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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 TX is the mother given before delivery - and what TXs are given to the infant
Steroids to mom - artificial surfactant and thyroxine to neonate
CT angio
Inc O2 consumption
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

2. In which zone of the lung is PA > Pa > Pv
Zone 1
Tight jxns
Dec dec in FEV1 - dec in FVC
Type II cells

3. What is the V/Q ratio at the apex and base of the lung
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Long bone fractures and liposuction

4. What cellular changes occur at high altitude
Inspiration by diaphragm - expiration is passive
Surfactant def leading to inc surfact tension and alveolar collapse
Inc mitochondria
Dec - due to lactic acidosis

5. What does ACE do
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

6. What changes at high altitude can result in RVH
Chronic hypoxic vasocxn
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Air in lung after maxmimal expiration - cannot be measured on spirometry
Dec in the FEV1/FVC

7. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Activates bradykinin
Upper lobes - cor pulmonale - caplan's syndrome
P = 2ST/radius

8. Where does lung cancer met to...
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Deoxygenated blood - elastic walls
Brings air in and out - warms - humidifies - filters

9. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Upper lobes
Histiocytosis X - Langerhans cells
Inc airway pressure to prevent airway collapse during exhalation
High alveolar pressure compresses capillaries

10. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
Clara cells - type II pneumocytes; multiple densitites on CXR
Shed epithelium from mucus plugs
Methacholine challenge
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

11. In emphysema - What is increased lung compliance due to...
Methylene blue
Pa > PA > Pv
Loss of elastic fibers
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

12. What are potential triggers for asthma
DIC - especially postpartum
Viral - URIs - allergens and stress
RALS - righ anterior - left superior
Both highest in the base

13. What is occupied in the space that would have been the left middle lobe
Viral - URIs - allergens and stress
Anatomic dead space and smooth muscle
Heart
PA02 = 150 - PACO2/0.8

14. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Dec in lung volumes - FVC - TLC
Deoxygenated blood - elastic walls
Elastic properties

15. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Low resistance and high compliance
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

16. What happens to diffusing capacity in interstiial lung diseases
IRV + TV + ERV + RV
No change - but inc venous CO2 content
Lowered
Bleomycin - busulfan - anmiodorone

17. How does autoimmune dz cause thromboemboli
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Lobar PNA
Right lung - right main stem bronhus is wider and more vertical

18. What is the nl form of iron in hemoglobin
Lungs collapse inwards and chest wall spring out
Dec in lung volumes - FVC - TLC
Hypertrophy of mucus secreting glands in the bronchioles
Fe 2+

19. What findings are associated with emphysema
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Drainage
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

20. What is early onset hypoxemia from in chronic bronchitis
Shunting
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
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

21. What are the 3 reasons for an increased A- a gradient
High alveolar pressure compresses capillaries
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Dec - due to lactic acidosis
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

22. What is used to treat CN poisoning and why
Nitrates to oxidize hemoglobin to methemoglobin Which binds CN allowing cyto C oxidase to fxn - use thiosulfate to bind this cyanide forming thiocynate - which is renally excreted
Ciliated cells
Metastasis - breast - colon - prostate - bladder -
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

23. What is the ideal V/Q ratio and why
Everything but RV - TV + IRV + ERV
Matched - =1 adequate gas exchange
Surfactant def leading to inc surfact tension and alveolar collapse
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

24. What effects do O2 and CO2 have on pulm circulation - in relation to the other
FEV1/FVC > 80%
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Opposites
Superior portion of right inferior lobe

25. What is methemoglobin
Hypoxic vasocxn
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Dorsiflexion of food leads to tender calf muscle
Elastase

26. What is an association and potential complication of paraseptal emphysema
Inc shear stress leading to endothelial injury
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
CO - 200x
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

27. What happens as a result of hypoxia in sleep apnea
Airways close prematurely resulting in inc RV and dec FVC
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Inc EPO leading to erythrocytosis
Dipalmatoyl phosphatidylcholine - decreases surface tension

28. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Lobar PNA
Mesothelioma - pleura - psammoma bodies
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT

29. In which zone of the lung is Pa > Pv >PA
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Zone 3
Loss of blood flow - impeded arterial flow - reduced venous drainage

30. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Retinopathy of maturity
Airway obstruction (shunt) 100% O2 does not improve PO2
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

31. What does CADET face to the right stand for
CO - 200x
CO2 - acid/altitude - DPG - Exercise - Temperature
Air in excess of tidal volume that moves into lung on maximal inspiration
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

32. Define inspiratory reserve volume (IRV)
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Air in excess of tidal volume that moves into lung on maximal inspiration
Viral - URIs - allergens and stress
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

33. Define physilogic dead space
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
RALS - righ anterior - left superior
Viral - URIs - allergens and stress

34. What is tha hallmark finding of COPD
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
N- terminus - carbaminohemoglobin
Pleural effusion
Dec in the FEV1/FVC

35. What is the appoximate O2 binding capacity
Repeated cycles of lung injury and wound healing with inc collagen
20.1 mL O2 /dL
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

36. What cells in the lung produce surfactant and What does it do
Inc to meet O2 demand
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

37. What changes in CO2 occur during exercise
Low resistance and high compliance
Shed epithelium from mucus plugs
Inc production
<60

38. Why is cesarean delivery a risk factor for neonatal RDS
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Dec release of fetal glucocorticoids
Carcinoid - carcinoid
DIC - especially postpartum

39. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Respiratory effort against airway obstruction
Inc excretion of bicarb to compensate for respiratory alkalosis

40. How is pulmonary circulation characterized in terms of resistance and compliance
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Drainage
Low resistance and high compliance
No change - but inc venous CO2 content

41. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Positive cooperativity and negative allostery - unlike myoglobin
Brings air in and out - warms - humidifies - filters
Elastase
Dec - because physiologic shunt dec O2 extraction from ratio

42. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Squamous cell carcinoma - keratin pearls and intracellular bridges
O2 binding x O2 sat + dissolved O2
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Dorsiflexion of food leads to tender calf muscle

43. What are the 3 forms that CO2 is transported from tissues to lungs
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
PVR = (PpulmA - PleftA)/CO
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
IRV + TV

44. At what lung volume is system pressure atmospheric and why
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Mesothelioma - pleura - psammoma bodies
FRC - inward pull of lung balanced by outward pull of chest wall

45. What is the initial damage of ARDS caused by
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Zone 3
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

46. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
Heparin
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
No change - but inc venous CO2 content
RALS - righ anterior - left superior

47. What is used to treat methemoglobin
Deoxygenated blood - elastic walls
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Methylene blue
Elastic properties

48. What causes neonatal RDS
Elastic properties
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Surfactant def leading to inc surfact tension and alveolar collapse
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

49. What are mucus secretion swept out by
Both highest in the base
Ciliated cells
Milky fluid with inc TGs
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

50. What is the defect in panacinar emphysema - and what else do you see
It binds to Hb -
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Alpha1- antitrypsin def - also cirrhosis
FEV1/FVC > 80%