Respiratory 1 USMLE Flashcards
1
Q
pt exhibits an extended epiratory phase. What is the dz process?
A
obstructive lung dz
2
Q
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?
A
spontaneous pneumothorax
3
Q
young wife is concerned about his wifes inability to conceive and her recurrent URIs. She has dextrocardia. Which of her proteins is defective?
A
dynein (Kartagener’s)
4
Q
pseudocolumnar ciliated cells extend to _______ bronchioles
A
respiratory
5
Q
goblet cells extend only to the ________ bronchioles
A
terminal
6
Q
this type pneumocytes line the alveoli (97% of the aveolar surfaces)
A
type I cells
7
Q
this type pneumocytes secrete pulmonary surfactant (dipalmitoyl phosphatidylcholine), which decrease the alveolar surface tension.
A
type II cells
8
Q
These cells also serve as precursors to type I cells and other type II cells. They proliferated during lung damage
A
type II cells
9
Q
mucus secretions are swept out of the lungs toward the mouth by these cells
A
ciliated cells
10
Q
a lecithin-to-sphingomyelin ratio of this in amniotic fluid is indicative of fetal lung maturity
A
> 2.0
11
Q
each bronchopulmonary segment has a tertiary (segmental) bronchus and 2 of these in the center; veins and lymphatics drain along the borders
A
arteries (bronchial and pulmonary
mneu:arteries run with airways
12
Q
the right lung has this many lobes
A
3
13
Q
the left lung has this many lobes
A
2
14
Q
what is the homologue of the right middle lobe
A
lingula
15
Q
which is the more common site foir inhaled foreign body owing to the less acute angle of the main stem bronchus
A
right lung
16
Q
The relation of the pulmonary artery to the bronchus at each lung hilus is described as this
A
RALS–
Right Anterior, Left superior
17
Q
Stuctures perforating diaphram:
IVC
Esophagus, vagus (2 trunks)
aorta (red), thoracic duct (white), azygous vein (blue
A
T8
T10
T12
18
Q
what is the diaphram innervatd by
A
phrenic nerve (C3,4,5)
19
Q
pain from the diaphram can be referred here
A
shoulder
20
Q
what are the mm of respiration in quiet breathing
A
inspiration-diaphram
expiration-passive
21
Q
what are the mm of respiration in exercise
A
expiration-external intercostals, scalene muscles, sternomastoids
inspiration-rectus abdominis, internal and external obliques, transversus abdominis, internal intercostals
22
Q
in high altitude respiration will ____
A
increasie
23
Q
in high altitude erythropoietin will ____
A
increase leading to increase in HCT & HGB
24
Q
in high altitude 2,3-DPG will ______
A
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
