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1
Q

formation lung in embryonic

A

tertiary bronchi

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2
Q

errors embryonic

A

TE fistula

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3
Q

formation in pseudoglandular

A

terminal bronchioles

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4
Q

respiration capable

A

25 weeks

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5
Q

terminal ducts

A

sacccular phase 26 weeks

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6
Q

alveolar phase

A

secondary septation in terminal sacs

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7
Q

end alveolar phase

A

8 years

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8
Q

associations pulmonary hypoplasia

A

congenital diaphragmatic hernia and bilateral renal agenesis

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9
Q

bronchogenic cysts

A

abnormal budding of foregut and dilation of terminal or large bronchi

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10
Q

club cells

A

nonciliated, low cuboidal

secrete component of surfactant and degrade toxins

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11
Q

secretion of surfactant

A

from lamellar bodies in type II pneumocytes

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12
Q

composition surfactant

A

lecithins, mostly DPPC

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13
Q

time surfactant synthesis

A

26 weeks

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14
Q

risk factors neonatal respiratory distress syndrome

A

prematurity, maternal diabetes (due to fetal insulin), C section (decrease glucocorticoids)

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15
Q

result supplemental O2

A

retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia

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16
Q

least airway resistance

A

terminal bronchioles

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17
Q

anatomic dead space

A

does not participate in gas exchange

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18
Q

extend to beginning of terminal bronchioles

A

ciliated

mucociliary escalator

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19
Q

smooth muscle cells

A

extend to end of terminal bronchioles

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20
Q

histology respiratory bronchioles

A

cuboidal cells

then simple squamous cells up to alveoli

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21
Q

termination cilia

A

respiratory bronchioles

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22
Q

pulmonary artery relative to bronchus

A

right anterior

left superior

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23
Q

carina

A

posterior to ascending aorta

anteromedial to descending aorta

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24
Q

upright aspiration

A

basal RLL

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25
Q

supine aspiration

A

posterior RUL

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26
Q

at T8

A

IVC, phrenic

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27
Q

at T10

A

esophagus, vagus

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28
Q

at T12

A

aorta, thoracic duct, azygos vein

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29
Q

bifurcation carotic

A

C4

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30
Q

bifurcation trachea

A

T4

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31
Q

abdominal bifurcation

A

L4

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32
Q

normal tidal volume

A

500 mL

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33
Q

residual volume

A

cannot be measured by spirometry

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34
Q

inspiratory capacity

A

IRV+TV

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35
Q

FRC

A

RV+ERV

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36
Q

vital capacity

A

TV+IRV+ERV

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37
Q

TLC

A

IRV+TV+ERV+RV

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38
Q

largest contributor of dead space

A

apex

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39
Q

pathologic dead space

A

unable to perform gas exchange

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40
Q

physiologic dead space

A

anatomic and alveolar dead space

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41
Q

inward pull of lung balanced by outward pull of chest wall

A

FRC
and system pressure is atmospheric
intrapleural pressure is negative

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42
Q

high compliance

A

easy to fill

emphysema and normal aging

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43
Q

low compliance

A

pulmonary fibrosis, pneumonia, NRDS, pulmonary edema

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44
Q

hysteresis

A

lung inflation different than deflation due to need to overcome surface tension in inflation

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45
Q

positive cooperativity and negative allostery

A

Hb

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46
Q

taut form for unloading

A

Cl, H, CO2, 23BPG and T

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47
Q

O2 affinity in fetal Hb

A

from decrease affinity for 23 BPG

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48
Q

methemoglobin

A

oxidized

increase affinity for cyanide

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49
Q

induced methemoglobin

A

nitrite followed by thiosulfate

used for cyanide poisoning

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50
Q

decrease O2 binding capacity with left shift in dissociation, decrease unloading

A

carboxyhemoglobin

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51
Q

treatment methemoglobinemia

A

methylene blue and vitamin C

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52
Q

cause Fe2 to Fe3

A

nitrites and benzocaine

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53
Q

does not show positive cooperativity

A

myoglobin

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54
Q

left shift

A

renal hypoxia leads to increase EPO

compensatory erythrocytosis

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55
Q

perfusion limited

A

O2, CO2, N2O
equilibrates early
only increase diffusion with increase in flow

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56
Q

diffusion limited

A

O2 in emphysema and fibrosis, CO

does not equilibrate

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57
Q

causes increase A-a gradient

A

shunting, V/Q mismatch, fibrosis

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58
Q

hypoxemia with normal A-a

A

high altitude

hypoventilation

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59
Q

loss of blood flow

A

decrease venous drainage

impeded arterial flow

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60
Q

wasted ventilation

A

apex

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61
Q

wasted perfusion

A

base

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62
Q

shunt

A

airway obstruction

does not improve with 100% O2

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63
Q

dead space

A

blood flow obstruction

improves with 100% O2

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64
Q

carboxyhemoglobin

A

CO2 bound to N terminus of globin

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65
Q

highest % CO2 transport

A

HCO3

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66
Q

altitude sickness

A

increase ventialtion leading to respiratory alkalosis

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67
Q

responses altitude sickness

A

EPO
increase 2,3BPG
incrase HCO3 excretion
pulmonary vasoconstriction

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68
Q

response to exercise

A

increase O2 consumption
increase ventilation rate to meet O2 demand
V/Q more uniform
decrease pH
no change in PaO2 or PaCO2 but increase in venous CO2 content and decrease in venous O2 content

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69
Q

drain maxillary sinuses

A

middle meatus

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70
Q

superimposed rhinosinusistis

A

s pneumo, h flu, m catarrhalis

71
Q

Kisselbach plexus

A

anterior segment of nostril

72
Q

sphenopalatine artery

A

life threatening posterior segment hemorrhage

branch of maxillary

73
Q

risk factors head and neck cancer

A

tobacco, alcohol, HPV 16, EBV

74
Q

field cancerization

A

damages wide mucosal area leading to multiple tumors that develop independently

75
Q

Virchow triad

A

stasis
hypercoag
endothelial damage (exposed collagen)

76
Q

imaging DVT

A

compression ultrasound with Doppler

77
Q

acid base in PE

A

respiratory alkalosis

78
Q

Lines of Zahn

A

found only in thrombi before death

pink-platelets, fibrin

79
Q

imaging for PE

A

CT pulmonary angiography

80
Q

fat emboli

A

hypoxemia, neuro, petechial rash

81
Q

amniotic fluid emboli

A

leads to DIC

82
Q

obstructive lung volumes

A

increased

but decreased ratio

83
Q

restrictive lung volumes

A

decreased

but increased ratio

84
Q

chronic hypoxic vasoconstriction in obstructive

A

leads to cor pulmonale

85
Q

chronic bronchitis histology

A

hypertrophy and hyperplasia of mucus glands in bronchi

86
Q

diagnostic bronchitis

A

> 3 months for >2 consecutive years

87
Q

histology emphysema

A

enlarged air spaces

88
Q

pursed lips

A

increase airway pressure and prevent airway collapse

89
Q

decreased inspiratory/expiratory ratio, pulsus paradoxus

A

asthma

90
Q

histology asthma

A

smooth muscle hypertrophy and hyperplasia

91
Q

Curschmann spirals

A

shed epithelium forms wholed mucous plugs

92
Q

Charcot-Leyden crystals

A

eosinophilic, hexagonal, double pointed, needle-like crystals from breakdown of eosinophils in sputum

93
Q

aspirin induced asthma

A

leukotriene overproduction

associated with nasal polyps

94
Q

purulent sputum, recurrent infections, hemoptysis, digital clubbing

A

bronchiectasis

95
Q

associations bronchiectasis

A

obstruction, poor motility

smoking, Kartagener, CF, ABPA

96
Q

poor breathing mechanics in restrictive

A

muscular-polio, MG, GBS

structural-scoliosis, morbid obesity

97
Q

hypersensitivity pneumonitis

A

mixed III/IV HSR
seen in farmers and birds
reversible if stimulus avoided

98
Q

bronchoscopy of inhalation injury

A

edema, congestion, soot deposition

resolution at 11 days

99
Q

risks from pneumoconioses

A

cor pulmonale, cancer, Caplan (RA and pneumoconioses)

100
Q

calcified supradiaphragmatic and pleural plaques

A

asbestos

101
Q

golden brown fusiform rods resembling dumbbells found in alveolar sputum sample, visualized with Prussian blue

A

asbestos bodies

102
Q

risk from asbestos

A

pleural effusions

103
Q

noncaseating granulomas in aerospace

A

berrylliosis

affects upper lobes

104
Q

anthracosis

A

asymptomatic condition from sooty air

105
Q

macrophages and silica

A

release fibrogenic factors leading to fibrosis

increase susceptibility to TB

106
Q

eggshell calcifications

A

silicosis

107
Q

hemorrhagic pleural effusion from cancer

A

mesothelioma

108
Q

stain mesothelioma

A

cytokeratin and calretinin+

109
Q

hypoxemia in ARDS

A

due to intrapulmonary shunting and diffusion abnormalities

110
Q

associations ARDS

A

sepsis, pancreatitis, pneumonia, aspiration, trauma, shock

111
Q

steps of ARDS

A

endothelial damage leading to increase capillary permeability
protein rich leakage and alveolar damage

112
Q

histology ARDS

A

hyaline membranes

113
Q

source of damage ARDS

A

neutrophilic substances injure alveolar wall and pulmonary capillary endothelial cells, free radicals, oxygen-derived free radicals

114
Q

management ARDS

A

ventilation with low tidal volumes

115
Q

nocturnal hypoxia in sleep apnea

A

systemic and pulmonary HTN

arrhythmias and sudden death

116
Q

obstructive sleep apnea

A

from excess parapharyngeal tissue and adenotonsillar hypertrophy

117
Q

treatment obstructive sleep apnea

A

weight loss, CPAP, surgery

118
Q

central sleep apnea

A

CNS injury, HF, opioids

119
Q

respiration patterns central sleep apnea

A

Cheyne-Stokes respiration

120
Q

treatment central sleep apnea

A

positive airway pressure

121
Q

obesity hypoventilation syndrome

A

hypoventilation increase PaCO2 during waking hours and during sleep
Pickwickian syndrome

122
Q

results pulmonary HTN

A

arteriosclerossis, medial hypertrophy, intimal fibrosis, plexiform lesions

123
Q

genetics heritable PAH

A

inactivating BMPR2 gene

normally inhibits vascular smooth muscle proliferation

124
Q

causes pulmonary arterial hypertension

A

amphetamines, cocaine, connective tissue disease, HIV, portal hypertension, congenital HTN, schistosomiasis

125
Q

causes left heart disease

A

systolic/diastolic dysfunction

valvular disease

126
Q

tracheal deviation tension pneumo

A

away from lesion

127
Q

consolidation

A

increase fremitus

dull to percussion

128
Q

bronchial breath sounds

A

late inspiratory crackles, egophony, bronchophony, whispered pectoriloquy

129
Q

atelectasis

A

dull to percussion
deviates toward lesion
decreased fremitus

130
Q

hyperresonant

A

simple or tension pneumothorax

131
Q

cause transudate

A

increase hydrostatic pressure (HF) or decrease oncotic pressure (nephrotic syndrome, cirrhosis)

132
Q

cause exudate

A

malignancy, pneumonia, collagen vascular disease, trauma

due to increase vascular permeabiltiy

133
Q

content lymphatic effusions

A

TG

from trauma or malignancy

134
Q

primary spontaneous pneumothorax

A

tall, thin, young males

135
Q

secondary spontaneous pneumothorax

A

diseased lung, mechanical ventilation with high pressures

136
Q

causes bronchopneumonia

A

strep pneumo, staph, h flu, klebsiella

137
Q

cryptogenic pneumonia

A

inflammation of bronchioles

no response to ABX

138
Q

congestion pneumo

A

1-2 days
red-purple, partial consolidation of parenchyma
exudate with bacteria

139
Q

red hepatization

A

3-4 days
red-brown
exudate with fibrin, bacteria, RBC, WBC

140
Q

gray hepatization

A

5-7 days
uniformly gray
WBCs and fibrin

141
Q

resolution

A

+ days

enzymes digest components of exudate

142
Q

air fluid levels on CXR

A

lung abscess

143
Q

hoarseness from Pancoast

A

recurrent laryngeal nerve

144
Q

Horner syndrome

A

stellate ganglion

145
Q

sensorimotor deficits

A

brachial plexus

146
Q

other damage superior sulcus tumor

A

brachicephalic vein

SVC

147
Q

causes SVC

A

pancoast

thrombosis from indwelling catheters

148
Q

sites of mets lung

A

adrenal, brain, bone, liver

149
Q

lung cancer from mets

A

breast, colon, prostate, bladder cancer

150
Q

risk factors lung cancer

A

smoke, radon, asbestos, family history

151
Q

genetics small cell

A

amplification of myc oncogenes

152
Q

histology small cell

A

neuroendocrine, small blue

chromogranin A+, neuron-specific enolase +

153
Q

mutations adenocarcinoma

A

KRAS, EGFR, ALK

154
Q

hypertrophic osteoarthropathy clubbing

A

adenocarcinoma

155
Q

histology adenocarcinoma

A

glandular pattern

mucin+

156
Q

bronchoalveolar adenocarcinoma

A

along septa

apparent thickening of alveolar walls

157
Q

keratin pearls and intercellular bridges

A

squamous cell carcinoma

158
Q

carcinoid tumor histology

A

neuroendocrine cells

chromogranin A+

159
Q

thins secretions

A

guaifenesin

does not suppress cough reflex

160
Q

MOA n-acetyl

A

disrupt disulfide bonds

161
Q

antagonist to NMDA glutamate receptors

A

dextromethorphan

can cause serotonin syndrome

162
Q

drug to open eustachian tubes

A

pseudophedrine or phenylephrine

163
Q

competitively antagonizes endothelin-1 receptors

A

bosentan

164
Q

adverse bosentan

A

hepatotoxic

165
Q

adverse epoprostenol, iloprost

A

flushing, jaw pain

166
Q

MOA epoprostenol, iloprost

A

PGI2 with vasodilatory effects

167
Q

bronchoconstriction in asthma

A

inflammatory

parasympathetic tone

168
Q

adverse salmeterol

A

tremor and arrhythmia

169
Q

cause oral thrush

A

inhaled corticosteroids

170
Q

long acting muscarinic antagonist

A

tio

171
Q

MOA zileuton

A

5 lipoxygenase inhibitor

172
Q

MOA montelukast

A

blocks CysLT1 receptor

good for aspirin-induced asthma

173
Q

binds mostly unbound serum IgE and blocks binding to FCERI

A

omalizumab

174
Q

increase cAMP from inhibition of phosphodiesterase

A

theophylline

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