Test your basic knowledge |

Respiratory

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 does kallikrein do
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Activates bradykinin
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

2. Define total lung capcaity
Right
IRV + TV + ERV + RV
Everything but RV - TV + IRV + ERV
Surfactant

3. What is the formula for collapsing pressure
PAO2 - PaO2 = 10-15 mmHg
Right shift - favors taut - low affinity for O2 - O2 unloading
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
P = 2ST/radius

4. In which zone of the lung is PA > Pa > Pv
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Surfactant
Zone 1
Lungs collapse inwards and chest wall spring out

5. What are the causes of hypoxemia
Mismatch
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
0 - negative - prevents pneumothorax
CO x O2 content of blood

6. What changes at high altitude can result in RVH
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Chronic hypoxic vasocxn
Lost with alveolar walls

7. What are the risk factors for neonatal RDS
<60
20.1 mL O2 /dL
Prematurity - maternal RDS - cesarean delivery
Histiocytosis X - Langerhans cells

8. What is the course of of pulm HTN
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

9. What is tha hallmark finding of COPD
Elastase
Dec in the FEV1/FVC
Drainage
Inc O2 consumption

10. What happens to diffusing capacity in interstiial lung diseases
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
0 - negative - prevents pneumothorax
Lowered
PVR = (PpulmA - PleftA)/CO

11. What changes occur to pulm blood flow during exercise
Zone 1
Inc due to inc CO
Inspiration by diaphragm - expiration is passive
Methacholine challenge

12. What TX is the mother given before delivery - and what TXs are given to the infant
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
Milky fluid with inc TGs
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Steroids to mom - artificial surfactant and thyroxine to neonate

13. How do you prevent DVT
Heparin
TB - apex
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Dec cross sectional area of pulm vasc bed

14. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Inc shear stress leading to endothelial injury
Zone 3
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Pleural effusion

15. What happens as a result of hypoxia in sleep apnea
Right shift - favors taut - low affinity for O2 - O2 unloading
Alpha1- antitrypsin def - also cirrhosis
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Inc EPO leading to erythrocytosis

16. How does mitral stenosis cause pulm HTN
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Inc resistance leading to inc pressure
Inspiration by diaphragm - expiration is passive

17. What do type II cells do - What is their morphology - when do they proliferate
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
L/S > 2 = lecithin/sphingomyelin
Lung cancer
Incr - right - dec - left

18. What causes neonatal RDS
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
N- terminus - carbaminohemoglobin
Surfactant def leading to inc surfact tension and alveolar collapse
Stasis - hypercoagulability - endothelial damage

19. What does PFTs show in COPD
Dec dec in FEV1 - dec in FVC
Prostaglandins - histamine - ACE - kallikrein
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

20. What are the 3 forms that CO2 is transported from tissues to lungs
In between perfusion limited and diffusion limited
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
4 polypeptide subunits - 2 alpha and 2 beta
RALS - righ anterior - left superior

21. What kind of course does interstitial PNA follow in comparison to bronchoPNA
More indolent
Tight jxns
Anatomic dead space and smooth muscle
No change - but inc venous CO2 content

22. What is an example of hypercoagulability
Tissue hypoxia from dec O2 sat and dec O2 content
CO - 200x
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Defect in coagulative cascace proteins

23. What does each bronchopulmonary segment have in the center and along its border
Pa > PA > Pv
Clara cells - type II pneumocytes; multiple densitites on CXR
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Acetazolamide - inhibits CA and acidifies the blood

24. What is the most common cancerous lesion in the lun
RV + ERV - volume in lungs after nl expiration
Metastasis - breast - colon - prostate - bladder -
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Alpha1- antitrypsin def - also cirrhosis

25. What lobes does Coal Miner's pneumoconioses affect - and What can it result in

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

26. What is carboxyhemoglobin and What does it cause
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Form of hemoglobin bound to CO in place of O2 - causes dec O2 binding capacituy with a left shift in the O2 hemoglobin dissociation curve - dec unloading in tissues
Inc due to inc CO
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

27. Define inspiratory capacity (IC)
IRV + TV
Acetazolamide - inhibits CA and acidifies the blood
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Lungs collapse inwards and chest wall spring out

28. What is the criteria for chronic bronchitis
Steroids to mom - artificial surfactant and thyroxine to neonate
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Productive cough for greater than 3 months in at least 2 years
Long bone fractures and liposuction

29. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Heparin
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
Hyaline membrane disease
0 - negative - prevents pneumothorax

30. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Defect in coagulative cascace proteins
Matched - =1 adequate gas exchange

31. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
500mL
Elastic properties

32. What do PFTs show in restrictive lung disease
Lost with alveolar walls
FEV1/FVC > 80%
Inc O2 consumption
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

33. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Airways close prematurely resulting in inc RV and dec FVC
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
IRV + TV

34. What is sleep apnea associated with
High alveolar pressure compresses capillaries
Type II pneumocytes - after week 35
Positive cooperativity and negative allostery - unlike myoglobin
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

35. Other than surfactant - what other important substances are produced by the lungs
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Dec - no change
Prostaglandins - histamine - ACE - kallikrein
Metastasis - breast - colon - prostate - bladder -

36. Define inspiratory reserve volume (IRV)
Air in excess of tidal volume that moves into lung on maximal inspiration
IRV + TV
Both highest in the base
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

37. What is the formula for A- a gradient - and What is it normally
PAO2 - PaO2 = 10-15 mmHg
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Centriacinar
S. aureus or anaerobes

38. Define residual volume (RV)
Methylene blue
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Inc resistance leading to inc pressure
Air in lung after maxmimal expiration - cannot be measured on spirometry

39. What is virchow's triad
Surfactant
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Dec cross sectional area of pulm vasc bed
Stasis - hypercoagulability - endothelial damage

40. What are the causes of ischemia
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Loss of blood flow - impeded arterial flow - reduced venous drainage
Inc to meet O2 demand
Upper lobes

41. What cellular changes occur at high altitude
Inc mitochondria
Steroids to mom - artificial surfactant and thyroxine to neonate
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Opposites

42. What is the pathology of bronchiectasis
Everything but RV - TV + IRV + ERV
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Elastic properties

43. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Bleomycin - busulfan - anmiodorone
Air in excess of tidal volume that moves into lung on maximal inspiration
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Dec dec in FEV1 - dec in FVC

44. What doe FAT BAT stand for
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Lower portion of right inferior lobe
Squamous cell carcinoma - keratin pearls and intracellular bridges
Deep leg veins

45. If you aspirate a peanut while supine - where will it go
Superior portion of right inferior lobe
High alveolar pressure compresses capillaries
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Airways close prematurely resulting in inc RV and dec FVC

46. In which zone of the lung is Pa > Pv >PA
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Zone 3
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Shunting

47. Why is there eventual loss of capillary beds in emphysema
Acetazolamide - inhibits CA and acidifies the blood
Inc 2 -3- DPG - righward shift
Lost with alveolar walls
Clara cells - type II pneumocytes; multiple densitites on CXR

48. What is the imaging test of choice for PE
Anatomic dead space and smooth muscle
CT angio
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
PAO2 - PaO2 = 10-15 mmHg

49. What is the initial damage of ARDS caused by
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Lungs collapse inwards and chest wall spring out
Form of hemoglobin bound to CO in place of O2 - causes dec O2 binding capacituy with a left shift in the O2 hemoglobin dissociation curve - dec unloading in tissues
<75

50. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
CO x O2 content of blood
Bleomycin - busulfan - anmiodorone
Lung cancer