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NBME CBSE STUDY GUIDE SOLUTION EXAM
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NBME CBSE STUDY GUIDE SOLUTION EXAM
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NBME CBSE STUDY GUIDE SOLUTION EXAMType II pneumocytes - >>>surfactant (*lecithin*)
Proliferate after injury
Type I progenitors
*Neonatal Respiratory Distress Syndrome*
Polio live v killed vaccine - >>>Killed = Salk = IgG Live = Sabin = IgG + IgA
- can be shed in feces
Neonatal Respiratory Distress: Etiology + Tx - >>>Maternal DM (*high insulin*) or C-section (*low cortisol*)
TX: *dexamethasone* before birth
Lung maturity determined with - >>>Amniocentesis of Phospholipids (*type II pneumocytes)
L >> S
Type I pneumocytes - >>>Squamous gas diffusion
Elastase in lungs - >>>macrophage: *lysosomes*
PMN: *azuronphilic granules* Elastin stretches and recoils due to - >>>Lysine interchain crosslinks
air pressure and intrapleural pressure at FRC - >>>Air pressure = 0
Intrapleural pressure = -5
Pulm Vasc Resistance is lowest during - >>>Exhale of Tidal Volume
Lung Compliance is decreased by - >>>LHF, pulmonary edema, pulmonary fibrosis
Lung Compliance is increased by - >>>emphysema, age
Obesity affects ERV and FRC - >>>DECREASE ERV & FRC
Blood flow/min (pulmonary v systemic) - >>>pulmonary = systemic
Anatomic pulmonary shunting - >>>Bronchial circulation causes *decreased PO2 in LA/LV*
than in pulmonary capillaries
More ventilation is at the - >>>BASE
O2-Hgb dissociation LEFT shift - >>>basic, cold, low 2,3 BPG low pO2 (compensatory erythrocytosis)
O2-Hgb dissociation RIGHT shift - >>>low pH, high 2,3BPG, high T
HOT, ACIDIC
CO2 transport to lungs - >>>*carbonic anhydrase*
Cl shift
*Haldane*: CO2 released to lung
(*Bohr*: O2 release to tissue)
CO poisoning causes - >>>carboxyhemoglobin no affect on PaO2
Cyanide poisoning causes - >>>lactic acidosis
How to treat cyanide poisoning - >>>*Amyl nitrite* --> Methemoglobin
THEN *Thiosulfate* (hydroxycobalamin)
Normal A-a gradient - >>>5-15
Hypoventilation: Heroin OD or high altitude
Increased A-a gradient - >>>*Diffusion impairment* (fibrosis)
*R-L shunt* (aspiration, ARDS)
*V/Q mismatch* (pulmonary edema AT --> AT II where and how - >>>ACE (- high in sarcoidosis)
In small pulmonary bV
C5a induces what - >>>PMN influx (ie: in lungs)
Korotkoff sound - >>>BP cuff - appear and disappear in inflation/deflation
Pulsus Paradoxus - >>>10mmHg difference in Korotkoff sound
Pulsus Paradoxus occurs in - >>>Cardiac Tamponade
Kussmaul sign - >>>JVP rises *during inspiration*
Constrictive Pericardiditis
Restrictive/Interstitial Lung Disease: A-a, FVC, FEV1, EFR - >>>Airway widening due to *radial traction* from fibrosis
*increase Aa*
decreased FVC & FEV1
*Increased EFR*
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