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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 organism thrives in high O2 and where in the lung does it flourish
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
TB - apex
PA02 = 150 - PACO2/0.8
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging

2. What is an example of hypercoagulability
Trachea and bronchi
Defect in coagulative cascace proteins
Metastasis - breast - colon - prostate - bladder -
S. aureus or anaerobes

3. What is a typical tidal volume
Prostaglandins - histamine - ACE - kallikrein
Tissue hypoxia from dec O2 sat and dec O2 content
Deoxygenated blood - elastic walls
500mL

4. What is the alveolar gas equation
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Fe 2+
Metastasis - breast - colon - prostate - bladder -
Surfactant

5. Why do pts with emphysema exhale through pursed lips
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Inc airway pressure to prevent airway collapse during exhalation
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

6. What cellular changes occur at high altitude
Inc mitochondria
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Inc resistance leading to inc pressure

7. What organisms cause interstitial PNA and What are the characteristics
Lower portion of right inferior lobe
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

8. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Inc 2 -3- DPG - righward shift
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Stasis - hypercoagulability - endothelial damage
Histiocytosis X - Langerhans cells

9. What is the fxn of the conducting zone
Clara cells - type II pneumocytes; multiple densitites on CXR
Brings air in and out - warms - humidifies - filters
Fe 2+
Person stops breathing for at least 10 seconds repeatedly during sleep

10. Why is cesarean delivery a risk factor for neonatal RDS
Dec release of fetal glucocorticoids
FRC - inward pull of lung balanced by outward pull of chest wall
Inc mitochondria
Inc

11. What is a consequence of pulm HTN
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Deep leg veins
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

12. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Zone 3
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Alpha1- antitrypsin def - also cirrhosis

13. What is compliance and When is it decrease
Alchoholics or epileptics
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Zone 1
Respiratory bronchioles - clear debris in alveoli - bronchi

14. What TX is the mother given before delivery - and what TXs are given to the infant
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Inc 2 -3- DPG - righward shift
Steroids to mom - artificial surfactant and thyroxine to neonate
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

15. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Hyaline membrane disease
Incr - right - dec - left
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
L/S < 1.5

16. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Hypertrophy of mucus secreting glands in the bronchioles
Acetazolamide - inhibits CA and acidifies the blood
No respiratory effort
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

17. What are the potential TX for sleep apnea
Weight loss - CPAP - surgery
In between perfusion limited and diffusion limited
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

18. At what PaO2 does hypoxemia begin
<75
Lungs collapse inwards and chest wall spring out
Prostaglandins - histamine - ACE - kallikrein
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

19. What cells in the lung produce surfactant and What does it do
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Surfactant def leading to inc surfact tension and alveolar collapse
Elastase
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

20. What is the formula for oxygen delivery to tissues
CO x O2 content of blood
Matched - =1 adequate gas exchange
Persistently low O2 tension
Dec in the FEV1/FVC

21. What does a V/Q ratio of infinity indicate
Deoxygenated blood - elastic walls
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Dec in lung volumes - FVC - TLC

22. What are fat emboli associated with
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Small airways
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Long bone fractures and liposuction

23. What must occur with a exudate pleural effusion
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Drainage
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
L/S > 2 = lecithin/sphingomyelin

24. What is central sleep apnea
In between perfusion limited and diffusion limited
No respiratory effort
Squamous cell carcinoma - keratin pearls and intracellular bridges
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

25. What is the course of of pulm HTN
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Lost with alveolar walls
Opposites
Histiocytosis X - Langerhans cells

26. What is are the symptoms of a pulmonary embolism
Stasis - hypercoagulability - endothelial damage
Chest pain - tachypnea and dyspnea
Dorsiflexion of food leads to tender calf muscle
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

27. What do pulmonary arteries carry - and how are pulm arterial pressures maintained during the cardiac cycle
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
CO2 - acid/altitude - DPG - Exercise - Temperature
Deoxygenated blood - elastic walls

28. Define residual volume (RV)
CO x O2 content of blood
PAO2 - PaO2 = 10-15 mmHg
Air in lung after maxmimal expiration - cannot be measured on spirometry
Alpha1- antitrypsin def - also cirrhosis

29. Lung absecss often reults From what organisms
S. aureus or anaerobes
O2 binding x O2 sat + dissolved O2
RV + ERV - volume in lungs after nl expiration
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

30. What is used to treat CN poisoning and why
Heart
Deoxygenated blood - elastic walls
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
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

31. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
C3 - 4 - 6 - phrenic nerve - referred to shoulder
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

32. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Inc shear stress leading to endothelial injury
In between perfusion limited and diffusion limited
O2 binding x O2 sat + dissolved O2
Right shift - favors taut - low affinity for O2 - O2 unloading

33. What is another name for neonatal RDS
Hyaline membrane disease
Viral - URIs - allergens and stress
Clara cells - type II pneumocytes; multiple densitites on CXR
Weight loss - CPAP - surgery

34. What lab ration indicates fetal lung maturity
Elastic properties
L/S > 2 = lecithin/sphingomyelin
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
No respiratory effort

35. Where do 95% of PE arise from
Deep leg veins
Brings air in and out - warms - humidifies - filters
Zone 3
Dec in the FEV1/FVC

36. What is used to treat methemoglobin
Methylene blue
Prostaglandins - histamine - ACE - kallikrein
Elastic properties
TB - silica disrupt phagolysosomes and impair MACS

37. What is the appoximate O2 binding capacity
Right lung - right main stem bronhus is wider and more vertical
Activates bradykinin
20.1 mL O2 /dL
Upper lobes - cor pulmonale - caplan's syndrome

38. What are the subtypes of pneumoconioses

39. How does autoimmune dz cause thromboemboli
N- terminus - carbaminohemoglobin
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Chronic hypoxic vasocxn
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

40. What muscles are involved in breathing during exercise and What do they control
FRC - inward pull of lung balanced by outward pull of chest wall
Metastasis - breast - colon - prostate - bladder -
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

41. What area of the lung is the largest physiologic contributor of fxnal dead space
Apex of healthy lung
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
High alveolar pressure compresses capillaries
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

42. What organisms cause a bronchoPNA and What are the characteristics
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
No change - but inc venous CO2 content
Dec
Dec in the FEV1/FVC

43. What is fetal hemoglobin made of and why does it have a higher affinity for O2
It binds to Hb -
Deep leg veins
Inc excretion of bicarb to compensate for respiratory alkalosis
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

44. What is hemoglobin composed of...
4 polypeptide subunits - 2 alpha and 2 beta
Persistently low O2 tension
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
0 - negative - prevents pneumothorax

45. What changes in O2 consumption change during exercise
Right shift - favors taut - low affinity for O2 - O2 unloading
Inc O2 consumption
Dec in lung volumes - FVC - TLC
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

46. What does the conducting zone consist of...
L/S > 2 = lecithin/sphingomyelin
Ciliated cells
Ivory white calcified pleural plaques
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

47. What is tha hallmark finding of COPD
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
4 polypeptide subunits - 2 alpha and 2 beta
Dec in the FEV1/FVC

48. What are the various causes of ARDS
Defect in coagulative cascace proteins
Inspiration by diaphragm - expiration is passive
Shunting
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

49. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Loss of blood flow - impeded arterial flow - reduced venous drainage
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
L/S < 1.5
Exposed collagen fibers provides impetus for clotting cascade

50. What are the causes of hypoxia
Inc resistance leading to inc pressure
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Inc shear stress leading to endothelial injury
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-