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Respiratory

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1. What is the pathology of bronchiectasis
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Mesothelioma - pleura - psammoma bodies
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Ivory white calcified pleural plaques

2. Why is there eventual loss of capillary beds in emphysema
Inspiration by diaphragm - expiration is passive
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Lost with alveolar walls

3. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
PAO2 - PaO2 = 10-15 mmHg
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Airway obstruction (shunt) 100% O2 does not improve PO2
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

4. What are mucus secretion swept out by
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Inspiration by diaphragm - expiration is passive
Ciliated cells
CO2 - acid/altitude - DPG - Exercise - Temperature

5. Where does lung cancer met to...
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Lung cancer

6. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
PA02 = 150 - PACO2/0.8
Productive cough for greater than 3 months in at least 2 years
RALS - righ anterior - left superior
Inc production

7. What happens to lung volumes in restrictive lung disease
<60
Alchoholics or epileptics
Dec
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

8. What is the formula for collapsing pressure
Right shift - favors taut - low affinity for O2 - O2 unloading
P = 2ST/radius
Exposed collagen fibers provides impetus for clotting cascade
Upper lobes

9. What changes in O2 consumption change during exercise
Shunting
Inc O2 consumption
Pleural effusion
Methylene blue

10. What kind of space is in the conducting tree and what kind of muscle exists there
Inc airway pressure to prevent airway collapse during exhalation
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Repeated cycles of lung injury and wound healing with inc collagen
Anatomic dead space and smooth muscle

11. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Incr - right - dec - left
CO - 200x

12. What changes at high altitude can result in RVH
Chronic hypoxic vasocxn
Prostaglandins - histamine - ACE - kallikrein
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

13. Define residual volume (RV)
Steroids to mom - artificial surfactant and thyroxine to neonate
Air in lung after maxmimal expiration - cannot be measured on spirometry
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Deep leg veins

14. What changes in EPO occur at high altitude
Pa > PA > Pv
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
4 polypeptide subunits - 2 alpha and 2 beta
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

15. What does alveolar pressure do to capillaries in the apex of the lung
Right
High alveolar pressure compresses capillaries
Coal miner's - silicosis - abestosis
Ciliated cells

16. What does CADET face to the right stand for
Methacholine challenge
RV + ERV - volume in lungs after nl expiration
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
CO2 - acid/altitude - DPG - Exercise - Temperature

17. What are the SPHERE of complications in lung cancer
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Lungs collapse inwards and chest wall spring out
Metastasis - breast - colon - prostate - bladder -

18. How is pulmonary circulation characterized in terms of resistance and compliance
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Low resistance and high compliance
4 polypeptide subunits - 2 alpha and 2 beta
Inoperable - responsive to chemotherapy

19. Define physilogic dead space
CO2 - acid/altitude - DPG - Exercise - Temperature
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
It binds to Hb -
Hyaline membrane disease

20. What is carboxyhemoglobin and What does it cause
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
No change - but inc venous CO2 content
Milky fluid with inc TGs
Acute/chronic inc in vent

21. Lung absecss often reults From what organisms
Milky fluid with inc TGs
0 - negative - prevents pneumothorax
S. aureus or anaerobes
Trachea and bronchi

22. What is another name for neonatal RDS
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
TB - apex
Hyaline membrane disease
Respiratory bronchioles - clear debris in alveoli - bronchi

23. How does sleep apnea or high altitude cause pulm HTN
Hypoxic vasocxn
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Dec cross sectional area of pulm vasc bed

24. What is the Reid index and what perfectange is characteristic of chronic bronchitis
IRV + TV
Upper lobes
Acetazolamide - inhibits CA and acidifies the blood
Gland depth/total thickness of broncial wall - >50%

25. Why is endothelial damage a risk factor for DVT
Dec - due to lactic acidosis
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Exposed collagen fibers provides impetus for clotting cascade
Squamous cell carcinoma - keratin pearls and intracellular bridges

26. What does ACE do
L/S > 2 = lecithin/sphingomyelin
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Apex of healthy lung
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

27. At what PaO2 does hypoxemia begin
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
<75
Defect in coagulative cascace proteins

28. Which muscles are involved in quiet breathing and What part of respiration do the control
Inspiration by diaphragm - expiration is passive
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Chronic hypoxic vasocxn

29. What organisms cause a bronchoPNA and What are the characteristics
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Both highest in the base
Histiocytosis X - Langerhans cells
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

30. Other than surfactant - what other important substances are produced by the lungs
Incr - right - dec - left
Dec - no change
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Prostaglandins - histamine - ACE - kallikrein

31. What is the presentation of lung cancer

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32. What is used to treat methemoglobin
Dec - due to lactic acidosis
Methylene blue
Inc O2 consumption
Inc mitochondria

33. What is the main complication of therapeutic supplemental O2?
Retinopathy of maturity
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
CO - 200x
Low resistance and high compliance

34. What are the 3 reasons for an increased A- a gradient
Viral - URIs - allergens and stress
Inc shear stress leading to endothelial injury
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

35. What are the 3 forms that CO2 is transported from tissues to lungs
Productive cough for greater than 3 months in at least 2 years
Shed epithelium from mucus plugs
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

36. How does recurrent thromboemboli cause pulm HTN
4 polypeptide subunits - 2 alpha and 2 beta
Alchoholics or epileptics
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Dec cross sectional area of pulm vasc bed

37. What lab ration indicates fetal lung maturity
L/S > 2 = lecithin/sphingomyelin
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Elastase
Drainage

38. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Lungs collapse inwards and chest wall spring out
Inc airway pressure to prevent airway collapse during exhalation
Dec - due to lactic acidosis
Inc 2 -3- DPG - righward shift

39. What is the formula for A- a gradient - and What is it normally
PAO2 - PaO2 = 10-15 mmHg
FRC - inward pull of lung balanced by outward pull of chest wall
Productive cough for greater than 3 months in at least 2 years
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

40. What does kallikrein do
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Activates bradykinin

41. Tumor secreting serotonin causes a syndrome with flushing - diarrhea - wheezing - salvation; fibrous deposits in the right heart valves may lead to tricuspid insuff - pulmonary stenosis - right heart failure - tumor and syndrome
O2 binding x O2 sat + dissolved O2
Carcinoid - carcinoid
Coal miner's - silicosis - abestosis
Airway obstruction (shunt) 100% O2 does not improve PO2

42. What do type II cells do - What is their morphology - when do they proliferate
Everything but RV - TV + IRV + ERV
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Defect in coagulative cascace proteins
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

43. What are the causes of hypoxemia
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Prematurity - maternal RDS - cesarean delivery
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

44. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Ciliated cells
Zone 1
Dorsiflexion of food leads to tender calf muscle
L/S < 1.5

45. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Ivory white calcified pleural plaques
Right shift - favors taut - low affinity for O2 - O2 unloading
Exposed collagen fibers provides impetus for clotting cascade
4 polypeptide subunits - 2 alpha and 2 beta

46. What must occur with a exudate pleural effusion
Inc mitochondria
Drainage
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
P = 2ST/radius

47. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Loss of blood flow - impeded arterial flow - reduced venous drainage
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
<75
Respiratory bronchioles - clear debris in alveoli - bronchi

48. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Gland depth/total thickness of broncial wall - >50%
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
1 g of Hb can bind 1.34 mL of O2 - nl O2 in blood is 15 g/dL - cyansosis when deoxy Hb > 5 g/dL

49. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Respiratory effort against airway obstruction
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

50. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Tissue hypoxia from dec O2 sat and dec O2 content
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Right shift - favors taut - low affinity for O2 - O2 unloading
Lowered

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