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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 is a typical tidal volume
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
500mL
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Weight loss - CPAP - surgery

2. What is the formula for A- a gradient - and What is it normally
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Respiratory bronchioles - clear debris in alveoli - bronchi
TB - apex
PAO2 - PaO2 = 10-15 mmHg

3. What are curschmann's spirals
Small airways
Shed epithelium from mucus plugs
Repeated cycles of lung injury and wound healing with inc collagen
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

4. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Inoperable - responsive to chemotherapy
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Lobar PNA
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

5. How does left to right shunt cause pulm HTN
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Inc shear stress leading to endothelial injury
Lost with alveolar walls

6. What kind of space is in the conducting tree and what kind of muscle exists there
Mismatch
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Anatomic dead space and smooth muscle
Chest pain - tachypnea and dyspnea

7. What is a consequence of pulm HTN
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Long bone fractures and liposuction
TB - silica disrupt phagolysosomes and impair MACS
Histiocytosis X - Langerhans cells

8. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Respiratory bronchioles - clear debris in alveoli - bronchi
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

9. What does a V/Q ratio of infinity indicate
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
TB - apex
Viral - URIs - allergens and stress
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

10. What is a lung abscess and What does usually result from
Methylene blue
Low resistance and high compliance
Right
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

11. What are the causes of hypoxemia
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Surfactant def leading to inc surfact tension and alveolar collapse

12. What is central sleep apnea
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Pleural effusion
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
No respiratory effort

13. What organism causes a lobar PNA and What are the characteristics
Right
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Right shift - favors taut - low affinity for O2 - O2 unloading
Right lung - right main stem bronhus is wider and more vertical

14. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Lobar PNA
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Dec - no change

15. Why is endothelial damage a risk factor for DVT
Exposed collagen fibers provides impetus for clotting cascade
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
FEV1/FVC > 80%
PAO2 - PaO2 = 10-15 mmHg

16. Which muscles are involved in quiet breathing and What part of respiration do the control
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Inspiration by diaphragm - expiration is passive
More indolent
IRV + TV + ERV + RV

17. What is the presentation of lung cancer

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18. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Mesothelioma - pleura - psammoma bodies
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Dec cross sectional area of pulm vasc bed

19. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Productive cough for greater than 3 months in at least 2 years
Elastase

20. What is the most common cancerous lesion in the lun
Metastasis - breast - colon - prostate - bladder -
Carcinoid - carcinoid
In between perfusion limited and diffusion limited
Inc due to inc CO

21. What are clara cells What is their morphology and What do they do
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Dec in lung volumes - FVC - TLC
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
20.1 mL O2 /dL

22. Define expiratory reserve volume (ERV)
Inc 2 -3- DPG - righward shift
Right lung - right main stem bronhus is wider and more vertical
Inc resistance leading to inc pressure
Air that can still be breathed out after nl expiration

23. What is virchow's triad
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Stasis - hypercoagulability - endothelial damage
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

24. What are the subtypes of pneumoconioses

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25. What are the findings associated with sarcoidosis
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
L/S > 2 = lecithin/sphingomyelin
Dec release of fetal glucocorticoids
Hypoxic vasocxn

26. What is tha hallmark finding of COPD
CT angio
Type II cells
Dec in the FEV1/FVC
Inc 2 -3- DPG - righward shift

27. Why is there eventual loss of capillary beds in emphysema
Inc production
Both highest in the base
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Lost with alveolar walls

28. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Dec release of fetal glucocorticoids
Air that can still be breathed out after nl expiration
Gland depth/total thickness of broncial wall - >50%
Pleural effusion

29. What is the nl form of iron in hemoglobin
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Anatomic dead space and smooth muscle
Fe 2+

30. What changes occur to PaO2 and PaCO2
Lung cancer
Trachea and bronchi
Airway obstruction (shunt) 100% O2 does not improve PO2
No change - but inc venous CO2 content

31. Where do you find type I cells - What is their morphology - and What do they do
Metastasis - breast - colon - prostate - bladder -
Chest pain - tachypnea and dyspnea
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Opposites

32. What is another name for neonatal RDS
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Opposites
Hyaline membrane disease
FRC - inward pull of lung balanced by outward pull of chest wall

33. What is the alveolar gas equation approximation
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
PA02 = 150 - PACO2/0.8
Inc shear stress leading to endothelial injury

34. In COPD - what happens to airways at high lung volumes
IRV + TV
Ciliated cells
Everything but RV - TV + IRV + ERV
Airways close prematurely resulting in inc RV and dec FVC

35. What cells in the lung produce surfactant and What does it do
Hypoxic vasocxn
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

36. What does ACE do
Alpha1- antitrypsin def - also cirrhosis
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Inc production
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

37. What does a V/Q ratio of 0 indicate
Type II pneumocytes - after week 35
Inspiration by diaphragm - expiration is passive
No change - but inc venous CO2 content
Airway obstruction (shunt) 100% O2 does not improve PO2

38. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Incr - right - dec - left
Weight loss - CPAP - surgery
Heart
Heparin

39. What is the V/Q ratio at the apex and base of the lung
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Loss of blood flow - impeded arterial flow - reduced venous drainage
PVR = (PpulmA - PleftA)/CO
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

40. What layers must CO2 and O2 traverse to complete gas exchange
TB - silica disrupt phagolysosomes and impair MACS
Air that can still be breathed out after nl expiration
CO x O2 content of blood
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

41. What are the 9 interstitial lung diseases

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42. What are fat emboli associated with
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Long bone fractures and liposuction

43. Where does lung cancer met to...
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Dec - no change
Tension pneumo - away from lesion
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

44. What can amniotic fluid emboli lead to...
Trachea and bronchi
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
DIC - especially postpartum

45. Define total lung capcaity
Fe 2+
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Mesothelioma - pleura - psammoma bodies
IRV + TV + ERV + RV

46. What is the cycle of idiopathic pulmonary fibrosis
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Repeated cycles of lung injury and wound healing with inc collagen
Hypertrophy of mucus secreting glands in the bronchioles
CO - 200x

47. What does the law of Laplace state about tendency of alveoli to collapse
On expiration as radius dec
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Inc mitochondria
L/S > 2 = lecithin/sphingomyelin

48. If you aspirate a peanut while supine - where will it go
Superior portion of right inferior lobe
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
20.1 mL O2 /dL
Everything but RV - TV + IRV + ERV

49. What TX is the mother given before delivery - and what TXs are given to the infant
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Inc airway pressure to prevent airway collapse during exhalation
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Steroids to mom - artificial surfactant and thyroxine to neonate

50. What happens with the O2 curve shifts to the right and What does it facilitate
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Small airways
Low resistance and high compliance