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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. Where do you find type I cells - What is their morphology - and What do they do
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
No respiratory effort
On expiration as radius dec
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

2. Why is there eventual loss of capillary beds in emphysema
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Lost with alveolar walls
Loss of blood flow - impeded arterial flow - reduced venous drainage
Hypoxic vasocxn

3. What is the course of of pulm HTN
Type II cells
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Chronic hypoxic vasocxn
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

4. What is the definition of sleep apnea
Inc 2 -3- DPG - righward shift
Person stops breathing for at least 10 seconds repeatedly during sleep
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Dec in the FEV1/FVC

5. What is an association and potential complication of paraseptal emphysema
Lung cancer
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Tension pneumo - away from lesion
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

6. What is the appoximate O2 binding capacity
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
N- terminus - carbaminohemoglobin
20.1 mL O2 /dL
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

7. What changes in O2 consumption change during exercise
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Inc O2 consumption
Persistently low O2 tension
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

8. What happens to lung volumes in restrictive lung disease
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Metastasis - breast - colon - prostate - bladder -
Dec
Inc resistance leading to inc pressure

9. What are mucus secretion swept out by
Ciliated cells
Centriacinar
Defect in coagulative cascace proteins
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

10. What happens to diffusing capacity in interstiial lung diseases
CO x O2 content of blood
Lowered
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Acetazolamide - inhibits CA and acidifies the blood

11. If you aspirate a peanut while supine - where will it go
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Superior portion of right inferior lobe
Inc to meet O2 demand
Mismatch

12. What is occupied in the space that would have been the left middle lobe
Heart
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
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

13. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Respiratory bronchioles - clear debris in alveoli - bronchi
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Air in excess of tidal volume that moves into lung on maximal inspiration
Long bone fractures and liposuction

14. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Matched - =1 adequate gas exchange
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Zone 1

15. What do hemoglobin modifacations lead to...
Milky fluid with inc TGs
PA02 = 150 - PACO2/0.8
Tissue hypoxia from dec O2 sat and dec O2 content
On expiration as radius dec

16. What is the response for ventilation of high altitude
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
No change - but inc venous CO2 content
Acute/chronic inc in vent
Air in excess of tidal volume that moves into lung on maximal inspiration

17. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
L/S > 2 = lecithin/sphingomyelin
Lobar PNA
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

18. In emphysema - What is increased lung compliance due to...
Loss of elastic fibers
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Tension pneumo - away from lesion

19. In which zone of the lung is PA > Pa > Pv
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Brings air in and out - warms - humidifies - filters
Zone 1
Bronchial obstruction - toward side of lesion

20. What does the respiratory zone consist of and What is its fxn
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Dec
Shunting
Right shift - favors taut - low affinity for O2 - O2 unloading

21. What is used to treat CN poisoning and why
Inc airway pressure to prevent airway collapse during exhalation
Dec release of fetal glucocorticoids
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
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

22. What are the potential TX for sleep apnea
Prematurity - maternal RDS - cesarean delivery
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Dipalmatoyl phosphatidylcholine
Weight loss - CPAP - surgery

23. What happens to bicarb once it is created in an RBC
TB - silica disrupt phagolysosomes and impair MACS
Tissue hypoxia from dec O2 sat and dec O2 content
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

24. At what lung volume is system pressure atmospheric and why
Acute/chronic inc in vent
FRC - inward pull of lung balanced by outward pull of chest wall
Pleural effusion
Zone 3

25. What changes in lung volunes occur as a result of restrictive lung disease
Dec in lung volumes - FVC - TLC
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
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Inc due to inc CO

26. What is the pathology of bronchiectasis
Bronchial obstruction - toward side of lesion
Inc excretion of bicarb to compensate for respiratory alkalosis
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
P = 2ST/radius

27. What kind of connection exists between endothelial cells in the capilaries
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Upper lobes - cor pulmonale - caplan's syndrome
Tight jxns
Pleural effusion

28. What is the main complication of therapeutic supplemental O2?
FEV1/FVC > 80%
L/S > 2 = lecithin/sphingomyelin
PA02 = 150 - PACO2/0.8
Retinopathy of maturity

29. Lung absecss often reults From what organisms
S. aureus or anaerobes
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Everything but RV - TV + IRV + ERV
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

30. What is the pathology of asthma

31. What is pulmonary surfactant made of - and What does it do
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Zone 3
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Dipalmatoyl phosphatidylcholine - decreases surface tension

32. Where does lung cancer met to...
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
No respiratory effort
Upper lobes
Repeated cycles of lung injury and wound healing with inc collagen

33. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
Viral - URIs - allergens and stress
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
RALS - righ anterior - left superior
Matched - =1 adequate gas exchange

34. What kind of pleural plaques are the result of asbestosis
Ivory white calcified pleural plaques
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Bleomycin - busulfan - anmiodorone

35. What are the two forms of hemoglobin
Brings air in and out - warms - humidifies - filters
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Zone 1
Dipalmatoyl phosphatidylcholine

36. What are the histological findings in asbestosis and what occupations are associated
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Inc production
Defect in coagulative cascace proteins
Hypoxic vasocxn

37. What is the protein content an exudative pleural effusion and What are the potential causes
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Lost with alveolar walls

38. What is the defect in panacinar emphysema - and what else do you see
Clara cells - type II pneumocytes; multiple densitites on CXR
Right
Alpha1- antitrypsin def - also cirrhosis
0 - negative - prevents pneumothorax

39. What changes at high altitude can result in RVH
Chronic hypoxic vasocxn
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Dec in the FEV1/FVC
No respiratory effort

40. What does kallikrein do
Inspiration by diaphragm - expiration is passive
Activates bradykinin
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Methacholine challenge

41. What changes in EPO occur at high altitude
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
Gland depth/total thickness of broncial wall - >50%
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Everything but RV - TV + IRV + ERV

42. 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
O2 binding x O2 sat + dissolved O2
Clara cells - type II pneumocytes; multiple densitites on CXR
IRV + TV

43. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Repeated cycles of lung injury and wound healing with inc collagen
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
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
IRV + TV

44. What ratio is used to measure lung maturity and What is the value is neonatal RDS
IRV + TV
L/S < 1.5
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Surfactant def leading to inc surfact tension and alveolar collapse

45. What is the formula for resistance
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Upper lobes
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
CO2 - acid/altitude - DPG - Exercise - Temperature

46. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Persistently low O2 tension
Chroniclly tired
Methylene blue
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

47. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Right
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Pleural effusion

48. Other than surfactant - what other important substances are produced by the lungs
Pa > PA > Pv
Prostaglandins - histamine - ACE - kallikrein
Dec release of fetal glucocorticoids
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

49. 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
Inspiration by diaphragm - expiration is passive
Carcinoid - carcinoid
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Alchoholics or epileptics

50. What cells in the lung produce surfactant and What does it do
Centriacinar
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Brings air in and out - warms - humidifies - filters