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1
Q

muscle of inspiration (use when)

A
  1. diaphragm (always)

2. External and accessory muscles (exercise and respiratory distress)

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2
Q

muscle of expiration

A

expiration is passive. Muscles uses during exercise or airway resistance (eg. asthma)

  1. abdominal muscles
  2. internal intercostal muscles
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3
Q

internal vs external intercostal muscles according to function

A

external intercostal –> inspiration

internal intercostal –> expiration

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4
Q

Compliance (C) equation

A

C=V/P

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5
Q

Lung - hysteresis?

A

lung inflation (inspiration) curve follows a different curve than the lung deflation (expiration) curve due to need to overcome surface tension forces in inflation

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6
Q

surfactant reduces surface tension by … (mechanism)

A

disrupting the intermolecular forces between liquid molecules

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7
Q

the site in respiratory system with the highest resistance

A

medium sized bronchi

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8
Q

changes in airway resistance - mechanism (explain)

A

by alterining the radius (SMCs contraction or relaxation)

  1. Paraysmpathetic –> constriction –> increased R
  2. Sympathetic –> relaxation –> decreased R
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9
Q

resistance of lung during deep-see dive

A

both air density and resistance to airflow are increased (increased viscosity)

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10
Q

resistance of lung - decreased viscosity during

A

breathing a low-density gas (such as helium)

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11
Q

lung - physiologic shunt (definition, results)

A

appriximately 2% of the systemic cardiac cardiac output bypasses the pulmonary circulation – PO2 of arterial blood slightly lower than the alveolar air

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12
Q

nomal values of PO2 and PCO2 in venous blood

A

PO2 –> 40

PCO2 –> 46

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13
Q

LUNG - for perfusion-limited process, diffusion of the gas can be increased only if

A

blood flow increases

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14
Q

P02 40 (venous blood) - Hb saturation

A

75%

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15
Q

PO2 25 - Hb saturation

A

50%

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16
Q

Hb saturation - the curve is almost half when PO2 is …. (purpose)

A

60 - 100 mmHg

humans can tolerate changes in atmospheric pressure

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17
Q

hemoglobin curve - P50?

A

partial pressure of PO2 in which Hb saturation is 50%

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18
Q

deohyhemoglobin

A

Hb + H+

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19
Q

Carboxyhemoglobin

A

Hb + CO

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20
Q

distribution of pulmonary blood flow - supine vs standing

A

supine –> uniform throughout lung

standing –> effect of gravity –> highest at the base

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21
Q

distribution of pulmonary blood flow - in Apex the alveolar pressure may compress the cappillaries and reduce blood flow - situation

A

if arterial blood pressure is decreased as a result of hemorrhage or if alveolar pressure is incresaed because of positive ventilation

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22
Q

The magnitude of a right-to-left shunt can be estimated by

A

having the patient breath 100% 02 and measuring the degree of dilution of oxygenated arterial blood by nonoxygenated shunted (venous) blood

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23
Q

LUNGS - normal V/Q is approximately

A

0.8

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24
Q

pO2 and pCO2 - apex vs base

A

pO2 is highest and pCO2 is lower at the apex because gas exchange is more efficient

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25
Q

Medullary respiratory center is located in

A

reticular formation:
dorsal –> inspiration
ventral –> expiration `

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26
Q

ventral respiratory group - states of activation

A

not active during normal (passive expiration)

is activated during active process

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27
Q

dorsal respiratory groups - input and output

A

input –> via vagus (peripheral chemoreceptors and mechanoreceptors of lung) and glossopharyngeal (peripheral chemoreceptors)
output –> phrenic nerve to diaphragm

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28
Q

Apneustic center - location and function

A

lower pon

stimulate inspiration, producing deep and prolonged inspiratory gasp (apneusis)

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29
Q

Pneumontaxic center - location and function

A

upper pons

inhibits inspiration –> regulates insiratory volume and respiratory rate

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30
Q

Cerebral cortex - breathing

A

can be under voluntary control

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31
Q

Hypoventilation (breath holding) is limited by

A

resulting inncrease in PCO2 and decrease PO2

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32
Q

peripheral vs central chemoreceptors according to location

A

peripheral –> carotid and aortic bodies

central medulla

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33
Q

central chemoreceptros - inreased breathing rate if

A 
low ph (CO2, not H+)
high PCO2
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34
Q

peripheral chemoreceptros - inreased breathing rate if

A 
low ph (H+, independently to pH)
high PCO2
low PO2 (under 60)
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35
Q

peripheral vs central chemoreceptors according to O2

A

detected only by peripheral

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36
Q

Beside chemoreceptros and central control, other types of receptors that control breathing

A
  1. Lung stretch receptor
  2. irritant receptors
  3. J (juxtacapillary receprors)
  4. Joint and muscles receptors
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37
Q

control breathing - Lung stretch receptor

A

when Lung strectch receptors (on SMC of the airways) are stimulated by distention –> decresea in RR (Hering-Breuer reflux)

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38
Q

Hering-Breuer reflux?

A

when Lung strectch receptors (on SMC of the airways) are stimulated by distention –> decresea in RR

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39
Q

control breathing - irritant receptors

A

located vetweein airway epithelial cells –> stimulated by noxious substance (eg. dust and polle)

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40
Q

control breathing - J (juxtacapillary receprors)

A

located in alveolar walls (close to capillaries)

engorgement of pulmon capillaries (eg. LHF) –> stimulates J receptos –> rapid, shallow breathing

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41
Q

control breathing - Joint and muscles receptors

A

movement of limbs –> activation –> early stimulation of breathing during exercise

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42
Q

arterial ph during exercise

A
  • not change during moderate exercise

- decrease during strenuous –> lactic acidosis

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43
Q

3 lung situations associated with clubbing

A
  1. Idiopathic pulmonary fibrosis
  2. Brochiectasia
  3. Adenocarcinoma
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44
Q

causes of increased vital capacity

A

acromegaly

45
Q

normal physiologic dead space

46
Q

lung metastasis - MC from

MC singe area of lung tumor metastasis

A
  1. colon, prostate, breast bladder

2. brain

47
Q

mesothelioma - histology

A

papillary bodies

carletin and cytokeratin (+)

48
Q

lung consolidation - breath sounds

A

bronchial breath + late inspiratory crackles

49
Q

symptoms of glucagonoma

A
  1. depression
  2. dermatitis
  3. DVT
  4. diabetes
50
Q

head + neck Ca - risk factros

A
  1. tobacco
  2. alcohol
  3. HPV-16 (oropharyngeal)
  4. EBV (nasopharyngeal)
51
Q

H. infl - type of pneumonia

A

brobronchopneumonia

52
Q

structrures that perforate diaphragm

A

IVC at T8
esophagus + vagus at T10
azygus, aorta, thoracic duct at T12

53
Q

Lung - collapsing pressure - equation

A

(2xsurface tension) / radius

54
Q

foam stability test

A

Mix amniotic fluid with 95% ethanol

if buccles –> (+)

55
Q

lung + chest wall - decreased + increased complaiance situations

A

decreased - consolidation, fibrosis

increased - COPD, age

56
Q

iron status Hb

A

Ferrous –> Fe2+

Ferric –> Fe3+

57
Q

O2 content (equation)

A

Hb x 1.34 x saturation = (0.03 x PaO2)

58
Q

Hypoventialtion causes hypoxemia - prove it

A

increased PaCO2 (PAO2 = PIO2 - PaCO2/R)

59
Q

Bohr vs Haldone effect according to location

A

Borh –> peripheral

Haldone –> lungs

60
Q

Chronic bronchitis vs emphysema according to PCO2 + PO2

A

chornic borchitis –> increased (retention), hypoxemia

emphysema –> normal CO2, mild hypoxemia

61
Q

Ferruginus bodies - visualised with

A

prussian blue

62
Q

ARDS - characteristics

A
  1. no HF
  2. acute resp failure
  3. bilateral lung opacities
  4. decreased PaO2/FiO2
63
Q

central sleep apnea - due to

A

CNS
opioids
HF

64
Q

aspirin induced asthma - treatment

A

modelukast, zafirlucast

65
Q

flunisolide

A

inhaled glucocorticoids - prophylactic treatment for astha

66
Q

Desquamative interstitial pneumonia? (treatment)

A

type of restrictive lung disease (association with smoking)

treat with steroids

67
Q

pancoast tumor vs SVC syndrome

A

pancoast tumor must cause lung shoulder pain (and maybe Horner) –> it also can cause SVC syndrome
if SVC syndrome alone –> mediastinal mass (mcc by lung ca, followed by non-Hodgkin)

68
Q

reactivation of TB - why upper lungs

A
  1. higher O2

2. decreased lymphatic flow

69
Q

MCC of 1ry spontaneous pneumothorax

A

smoking

also taller thin males are commonly affected

70
Q

most common presenting symptom of Pancoast tumor

A

shoulder pain radiating toward the axila + scapula (due to involvement of lower branchial plexus

71
Q

bronchiolitis obliterans - pulmonary test

A

drop of FEV1/FVC ratio

72
Q

lung tumor with neural cell adhension molecule (and aka

A

small cell

NCAM (CD56)

73
Q

Risk of 2nd hand smoke expouse

A
  1. prematurity, low birth weight (pregnancy)
  2. sudden infnat death syndrome (pregnancy or infants)
  3. middle ear disease (children)
  4. Asthma
  5. Respiratory tract infections
74
Q

major clinical manifestation of asbestos (and when)

A
  1. pleural plaques (parietal pleura) - dense circumscribed areas of dense collagen that become calcified –> 15 years after initial exposure
  2. Abestosis - diffuse pulmoary fibrosis + asbestos bodies (15-20 years after)
  3. Brochogenic carcinoma (synergistic with smoking) –> nonsmoking with asbestos is 6 fold, smoking + asbestos 60
  4. Mesothelioma (mor specific to HEAVY asbestos exposrue)
75
Q

PE - autopsy

A

wedge-shaped hemorrhagic

76
Q

Pulmonary alveolra proteinosis

A

very grandual worsening of dyspnea + PRODUCTIVE cough
histology: bilateral patchy pulmonary opacification due to intraalveolar accumulation of amorphous protein + phospholipid material (constituents of surfactant)

77
Q

CREST in lung

A

intimal thickening of pulmonary arterioles –> cor pulmonale

78
Q

Stages of lobar pneumonia

A
  1. Congestion (first 24h)
  2. Red hepatization (day 2-3)
  3. Gray hepatization (4-6h)
  4. Resolution
79
Q

lung hamartomas - manifestation / appearance

A

asymptomatic, peripherally located, coin lesion, age 50-60, composed of disorganized CARTILAGE, fibrous + adipose tissue

80
Q

Large cell carcinoma - paraneoplastic

A

Gynecomastia. Ga;actorrhea

81
Q

bronchorrhea?

A

watery sputum due to mucinous production

82
Q

Sarcoidosis - steps

A
  1. bilateral hilar lymphadeopathy
  2. bilateral hilar lymphadeopathy with pulmonary inflitrates (esp upper)
  3. disappearance of hilar lymphadeonpathy
  4. lung fibrosis
83
Q

except the classic triad, fat embolism also causes

A
  1. anemia (increased RBC aggregation + destruction, as well as possible pulm hemorrhage
  2. thrmombocytopenia
84
Q

increases the risk of Goopdasture

A

exposure to Hyrdoxycarbon solvent + cigaret

85
Q

long term exposure to nitroglycerine can cause

A

cardiac arrest

86
Q

alpha 1 antitrypsin - diagnosis / age of live disease / age of lung disease

A

diagnosis: measurement of serum ATT level –> followed by confirmatory genetic test
age of liver: first 2 decades
age of lung: 51 in nonsmokers, 36 in smokers

87
Q

ribs are divided to

A
  1. true (1-7)
  2. false (8-10)
  3. Floating (11-12)
88
Q

Sternal angle as a landmark

A

at T4-T5:

  1. trachea bifurcates
  2. Azygus in SVC
  3. begining of aortic arch
89
Q

fracture of the rib comonly occur at

A

anterior angle of the rib

90
Q

sensory innervation of diaphragm

A
  1. phrenic nerve (most)

2. intercostal nerves (periphery of diaphragm)

91
Q

external vs internal intercostal muscles

A

external –> elevates true + false ribs –> increase transverse diameter –> inspiration
internal –> expiration

92
Q

other accessory muscles of inspiration (beside external intercostal)

A
  1. Ssternocleidomastoid
  2. scalene
  3. pectoralis major and mino
    (attache the ribs)
93
Q

piriform recesses?

A

small cavities on either side of laryngeal orifice
bounded laterally by thyroid cartilage + thyrohyoid membrane
medially by aryepiglottic folds
contain the superficially the internal laryngeal nerve (branch of the superior laryngeal nerve) so it is susceptible to injury if foreign bodies lodged their

94
Q
  1. middle meningeal artery is a branch of
  2. facial artery is a branch of
  3. occipital artery is a branch of
  4. opthalmic artery is branch of
  5. sphenopalatine artery is a branch of
A
  1. maxillary
  2. external carotid
  3. facial artery
  4. internal carotid
  5. maxillary
95
Q

nerve that increases diameter of oropharynx (eg. in sleep apnea)

A

hypoglossal

96
Q

what is carina?

A

cartilaginous ridge within trachea that separates the opening of the right and left mainstem bronchi –> occurs at stenal angle (T4/5)

97
Q

superior mediastinum contains

A
  1. thymus gland (anterior inferior in children)
  2. trachea
  3. esophagus (intended in left by aorta and anteriorly by left main bronchus)
  4. thoracic duct (posterior the esophagus)
  5. aortic arch (and branches)
  6. SVC (and left/right brachiocephalic veins)
  7. vagus
  8. left recurrent (NOT THE RIGHT)
  9. phrenic nerve
98
Q

anter inferior mediastinum contains

A
  1. thymus in children
  2. smaller vessels
    NO NERVES
99
Q

middle inferior mediastinum

A
  1. heart (and pericardium and vessels)
  2. prhenic nerves
  3. pericardiophrenic nerves
100
Q

posterior mediastinum contains

A
  1. esophagus
  2. descending aorta
  3. thoracic duct
  4. azygus + hemiazygus
101
Q

lung - lymph nods

A

each lung to bronchopulmonary nodes at the hilus
right lung + inf lobe of left–> right lyphatic duct
left lung –> thoracic duct

102
Q

bronchopulmonary segment - supplied by

A

each is supplied by a tertary bronchus + 2 arteries (bronchial + pulmonary) all run in the center of the segment
veins + lymphatics tun together along the edge of the segment

103
Q

horizontal fissure of right lobe - location

A

4th rib anterior

104
Q

to anesthisize intercostal nerve –>

A

insert into superior part on interspace

105
Q

Thoracentisis - pass through

A

skin –> superficial fascia –> serratus anterior –> 3 layers of intercostal muscles –> parietal pleura

106
Q

inferior extend of visceral pleura and lung

A

midclavicular line –> 6th rib
midaxillary line –> 8th rib
paravertebral line –> 10th rib

107
Q

inferior extend of parietal pleura

A

midclavicular line –> 8th rib
midaxillary line –> 10th rib
paravertebral line –> 12th rib

108
Q

intercostal nerves + vessels course

A

superior part of each intercostal space –> VAN (ΦΑΝ)

–> vein is superior and nerve inferior

109
Q

pleural innervation

A
  1. visceral –> sensory nerves that course with autonomic (insensitive to pain)
  2. costal parietal –> intercostal nerves
    mediastinal parieta + most diaphragmatic –> phernic nerve (sensitive to pain)

respiratory (27 decks)

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