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Respiratory

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What are the findings in asthma
Type II cells
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Airways close prematurely resulting in inc RV and dec FVC

2. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
No respiratory effort
In between perfusion limited and diffusion limited
Defect in coagulative cascace proteins
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

3. What happens to lung volumes in restrictive lung disease
Retinopathy of maturity
PVR = (PpulmA - PleftA)/CO
Inc 2 -3- DPG - righward shift
Dec

4. Why is there eventual loss of capillary beds in emphysema
Inc 2 -3- DPG - righward shift
Form of hemoglobin bound to CO in place of O2 - causes dec O2 binding capacituy with a left shift in the O2 hemoglobin dissociation curve - dec unloading in tissues
Lost with alveolar walls
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

5. What do type II cells do - What is their morphology - when do they proliferate
FRC - inward pull of lung balanced by outward pull of chest wall
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Superior portion of right inferior lobe

6. At What terminal does CO2 bind the globin molecule
N- terminus - carbaminohemoglobin
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Metastasis - breast - colon - prostate - bladder -

7. What is the course of of pulm HTN
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Squamous cell carcinoma - keratin pearls and intracellular bridges
Opposites
Lowered

8. What is the formula for resistance
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Heparin
Coal miner's - silicosis - abestosis
Type II pneumocytes - after week 35

9. What are the two forms of hemoglobin
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Histiocytosis X - Langerhans cells
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Lost with alveolar walls

10. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Loss of elastic fibers
Inc 2 -3- DPG - righward shift
Viral - URIs - allergens and stress
Defect in coagulative cascace proteins

11. What is an association and potential complication of paraseptal emphysema
Inc airway pressure to prevent airway collapse during exhalation
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

12. What is methemoglobin
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Right
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

13. What cells make surfactant and At what week is produced most abundantly
Type II pneumocytes - after week 35
Brings air in and out - warms - humidifies - filters
No respiratory effort
Lobar PNA

14. What are mucus secretion swept out by
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Inc to meet O2 demand
Ciliated cells

15. What causes neonatal RDS
DIC - especially postpartum
TB - silica disrupt phagolysosomes and impair MACS
Surfactant def leading to inc surfact tension and alveolar collapse
Loss of elastic fibers

16. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Airways close prematurely resulting in inc RV and dec FVC
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
FEV1/FVC > 80%

17. What do PFTs show in restrictive lung disease
FEV1/FVC > 80%
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Lungs collapse inwards and chest wall spring out
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

18. What is surfactant made of...
High alveolar pressure compresses capillaries
Dipalmatoyl phosphatidylcholine
IRV + TV
Coal miner's - silicosis - abestosis

19. What is the defect in panacinar emphysema - and what else do you see
Ivory white calcified pleural plaques
Dec - because physiologic shunt dec O2 extraction from ratio
Alpha1- antitrypsin def - also cirrhosis
Respiratory bronchioles - clear debris in alveoli - bronchi

20. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Upper lobes - cor pulmonale - caplan's syndrome
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Surfactant def leading to inc surfact tension and alveolar collapse

21. What ratio is used to measure lung maturity and What is the value is neonatal RDS
PAO2 - PaO2 = 10-15 mmHg
Form of hemoglobin bound to CO in place of O2 - causes dec O2 binding capacituy with a left shift in the O2 hemoglobin dissociation curve - dec unloading in tissues
L/S < 1.5
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

22. What TX is the mother given before delivery - and what TXs are given to the infant
Steroids to mom - artificial surfactant and thyroxine to neonate
Lower portion of right inferior lobe
Methylene blue
Loss of elastic fibers

23. What is the formula for A- a gradient - and What is it normally
Shunting
PAO2 - PaO2 = 10-15 mmHg
Lowered
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude

24. Why is cesarean delivery a risk factor for neonatal RDS
Activates bradykinin
FRC - inward pull of lung balanced by outward pull of chest wall
Viral - URIs - allergens and stress
Dec release of fetal glucocorticoids

25. What are the lab/study findings in adenocarcinoma of the lung
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Lowered
N- terminus - carbaminohemoglobin
Clara cells - type II pneumocytes; multiple densitites on CXR

26. Where is cartilage present in the respiratory tree
Methylene blue
Coal miner's - silicosis - abestosis
CO2 - acid/altitude - DPG - Exercise - Temperature
Trachea and bronchi

27. What changes in 2 -3 - DPG occur at high altitude
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Ivory white calcified pleural plaques
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Methylene blue

28. What does the respiratory zone consist of and What is its fxn
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Inspiration by diaphragm - expiration is passive
CO2 - acid/altitude - DPG - Exercise - Temperature

29. What is a potential test for asthma
Dec - no change
Methacholine challenge
Dipalmatoyl phosphatidylcholine
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

30. Define physilogic dead space
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Productive cough for greater than 3 months in at least 2 years

31. What is another name for neonatal RDS
S. aureus or anaerobes
No respiratory effort
Hyaline membrane disease
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

32. What does a V/Q ratio of 0 indicate
Airway obstruction (shunt) 100% O2 does not improve PO2
In between perfusion limited and diffusion limited
Milky fluid with inc TGs
L/S > 2 = lecithin/sphingomyelin

33. What muscles are involved in breathing during exercise and What do they control
PA02 = 150 - PACO2/0.8
Type II pneumocytes - after week 35
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Dorsiflexion of food leads to tender calf muscle

34. What are the various causes of ARDS
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Chronic hypoxic vasocxn
DIC - especially postpartum

35. What is the TX for small cell lung cancer
No respiratory effort
N- terminus - carbaminohemoglobin
Inoperable - responsive to chemotherapy
Matched - =1 adequate gas exchange

36. What are fat emboli associated with
Centriacinar
Long bone fractures and liposuction
Clara cells - type II pneumocytes; multiple densitites on CXR
Weight loss - CPAP - surgery

37. What is early onset hypoxemia from in chronic bronchitis
Shunting
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
O2 binding x O2 sat + dissolved O2

38. If you aspirate a peanut while supine - where will it go
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Bleomycin - busulfan - anmiodorone
Inc resistance leading to inc pressure
Superior portion of right inferior lobe

39. What is used to treat methemoglobin
Methylene blue
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
No change - but inc venous CO2 content
Person stops breathing for at least 10 seconds repeatedly during sleep

40. What is the characteristic lymphatic pleural effusion
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Milky fluid with inc TGs
Everything but RV - TV + IRV + ERV
Weight loss - CPAP - surgery

41. What changes at high altitude can result in RVH
On expiration as radius dec
FRC - inward pull of lung balanced by outward pull of chest wall
Chronic hypoxic vasocxn
Right lung - right main stem bronhus is wider and more vertical

42. Lung absecss often reults From what organisms
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
S. aureus or anaerobes
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

43. What reaction and enzyme create bicarb and Where does it happen
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Lung cancer
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

44. What are potential triggers for asthma
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Viral - URIs - allergens and stress
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Inc airway pressure to prevent airway collapse during exhalation

45. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Hyaline membrane disease
Defect in coagulative cascace proteins
Hypertrophy of mucus secreting glands in the bronchioles
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

46. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Coal miner's - silicosis - abestosis
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

47. What is the nl form of iron in hemoglobin
Fe 2+
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Deep leg veins
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

48. What lobes does Coal Miner's pneumoconioses affect - and What can it result in

49. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Inc to meet O2 demand
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

50. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
High alveolar pressure compresses capillaries
Repeated cycles of lung injury and wound healing with inc collagen
Pa > PA > Pv
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary