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What is the primary function of mast cell stabilizers like Nedocromil?
What is the primary function of mast cell stabilizers like Nedocromil?
Which drug is classified as a long-acting muscarinic receptor antagonist (LAMA) for COPD?
Which drug is classified as a long-acting muscarinic receptor antagonist (LAMA) for COPD?
Which medication is known to help break down airway mucus in cystic fibrosis patients?
Which medication is known to help break down airway mucus in cystic fibrosis patients?
What is the mechanism of action of Omalizumab?
What is the mechanism of action of Omalizumab?
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Which drug is considered an anti-fibrotic agent used in idiopathic pulmonary fibrosis?
Which drug is considered an anti-fibrotic agent used in idiopathic pulmonary fibrosis?
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What physiological mechanism occurs in areas of the lung with low ventilation to improve the V/Q ratio?
What physiological mechanism occurs in areas of the lung with low ventilation to improve the V/Q ratio?
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What is the term used interchangeably with 'pathologic dead space'?
What is the term used interchangeably with 'pathologic dead space'?
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What characteristic shape indicates an obstructive pattern on a spirometry curve?
What characteristic shape indicates an obstructive pattern on a spirometry curve?
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What characterizes the V/Q ratio at the bases of the lungs compared to the apices?
What characterizes the V/Q ratio at the bases of the lungs compared to the apices?
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What is the mechanism of action of oseltamivir and zanamivir?
What is the mechanism of action of oseltamivir and zanamivir?
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Which type of dead space includes areas of the lung that are naturally ventilated but do not participate in gas exchange?
Which type of dead space includes areas of the lung that are naturally ventilated but do not participate in gas exchange?
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What leads to seasonal influenza epidemics?
What leads to seasonal influenza epidemics?
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Which condition is more likely in a young patient with a history of smoking if the spirometry shows a scooped-out curve?
Which condition is more likely in a young patient with a history of smoking if the spirometry shows a scooped-out curve?
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Which statement about restrictive lung disease is correct?
Which statement about restrictive lung disease is correct?
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Which pathogen is commonly associated with bacterial pneumonia following influenza infection?
Which pathogen is commonly associated with bacterial pneumonia following influenza infection?
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What is a common example of a condition that can lead to a significant reduction in blood flow to the lungs?
What is a common example of a condition that can lead to a significant reduction in blood flow to the lungs?
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How does physiological dead space relate to the components of ventilation and perfusion?
How does physiological dead space relate to the components of ventilation and perfusion?
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What does a low ventilation/perfusion (V/Q) ratio indicate?
What does a low ventilation/perfusion (V/Q) ratio indicate?
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At what age should the inactivated influenza vaccine first be administered?
At what age should the inactivated influenza vaccine first be administered?
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What type of influenza vaccine is suitable for immunocompetent individuals aged 2-45?
What type of influenza vaccine is suitable for immunocompetent individuals aged 2-45?
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What is true about the relationship of perfusion and ventilation in the apex and base of the lungs due to gravity?
What is true about the relationship of perfusion and ventilation in the apex and base of the lungs due to gravity?
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What condition is typically associated with a high V/Q ratio?
What condition is typically associated with a high V/Q ratio?
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What is the expected FEV1/FVC ratio in restrictive lung disease?
What is the expected FEV1/FVC ratio in restrictive lung disease?
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Which of the following is an indication of a pathologic shunt?
Which of the following is an indication of a pathologic shunt?
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What is a typical V/Q ratio observed at the apices of the lungs?
What is a typical V/Q ratio observed at the apices of the lungs?
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Which lung volume is typically increased in obstructive lung disease due to air trapping?
Which lung volume is typically increased in obstructive lung disease due to air trapping?
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Which of the following statements about SARS-CoV-2 is true?
Which of the following statements about SARS-CoV-2 is true?
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Which factor primarily causes decreased compliance in restrictive lung conditions?
Which factor primarily causes decreased compliance in restrictive lung conditions?
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In terms of expiratory flow rate, what characterizes obstructive lung disease?
In terms of expiratory flow rate, what characterizes obstructive lung disease?
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What led to the belief that the 2019 COVID-19 pandemic started from a laboratory leak?
What led to the belief that the 2019 COVID-19 pandemic started from a laboratory leak?
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Which term describes the reassortment of viral segments leading to a novel influenza virus?
Which term describes the reassortment of viral segments leading to a novel influenza virus?
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What effect does lung compliance have on the spirometry curve of restrictive lung disease?
What effect does lung compliance have on the spirometry curve of restrictive lung disease?
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Which lung volume is expected to decrease in patients with restrictive lung disease?
Which lung volume is expected to decrease in patients with restrictive lung disease?
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What is the common shape of the expiratory curve in flow-volume loops for obstructive lung disease?
What is the common shape of the expiratory curve in flow-volume loops for obstructive lung disease?
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What is the primary cause of decreased arterial oxygen in patients with pathologic shunts?
What is the primary cause of decreased arterial oxygen in patients with pathologic shunts?
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How does living in a polluted city affect lung health over time?
How does living in a polluted city affect lung health over time?
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In the context of shunts, what effect does administering oxygen typically have?
In the context of shunts, what effect does administering oxygen typically have?
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What does a high alveolar-arterial (A-a) gradient signify?
What does a high alveolar-arterial (A-a) gradient signify?
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In a healthy 70-year-old compared to a 20-year-old, which lung volume change is expected?
In a healthy 70-year-old compared to a 20-year-old, which lung volume change is expected?
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What does DLCO measure and how is it typically affected in restrictive lung disease?
What does DLCO measure and how is it typically affected in restrictive lung disease?
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What defines dead space in respiratory physiology?
What defines dead space in respiratory physiology?
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What typically causes the secondary drop in perfusion associated with shunts?
What typically causes the secondary drop in perfusion associated with shunts?
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Which of the following conditions often results in hypoventilation leading to a normal A-a gradient?
Which of the following conditions often results in hypoventilation leading to a normal A-a gradient?
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What role does hypoxic vasoconstriction play in the context of lung perfusion?
What role does hypoxic vasoconstriction play in the context of lung perfusion?
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What is the normal range for the A-a gradient in healthy individuals?
What is the normal range for the A-a gradient in healthy individuals?
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Study Notes
Lung Volume Terminology
- FEV1: Forced Expiratory Volume in 1 second. The amount of air forcefully exhaled in one second after a maximal inhalation.
- FVC: Forced Vital Capacity. The total volume of air that can be maximally exhaled after a maximal inhalation.
- FEV1/FVC Ratio: Used to differentiate between obstructive and restrictive lung diseases.
- TLC: Total Lung Capacity. The maximum amount of air that can be inhaled after a normal exhalation.
- TV: Tidal Volume. The amount of air inhaled and exhaled during normal breathing.
- IRV: Inspiratory Reserve Volume. The additional amount of air that can be inhaled after a normal inhalation.
- IC: Inspiratory Capacity. The total amount of air that can be inhaled after a normal exhalation.
- ERV: Expiratory Reserve Volume. The additional amount of air that can be exhaled after a normal exhalation.
- FRC: Functional Residual Capacity. The volume of air remaining in the lungs after a normal exhalation.
- RV: Residual Volume. The volume of air remaining in the lungs after a maximal exhalation.
- DLCO: Diffusion capacity of the lungs for carbon monoxide. Reflects the extent of gas exchange across the pulmonary capillaries. Its value is ↓ in most lung diseases, however, it can ↑ in asthma.
Obstructive vs Restrictive Lung Disease
-
Obstructive Patterns: Characterized by difficulty getting air out of the lungs.
- Asthma: FEV1/FVC is typically ↓.
- COPD: (Chronic bronchitis and Emphysema) FEV1/FVC is typically ↓.
- Age (Age 70 vs 20) FEV1/FVC is typically ↔
-
Restrictive Patterns: Characterized by difficulty getting air into the lungs.
- Pulmonary fibrosis: FEV1/FVC is typically ↔ or ↑.
- Pneumoconioses: (Asbestosis, Berylliosis, Silicosis, etc.) FEV1/FVC is typically ↓.
- Other conditions: such as Pulmonary fibrosis or various other conditions FEV1/FVC are typically ↓ or ↔
Flow-Volume Loops
- Obstructive: Expiratory component has a scooped-out/concave shape. Reduced flow throughout expiration because of obstruction.
- Restrictive: Smaller, more symmetric loop with reduced overall size due to lower lung volumes. Reduced pulmonary compliance.
Shunt vs. Dead Space
- Shunt: ↓ ventilation relative to perfusion, and the reason for hypoxemia is due to an area of lung where aeration is restricted but blood flow is not significantly altered. This will result in a ↓V/Q in the area of concern.
- Dead Space: ↑ ventilation relative to perfusion, due to areas of the lung receiving sufficient air but having no perfusion. This results in an ↑V/Q in the area of concern.
Alveolar-Arterial (A-a) Gradient
- ↑ A-a Gradient: The lungs have a problem with gas exchange (e.g., pathologic shunt, obstructive/restrictive disease). Patient is breathing adequately; however, arterial O2 is low.
- Normal A-a Gradient: Insufficient respirations are the cause of low arterial O2. Patient is not breathing adequately.
- High A-a Gradient: Hypoxic vasoconstriction is the cause of low arterial O2.
HY Pulmonary/Respiratory Tract Cancers
- Small cell carcinoma: Small basophilic cells, centrally located, associated with paraneoplastic syndromes (SIADH, Cushing's Syndrome, Lambert-Eaton syndrome).
- Squamous cell carcinoma: Centrally located, associated with smoking and cavitations. Positive for keratin and high calcium,
- Adenocarcinoma: Not typically central, with high incidence in non-smokers; associated with secretion associated with PTHrp.
HY Pulmonary Conditions
- Asbestosis: Occupational exposure to asbestos. Leads to restrictive lung disease and increased TB risk.
- Berylliosis: Occupational exposure to beryllium. Leads to restrictive lung disease.
- Silicosis: Occupational exposure to silicon dust. Leads to restrictive lung disease and ↑ TB risk.
- Anthracosis: Coal dust inhalation leading to black discoloration of the lung; can be obstructive or restrictive.
- Caplan Syndrome: Rheumatoid arthritis + pneumoconiosis, leading to pulmonary nodules.
- Large cell carcinoma: Not a high-yield condition for USMLE.
- Bronchogenic carcinoid tumor: A neuroendocrine tumor, associated with carcinoid syndrome which consists of flushing, tachycardia, and diarrhea.
HY General Lung Conditions for IM
- Idiopathic Pulmonary Fibrosis (Usual Interstitial Pneumonitis): Restrictive lung disease that leads to honeycombing (reticular/reticulonodular) pattern on imaging.
- Chronic Obstructive Pulmonary Disease (COPD): Obstructive lung disease characterized by chronic bronchitis and/or emphysema.
- Asthma: Obstructive lung disease triggered by various stimuli.
HY Trauma and Pleural Space Conditions
- Atelectasis: Lung collapse, a complication after surgery or other interventions.
- Flail chest: Multiple rib fractures causing paradoxical chest wall movement.
- Diaphragmatic rupture: Diaphragm injury, resulting in abdominal organs entering the chest cavity.
- Pneumothorax: Air in the pleural space, differing in types (spontaneous, tension).
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Description
Test your knowledge on key lung volume terminology such as FEV1, FVC, and TLC. This quiz covers essential definitions and concepts critical for understanding lung capacity and function. Perfect for students in respiratory physiology or healthcare fields.
