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Respiratory

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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 changes in 2 -3 - DPG occur at high altitude
Air in lung after maxmimal expiration - cannot be measured on spirometry
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
<60

2. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Mesothelioma - pleura - psammoma bodies
Hypertrophy of mucus secreting glands in the bronchioles
Air that can still be breathed out after nl expiration

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

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4. What do PFTs show in restrictive lung disease
4 polypeptide subunits - 2 alpha and 2 beta
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
FEV1/FVC > 80%
Exposed collagen fibers provides impetus for clotting cascade

5. What happens to O2 content and O2 sat as Hb falls
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Dec - no change
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
4 polypeptide subunits - 2 alpha and 2 beta

6. What does alveolar pressure do to capillaries in the apex of the lung
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
FRC - inward pull of lung balanced by outward pull of chest wall
Dec cross sectional area of pulm vasc bed
High alveolar pressure compresses capillaries

7. What does CADET face to the right stand for
Dorsiflexion of food leads to tender calf muscle
Prostaglandins - histamine - ACE - kallikrein
CO2 - acid/altitude - DPG - Exercise - Temperature
Type II pneumocytes - after week 35

8. What organism causes a lobar PNA and What are the characteristics
N- terminus - carbaminohemoglobin
Dipalmatoyl phosphatidylcholine
20.1 mL O2 /dL
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

9. What is methemoglobin
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Lung cancer
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

10. What enzyme increases activity in emphysema
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Shed epithelium from mucus plugs
Inoperable - responsive to chemotherapy
Elastase

11. What is the pathology of ARDS
Dec release of fetal glucocorticoids
Airways close prematurely resulting in inc RV and dec FVC
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

12. How do you prevent DVT
S. aureus or anaerobes
Heparin
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Dec - no change

13. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
In between perfusion limited and diffusion limited
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
It binds to Hb -

14. Define inspiratory reserve volume (IRV)
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Clara cells - type II pneumocytes; multiple densitites on CXR
Air in excess of tidal volume that moves into lung on maximal inspiration
Drainage

15. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Fe 2+
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Gland depth/total thickness of broncial wall - >50%

16. What lobes are affected in silicosis
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Upper lobes
Persistently low O2 tension
Retinopathy of maturity

17. What is the formula for A- a gradient - and What is it normally
PAO2 - PaO2 = 10-15 mmHg
CO - 200x
It binds to Hb -
Air in excess of tidal volume that moves into lung on maximal inspiration

18. What causes neonatal RDS
Surfactant def leading to inc surfact tension and alveolar collapse
Bleomycin - busulfan - anmiodorone
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
500mL

19. In COPD - what happens to airways at high lung volumes
Airways close prematurely resulting in inc RV and dec FVC
Superior portion of right inferior lobe
IRV + TV + ERV + RV
Methacholine challenge

20. Define total lung capcaity
CO - 200x
Retinopathy of maturity
IRV + TV + ERV + RV
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

21. What can amniotic fluid emboli lead to...
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
DIC - especially postpartum
Carcinoid - carcinoid
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

22. Why is cesarean delivery a risk factor for neonatal RDS
Dec release of fetal glucocorticoids
Methacholine challenge
Inc EPO leading to erythrocytosis
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

23. What are the causes of ischemia
Loss of elastic fibers
Loss of blood flow - impeded arterial flow - reduced venous drainage
Surfactant
Type II cells

24. If you aspirate a peanut while supine - where will it go
Anatomic dead space and smooth muscle
Weight loss - CPAP - surgery
CO - 200x
Superior portion of right inferior lobe

25. What does ACE do
Brings air in and out - warms - humidifies - filters
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Chroniclly tired

26. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
In between perfusion limited and diffusion limited
Chronic hypoxic vasocxn
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Superior portion of right inferior lobe

27. What are the SPHERE of complications in lung cancer
Gland depth/total thickness of broncial wall - >50%
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
High alveolar pressure compresses capillaries
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

28. What properties determine the combined volumes of the chest wall and lungs
Elastic properties
Methacholine challenge
Superior portion of right inferior lobe
<60

29. What changes in lung volunes occur as a result of restrictive lung disease
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Dec in lung volumes - FVC - TLC
Inc mitochondria
No respiratory effort

30. What is virchow's triad
Stasis - hypercoagulability - endothelial damage
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Matched - =1 adequate gas exchange
Ivory white calcified pleural plaques

31. What is the pathology of emphysema
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Pleural effusion
Type II cells
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

32. In what cells do you find lamellar bodies
TB - silica disrupt phagolysosomes and impair MACS
Lowered
Hypoxic vasocxn
Type II cells

33. What lung product is deficient in neonatal RDS
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Inc
Surfactant
0 - negative - prevents pneumothorax

34. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
N- terminus - carbaminohemoglobin
0 - negative - prevents pneumothorax
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Clara cells - type II pneumocytes; multiple densitites on CXR

35. What happens to arterial PO2 in chronic lung disease and why
It binds to Hb -
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Dec - because physiologic shunt dec O2 extraction from ratio
Airways close prematurely resulting in inc RV and dec FVC

36. What kind of emphysema is caused by smoking
Centriacinar
Defect in coagulative cascace proteins
Tight jxns
TB - apex

37. What is are the symptoms of a pulmonary embolism
TB - silica disrupt phagolysosomes and impair MACS
Chest pain - tachypnea and dyspnea
Loss of blood flow - impeded arterial flow - reduced venous drainage
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

38. In which zone of the lung is Pa > Pv >PA
Tension pneumo - away from lesion
Gland depth/total thickness of broncial wall - >50%
Type II cells
Zone 3

39. What do type II cells do - What is their morphology - when do they proliferate
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Hypoxic vasocxn
Persistently low O2 tension
Mesothelioma - pleura - psammoma bodies

40. What happens in perfusion limited circulatioin and which gases does this apply to...
Dec in lung volumes - FVC - TLC
Weight loss - CPAP - surgery
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

41. Where are ventilation and perfusion highest in the lung - respectively
Deep leg veins
Activates bradykinin
Both highest in the base
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

42. What renal changes occur at high altitude and What are they compensating for
TB - apex
Inc excretion of bicarb to compensate for respiratory alkalosis
PA02 = 150 - PACO2/0.8
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

43. What do hemoglobin modifacations lead to...
Deoxygenated blood - elastic walls
Upper lobes - cor pulmonale - caplan's syndrome
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Tissue hypoxia from dec O2 sat and dec O2 content

44. What changes in pH occur during strenuous exercise and why
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Surfactant def leading to inc surfact tension and alveolar collapse
Persistently low O2 tension
Dec - due to lactic acidosis

45. What does a V/Q ratio of infinity indicate
Inc due to inc CO
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Squamous cell carcinoma - keratin pearls and intracellular bridges

46. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Dipalmatoyl phosphatidylcholine
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
PVR = (PpulmA - PleftA)/CO
Airways close prematurely resulting in inc RV and dec FVC

47. What direction does an increase in metabolic need shift the O2 dissociation curve
Air in lung after maxmimal expiration - cannot be measured on spirometry
Right
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Surfactant def leading to inc surfact tension and alveolar collapse

48. What is an association and potential complication of paraseptal emphysema
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Carcinoid - carcinoid
Heart

49. What happens as a result of hypoxia in sleep apnea
Inc EPO leading to erythrocytosis
0 - negative - prevents pneumothorax
Steroids to mom - artificial surfactant and thyroxine to neonate
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

50. A carcinoma in the apex of the lung can cause what syndrome and What is the tumor called

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