Respiratory

Question 0

Muscles recruited to help breathing during exercise

inspiration vs. expiration

Answer 0

InSpiration: external intercostals, Scalenes, Sternocleidomastoids

Expiration: rectus abdominus, internal/external obliques, transversus abdominus, internal intercostals

Question 1

Anatomy of Lung lobes:

R vs. L differences

Answer 1

Left lung: Lingula & 2 lobes, less likely to aspirate

Right lung: 3 lobes, most likely to aspirate into inferior lobe (upper portion if supine, lower portion if upright/standing)

Question 2

pathogenesis of Primary Pulmonary HTN

Answer 2

INactivating mutation in BMPR2 gene
=> excessive vascular smooth muscle proliferation

(vs. Secondary, from destruction of lung parenchyma (COPD), vascular narrowing (sclerosis or thrombosis), or high altitude - hypoxic vasoconstriction)

Question 3

Serum O2 content vs. % saturation vs. binding capacity

Answer 3

Serum O2 content: includes dissolved AND bound O2, drops w/ low Hb.
% Saturation & PaO2 do NOT change w/ low Hb.
Binding capacity DOES drop w/ O2 bc less space for O2 loading.

Question 4

Physiologic changes in CHRONIC high altitude living (5)

Answer 4

1. increased ventilation (also acutely)
2. increase EPO = increase Hb & hematocrit
3. increase 2,3-BOG (more release of O2)
4. increase mitochondria
5. increased renal excretion of HCO3- (as compensation)
   * Complication: hypoxic pulmonary vasoconstriction => RVH!

Question 5

drugs that cause pulmonary fibrosis (=> restrictive lung disease)

Answer 5

1. bleomycin
2. busulfan
3. amiodarone
4. methotrexate

Question 6

Occupational risk for pneumociases:

which jobs w/ which disease?

Answer 6

1. Coal mines -> anthracosis (black lung)
2. Foundries/sandblasting –> silicosis (eggshell LN calcification)
   
   • risk TB & carcinoma
3. Ship-building/roofing/plumbing —> asbestosis (pleural plaques)
   
   • risk mesothelioma & carcinoma

Question 7

Teenager/young adult with recurrent respiratory infections, esp. Pseudomonas…

Answer 7

CF (Cystic Fibrosis, AR)
Also assoc. w/
- male infertility (absent vas deferens bilaterally)
- pancreatitis (bc mucus plugging, also in biliary tract)
- meconium ileus (aka obstruction, in newborns)
*Tx malabsorption & steatorrhea/diarrhea w/ exog. lipase!