Respiratory

Question 1

Where do cartilage and goblet cells, psuedostratified cilia, smooth muscle extend to?

Answer 1

cartilage and goblet cells: end of bronchi

psuedostratified cilia, SM: terminal bronchioles

Question 2

Type 1 vs Type II pneumocytes

Answer 2

Type I: squamous, thin, gas exchange

Type II: surfactant

Question 3

What is surfactant made of?

Answer 3

Lecthins, dipalmitoylphosphatidylcholine

Question 4

When does the lung begin to produce surfactant?

Answer 4

35 wks

Question 5

What nerve, nerve roots supply diaphragm?

Answer 5

phrenic nerve; C3, 4, 5

Question 6

What levels do IVC, esophagus, aorta perforate diaphragm?

Answer 6

T8: IVC
T10: esophagus
T12: aortic hiatus

Question 7

What is IRV?

Answer 7

Air that can still be breathed in after normal breath

Question 8

What is typical TV?

Answer 8

500ml

Question 9

What is ERV?

Answer 9

Air that can still be breathed out after normal breath

Question 10

What is IC?

Answer 10

IRV+TV

Question 11

What is FRC?

Answer 11

RV+ERV

Question 12

What is RV

Answer 12

Air in lung after maximal respiration; cannot be measured on spirometry

Question 13

what is VC

Answer 13

TV+IRV+ERV; maximum volume gas expired after maximal inspiration

Question 14

Formula for physiologic dead space

Answer 14

Vd=Vt-PaCO2-PECO2/PaCO2

Question 15

What is equation, normal value for alveolar ventillation?

Answer 15

normal- 3500ml

VA=(Vt-Vd)xRR

Question 16

How do T and R forms of Hb differ in affinity for O2

Answer 16

T (taut)- low affinity, tissues

R(relaxed)- high affinity, respiratory tract

Question 17

Explain how cyanide is treated (and relation to Hb)

Answer 17

1) Nitrites oxidize Hb to methemoglobin, bind cyanide

2) thiosulfate binds cyanide, excreted by kidney

Question 18

What is methemoglobin? How treat?

Answer 18

Oxidized (Ferric, Fe3+) Hb- lower O2 affinity

treat with methylene blue

Question 19

Formula for O2 content of blood

Answer 19

1.39xHbxSatO2+0.003xPO2

Question 20

What is resistance and compliance of pulmonary circulation?

Answer 20

Low resistance, high compliance

Question 21

In what states (2) is O2 diffusion limited?

Answer 21

emphysema, fibrosis

Question 22

Formula for alveolar gas exchange

Answer 22

PAO2=150-PaCO2/0.8

Question 23

Normal A-a gradient

Answer 23

10-15mmHg

Question 24

What is hypoxemia vs hypoxia?

Answer 24

Hypoxemia: decr arterial O2
Hypoxia: decr O2 delivery to tissues

Question 25

How does V/Q compare at base/apex of lungs

Answer 25

Apex- wasted ventilation (V/Q=3) | Base- wasted perfusion (V/Q=0.6)

Question 26

Haldane vs Bohr effects

Answer 26

Haldane- lungs, CO2 released from RBC | Bohr- tissues, incr H+, O2 released

Question 27

Which sinuses most commonly infected?

Answer 27

Maxillary sinuses

Question 28

What does Reid index >50% indicate?

Answer 28

Chronic bronchitis

Question 29

What is associated with centriacinar vs panacinar emphysema?

Answer 29

centriacinar- smoking (upper lobes) | panacinar- a1 antitrypsin (lower lobes)

Question 30

What does exhalation through purse lips indicate

Answer 30

emphysema

Question 31

What are Curshmann spirals and Charcot-Leyden crystals associated with? Describe both

Answer 31

Curshmann- shed epithelium forms mucus plugs | CL- formed from breakdown of eosinophils

Question 32

What causes bronchiectasis?

Answer 32

chronic necrotizing infection of bronchi

Question 33

Restrictive lung disease with bilateral hilar LAD, noncaseating granulomas

Answer 33

sarcoidosis

Question 34

What reactions mediate hypersensitivity pneumonitis

Answer 34

Type III/IV mixed, birds

Question 35

What is the underlying pathology of Goodpasture?

Answer 35

Autoimmune attack of type IV collagen (alveoli + glomeruli)

Question 36

Assoc with calcified pleural plaques, ferruginous bodies

Answer 36

Asbestosis

Question 37

Which lobes are affected by asbestosis, Coal, silicosis?

Answer 37

Asbestosis, coal: lower lobes | Silicosis: upper lobes

Question 38

What is associated with eggshell calcifications of hilar lymph nodes?

Answer 38

Silicosis

Question 39

What is associated with formation of intra-alveolar hyaline membrane

Answer 39

ARDS

Question 40

FEV1/FVC in obstructive vs restrictive disease?

Answer 40

normal=80% | obstructive 80%

Question 41

What is BMPR2 associated with?

Answer 41

primary pulmonary hypertension

Question 42

What type of lung cancer is not associated with smoking?

Answer 42

Bronchial carcinoid

Question 43

Central lung cancer

Answer 43

squamous cell, small cell

Question 44

What type of lung cancer is associated with hypercalcemia?

Answer 44

squamous cell

Question 45

What are neuroendocrine kulitchsky cells

Answer 45

small dark blue cells, small cell lung cancer

Question 46

What type of lung cancer shows pleiomorphic giant cells

Answer 46

large cell

Question 47

What type of lung cancer is Chromogranin A+

Answer 47

bronchial carcinoid

Question 48

What paraneoplastic syndromes are associated with small cell?

Answer 48

ACTH, ADH, Lambert-Eaton

Question 49

What oncogene is assoc with smal cell lung cancer?

Answer 49

myc

Question 50

Presents with JVD, upperextremity edema, facial plethora

Answer 50

SVC syndrome

Question 51

What are most likely cause of spontaneous vs tension pnuemothorax

Answer 51

spontaneous- accum air, usually rupture of apical blebs | tension- trauma or infxn, deviation of trachea

Question 52

Transudate vs exudate

Answer 52

Transudate- low protein, exudate high protein