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Step 1 Complete > Respiratory 1 USMLE > Flashcards

Respiratory 1 USMLE Flashcards

1
Q

pt exhibits an extended epiratory phase. What is the dz process?

A

obstructive lung dz

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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

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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)

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4
Q

pseudocolumnar ciliated cells extend to _______ bronchioles

A

respiratory

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5
Q

goblet cells extend only to the ________ bronchioles

A

terminal

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6
Q

this type pneumocytes line the alveoli (97% of the aveolar surfaces)

A

type I cells

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7
Q

this type pneumocytes secrete pulmonary surfactant (dipalmitoyl phosphatidylcholine), which decrease the alveolar surface tension.

A

type II cells

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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

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9
Q

mucus secretions are swept out of the lungs toward the mouth by these cells

A

ciliated cells

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10
Q

a lecithin-to-sphingomyelin ratio of this in amniotic fluid is indicative of fetal lung maturity

A

> 2.0

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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

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12
Q

the right lung has this many lobes

A

3

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13
Q

the left lung has this many lobes

A

2

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14
Q

what is the homologue of the right middle lobe

A

lingula

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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

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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

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17
Q

Stuctures perforating diaphram:
IVC
Esophagus, vagus (2 trunks)
aorta (red), thoracic duct (white), azygous vein (blue

A

T8
T10
T12

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18
Q

what is the diaphram innervatd by

A

phrenic nerve (C3,4,5)

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19
Q

pain from the diaphram can be referred here

A

shoulder

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20
Q

what are the mm of respiration in quiet breathing

A

inspiration-diaphram

expiration-passive

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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

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22
Q

in high altitude respiration will ____

A

increasie

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23
Q

in high altitude erythropoietin will ____

A

increase leading to increase in HCT & HGB

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24
Q

in high altitude 2,3-DPG will ______

A

increase

DPG binds to HGB so that HGB releases more O2

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25
Q

in high altitude this cellular changes occurs _____

A

increase in mitochondria

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26
Q

in high altitude there is an increased renal excretion of this

A

bicarbinate

compinsatig for respiratory alkalosis

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27
Q

in high altitude chronic hypoxic pulmonary vasoconstriction will result in this cardiac change

A

RVH

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28
Q

this is produced by type II pneumocytes, it decreases alveolar surface tension, and inceases compliance

A

surfactant

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29
Q

surfactant or dipalmitoyl phosphatidylcholine (lecithin) is deficient in this neonatal syndrome which occurs often in premies

A

neonatal RDS

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30
Q

give 4 other important lung products

A

prostaglandins
histamine
Angiotensin converting enzyme (ACE)
kallikrein

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31
Q

how do ACE inhibitors cause cough

A

increase bradykinin which causes cough and causes angioedema

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32
Q

Kallikrein activates what?

A

bradykinin

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33
Q

what is the collapsing pressure of alveola

A

2 (tension)/radius

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34
Q

this describes the air in lung after maximal expiration

A

residual volume (RV)

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35
Q

this describes air that can still be breathed out after normal expiration

A

expiratory reserve volume (ERV

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36
Q

this describes air that moves into lung with each quiet inspiration, typically 500 mL

A

tidal volume (TV)

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37
Q

this describes air in excess of tidal volume that moves into lung on maximal inspiration

A

Inspiratory reserve volume (IRV

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38
Q

vital capacity (VC)=

A

TV+IRV+ERV

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39
Q

Functional reserve capacity (FRC)=

A

RV+ERV

volume in lungs after normal expiration

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40
Q

Inspiratory capacity (IC)=

A

IRV + TV

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41
Q

Total lung capacty(TLC)=

A

IRV+TV+ERV+RV

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42
Q

vital capacity is everything but this

A

residual volume

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43
Q

an decrease in all factors (except pH) causes a shift of the curve to the ______

A

left

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44
Q

right shift –CADET face RIGHT - stands for

A 
CO2
Acid/Altitude
DPG (2,3-DPG)
Exercise
Temperature
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45
Q

pulmonary circulation is normally a _____ resistance, ____ compliance system

A

low

high

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46
Q

PO2 & PCO2 exert opposite effects on pulmonary and systemic circulation. A decrease in PaO2 causes this

A

hypoxic vasoconstriction that shifts blood away from the poorly ventilated regions of the lung to well ventilated regions of the lung

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47
Q

what is a consequence of pulmonary hypertension

A

cor pulmonale and subsequent right ventricular failure

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48
Q

what is a physical exam finding of cor pulmonale and subsequent right ventricular failure

A

jugular venous distension, edema, hepatomegaly

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49
Q

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.

A

perfusion limited

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50
Q

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

A

diffusion limited

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51
Q

Determination of physiologic dead space (VD)=

A

VT x [(PaCO2-PeCO2)/PaCO2

PaCO2=arterial PCO2,
PeCO2=expired air PCO2

52
Q

when a curve shifts to this direction there is a decreased affinity of hgb for O2 (facilitates unloading of O2 to the tissue)

A

right

53
Q

an increase in all factors (except pH) causes a shift of the curve to the ______

A

right

54
Q

ideally, ventilation is matched to perfusion in order to achieve adequate gas exchange. V/Q=

A

1

55
Q

Both ventilatio and perfusion are greater at this part of the lung.

A

base of the lung

56
Q

at the apex of the lung V/Q=

A

3 (wasted ventilation)

57
Q

at the base of the lung V/Q=

A

0.6 (wasted perfusion

58
Q

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

A

exercise

59
Q

certain organisms thrive in high O2 and flurish at the apex of the lung. Give an example of such an organism

A

TB

60
Q

when V/Q =0 this is happening

A

there is an airway obstruction(shunt)

61
Q

when V/Q =infinity

this is happening

A

there is a blood flow obstruction (physiologic dead space

62
Q

CO2 is transported from the tissue to the lungs in 3 forms. What are they

A

1) Bicarbinate (90%)
2) bound to hgb as carbinohemoglobin (5%)
3) dissolved CO2 (5%)

63
Q

what is the haldane effect?

A

in lungs, oxygenation of hemoglobin promotes dissociation of CO2 from hgb

64
Q

what is the bohr effect

A

in peripheral tissue, increased H+ shifts curve to the right unloading O2

65
Q

alveolar-arterial O2 difference=

A

[(A-a)Do2]<10 mmHg

66
Q

this dz results from an obstruction of air flow, resulting in air trapping in the lungs

A

COPD

67
Q

what will PFTs show with COPD

A

decreased FEV1/FVC ratio

68
Q

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%)

A

chronic bronchitis (“Blue Bloater”)

69
Q

what PE findings might you find with chronic bronchitis

A

wheezing, crackles, cyanosis

70
Q

what is the leading cause of chronic bronchitis

A

smoking

71
Q

this type of COPD manifests with enlargement of air spaces and decreased recoil resulting from destruciton of alveolar walls.

A

emphysema (“pink puffer”)

72
Q

smoking causes this type of emphysema

A

centriacinar emphysema

73
Q

alpha 1 antitrypsin deficiency causes this type of deficiency

A

panacinar

74
Q

alpha 1 antitrypsin deficiency also causes this

A

liver cirrhosis

75
Q

in emphysema there is increased activity of this enzyme

A

elastase

76
Q

what are some PE findings in emphysema

A

dyspnea, decreased breath sounds, tachycarida, decreased inspiration/expiration ratio

77
Q

this form of COPD is caused by bronchial hyperresponsiveness that causes reversible bronchostrinction.

A

asthma

78
Q

name some triggers for asthma

A

viral URIs, allergins, and stress

79
Q

give some findings in asthma

A

cough, wheezing, dyspnea, tachypnea, hypoxemia, decrease I/E ratio, pusus paradoxus, Curschmann’s spirals, smooth muscle hypertrophy, mucous plugging

80
Q

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

A

Bronchiectasis

81
Q

in this dz, restricted lung expansion causes decreased lung volumes (decreased VC and TLC)

A

restrictive lung dz

82
Q

what will PFTs show with restrictive lung dz

A

FEV1/FVC ratio > 80%

83
Q

give 2 types of restrictive lung dz that result from poor breathing mechanics (extrapulmonary)

A

1) poor muscular effort - polio, myasthenia gravis

2) poor structural apparatus –scoliosis, morbid obesity

84
Q

give 4 types of restrictive lung dz that result from interstitial lung diseases (pulmonary)

A

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
Q 
describe the physical exam findings of bronchial obstruction
BS:
Resonance:
Fremitus:
Tracheal Deviation:
A

BS: absent/decreased over affected area
Resonance:↓
Fremitus:↓
Tracheal Deviation: toward side of lesion

86
Q

describe the physical exam findings of pleural effusion BS:
Resonance:
Fremitus:
Tracheal Deviation:

A

BS: ↓ over effusion
Resonance:dullness
Fremitus:↓
Tracheal Deviation: NA

87
Q 
describe the physical exam findings of pneumonia
BS:
Resonance:
Fremitus:
Tracheal Deviation:
A

BS: may have bronchial BS over the lesion
Resonance: dullness
Fremitus: ↑
Tracheal Deviation: NA

88
Q 
describe the physical exam findings of pneumothorax
BS:
Resonance:
Fremitus:
Tracheal Deviation:
A

BS:↓
Resonance: hyperresinant
Fremitus: absent
Tracheal Deviation: away from side of lesion

89
Q

obstructive lung volumes are ____ normal

A

> (↑TLC,↑FRC,↑RV)

90
Q

restrictive lung volumes are ___ normal

A

<

91
Q

in both obstructive and restrictive lung dz, these are reduced

A

FEV1 & FVC

92
Q

in obstructive or restrictive lung dz is FEV1 more dramatically reduced resulting in a decreased FEV1/FVC ratio

A

obstructive lung dz

93
Q

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

A

Kartagener’s syndrome

94
Q

this is caused by diffuse pulmonary interstitial fibrosis caused by inhaled asbestos fibers

A

asbestosis

95
Q

asbestosis increase the risk of these 2 malignancie

A

mesothelioma and bronchogenic carcinoma

96
Q

asbestosis and smoking greatly increases the risk of this malignancy

A

bronchiogenic cancer (smoking is not additive with mesothelioma)

97
Q

ivory-white pleural plaques and ferruginous bodies are often seen in the lungs of people with asbestosis. What are ferruginous bodies

A

asbestos fiber coated with hemosiderin

98
Q

asbestosis is often seen in these 2 professions

A

shipbuilders and plumbers

99
Q

this syndrome in neonates results from a surfactant deficiency leading to increased surface tension, resulting in alveolar collapse.

A

neonatal respiratory distress syndrome

100
Q

surfactant is made by these pneumocytes most abundantly after 35th week of gestation

A

type II pneumocytes

101
Q

what is the lecithin-to-sphingomyelin ratio in the amniotic fluid (measure of lung maturity) in neonatal respiratory distress syndrome

A

<1.5

102
Q

what is surfactant

A

dipalmitoyl phosphatidylcholine

103
Q

what is the treatment for neonatal respiratory distress syndrome

A

maternal streroids before birth; artificial surfactant for infant

104
Q

what is the leading cause of cancer death

A

Lung CA

105
Q

these are bronchogenic carcinomas that arise CENTRALLY

A

squamous cell carcinoma
small cell carcinoma

mneu: Small Squamous Center

106
Q

these 2 forms of lung cancer have a clear link to smoking

A

squamous cell carcinoma
small cell carcinoma

mneu: S & S from Smoking

107
Q

squamous cell carcinoma sometimes produces this peptide

A

PTH-related peptide

108
Q

small cell carcinoma sometimes produces these hormones

A

ADH, ACTH

109
Q

small cell carcinoma sometimes produces this syndrome

A

Lambert-Eaton syndrome

110
Q

this lung cancer often presents with cough, hemoptysis, bronchial obstruction, wheezingg, pneumonic “coin” lesion on x-ray

A

small cell carcinoma

111
Q

what are the bronchogenic carcinomas that arise peripherally

A

1) adenocarcinoma (most common)
2) bronchioalveolar carcinoma
3) large cell carcinoma

112
Q

is bronchioalveolar carcinoma thought to be related to smoking

A

No

113
Q

Lung CA can cause a SPHERE of complictions. name them

A 
Superior vena cava syndrome
Pancoast's tumor
Horners syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (horseness)
Effusions (pleural or paricardial)
114
Q

this type of lung tumor causes flushing, diarrhea, wheezing, and salivation

A

carcinoid tumor

115
Q

symptoms such as siezure, bone fracture, jaundice or hepatomegly may be a sign that lung cancer has done this

A

metastesized

116
Q

this is a carcinoma that occurs in the apex of lung and may affect cervical sympathetic plexus, causing Horner’s syndrome

A

pancoast’s tumor

117
Q

what is horner’s syndrome

A

ptosis, miosis, anhidrosis

118
Q

this type of pneumonia involves intra-alveolar exudate which develops into consolidation. It may involve the entire lung.

A

lobar pneumonia

119
Q

what organism is usually implicated in lobar pneumonia

A

pneumococcus most frequently

120
Q

this type of pneumonia involves acute inflammatory infiltrates from bronchioles into adjacent alveoli. There is a patchy distribution involving >/=1 lobes

A

bronchopneumonia

121
Q

what organism is usually implicated in bronchopneumonia

A

S. aureus, H. flu, Klebsiella, S. pyogenes

122
Q

this type of pneumonia involves diffuse patchy inflammation localized to interstitial areas at alveolar walls. Distribution involves >/=1 lobes

A

intertitial (atypical) pneumonia

123
Q

what organism is usually implicated in intertitial (atypical) pneumonia

A

viruses (RSV, adenoviruses), mycoplasma, legionella, chlamydia

124
Q

the lipoxygenase pathway yields thses

A

Leukotrienes

mne: L for lipoxygenase and leukotriene

125
Q

LTB4 is this

A

neutrophil chemotactic agent

126
Q

LTC4,D4, and E4 fuction in this

A

bronchoconstriction, vasoconstriction, constrictionof smooth mm, andincreased vascular permeability

127
Q

PGI2 does this

A

inhibits platelet aggregation and promotes vasodilation

mneu: Platelet-Gathering Inhibitor

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