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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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1. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
0 - negative - prevents pneumothorax
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Inc airway pressure to prevent airway collapse during exhalation
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

2. What is the TX for small cell lung cancer
Fe 2+
Inoperable - responsive to chemotherapy
Opposites
Air in excess of tidal volume that moves into lung on maximal inspiration

3. Define physilogic dead space
Dec in the FEV1/FVC
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Dec - no change

4. In COPD - what happens to airways at high lung volumes
500mL
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Airways close prematurely resulting in inc RV and dec FVC
Deoxygenated blood - elastic walls

5. What does a V/Q ratio of infinity indicate
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
P = 2ST/radius

6. What cellular changes occur at high altitude
Methacholine challenge
Inc mitochondria
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Shunting

7. What changes occur to PaO2 and PaCO2
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Shed epithelium from mucus plugs
No change - but inc venous CO2 content

8. What happens as a result of hypoxia in sleep apnea
Viral - URIs - allergens and stress
Inc EPO leading to erythrocytosis
Fe 2+
Air that can still be breathed out after nl expiration

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

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10. How does left to right shunt cause pulm HTN
Inc shear stress leading to endothelial injury
Matched - =1 adequate gas exchange
Dec - no change
Opposites

11. What layers must CO2 and O2 traverse to complete gas exchange
20.1 mL O2 /dL
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Brings air in and out - warms - humidifies - filters
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor

12. Define inspiratory reserve volume (IRV)
Inc resistance leading to inc pressure
<75
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Air in excess of tidal volume that moves into lung on maximal inspiration

13. What happens to diffusing capacity in interstiial lung diseases
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
O2 binding x O2 sat + dissolved O2
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Lowered

14. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Lost with alveolar walls
L/S < 1.5
Everything but RV - TV + IRV + ERV
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

15. What is the pathology of bronchiectasis
Persistently low O2 tension
Chest pain - tachypnea and dyspnea
Repeated cycles of lung injury and wound healing with inc collagen
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

16. What is fetal hemoglobin made of and why does it have a higher affinity for O2
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Surfactant def leading to inc surfact tension and alveolar collapse
N- terminus - carbaminohemoglobin

17. What is sleep apnea associated with
CO - 200x
Person stops breathing for at least 10 seconds repeatedly during sleep
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Methylene blue

18. What is the presentation of lung cancer

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19. Define functional residual capacity (FRC)
O2 binding x O2 sat + dissolved O2
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
RV + ERV - volume in lungs after nl expiration
Air in lung after maxmimal expiration - cannot be measured on spirometry

20. What is the leading cause of cancer death
<75
Air in excess of tidal volume that moves into lung on maximal inspiration
Inc EPO leading to erythrocytosis
Lung cancer

21. What can amniotic fluid emboli lead to...
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Inc EPO leading to erythrocytosis
DIC - especially postpartum
Fe 2+

22. What does pulm HTN result in
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Inc
Lungs collapse inwards and chest wall spring out
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

23. If you aspirate a peanut while supine - where will it go
Superior portion of right inferior lobe
Dec cross sectional area of pulm vasc bed
PA02 = 150 - PACO2/0.8
Chest pain - tachypnea and dyspnea

24. What lobes are affected in silicosis
Upper lobes
Inc
Incr - right - dec - left
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

25. What happens to arterial PO2 in chronic lung disease and why
Lungs collapse inwards and chest wall spring out
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Dec - because physiologic shunt dec O2 extraction from ratio
Dorsiflexion of food leads to tender calf muscle

26. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Mesothelioma - pleura - psammoma bodies
Zone 3
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 does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Apex of healthy lung
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Type II cells

28. What does a V/Q ratio of 0 indicate
On expiration as radius dec
Airway obstruction (shunt) 100% O2 does not improve PO2
Mesothelioma - pleura - psammoma bodies
Low resistance and high compliance

29. What are the causes of hypoxia
S. aureus or anaerobes
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

30. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Dipalmatoyl phosphatidylcholine
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Brings air in and out - warms - humidifies - filters

31. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Drainage
Respiratory effort against airway obstruction
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

32. What effects do O2 and CO2 have on pulm circulation - in relation to the other
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Centriacinar
Opposites

33. What lab ration indicates fetal lung maturity
Type II cells
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
L/S > 2 = lecithin/sphingomyelin
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

34. What is the formula for O2 content
Zone 3
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
O2 binding x O2 sat + dissolved O2
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

35. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
RALS - righ anterior - left superior
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Acute/chronic inc in vent
Right

36. How does mitral stenosis cause pulm HTN
Zone 1
Inc resistance leading to inc pressure
Acetazolamide - inhibits CA and acidifies the blood
Bronchial obstruction - toward side of lesion

37. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Pleural effusion
Respiratory bronchioles - clear debris in alveoli - bronchi
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
4 polypeptide subunits - 2 alpha and 2 beta

38. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Acute/chronic inc in vent
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
IRV + TV + ERV + RV
Tension pneumo - away from lesion

39. Why is endothelial damage a risk factor for DVT
CO - 200x
Air in excess of tidal volume that moves into lung on maximal inspiration
S. aureus or anaerobes
Exposed collagen fibers provides impetus for clotting cascade

40. What is tha hallmark finding of COPD
Coal miner's - silicosis - abestosis
Matched - =1 adequate gas exchange
Dec in the FEV1/FVC
Shed epithelium from mucus plugs

41. What happens to bicarb once it is created in an RBC
Lowered
Clara cells - type II pneumocytes; multiple densitites on CXR
Upper lobes
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

42. Which muscles are involved in quiet breathing and What part of respiration do the control
Inspiration by diaphragm - expiration is passive
IRV + TV + ERV + RV
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
500mL

43. How do you prevent DVT
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Lobar PNA
Heparin
Histiocytosis X - Langerhans cells

44. 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
Type II pneumocytes - after week 35
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
Productive cough for greater than 3 months in at least 2 years

45. In which zone of the lung is Pa > Pv >PA
It binds to Hb -
Drainage
Zone 3
Inc EPO leading to erythrocytosis

46. What kind of course does interstitial PNA follow in comparison to bronchoPNA
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
More indolent
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Upper lobes - cor pulmonale - caplan's syndrome

47. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Heparin
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Bleomycin - busulfan - anmiodorone

48. What enzyme increases activity in emphysema
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Superior portion of right inferior lobe
Elastase
Dec cross sectional area of pulm vasc bed

49. What is compliance and When is it decrease
Dec release of fetal glucocorticoids
Acute/chronic inc in vent
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
FEV1/FVC > 80%

50. What increases the risk of PDA in neonatal RDS
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Shunting
Persistently low O2 tension
Repeated cycles of lung injury and wound healing with inc collagen