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Last region of respiratory tree where goblet cells are found
Terminal bronchioles
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Cells that mediate gas exchange
Type I pneumocytes
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Cells that secrete surfactant
Type II pneumocytes
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Way to measure fetal lung maturity
Lecithin:sphingomyelin ratio in amniotic fluid should be over 2
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Which lung is the lingula found on?
Left
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Most common site for inhaled foreign body to lodge
Right lung
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Where is the pulmonary artery, relative to the bronchus, in each lung?
- Right--anterior
- Left--superior
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At what level does the IVC perforate the diaphragm?
T8
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At what level do the esophagus and vagus perforate the diaphragm?
T10
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At what level do the aorta, thoracic duct, and azygos perforate the diaphragm?
T12
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Functions of ACE
- Converts angiotensin I to angiotensin II
- Inactivates bradykinin
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Role of kallikrein
Activates bradykinin
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Definition of vital capacity
Maximal air volume that can be pushed in and out of the lungs: tidal volume + inspiratory reserve volume + expiratory reserve volume
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Definition of functional residual capacity
Air left in lungs after normal expiration: expiratory reserve volume + residual volume
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Region of lung that is the largest contributor to functional dead space
Apex
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When does airway pressure equal atmospheric pressure?
FRC
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Factors that favor the tense conformation of Hb
- Acidity
- Decreased oxygen pressure, increased carbon dioxide pressure
- Cl-
- 2,3 BPG
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Treatment for methemoglobinemia
Methylene blue
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Effect of carboxyhemoglobin
Carbon monoxide binds to Hb much more strongly than oxygen. This displaces oxygen from hemoglobin, causes a left shift of the Hb/O2 dissociation curve, and decreases oxygen delivery to the tissues.
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In whom does 2,3 BPG concentration increase, and why?
- COPD patients
- People who live at high altitudes
Increased 2,3 BPG promotes unloading of oxygen in the tissues, which compensates for a low oxygen pressure
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Effect of decreased oxygen pressure in the lungs
Vasoconstriction shunts blood in the lungs away from poorly ventilated areas (diffuse hypoxia in the lungs can lead to pulmonary hypertension
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Cause of primary pulmonary hypertension
Inactivating mutation in the BMPR2 gene (which normally functions to inhibit vascular smooth muscle proliferation)
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How much oxygen can one gram of hemoglobin bind to?
1.34 mL
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Alveolar arterial gradient
- Alveolar oxygen - arterial oxygen
- Normal is 10-15 mmHg
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Five causes of hypoxemia
- High altitude
- Hypoventilation
- V/Q mismatch
- Diffusion limitation
- Right to left shunt
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Five causes of hypoxia (decreased oxygen delivery to the tissues)
- Hypoxemia
- Decreased cardiac output
- Anemia
- Cyanide poisoning
- CO poisoning
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Where are ventilation and perfusion highest?
Base of the lungs--but perfusion is a lot higher than ventilation
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What is the V/Q ratio if the airways are obstructed?
Zero
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What is the V/Q ratio if blood flow is obstructed?
Infinity
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Why does bicarb turn back to carbon dioxide in the lungs?
Oxygenation of Hb causes H+ to be released from Hb; H+ protenates bicarb, converting it back into CO2 and water
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What happens to the body's acid base balance at high altitudes?
- Decreased oxygen concentrations cause hypoxemia
- Hypoxemia activates central respiratory centers, leading to hyperventilation
- Hyperventilation decreases CO2, which causes respiratory alkalosis
- ("acute mountain sickness" can be treated with acetazolamide)
- The kidneys excrete bicarb to compensate for the respiratory alkalosis
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When is FEV1/FVC ratio decreased?
Obstructive lung disease
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What is the Reid index, and in what disease does it increase?
- The ratio of gland depth:bronchiolar wall
- Increases over 50% in chronic bronchitis, due to hypertrophy of mucus-producing glands
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What happens to bronchiolar smooth muscle in asthma patients?
It hypertrophies
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Why do asthmatics have a pulsus paradoxus?
- High negative pressure in the thorax during inspiration increases venous return to the right ventricle
- The right ventricle distends and compresses the left ventricle, causing systolic pressure to weaken during inspiration
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What happens to the FEV1:FVC ratio in restrictive lung disease?
- It stays normal, or increases
- Both FEV1 and FVC go down in restrictive lung disease, but FEV1 tends to go down less, since stiff lungs are good at expelling air
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Name three drugs that cause pulmonary fibrosis
- Busulfan
- Bleomycin
- Amiodarone
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What lobes are affected by coal worker's lung?
Upper
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Eggshell calcification on hilar lymph nodes
Silicosis
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Which alveoli are most vulnerable to surfactant deficiency?
The smaller ones, since collapsing pressure decreases with radius
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Locations of:
1. Squamous cell carcinoma
2. Bronchial adenocarcinoma
3. Small cell carcinoma
- Squamous--central
- Bronchial--peripheral
- Small cell--central
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Lung cancer that has psammoma bodies on biopsy
Mesothelioma
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Lung cancer with small, dark blue cells that stain positive for chromogranin
Small cell carcinoma
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