CBSE
Type II pneumocytes Correct Answer: surfactant (*lecithin*)
Proliferate after injury
Type I progenitors
*Neonatal Respiratory Distress Syndrome*
Polio live v killed vaccine Correct Answer: Killed = Salk = IgG
Live = Sabin = IgG + IgA
- can be shed in feces
Neonatal Respiratory Distress:
Etiology + Tx Correct Answer: Maternal DM (*high insulin*)
or C-section (*low cortisol*)
TX: *dexamethasone* before birth
Lung maturity determined with Correct Answer: Amniocentesis of Phospholipids (*type II pneumocytes)
L >> S
Type I pneumocytes Correct Answer: Squamous gas diffusion
Elastase in lungs Correct Answer: macrophage: *lysosomes*
PMN: *azuronphilic granules*
Elastin stretches and recoils due to Correct Answer: Lysine interchain crosslinks
air pressure and
intrapleural pressure at FRC Correct Answer: Air pressure = 0
Intrapleural pressure = -5
Pulm Vasc Resistance is lowest during Correct Answer: Exhale of Tidal Volume
Lung Compliance is decreased by Correct Answer: LHF, pulmonary edema,
pulmonary fibrosis
Lung Compliance is increased by Correct Answer: emphysema, age
Obesity affects ERV and FRC Correct Answer: DECREASE
ERV & FRC
Blood flow/min (pulmonary v systemic) Correct Answer: pulmonary = systemic
Anatomic pulmonary shunting Correct Answer: Bronchial circulation causes
*decreased PO2 in LA/LV*
,than in pulmonary capillaries
More ventilation is at the Correct Answer: BASE
O2-Hgb dissociation LEFT shift Correct Answer: basic, cold, low 2,3 BPG
low pO2 (compensatory erythrocytosis)
O2-Hgb dissociation RIGHT shift Correct Answer: low pH, high 2,3BPG, high T
HOT, ACIDIC
CO2 transport to lungs Correct Answer: *carbonic anhydrase*
Cl shift
*Haldane*: CO2 released to lung
(*Bohr*: O2 release to tissue)
CO poisoning causes Correct Answer: carboxyhemoglobin
no affect on PaO2
Cyanide poisoning causes Correct Answer: lactic acidosis
How to treat cyanide poisoning Correct Answer: *Amyl nitrite* --> Methemoglobin
THEN *Thiosulfate* (hydroxycobalamin)
Normal A-a gradient Correct Answer: 5-15
Hypoventilation: Heroin OD or high altitude
Increased A-a gradient Correct Answer: *Diffusion impairment* (fibrosis)
*R-L shunt* (aspiration, ARDS)
*V/Q mismatch* (pulmonary edema
AT --> AT II
where and how Correct Answer: ACE
(- high in sarcoidosis)
In small pulmonary bV
C5a induces what Correct Answer: PMN influx (ie: in lungs)
Korotkoff sound Correct Answer: BP cuff - appear and disappear
in inflation/deflation
Pulsus Paradoxus Correct Answer: 10mmHg difference in
Korotkoff sound
Pulsus Paradoxus occurs in Correct Answer: Cardiac Tamponade
Kussmaul sign Correct Answer: JVP rises *during inspiration*
Constrictive Pericardiditis
,Restrictive/Interstitial Lung Disease:
A-a, FVC, FEV1, EFR Correct Answer: Airway widening due to *radial traction* from fibrosis
*increase Aa*
decreased FVC & FEV1
*Increased EFR*
Sarcoidosis Correct Answer: *Th1 *noncaseating granulmona
bilateral hilar adenopathy
increased *ACE*
increased IL2, IFNg
1-a-hydroxylase in macrophages: vit D --> *HyperCa*
Hyper Ca causes Correct Answer: stones, thrones, groans, psych overtones
1-a-hydroxylase in macrophages Correct Answer: PTH independent conversion of
Calcifediol to *calcitriol* (bioactive Vit D)
Vit D --> Hyper Ca
Idiopathic pulmonary fibrosis Correct Answer: *Honeycomb* pattern
loss of Type 1 pneumocytes
*hyperplasia Type II* pneumocytes
Goodpasture Correct Answer: HS II
Auto-Ab against BM destroys lung alveoli (*restrictive*) and renal glomeruli
Obstructive Lung Disease Correct Answer: DECREASED FEV1, Decreased FVC
increased RV, FRC, TLC
**different shape
COPD Correct Answer: PMN, mo, CD8
*V/Q mismatch:* O2 induced hypercapnia;
physio dead space
Myeloperoxidase causes Correct Answer: Green sputum/pus
Do not give O2 supplement to Correct Answer: COPD patient
Decreased stimulation of
*carotid bodies* = decreased RR
TX COPD with Correct Answer: *Fluticasone* (glucocorticoid)
inhibit cellular reaction
a1-antitrypsin deficiency Correct Answer: Serine protease inhibitor
*LIVER*
, *LUNG*: inc PMN elastase --> emphysema
Asthma dx Correct Answer: *Methacholine* (maCh) challenge
= induce bronchoconstriction
to reduce FEV1
+ test = Airways ARE reactive
B2 agonist MOA Correct Answer: B2 (Gs) --> AC --> increase *cAMP*
Corticosteroid MOA Correct Answer: inhibit cytokine synthesis
suppress T lymphocyte
mACh Antagonist ("tropium") MOA Correct Answer: *inhibit Vagal* via ACh
--> decreased Ca
OSA causes Correct Answer: pulmonary HTN and RHF
increases EPO which worsens HTN
EPO can do what
on Cardiovascular Correct Answer: worsen HTN
Pulmonary Arterial HTN Correct Answer: *BMPR2*
High *endothelin*, Low NO
SMC hypertophy, fibrosis, narrow lumen
*P2 louder* than A2
When is P2 louder than A2 Correct Answer: Pulmonary Artherial Hypertension
TX pulmonary arterial hypertension Correct Answer: Endothelin-R antagonist:
- Bo*sentan*, Ambi*sentan*
PGEi (inc cGMP):
- Silden*afil*
Pulmonary Embolism Correct Answer: *perfusion defect* (V/Q mismatch)
sudden SOB + calf swelling
Hypoxemia --> *Hyperventilate *
--> *Respiratory Alkalosis *
--> Metabolic compensation in 2 days
dx pulmonary embolism Correct Answer: *D-dimer* test
CT angiogram
Lines of Zahn
*Homan's sign* (DVT calf pain on dorsiflex)
TX pulmonary embolism Correct Answer: Heparin/LMWH
THEN
Warfarin
Type II pneumocytes Correct Answer: surfactant (*lecithin*)
Proliferate after injury
Type I progenitors
*Neonatal Respiratory Distress Syndrome*
Polio live v killed vaccine Correct Answer: Killed = Salk = IgG
Live = Sabin = IgG + IgA
- can be shed in feces
Neonatal Respiratory Distress:
Etiology + Tx Correct Answer: Maternal DM (*high insulin*)
or C-section (*low cortisol*)
TX: *dexamethasone* before birth
Lung maturity determined with Correct Answer: Amniocentesis of Phospholipids (*type II pneumocytes)
L >> S
Type I pneumocytes Correct Answer: Squamous gas diffusion
Elastase in lungs Correct Answer: macrophage: *lysosomes*
PMN: *azuronphilic granules*
Elastin stretches and recoils due to Correct Answer: Lysine interchain crosslinks
air pressure and
intrapleural pressure at FRC Correct Answer: Air pressure = 0
Intrapleural pressure = -5
Pulm Vasc Resistance is lowest during Correct Answer: Exhale of Tidal Volume
Lung Compliance is decreased by Correct Answer: LHF, pulmonary edema,
pulmonary fibrosis
Lung Compliance is increased by Correct Answer: emphysema, age
Obesity affects ERV and FRC Correct Answer: DECREASE
ERV & FRC
Blood flow/min (pulmonary v systemic) Correct Answer: pulmonary = systemic
Anatomic pulmonary shunting Correct Answer: Bronchial circulation causes
*decreased PO2 in LA/LV*
,than in pulmonary capillaries
More ventilation is at the Correct Answer: BASE
O2-Hgb dissociation LEFT shift Correct Answer: basic, cold, low 2,3 BPG
low pO2 (compensatory erythrocytosis)
O2-Hgb dissociation RIGHT shift Correct Answer: low pH, high 2,3BPG, high T
HOT, ACIDIC
CO2 transport to lungs Correct Answer: *carbonic anhydrase*
Cl shift
*Haldane*: CO2 released to lung
(*Bohr*: O2 release to tissue)
CO poisoning causes Correct Answer: carboxyhemoglobin
no affect on PaO2
Cyanide poisoning causes Correct Answer: lactic acidosis
How to treat cyanide poisoning Correct Answer: *Amyl nitrite* --> Methemoglobin
THEN *Thiosulfate* (hydroxycobalamin)
Normal A-a gradient Correct Answer: 5-15
Hypoventilation: Heroin OD or high altitude
Increased A-a gradient Correct Answer: *Diffusion impairment* (fibrosis)
*R-L shunt* (aspiration, ARDS)
*V/Q mismatch* (pulmonary edema
AT --> AT II
where and how Correct Answer: ACE
(- high in sarcoidosis)
In small pulmonary bV
C5a induces what Correct Answer: PMN influx (ie: in lungs)
Korotkoff sound Correct Answer: BP cuff - appear and disappear
in inflation/deflation
Pulsus Paradoxus Correct Answer: 10mmHg difference in
Korotkoff sound
Pulsus Paradoxus occurs in Correct Answer: Cardiac Tamponade
Kussmaul sign Correct Answer: JVP rises *during inspiration*
Constrictive Pericardiditis
,Restrictive/Interstitial Lung Disease:
A-a, FVC, FEV1, EFR Correct Answer: Airway widening due to *radial traction* from fibrosis
*increase Aa*
decreased FVC & FEV1
*Increased EFR*
Sarcoidosis Correct Answer: *Th1 *noncaseating granulmona
bilateral hilar adenopathy
increased *ACE*
increased IL2, IFNg
1-a-hydroxylase in macrophages: vit D --> *HyperCa*
Hyper Ca causes Correct Answer: stones, thrones, groans, psych overtones
1-a-hydroxylase in macrophages Correct Answer: PTH independent conversion of
Calcifediol to *calcitriol* (bioactive Vit D)
Vit D --> Hyper Ca
Idiopathic pulmonary fibrosis Correct Answer: *Honeycomb* pattern
loss of Type 1 pneumocytes
*hyperplasia Type II* pneumocytes
Goodpasture Correct Answer: HS II
Auto-Ab against BM destroys lung alveoli (*restrictive*) and renal glomeruli
Obstructive Lung Disease Correct Answer: DECREASED FEV1, Decreased FVC
increased RV, FRC, TLC
**different shape
COPD Correct Answer: PMN, mo, CD8
*V/Q mismatch:* O2 induced hypercapnia;
physio dead space
Myeloperoxidase causes Correct Answer: Green sputum/pus
Do not give O2 supplement to Correct Answer: COPD patient
Decreased stimulation of
*carotid bodies* = decreased RR
TX COPD with Correct Answer: *Fluticasone* (glucocorticoid)
inhibit cellular reaction
a1-antitrypsin deficiency Correct Answer: Serine protease inhibitor
*LIVER*
, *LUNG*: inc PMN elastase --> emphysema
Asthma dx Correct Answer: *Methacholine* (maCh) challenge
= induce bronchoconstriction
to reduce FEV1
+ test = Airways ARE reactive
B2 agonist MOA Correct Answer: B2 (Gs) --> AC --> increase *cAMP*
Corticosteroid MOA Correct Answer: inhibit cytokine synthesis
suppress T lymphocyte
mACh Antagonist ("tropium") MOA Correct Answer: *inhibit Vagal* via ACh
--> decreased Ca
OSA causes Correct Answer: pulmonary HTN and RHF
increases EPO which worsens HTN
EPO can do what
on Cardiovascular Correct Answer: worsen HTN
Pulmonary Arterial HTN Correct Answer: *BMPR2*
High *endothelin*, Low NO
SMC hypertophy, fibrosis, narrow lumen
*P2 louder* than A2
When is P2 louder than A2 Correct Answer: Pulmonary Artherial Hypertension
TX pulmonary arterial hypertension Correct Answer: Endothelin-R antagonist:
- Bo*sentan*, Ambi*sentan*
PGEi (inc cGMP):
- Silden*afil*
Pulmonary Embolism Correct Answer: *perfusion defect* (V/Q mismatch)
sudden SOB + calf swelling
Hypoxemia --> *Hyperventilate *
--> *Respiratory Alkalosis *
--> Metabolic compensation in 2 days
dx pulmonary embolism Correct Answer: *D-dimer* test
CT angiogram
Lines of Zahn
*Homan's sign* (DVT calf pain on dorsiflex)
TX pulmonary embolism Correct Answer: Heparin/LMWH
THEN
Warfarin
