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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. Define physilogic dead space
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Gland depth/total thickness of broncial wall - >50%
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Repeated cycles of lung injury and wound healing with inc collagen

2. What is the course of of pulm HTN
Milky fluid with inc TGs
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Dorsiflexion of food leads to tender calf muscle

3. What lobes are affected in silicosis
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Carcinoid - carcinoid
0 - negative - prevents pneumothorax
Upper lobes

4. How does mitral stenosis cause pulm HTN
On expiration as radius dec
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Inc resistance leading to inc pressure
IRV + TV + ERV + RV

5. What is the presentation of lung cancer

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6. What is central sleep apnea
4 polypeptide subunits - 2 alpha and 2 beta
Inc due to inc CO
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
No respiratory effort

7. What lung abnl is characterized by absent or decreased breath sounds over affected area - dec resonance - dec fremitus - and which side is the trachea deviated towards
Drainage
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Bronchial obstruction - toward side of lesion

8. What findings are associated with emphysema
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Carcinoid - carcinoid
Chest pain - tachypnea and dyspnea
Inc 2 -3- DPG - righward shift

9. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
Ciliated cells
Heart
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Bleomycin - busulfan - anmiodorone

10. Why is cesarean delivery a risk factor for neonatal RDS
Dec release of fetal glucocorticoids
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

11. What organisms cause interstitial PNA and What are the characteristics
Bleomycin - busulfan - anmiodorone
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Dec in the FEV1/FVC

12. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Histiocytosis X - Langerhans cells
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Brings air in and out - warms - humidifies - filters
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

13. What are the findings of chronic bronchitis
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Lowered

14. What is the formula for oxygen delivery to tissues
Right
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
CO x O2 content of blood

15. What is the Reid index and what perfectange is characteristic of chronic bronchitis
TB - apex
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Gland depth/total thickness of broncial wall - >50%

16. Define residual volume (RV)
Dorsiflexion of food leads to tender calf muscle
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Air in lung after maxmimal expiration - cannot be measured on spirometry
P = 2ST/radius

17. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Surfactant
20.1 mL O2 /dL
Right shift - favors taut - low affinity for O2 - O2 unloading
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

18. What is used to treat methemoglobin
Dipalmatoyl phosphatidylcholine
Histiocytosis X - Langerhans cells
Methylene blue
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT

19. What is the formula for pulm vasc resistance
PVR = (PpulmA - PleftA)/CO
Inc shear stress leading to endothelial injury
Dipalmatoyl phosphatidylcholine - decreases surface tension
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

20. What is a consequence of pulm HTN
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Dec
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

21. What organism thrives in high O2 and where in the lung does it flourish
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Type II cells
TB - apex
Incr - right - dec - left

22. What is the protein content an exudative pleural effusion and What are the potential causes
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Lungs collapse inwards and chest wall spring out
Chronic hypoxic vasocxn

23. In which zone of the lung is PA > Pa > Pv
Dec in lung volumes - FVC - TLC
500mL
Zone 1
Pa > PA > Pv

24. What is compliance and When is it decrease
RV + ERV - volume in lungs after nl expiration
Dec dec in FEV1 - dec in FVC
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Right lung - right main stem bronhus is wider and more vertical

25. 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
No respiratory effort
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Carcinoid - carcinoid
Dipalmatoyl phosphatidylcholine - decreases surface tension

26. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Fe 2+
Airway obstruction (shunt) 100% O2 does not improve PO2
In between perfusion limited and diffusion limited

27. What are potential triggers for asthma
Viral - URIs - allergens and stress
Methacholine challenge
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Zone 1

28. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Carcinoid - carcinoid
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Tension pneumo - away from lesion

29. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
CO - 200x

30. What does the respiratory zone consist of and What is its fxn
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Weight loss - CPAP - surgery
Inc mitochondria
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

31. How happens to the proton from the rxn the created bicarb
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
It binds to Hb -
Everything but RV - TV + IRV + ERV
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

32. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Lower portion of right inferior lobe
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Inc due to inc CO

33. What is the pathology of bronchiectasis
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
No respiratory effort
Shunting

34. Which lung is the more common site for an inhaled foreign body and why
Right lung - right main stem bronhus is wider and more vertical
Defect in coagulative cascace proteins
Pleural effusion
O2 binding x O2 sat + dissolved O2

35. Where are ventilation and perfusion highest in the lung - respectively
Acetazolamide - inhibits CA and acidifies the blood
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Both highest in the base

36. What direction does an increase in metabolic need shift the O2 dissociation curve
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Right
RALS - righ anterior - left superior
L/S > 2 = lecithin/sphingomyelin

37. How many lobes does each lung have - and What is the lingula
S. aureus or anaerobes
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Inc
Inc to meet O2 demand

38. What is the formula for A- a gradient - and What is it normally
Air in excess of tidal volume that moves into lung on maximal inspiration
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
PAO2 - PaO2 = 10-15 mmHg

39. What is sleep apnea associated with
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Dec - because physiologic shunt dec O2 extraction from ratio
<75
Shunting

40. What kind of emphysema is caused by smoking
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Alchoholics or epileptics
Centriacinar
Tension pneumo - away from lesion

41. Where does lung cancer met to...
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

42. At what PaO2 does hypoxemia begin
Chest pain - tachypnea and dyspnea
<75
Lobar PNA
Air that can still be breathed out after nl expiration

43. What is positive cooperativity of hemoglobin refer to...
Fe 2+
Tissue hypoxia from dec O2 sat and dec O2 content
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

44. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Dec - no change
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Right
IRV + TV

45. What is the leading cause of cancer death
Lung cancer
Mesothelioma - pleura - psammoma bodies
Opposites
Dipalmatoyl phosphatidylcholine

46. What are the associations with bronchiectasis

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47. What is the pathology of ARDS
Retinopathy of maturity
Ivory white calcified pleural plaques
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

48. What causes secondary pulm HTN
CO2 - acid/altitude - DPG - Exercise - Temperature
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Coal miner's - silicosis - abestosis
Prostaglandins - histamine - ACE - kallikrein

49. What are the risk factors for neonatal RDS
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Lost with alveolar walls
Alchoholics or epileptics
Prematurity - maternal RDS - cesarean delivery

50. What renal changes occur at high altitude and What are they compensating for
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Inc excretion of bicarb to compensate for respiratory alkalosis
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Heart