First Aid Express 2016 workbook: RESPIRATORY page 1 Respiratory A OCR URAL rece RL ech tasd Using this table as a guide, read the Facts in First Aid for the USMLE Step 7 2016, watch the corresponding First Aid Express 2016 videos, and then answer the workbook questions. Paco ed red Pa Eee ee ed red 606.1-607.2 Embryology (1 video) 1-6 608.1602 ‘Anatomy (1 video) 713 B10.1-6153 Physiology (4 videos) 14-35, 16 1-628.1 Pathology (4 videos) 26-54 (6271-6282 Pharmacology (1 video) 55-601 Fansoaen tema reomaow EMBRYOLOGY 1. Ab which wook does respiration become possible? During which phase of lung development does: ‘this occur? (p 606) ee 2. ___ (Type irType 1) pneumocytes proliferate during lung damage. (0 607) 3. What is the function of surfactant? (p 607). 4. What ate the risk factors for neonatal respiratory distress syndrome? (p 607) 5. What is the treatment of neonatal respiratory distress syndrome prior to birth? (p 607) 6. Name three conditions that can result from therapeutic oxygen supplementation in neonatal respiratory distress syndrome. (p 607) ANATOMY 7. Which six structures make up the conducting zone of the respiratory tree? (p 608) 8. What are the three main functions of the conducting zone of the respiratory tree? (p 608) 9. Which anatomic structures are encompassed by the respiratory zone, and what is their major function? (p 608) 10. Match the functions and characteristics with the cell type that best describes them. (Numbers may be used more than once.) (p 608) A Clliated 1. Club (Clara) cells B. Clear debris from alveoli 2. Macrophages C. Comprise 3% of pneumocytes 3. Pseudostratified ciliated columnar cells 1D. Cuboidal and clustered 4. Type | cells E. Degrade toxins 5. Type Il cells, F. Make up the majority of pneumocytes. G. Noneiliated H_ Procursors to type | pneumocytes |. Produce surfactant J. Squamous cells,First Aid Express 2016 workbook: RESPIRATORY page 3 11. Ityou aspirate a peanut while standing upnght, where will it most likely go? (o 609) 12. Ifyou aspirate a peanut while ling supine, where will most likely go? (p 609) 13. Match the structure and the thoracic vertebral level whore it crosses the diaphragm. (Numbers may be used more than once.) (0 609) A Aorta 1. 18 B. Azygous vein 2 10 ‘C. Esophagus a 112 D. Inferior vena cava E, Thoracic duct, F Vagal trunk PHYSIOLOGY 14. Match the term with its description. (p 610) ‘A. Additional air that can be inspired after anormal breath 1. ERV Air remaining in lung after maximal expiration 2. FRC ‘C. Airthat can stil be exhaled after normal expiration a Ic D. Air that moves into lung with each quiet inspiration 4 IRV EIRV+TV 5. RV F IRV+TV+ERV+RV 6 Tc G.RV + ERV TW HOTV+IRV+ERV 8 ve 15. Onthe image below, fil n the rectangles to describe the lung volume measurement. (2 60) Lung volumes (LITER): 60 +07 Volume siepage 4 First Aid Express 2016 workbook: RESPIRATORY 16. 17. 18. 19. a 24 25. 2 What are the components of physiologic dead space? (p 610) In which three conditions is lung compliance decreased? (p 611) What are the two forms of hemoglobin? Which has a greater affinity for Oz? (p 611) What is the treatment for cyanide poisoning? (p 612) When the oxygen-hemoglobin dissociation curve shifts tothe right, the affnty of hemoglobin for Oz (decreases/increases). When the oxygen-hemogiobin dissociation curve shifts tothe Ief the affinfy of hemoglobin for O> (decreases/increases). (0 612) In the chart below, checkmark whether the effect shifts the oxygen-hemoglobin dissociation curve to the left or to the nght. (p 612) Eel Peco! Decreased 2,3.BPG Decreased pH Decreased temperature Foetal hemoglobin High altitude Increased metabolic neads Increased pH Increased temperature ‘What gases are perfusion limited when diffusing into the pulmonary capillary? (p 613) How is the A.a gradient calculated? (p 614) Which three pathologic processes can lead to an increased A-a gradient? (p 614), Which two processes lead to hypoxemia with @ normal A-a gradient? (p 614) Which three processes can lead to hypoxemia with an increased A.a gradient? (p 614), ‘Name four processes that can lead to hypoxia (le, decreased O: delivery to tissue). (p 614) ‘With respect to the lung apex (zone 1), arrange the following in order of increasing pressure: artery, vein, alveolus. (p 614) eeFt ie es 206 woo RESPRATORY rans 20. With respect o zone 2 ofthe lung, arrange the following inorder of increasing pressure: artery, voin, alveolus. (p 614) ee 30. With respect tothe lung base (zone 3), arrange the folowing in order of increasing pressure: artery, vein, alveolus. (p 674) 31. _Inwhich forms is CO; transported from the tissues tothe lungs? (p 615) 32. What enzyme catalyzes the conversion of CO: and water into carbonic acid? (p 65) 33. What is tho namo for the offect in which oxygenation of hemoglobin within the lungs promotes tho dissociation of CO: from hemoglobin? (p 675). 34. In peripheral tissues, the right shift of the oxygen-hemoglobin dissociation curve that results from docteasod pH causes an unloading of O:- What isthe nama forts effect? (p 615) 38. For each item in the chart below, indicate whether altitude or exercise would induce the response. 615) ponse to Response to Gr vr aaa Decreased pH Increased 2,3. BPG Increased CO: production Increased erythropotetin Increased O: consumption Increased mitochondria Increased pulmonary blood flow Increased renal excration of bicarbonate Increased ventilation More uniform V/Q ratio from apex to base Right ventricular hypertrophy PATHOLOGY 38. Which three factors that promote blood coagulation are collectively known as Virchows triad? 616) 37. Name the six most common causes of emboli to the lungs. (p 647)page 6 First Aid Express 2016 workbook RESPIRATORY 40, a 42, 43, 46. 4. 43, For each patient, indicate the most ikely type of pulmonary embolus. (p 617) A 30-year-old postpartum woman B. An 18-year-old man who sustained a motor vehicle collision C.__A35-year-old professional scuba diver D. An 83-year-old woman with a hip fracture after falling Match the characteristic finding with the obstructive lung disease with which itis associated (Numbers may be used more than once.) (0 618) ‘A. Associated with Kartagener syndrome 1. Asthma B. Chronic productive cough 2. Bronchiectasis C. Curschmann spirals. 3 Chronic bronchitis . Hyperplasia of mucus-secreting glands 4. Emphysema E Increased lung compliance F. Increased susceptibility to aspergillosis ‘G. Mucus plugs H. Permanently dilated airways 1. Reid index >80% ‘J. Results from hyperresponsiveness of bronchi K Destruction of alveolar walls L. Wheezing and crackles on auscultation Wheat is the typical range of FEV:/FVC for patients with restrictive lung disease? (p 619). What typo of hypersensitivity reaction is involved in hypersensitivity poumonitis? (p 619), Which of the pneumoconiases is associated with an increased incidence of bronchogenic ‘carcinoma? (p 620) ‘What are the risk factors for acute respiratory distress syndrome? (p 621) Match the physical examination finding with its associated pathology. (p 622) ‘A. Duliness to percussion with | fremitus 1. Bronchial obstruction B.Dulness to percussion wath + fremitus. 2. Lobar pneumonia ‘C. Tracheal deviation away from affected side 3. Pleural effusion D. Tracfheal deviation toward affected side 4. Tension pneumothorax Name three causes of transudate pleural effusions. (p 623) Name four causes of exudate pleural effusions. (p 623)First Aid Express 2016 workbook RESPIRATORY page 7 49. Atal, thin man comes to the ER because of right-sided chest pain and dyspnea. On exam, there are diminished breath sounds on the right side and hyperresonance to percussion. What type of pneumothorax is most likely? (p 623) A. Adenoviruses 4. Bronchopneumonia B Chlamydia 2 Lobar pneumonia C. Haemophilus infivenzae 3. Interstitial pneumonia H. Staphylococcus aureus 1. Streptococcus pneumoniae 51. What arganisms are most likely found in a lung abscess? (p 624) 52. Match the lung cancer with its characteristic. (Numbers may be used more than once.) (bp 624-626) A. Associated ith k-ras mutation 4. Adenocarcinoma B. Associated with asbestos exposure. 2 Lage call carcinoma C._ Associated with smoking 3. Mesothelioma. =D" Forms keratin pearls 4 Small cell carcinoma E. Inoperable 5. Squamous coll carcinoma F. May lead to Lambert-Eaton syndrome |G. May produce ACTH or ADH H. May be associated with amplification of myc oncogenes |. Mast common lung cancer among nonsmokers J. Parathyroid-lke activity K._Pleomorphic giant colls with cytoplasmic loukocyte fragments in cytoplasm L._ Precursors are neuroendocrine cells M. Psammoma bodies 53. What are the three findings of Homer syndrome? (p 625) 54. What are the four most common sites of lung cancer metastases? (p 626) PHARMACOLOGY 55. What is the mechanism of action of dextromethorphan? (p 627) ‘56. With respact to toxicity, what is the main difference between first. and second.generation Hs histamine receptors? (p 627)page 8 Furst Atd Express 2016 workbook: RESPIRATORY B 57 What the mechanism of action of bosentan? (p 627) 58. Whatis the mechanism of action of albuterol? (p 628) 8 Ipratropium is a member of which class of drugs? (p 628) 60. _ Inthe image below, filin the rectangles to identify the treatments for asthma. (p 628) Sponretoanigen (Gon ple acgen eer Nsain, ) onctormnnon ‘aniston | |Furst Aid Express 2016 workbook: RESPIRATORY page 9 Bus EMBRYOLOGY 4. Week 25. Canalicular phase 2 Type tl Decreases alveolar surface tension. 4. Maternal diabetes, cesarean delivery, and premature birth, Matemal steroids. 6. Retinopathy of prematurity, intraventricular hemorrhage, and bronchopulmonary dysplasia ANATOMY 7. Nose, pharynx, trachea, bronchi, bronchioles, and terminal bronchioles. 8 The conducting zone warms, humidifies, and fers the air. 9. The respiratory bronchioles, the alveolar ducts, and alveoli, all of which function in gas exchange. 10. B2,A3,C-5,0-5, £4, F-4,G-4,H5, 15,04 41 Lower portion of right inferior lobe. 12. Superior portion of right inferior lobe. 13. A3,B3,C2,D1,E3,F2, PHYSIOLOGY 14. A4,B5,C-1,D-7, £3, F-6,6-2,H2.ose 10 Fret ad oes 2r6 vost ResERrORY [ES 60 Volume | | we] [ve wu 15 Lung volumes (LITER) Frio] 22 22 12 [FRE 16. Anatomic and alveolar dead space, 17. _Instates of pulmonary fibrosis, pulmonary edema, and decreased surfactant production, 18. The relaxed (R) form has a higher affinity for O- than the taut (T) form. 19. Nitrites and thiosutfates. 20. Decreases; increases. a Eel re el Decreased 2,3-BPG v Decreased pH v Decreased temperature v Fetal hemoglobin v High aitude v Tncreased metabolic needs v Increased pH q Increased temperature v 22. Oxygen (in normal health), carbon dioxide, and nitrous oxide (NeO, not to be confused with nitric ‘oxide, NO). 23. Aca gradient = PA: — Pade, normal is 10-15 mm Hg. 24. Shunting, ventilation/perfusion mismatch, and pulmonary fibrosis.26. mr. 28. 29, 20, g ae ee Furst Aid Express 2016 workbook: RESPIRATORY page 11 High altitude and hypoventilation. \Ventilation/perfusion mismatch, diffusion limitation, and right-to-left shunt, Hypoxemia, anemia, carbon monoxide poisoning, and decreased cardiac output. Vein < artery < alveolus. Vein « alveolus « artery Alveolus < vein < artery, {As bicarbonate, bound to hemoglobin as carbaminohemoglobin, and ai Carbonic anhydrase. ‘The Haldane effect. ‘The Bohr effect eo See ase Decreased pH Increased 2,3-DPG T Increased CO; production 7 Increased erythropoietin T Increased 0; consumption 7 Increased mitochondria 7 Increased pulmonary blood flow T Increased renal excretion of bicarbonate Increased ventilation More uniform VIO rao from apex to base Right ventricular hypertrophy q 4 24 PATHOLOGY 26, ar. 8 44 ‘Stasis, hypercoagulabiity, and endothelial damage. Fat, ar, tirombus, bacteria, amniotic fluid, and tumor. ‘A= amniotic fluid, B = fat, C = air, D = thrombus. A2,B3, C1, D-4, £3, F-4, 2, Hl, 2, J-3, K-1,L3. > 80%. (Mixed type IIVIV hypersensitivity reaction to environmental antigen.page 12 Frist Aid Express 2016 workbook: RESPIRATORY (ES) 42. Asbestosis. 43. Trauma, sepsis, shock, gastric aspiration, uremia, acute pancrealits, and amniotic fluid embolism, 44, A form of sleep apnea that results from lack of respiratory effort 45. A form of sleep apnea in which there is a drive to breathe but respiration is prevented because of mechanical airway obstruction (usually from obesity) 46. A3,B2,C-4,D-1 47. HF, nephrotic syndrome, and hepatic cirrhosis. 48. Malignancy, pneumonia, collagen vascular disease, and trauma, 8 ‘Spontaneous pneumothorax due to rupture of apical blebs. 50. A3,B-3, C-1, D-l and 2, E-3, F-3, 6-3, HH, IM and 2. 51. Staphylococcus aureus, Bacteroides, Fusobactertum, and Peptostreptococcus. 92 A1,B3,C-9,D.5,E4, F4,6-4,H-4,14,J5,K2,L4,M3. 53. _ Ipsilateral ptosis, miosis, anhidrosis 54. Adrenals, brain, bone, and liver. PHARMACOLOGY 55. Itantagonizes NMDA glutamate receptor and acts as a noncompetitive channel blocker 56. Second.generation H; histamine receptors are far less sedating because their CNS penetration is much lower than that of first-generation agents. ST. _Itis a competitive antagonist of endothelin-1 at the endothelin (ET-A) and endothelin-B (ET-B) receptors. Albuterol relaxes bronchial smooth muscle through its agonism of f-adrenergic receptors. B 59. Muscarinic antagonists.re mn oe acs Resse moe « Srcnretosntoen Waxsont ad tote gk (2a Meteo Ceaaees nse) \ B-agoriets \\ 5 | seroiae Treophyline |< \+2+ Antleukottones | Muscarinic 4 ‘antagonists xy repese Uuerezone rer acoso wanreaton st yperssoiey