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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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1. What is methemoglobin
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Hypertrophy of mucus secreting glands in the bronchioles
Air that can still be breathed out after nl expiration
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

2. What is central sleep apnea
Lowered
Tension pneumo - away from lesion
No respiratory effort
Milky fluid with inc TGs

3. What is a lung abscess and What does usually result from
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Right shift - favors taut - low affinity for O2 - O2 unloading
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Inc to meet O2 demand

4. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Mesothelioma - pleura - psammoma bodies
Inoperable - responsive to chemotherapy
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

5. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
Dipalmatoyl phosphatidylcholine
Zone 1
RALS - righ anterior - left superior
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

6. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
N- terminus - carbaminohemoglobin
Alchoholics or epileptics
O2 binding x O2 sat + dissolved O2

7. What is the leading cause of cancer death
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Lung cancer
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Prostaglandins - histamine - ACE - kallikrein

8. What is early onset hypoxemia from in chronic bronchitis
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Shunting
Inc O2 consumption
Inc due to inc CO

9. Where do you find type I cells - What is their morphology - and What do they do
Chest pain - tachypnea and dyspnea
CO x O2 content of blood
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

10. What are the 3 reasons for an increased A- a gradient
TB - silica disrupt phagolysosomes and impair MACS
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

11. How happens to the proton from the rxn the created bicarb
RV + ERV - volume in lungs after nl expiration
CO2 - acid/altitude - DPG - Exercise - Temperature
It binds to Hb -
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

12. What is the course of of pulm HTN
Superior portion of right inferior lobe
No change - but inc venous CO2 content
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Inc shear stress leading to endothelial injury

13. What is the appoximate O2 binding capacity
Tension pneumo - away from lesion
20.1 mL O2 /dL
Repeated cycles of lung injury and wound healing with inc collagen
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

14. In emphysema - What is increased lung compliance due to...
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Loss of elastic fibers
20.1 mL O2 /dL

15. 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
CO x O2 content of blood
IRV + TV
Acute/chronic inc in vent

16. What causes primary pulm HTN
Histiocytosis X - Langerhans cells
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Tight jxns
Respiratory bronchioles - clear debris in alveoli - bronchi

17. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Mismatch
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
It binds to Hb -
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

18. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Inc 2 -3- DPG - righward shift
Gland depth/total thickness of broncial wall - >50%
Heart
Zone 3

19. What is the pathology of bronchiectasis
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Zone 1

20. What are the 9 interstitial lung diseases

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21. Chronic bronchitis is a disease of what kind of airways
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Inc due to inc CO
Histiocytosis X - Langerhans cells
Small airways

22. What changes occur to PaO2 and PaCO2
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
TB - apex
No change - but inc venous CO2 content
Long bone fractures and liposuction

23. Where is cartilage present in the respiratory tree
Hypoxic vasocxn
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Trachea and bronchi

24. 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
Weight loss - CPAP - surgery
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Inc shear stress leading to endothelial injury
Carcinoid - carcinoid

25. What is the ideal V/Q ratio and why
Matched - =1 adequate gas exchange
Dorsiflexion of food leads to tender calf muscle
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Person stops breathing for at least 10 seconds repeatedly during sleep

26. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Lowered
Alpha1- antitrypsin def - also cirrhosis
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
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

27. Define inspiratory capacity (IC)
Acetazolamide - inhibits CA and acidifies the blood
Inc production
IRV + TV
Inc due to inc CO

28. What is the equation for physiologic dead space
No change - but inc venous CO2 content
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Defect in coagulative cascace proteins
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

29. What is the pathology of chronic bronchitis
Hypertrophy of mucus secreting glands in the bronchioles
Inc due to inc CO
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

30. What is the Reid index and what perfectange is characteristic of chronic bronchitis
<75
Drainage
Right lung - right main stem bronhus is wider and more vertical
Gland depth/total thickness of broncial wall - >50%

31. What changes in CO2 occur during exercise
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Inc production
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

32. What are the 3 forms that CO2 is transported from tissues to lungs
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Low resistance and high compliance

33. At what PaO2 does hypoxemia begin
Inoperable - responsive to chemotherapy
Lungs collapse inwards and chest wall spring out
<75
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor

34. What is the pathology of emphysema
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
<60
Person stops breathing for at least 10 seconds repeatedly during sleep

35. What is a typical tidal volume
Deoxygenated blood - elastic walls
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
500mL
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

36. What are the potential TX for sleep apnea
Methylene blue
Metastasis - breast - colon - prostate - bladder -
Weight loss - CPAP - surgery
Positive cooperativity and negative allostery - unlike myoglobin

37. What is tha hallmark finding of COPD
RALS - righ anterior - left superior
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Dec in the FEV1/FVC
Exposed collagen fibers provides impetus for clotting cascade

38. How is pulmonary circulation characterized in terms of resistance and compliance
Pa > PA > Pv
Acetazolamide - inhibits CA and acidifies the blood
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Low resistance and high compliance

39. What doe FAT BAT stand for
Chronic hypoxic vasocxn
Dec cross sectional area of pulm vasc bed
Airways close prematurely resulting in inc RV and dec FVC
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

40. What is the formula for resistance
Dec cross sectional area of pulm vasc bed
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
More indolent
Persistently low O2 tension

41. What is compliance and When is it decrease
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Right lung - right main stem bronhus is wider and more vertical
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

42. What is virchow's triad
Stasis - hypercoagulability - endothelial damage
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
In between perfusion limited and diffusion limited
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT

43. What is used to treat CN poisoning and why
Heparin
Loss of blood flow - impeded arterial flow - reduced venous drainage
Centriacinar
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

44. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Air that can still be breathed out after nl expiration
PVR = (PpulmA - PleftA)/CO
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
L/S < 1.5

45. What changes in EPO occur at high altitude
Bronchial obstruction - toward side of lesion
IRV + TV
Respiratory effort against airway obstruction
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

46. What TX is the mother given before delivery - and what TXs are given to the infant
Carcinoid - carcinoid
Steroids to mom - artificial surfactant and thyroxine to neonate
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Coal miner's - silicosis - abestosis

47. Susceptibility to what infection is increased in silicosis and why
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
TB - silica disrupt phagolysosomes and impair MACS
Opposites
Respiratory bronchioles - clear debris in alveoli - bronchi

48. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
No change - but inc venous CO2 content
Methylene blue
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

49. What is an example of hypercoagulability
Histiocytosis X - Langerhans cells
Brings air in and out - warms - humidifies - filters
Defect in coagulative cascace proteins
<75

50. What causes neonatal RDS
Surfactant def leading to inc surfact tension and alveolar collapse
CT angio
Air that can still be breathed out after nl expiration
Coal miner's - silicosis - abestosis