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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 kind of emphysema is caused by smoking
RALS - righ anterior - left superior
Ciliated cells
Centriacinar
Dec in lung volumes - FVC - TLC

2. What are the causes of hypoxia
Ivory white calcified pleural plaques
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Clara cells - type II pneumocytes; multiple densitites on CXR
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

3. What are the causes of ischemia
Lobar PNA
Elastase
Loss of blood flow - impeded arterial flow - reduced venous drainage
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

4. What happens with the O2 curve shifts to the right and What does it facilitate
Zone 1
Dec - due to lactic acidosis
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
CO2 - acid/altitude - DPG - Exercise - Temperature

5. What are the causes of hypoxemia
Activates bradykinin
Metastasis - breast - colon - prostate - bladder -
Air that can still be breathed out after nl expiration
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

6. What are the 3 forms that CO2 is transported from tissues to lungs
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

7. What direction does an increase in metabolic need shift the O2 dissociation curve
Right
4 polypeptide subunits - 2 alpha and 2 beta
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

8. What are mucus secretion swept out by
Ciliated cells
L/S < 1.5
Chronic hypoxic vasocxn
Deep leg veins

9. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Pleural effusion
Positive cooperativity and negative allostery - unlike myoglobin

10. What is hemoglobin composed of...
<60
Lowered
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
4 polypeptide subunits - 2 alpha and 2 beta

11. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Inc resistance leading to inc pressure
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Lungs collapse inwards and chest wall spring out

12. What changes in lung volunes occur as a result of restrictive lung disease
Zone 3
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Dec in lung volumes - FVC - TLC

13. What is the ideal V/Q ratio and why
Matched - =1 adequate gas exchange
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
IRV + TV + ERV + RV
Gland depth/total thickness of broncial wall - >50%

14. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Positive cooperativity and negative allostery - unlike myoglobin
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Chest pain - tachypnea and dyspnea

15. 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
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Lungs collapse inwards and chest wall spring out
O2 binding x O2 sat + dissolved O2

16. What kind of course does interstitial PNA follow in comparison to bronchoPNA
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Inoperable - responsive to chemotherapy
More indolent
N- terminus - carbaminohemoglobin

17. What does a V/Q ratio of infinity indicate
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
On expiration as radius dec
Acetazolamide - inhibits CA and acidifies the blood
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

18. What changes in CO2 occur during exercise
Inc production
Shed epithelium from mucus plugs
Right shift - favors taut - low affinity for O2 - O2 unloading
Inc excretion of bicarb to compensate for respiratory alkalosis

19. What happens to lung volumes in restrictive lung disease
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Dec
Inc airway pressure to prevent airway collapse during exhalation

20. At what PaO2 does hypoxemia begin
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
CO - 200x
<75
Dec

21. What is the characteristic lymphatic pleural effusion
Dipalmatoyl phosphatidylcholine - decreases surface tension
Shunting
PAO2 - PaO2 = 10-15 mmHg
Milky fluid with inc TGs

22. What is the response for ventilation of high altitude
Lungs collapse inwards and chest wall spring out
Dec in the FEV1/FVC
Acute/chronic inc in vent
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

23. What is the formula for pulm vasc resistance
PVR = (PpulmA - PleftA)/CO
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Inc O2 consumption
Methylene blue

24. If you aspirate a peanut while supine - where will it go
Superior portion of right inferior lobe
Alchoholics or epileptics
Tight jxns
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

25. What is the defect in panacinar emphysema - and what else do you see
IRV + TV
Alpha1- antitrypsin def - also cirrhosis
In between perfusion limited and diffusion limited
Ciliated cells

26. 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
Methacholine challenge
Exposed collagen fibers provides impetus for clotting cascade
Weight loss - CPAP - surgery

27. What is a lung abscess and What does usually result from
Histiocytosis X - Langerhans cells
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
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
Apex of healthy lung

28. What is the definition of sleep apnea
Person stops breathing for at least 10 seconds repeatedly during sleep
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
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

29. What are the findings in asthma
Hypertrophy of mucus secreting glands in the bronchioles
Loss of blood flow - impeded arterial flow - reduced venous drainage
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Productive cough for greater than 3 months in at least 2 years

30. What is the appoximate O2 binding capacity
Squamous cell carcinoma - keratin pearls and intracellular bridges
20.1 mL O2 /dL
Ivory white calcified pleural plaques
L/S > 2 = lecithin/sphingomyelin

31. What do type II cells do - What is their morphology - when do they proliferate
TB - silica disrupt phagolysosomes and impair MACS
Dipalmatoyl phosphatidylcholine
Steroids to mom - artificial surfactant and thyroxine to neonate
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

32. What organism causes a lobar PNA and What are the characteristics
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Lung cancer
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

33. In which zone of the lung is Pa > Pv >PA
Deep leg veins
Zone 3
Opposites
Positive cooperativity and negative allostery - unlike myoglobin

34. What is the most common cancerous lesion in the lun
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
PAO2 - PaO2 = 10-15 mmHg
Metastasis - breast - colon - prostate - bladder -
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

35. What is central sleep apnea
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Inc resistance leading to inc pressure
No respiratory effort

36. What does decreased PAO2 do
Dorsiflexion of food leads to tender calf muscle
Elastic properties
IRV + TV
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

37. What does pulm HTN result in
FEV1/FVC > 80%
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
500mL

38. What is used to treat methemoglobin
Methylene blue
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Dec dec in FEV1 - dec in FVC
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

39. What is carboxyhemoglobin and What does it cause
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Dec - because physiologic shunt dec O2 extraction from ratio
Ivory white calcified pleural plaques
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

40. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Repeated cycles of lung injury and wound healing with inc collagen
Bleomycin - busulfan - anmiodorone
Opposites
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

41. What are the lab/study findings in adenocarcinoma of the lung
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Clara cells - type II pneumocytes; multiple densitites on CXR
Shunting
Inc EPO leading to erythrocytosis

42. What are the associations with bronchiectasis

43. 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
Low resistance and high compliance
Metastasis - breast - colon - prostate - bladder -
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

44. What is the initial damage of ARDS caused by
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Dorsiflexion of food leads to tender calf muscle
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Retinopathy of maturity

45. What is the formula for oxygen delivery to tissues
CO x O2 content of blood
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

46. What does the respiratory zone consist of and What is its fxn
Alpha1- antitrypsin def - also cirrhosis
Mesothelioma - pleura - psammoma bodies
CO - 200x
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

47. What enzyme increases activity in emphysema
Inc excretion of bicarb to compensate for respiratory alkalosis
Elastase
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude

48. What happens to arterial PO2 in chronic lung disease and why
Dec - because physiologic shunt dec O2 extraction from ratio
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

49. What drug therapy is used to augment the changes in bicarb exretion
Respiratory bronchioles - clear debris in alveoli - bronchi
Dec in lung volumes - FVC - TLC
Dec in the FEV1/FVC
Acetazolamide - inhibits CA and acidifies the blood

50. What is tha hallmark finding of COPD
Dec in the FEV1/FVC
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Inc 2 -3- DPG - righward shift
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale