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2012-06-04 18:47:17

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  1. What structures traverse the diaphragm and what vertebral levels do they pass through?
    I ate 10 eggs at 12

    • IVC - T8
    • Esophagus - T10
    • Aorta - T 12
  2. Which molecule has a greater direct effect on respiration at the brainstem, oxygen or hydrogen ions?
    Hydrogen Ion - it's in balance with CO2 which is measured by central chemoreceptors
  3. By what mechanism does oxygen effect respiration?
    Carotid body (CN IX) and aortic body (CN X) chemoreceptors
  4. What is the difference between a hiatal hernia and an incisional hernia after an abdominal surgery?
    Hiatal - peritoneal contents herniate through the diaphragm

    Incisional - defect in the abdominal wall
  5. Distinguish the respiratory zone from the conducting zone.
    resp - respiratory bronchioles, alveoli - gas exchange

    conducting - trachea, bronchi, terminal bronchioles - anatomic dead space
  6. Type I pneumocyte function vs Type II pneumocyte function, and proportion of cells
    • Type I - 97%, gas diffusion
    • Type II - 3% - secrete surfactant
  7. What are clara cells?
    nonciliated with secretory granules that contribute to surfactant
  8. Name the 10 bronchopulmonary segments
    R - 3 superior, 2 middle, 5 inferior

    L - 5 upper, 5 lower
  9. Each bronchopulmonary segment is _ (connected or separated)?
    separated - can be removed if diseased
  10. What do you give to cause surfactant production in premies?
  11. Where is the pulmonary artery related to the bronchus at each lung hilus?

    Right Anterior, Left Superior
  12. Which side is more common for inhaled foreign body and why?
    Right side, main stem is wide and vertical
  13. What muscles are used for breathing?
    Inspiration - external intercostals, Scalenes, SCM

    Expiration - should be passive. If diseased: rectus abdominus, internal/external obliques, transversus abdominus, internal intercostals
  14. Name the 5 important lung products
    • Surfactant
    • Prostaglandins
    • Histamine
    • Angiotensin Converting Enzyme (ACE)
    • Kallikrein - activates bradykinin
  15. Know the lung volumes diagram
  16. What is the equation to determine physiologic dead space?
    VD = Vt x [(PaCO2 - PeCO2) / Paco 2]

    • Vt = tidal volume
    • PaCO2 = arterial PCO2
    • PeCO2 = expired air PCO2
  17. Lungs want to pull _ and chest wall wants to pull _ .
    • Lungs - in
    • Chest - out
  18. Define: change in lung volume for a given change in pressure, decreased in pulmonary fibrosis
    Decreased Compliance

    This causes the lung to pull in
  19. Emphysema results in _ compliance, which results in an expanded chest wall.
  20. Hemoglobin is comprised of 2 _ and 2 _ subunits.
    Alpha and Beta
  21. Hemoglobin has 2 forms. Describe and their affinity for O2.
    • T - taut form, low affinity for O2
    • R - relaxed form, high affinity for O2
    • when you're relaxed, you breathe better
  22. Fetal hemoglobin has 2 _ and 2 _ subunits.
    Alpha and Gamma
  23. Fetal Hemoglobin has a _ affinity for 2,3 BPG which makes it have a _ affinity for O2.
    • lower BPG
    • higher O2
  24. What are the factors that encourage unloading of O2 to the tissues?
    • High temperature
    • Increased Cl-, H+, CO2 and 2,3 BPG
  25. This oxidized form of hemoglobin has an increased affinity for CN-. The iron is in Ferric F3+ form.
  26. How do you treat Methemoglobin poisoning? What causes it?
    Nitrites cause it (NO drugs)

    Methylene blue - treatment
  27. Carboxyhemoglobin is when this substance binds instead of Oxygen. It binds more tightly and prevents release of O2 to tissues
    Carbon Monoxide 200x greater affinity for O2 than hemoglobin - won't give it to tissues
  28. What does Pulse Ox measure? When is a right shift in an oxygen hemoglobin dissociation curve seen (more likely to give O2 to tissues)?
    Hb saturation

    • Right shift - C BEAT
    • CO2
    • BPG
    • Exercise
    • Acid/Altitude
    • Temperature

    It's RIGHT to give O2 to your tissues!
  29. The pulmonary circulation is normally a _ resistance, _ compliance system.
    low resistance, high compliance
  30. A decrease in PAo2 causes hypoxic _ and shifts blood _ from poorly ventilated regions of the lung _ well-ventilated regions of the lung
    A decrease in PAo2 causes hypoxic VASOCONSTRICTION and shifts blood AWAY from poorly ventilated regions of the lung TOWARD well-ventilated regions of the lung
  31. Perfusion or Diffusion?

    O2, CO2, N2O - gas equilibrates early along the length of the capilary. Increase in blood flow means increased absorption.
    Perfusion limited
  32. Perfusion or Diffusion?

    O2 in emphysema and fibrosis, CO. Gas does not equilibrate by the time blood reaches the end of the capillary. Alveoli can't do any better.
    Diffusion limited
  33. This results in athersclerosis, medial hypertrophy and intimal fibrosis of the pulmonary arteries.
    Pulmonary hypertension
  34. Primary or secondary?

    due to inactiavation in BMPR2 gene resulting in excess smooth muscle proliferation
    Primary Pulm HTN
  35. What are the causes of secondary pulmonary HTN?
    • COPD
    • Mitral Stenosis (back up pressure)
    • Recurrent thromboemboli
    • Autoimmune
    • Left to Right shunt (back up pressure)
    • Sleep Apnea
    • High Altitude
  36. What cardiac condition can be caused by pulmonary hypertension?
    Cor Pulmonale (RVH and failure)
  37. What is the formula for pulmonary vascular resistance?
    PVR = [Ppulm artery - P L atrium] / CO

    • P pulm artery = pressure in the pulmonary artery
    • P L atrium = pulmonary wedge pressure
  38. what variables change airway resistance?
    the radius of the vessel and airway
  39. what is the formula for O2 blood content
    O2 content of the blood = [O2 binding capacity x % saturation] + dissolved O2
  40. How much O2 can normally be bound by 1g of Hb?
    1.34 mL
  41. What is the alveolar gas equation?

    What can usually be used to estimate it?
    PAo2 = PIo2 - [Paco2 / R]

    • PAo2 = alveolar PO2
    • PI o2 = inspired air
    • PaCO2 = arteriolar PCO2

    PAo2 = 150 - Paco2/0.8
  42. What does a large A-a gradient mean?

    hypoxemia, V/Q mismatch, fibrosis
  43. Oxygen deprivation: decreased Pao2

    when do you see decreased arteriolar PO2?

    • Normal A-a gradient
    • High altitude
    • Hypoventilation

    • Increased A-a gradient
    • V/Q mismatch (ventilation/perfusion)
    • Diffusion limitation (fibrosis)
    • Right-to-left shunt (cardiac)
  44. Oxygen deprivation: decreased O2 delivery to tissues

    • decreased CO
    • hypoxemia
    • anemia
    • CN poisoning
    • CO poisoning
  45. V/Q mismatch
    • Apex V/Q = 3 (wasted ventilation)
    • Base V/Q = 0.6 (wasted perfusion)

    Ventilation and Perfusion are both much greater at the base of the lung
  46. CO2 is transported from tissue to lungs in these 3 ways:
    • HCO3- (via Carbonic Anhydrase) 90%
    • Bound to hemoglobin
    • Dissolved in Blood
  47. If a lung collapses, what happens to the intrathoracic volume?
    • Chest wall is unopposed - it expands
    • Lung volume - nearly zero

    Intrathoracic volume increases
  48. What gene mutation can cause primary pulmonary hypertension?
  49. What are some of the treatment options for pulmonary hypertension?
    • Bosentan
    • Prostaglandins
    • Sildenafil
    • Nifedipine (CCB)
  50. what is the mechanism of action for Bosentan?
  51. What is the normal value for the A-a gradient? What might an elevated A-a gradient indicate?
    10-15mmHg normal

    • 1) Advanced Age
    • 2) High FiO2
    • 3) Hypoxemia
    • 4) Pulm Fibrosis
    • 5) R to L shunt
    • 6) V/Q mismatch
  52. A 42 year old woman with fibroids is chronically tired. What is the most likely diagnosis and what changes have occurred in the oxygen content and saturation?
    Chronic Fatigue

    • decreased O2 in blood
    • O2 sat normal
    • anemia
  53. Patient is shown to have hypoxia and CXR reveals an enlarged heart. What is the most likely cause of hypoxia?
    Decreased cardiac output -> heart failure
  54. What is the V/Q during airway obstruction? During blood flow obstruction?
    Airway - V/Q decreases toward 0 = shunting

    Blood Flow - V/Q increases toward infinity = dead space
  55. How do CO2 levels in circulation change during exercise?
    Increase in Venous CO2
  56. How does the body compensate for hypoxia at high altitude?

    • breathing
    • erythropoeitin
    • 2,3 BPG
    • RBC's
    • Renal Excretion of Bicarb
    • mitochondrial tissues
  57. How much does the H&H change in a person that has acclimatized to a hypoxic environment for a few weeks?
    • Both increase
    • Hct - 60%
    • Hg - 20
  58. At what positive G force does visual black out occur? Why?
    • 4-6 G's -> Blackout
    • not enough blood to the heart and brain
  59. How is the body affected by a prolonged stay in space at zero gravity?

    • RBC mass
    • blood volume
    • muscle strength
    • cardiac output
    • bone mass
  60. What physiologically is taking place in decompression sickness?
    nitrogen dissolved in blood. at high pressures, gases escape the dissolved state and form bubbles in the blood that can occlude the vessels.
  61. What are decompression sickness symptoms?
    • Pain in joints and muscles
    • Dizziness, paralysis, syncope
    • SOB/Pulmonary Edema
  62. For what conditions is hyperbaric oxygen therapy helpful?
    • Gas gangrene
    • Arterial gas embolism (decompression sickness)
    • CO poisoning
    • MI
    • Osteomyelitis
  63. What is Virchow's Triad?
    • Stasis
    • Hypercoagulability
    • Endothelial Damage

    All predispose to DVTs
  64. DVTs - symptoms, prevention, treatment
    • Sx: unilateral pain, swelling, Homan's sign (pain with dorsiflexion)
    • Prev: heparin, warfarin
    • Tx: heparin, warfarin
  65. Pulmonary Embolism: symptoms, studies, treatment
    • Sx: chest pain, SOB, fever, tachypnea, tachycardia
    • Studies: d-dimers, DVT's, large A-a gradient, gold standard - pulm angiogram, CT
    • Tx: heparin, warfarin
  66. What is the hallmark sign of COPD? What is the hallmark sign of restrictive lung disease?
    COPD - FEV1/FVC = < 80%

    Restrictive - FEV1/FVC > 80% (normal), Decreased TLC
  67. A patient suffers a stroke after incurring multiple long bone fractures in a skiing accident. What caused the infarct?
    Fat embolus
  68. A patient with a recent tibia fracture and no history of COPD or asthma is shown to have hypoxia. CXR is normal. What is the casue of the hypoxia and what disease process does it mimic?
    Pulmonary embolism from a DVT

    Mimics MI
  69. How does emphysema caused by smoking differ from the emphysema caused by alpha-1-antitrpysin deficiency?
    smoking - centriacinar

    A1AT - pan acinar

    both are characterized by a decrease in elasticity and an increase in compliance
  70. What is the differential diagnosis for eospinophilia?
    • Drugs
    • Neoplasm
    • Atopic (allergy, asthma, Churg-Strauss)
    • Addison's Disease
    • Acute Interstitial Nephritis
    • Collagen Vascular Disease
    • Parasites

    Call "Da NAAACP!"
  71. Name the use of the antihistamine: Cyproheptadine
    Appetite stimulant
  72. Name the use of the antihistamine: Promethazine
    dopaminergic - nausea and vomiting
  73. Name the use of the antihistamine: Chlorpheniramine
    OTC allergy/cold
  74. Name the use of the antihistamine: Hydroxyzine
    Sedation, itching
  75. Name the use of the antihistamine: Meclizine
  76. A patient presents with an asthma attack. What immunological reaction is taking palce that is responsible for anaphylaxis in this patient (2nd exposure)? What was the first reaction?
    Initial stimulation causes CD4 Th2 cells to release IL-4 to stimulate IgE production and IL-5 to activate eosinophils

    IgE crosslinking presensitized Mast Cells- 2nd exposure
  77. Name the asthma medication: Inhaled treatment of choice for chronic asthma
  78. Name the asthma medication: inhaled treatment of choice for acute exacerbations
  79. Name the asthma medication: narrow therapeutic index - drug of last resort
  80. Name the asthma medication: blocks conversion of arachidonic acid to leukotriene
  81. Name the asthma medication: inhibits mast cell release of mediators, used for prophylaxis only
  82. Name the asthma medication: inhaled treatement that blocks muscarinic receptors
  83. Name the asthma medication: inhaled long-acting B2 agonist
  84. Name the asthma medication: blocks leukotriene receptors
    Zafirlukast, Montelukast
  85. A patient has an extended expiratory phase. What is the disease process?
    Emphysema, COPD - obstructive lung disease
  86. What emboli can lead to DIC in a woman delivering a baby?
    Amniotic fluid
  87. Aproximately 95% of pulmonary emboli arise from where?
    deep leg veins
  88. hypertrophy of mucus secreting glands in the bronchoiles. productive cough for > 3 consecutive months in >2 years.
    Chronic Bronchitis - Blue Bloaters
  89. enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls. Increased compliance. floppy
    Emphysema - Pink Puffer
  90. smooth muscle hypertrophy and Curschmann's spirals, Chartcot-Leyden crystals - eosinophilic inflammation
  91. How do you test asthma?
    Methacholine challenge
  92. chronic necrotizing infection of bronchi - paralyzed ciliary motility, permanently dilated airways, purulent sputum
  93. A preterm infant has trouble breathing. An x-ray reveals diffuse ground glass appearance with air bronchograms. What is the diagnosis and what could have prevented this condition.
    NRDS - maternal steroids, surfactant
  94. A patient develops ARDS from an occupational inhalation of nitrogen dioxide. What histologic change is seen in a patient recovering from ARDS?
    Proliferation of Type II pneumocytes
  95. What are the common causes of Restrictive Lung Disease?
    • Poor breathing mechanics (MG, scoliosis)
    • Interstitial Lung Disease
    • - ARDS
    • - NRDS
    • - Pneumonoconioses (silicosis, asbestosis)
    • - Sarcoidosis (non caseating granulomas)
    • - Idiopathic pulmonary fibrosis
    • - Goodpastures
    • - Wegeners
    • -Eosinophilic Granuloma (histiocytosis X)
    • - Drug Tox (Bleomycin, Busulfan, Amiodarone)
    • - Cystic Fibrosis
  96. What are the three pneumoconioses and their defining character?
    Coal Miners - upper lobes, cor pulmonale

    Silicosis - upper lobes, eggshell calcification of hilar lymph nodes, impaired macrophages, increased susceptibility to TB

    Asbestosis - lower lobes, pleural plaques, dumbbell rods in macrophages, increased risk of mesothelioma and bronchogenic carcinoma
  97. What is dipalmitoyl phosphatidylcholine?
    Surfactant in the lungs
  98. How do you measure lung maturity?
    Lecithin to sphingomyelin ratio in amniotic fluid
  99. This causes diffuse alveolar damage where an increase in alveolar capillary permeability causes protein-rich leakage of fluid into the alveoli, resulting in a hyaline membrane.
  100. How do you differentiate between Goodpasture and Wegeners?
    Both affect the lungs and kidneys, Wegeners is in the upper airway
  101. What are the symptoms of sarcoidosis? How do you treat it?

    • Granulomas
    • RA
    • Uveitis
    • Erythema nodosum
    • Lymphadenopathy
    • Idiopathic
    • NOT TB
    • Gamma globulinemia

    Also, bilateral

    Tx: steroids
  102. H&E of lung biopsy from a plumber shows elongated structures with clubbed ends in tissue. What is the diagnosis and what is he at incresed risk for?
    Asbestosis - mesothelioma and bronchogenic carcinoma
  103. What do patients with silicosis need to be worried about?
    getting TB
  104. CXR shows pleural effusions. What are the clinical findings?
    • decreased breath sounds
    • dullness to resonance
    • decreased fremitus
  105. Describe the tracheal deviation: bronchial obstruction
    toward lesion (acts like suction)
  106. Describe the tracheal deviation: Tension pneumothorax
    away from lesion (air coming in is pushing trachea away)
  107. Describe the tracheal deviation: spontaneous pneumothorax
    toward lesion (suction -system is closed)
  108. The lung is the most common site of mets. Where does the lung mets to?
    adrenals, brain, bone, liver
  109. What complications can arise from lung cancer?

    • Superior vena cava syndrome
    • Pancoast tumor (apex carcinoma)
    • Horners syndrome
    • Endocrine issues
    • Recurrent laryngeal symptoms
    • Effusions
  110. Name the cancer: related to smoking, central, associated with ACTH or ADH ectopic production, may lead to Lambert Eaton syndrome (Ca2+ channel antibodies). Responds to chemo. Neoplasm of Kulchitsky cells (small dark blue).
    Small Cell (Oat Cell) Carcinoma
  111. Name the cancer: Peripheral, non smokers, due to injury or prior infection, grows along airways, involves clar cells and type II pneumocytes. Multiple densities seen on CXR
    Adenocarcinoma - Bronchial and/or Bronchioalveolar (grows along airways)
  112. Name the cancer: central, related to smoking, hilar mass arising from bronchus, Cavitation, parathyroid like activity (PTHrP), keratin pearls and intracellular bridges are seen. hypercalcemia, hypophosphatemia
    Squamous Cell Carcinoma
  113. Name the cancer: peripheral, non-smoker, highly anaplastic poor prognosis, pleomorphic giant cells with leukocyte fragments in cytoplasm
    Large cell carcinoma
  114. Name the cancer: secretes serotonin, causes BFDR, tricuspid insufficiency, pulmonary stenosis and right sided heart failure
    Carcinoid Tumor
  115. Name the cancer: pleural tumor, associated with asbestosis. Psammoma bodies seen in histo. Hemorrhagic pleural effusions and pleural thickening
  116. Carcinoma that occurs in the apex of the lung and may affect cervical sympathetic plexus, causing Horner's Syndrome (ptosis, anhydrosis, miosis)
    Pancoast tumor
  117. an obstruction that impairs blood drainage from the head, neck and upper extremities (JVD and edema). Can raise intracranial pressure -> headaches and dizziness, increased risk of aneurysm/rupture of cranial arteries.
    Superior vena cava syndrome
  118. A patient of yours develops bronchogenic lung cancer but has never smoked. He is a coal miner. Exposure to what has put him at risk?
    Radon gas in coal mines
  119. What are the 3 most common location of lung cancer mets?
    Brain, bone, liver
  120. Name infectious agent:

    common cause of pneumonia in immunocompromised patients
    pneumocystis jirovecci
  121. Name infectious agent:

    most common cause of atypical/walking pneumonia
    mycoplasma pneumoniae
  122. Name infectious agent:

    common causative agent for pnemonia in alcoholics
    Klebsiella pneumoniae
  123. Name infectious agent:

    can cause interstitial pneumonia in bird handlers
    Chlamydia psittici
  124. Name infectious agent:

    often the cause of pneumonia in a patient with a history of exposure to bats
  125. Name infectious agent:

    often the cause of pneumonia in a patient who has recently visited california
  126. Name infectious agent:

    pneumonia associated with "currant jelly" sputum
    Klebsiella pneumoniae
  127. Name infectious agent:

    Q fever
    Coxiella burnetti
  128. Name infectious agent:

    associated with pneumonia acquired from air conditioners
    Legionella pneumoniae
  129. Name infectious agent:

    most common cause of pneumonia in children 1 y/o or younger
  130. Name infectious agent:

    most common cause of pneumonia in the neonate
    E.coli, GBS
  131. Name infectious agent:

    most common cause of pneumonia in children and young adults
    mycoplasma pneumonia
  132. Name infectious agent:

    common cause of pneumonia in patients with other health problems
    Klebsiella pneumoniae
  133. Name infectious agent:

    most common cause of viral pneumonia
  134. Name infectious agent:

    causes a wool-sorters disease
    Bacillus anthracis
  135. Name infectious agent:

    Endogenous flora in 20% of adults
    S. pnemoniae
  136. Name infectious agent:

    common bacterial cause of COPD exacerbation
    H. influenza
  137. Name infectious agent:

    common pneumonia in ventilator patients and those with cystic fibrosis
    Pseudomonas aeruginosa
  138. Name infectious agent:

    Pontiac fever
  139. Examination of a lung at autopsy reveals a peripheral lesion with caseous necrosis. What is the diagnosis?
  140. A 30 year old comatose man on ventilatory support in the ICU develops an infection and dies. Autopsy reveals a pus-filled cavity in his right lung. What is the likely etiology?
    Pseudomonas aeruginosa - aspiration
  141. A 55 year old man who is a smoker and heavy drinker presents with new cough and flu-like symptoms. Gram stain shows no organisms, silver stain shows gram negative rods. What is the diagnosis?
    Legionella pneumophila
  142. CXR shows collapse of middle lobe of right lung and mass in right bronchus; patient has a history of recurrent pneumonias. What is the diagnosis?
    Bronchogenic carcinoma
  143. What infectious agent?

    Gram + cocci in clusters
    S. aureus
  144. Name infectious agent:

    Gram + cocci in pairs
    S. pneumoniae
  145. Name infectious agent:

    Gram - rods in 80 year old
    E. coli
  146. Name infectious agent:

    Gram + cocci in neonate
    Group B strep
  147. Name infectious agent:

    Gram - rods in neonate
    E. coli
  148. Name the type of pneumonia: caused by Klebsiella or S. pneumoniae. Consolidation
  149. Name the type of pneumonia: caused by viruses, Mycoplasma, Legionella or Chlamydia. Diffuse patchy inflammation
    Atypical "interstitial" pneumonia
  150. Name the type of pneumonia: S. aureus, H flu, Klebsiella, GBS. acute inflammatory infiltrates, patchy involving more than one lobe
  151. Hypersensitivity pneumonitis is a mixed type _ and _ reaction to environmental antigens
  152. What is the difference between a spontaneous and tension pneumothorax?
    Spontaneous - collapse of lung - accumulation of air in pleural space. Trachea toward

    Tension - trauma - air enters pleural space and can't leave. Trachea away
  153. 1st Gen antihistamines: Names, MOA, Use, Tox
    • Names:
    • - Diphenhydramine
    • - Dimenhydrinate
    • - Chlorpheniramine

    MOA: H1 histamine blockers

    Use: Allergy, motion sickness, sleep aid

    Tox: Sedation, antimuscarinic, anti-a-adrenergic (increases dementia)
  154. 2nd Gen antihistamines; Names, MOA, Use
    • Names:
    • - Loratadine
    • - Fexofenadine
    • - Desloratadine
    • - Cetirizine

    MOA: H1 histamine blockers

    Use: allergies
  155. Isoproterenol: MOA, Tox
    nonspecific B agonists - relaxes bronchial smooth muscle

    Tox: B1 effects (incresed tachy)
  156. Albuterol and Salmeterol: MOA, Tox
    MOA: B2 agonists

    Tox: tremor and arrhythmia (Salmeterol)
  157. Theophylline: MOA and Tox
    MOA: phosphodiesterase inhibitor

    Tox: Narrow therapeutic index. Cardiotox, Neurotox.
  158. Ipratropium: MOA
    Muscarinic antagonists - prevents bronchoconstriction
  159. Cromolyn: MOA, Use
    MOA: prevents release from mast cells

    Use: prophylaxis against asthma
  160. Corticosteroids: Names, MOA
    Beclomethasone, prednisone, methylprednisolone

    MOA: inhibit cytokine synthesis.

    1st line for chronic
  161. Antileukotrienes: Names, MOA, Special Notes
    • Zileuton
    • MOA: blocks production of leukotrienes

    • Zafirlukast, Montelukast
    • MOA: blocks leukotriene receptors
    • Notes: good for aspirin induced asthma, Montelukast good for kids at 1 years old.
  162. N-acetylcystein: MOA, Use
    MOA: mucolytic - loosen mucus plugs in CF patients

    * also antidote for acetaminophen overdose
  163. Bosentan: MOA, Use
    MOA: endothelin-1-receptor antagonist

    Pulmonary hypertension
  164. Dextromethorphan: MOA, use
    NMDA antagonist, opioid effect

  165. Pseudoephedrine, phenylephrine: MOA, Use, Tox
    a-agonistic nasal decongestants

    reduces edema, opens eustachian tubes, stimulant

    Tox: HTN, anxiety
  166. Methacholine: MOA and Use
    MOA: muscarinic receptor agonist

    Use: asthma challenge testing
  167. Prostaglandins, Sildenafil and Nifedipine: Class and Use
    Prostaglandins - pulmonary HTN

    Sildenafil - phosphodiesterase inhibitor - vasodilation

    Nifedipine - CCB