer higly anaplastic

Answer 43

**_large cell carcinoma_** peropheral

Question 44

chromogranin A possitive lung cancer

Answer 44

**_Bronchial carcinoid tumor_** not associated with cigarret

Question 45

intertitial pneumonia in transplanted patients

Answer 45

CMV pneumonia * diffuse patchy inflammation localized to interstitial areas at alveolar walls. * indolent course.

Question 46

Answer 46

**_Lung abscess_** air-fluid levels often seen on CXR oftehn due to S.aureus or anaerobes.

Question 47

cuts S bound in mucus

Answer 47

N-acetylcysteine

Question 48

induces bronchodiltation by increasing cAMP

Answer 48

**ß2 agonist** * Alburetol * long acting:salmeterol, formeterol

Question 49

promotes bronchodilation by inhibitil PDE and decreasin hydrolysis os cAMP

Answer 49

Methylxantines * theophylline * blocks adenosine(adenosine cause bronchoconstriction)

Question 50

preven bronchoconstriction by inhibitin M3 muscarinic receptors

Answer 50

**Muscarinic antagonis** * short acting:ipatropium * long acting:Tiotropium * used in ARDS