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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. Define physilogic dead space
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
<75
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

2. What is the leading cause of cancer death
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Lung cancer
Mismatch
Squamous cell carcinoma - keratin pearls and intracellular bridges

3. What are the SPHERE of complications in lung cancer
Alpha1- antitrypsin def - also cirrhosis
RV + ERV - volume in lungs after nl expiration
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

4. 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
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Hypoxic vasocxn
L/S > 2 = lecithin/sphingomyelin

5. What are the associations with bronchiectasis

6. A carcinoma in the apex of the lung can cause what syndrome and What is the tumor called

7. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Surfactant def leading to inc surfact tension and alveolar collapse
Methacholine challenge
Incr - right - dec - left
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals

8. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Prostaglandins - histamine - ACE - kallikrein
Tension pneumo - away from lesion
Shed epithelium from mucus plugs
Pleural effusion

9. What happens to V/Q ratio in COPD
Dorsiflexion of food leads to tender calf muscle
Air that can still be breathed out after nl expiration
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Mismatch

10. What is central sleep apnea
Productive cough for greater than 3 months in at least 2 years
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
PVR = (PpulmA - PleftA)/CO
No respiratory effort

11. What is the V/Q ratio at the apex and base of the lung
Mesothelioma - pleura - psammoma bodies
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Carcinoid - carcinoid
Methacholine challenge

12. What kind of connection exists between endothelial cells in the capilaries
Dorsiflexion of food leads to tender calf muscle
Tight jxns
Mesothelioma - pleura - psammoma bodies
Positive cooperativity and negative allostery - unlike myoglobin

13. What organism thrives in high O2 and where in the lung does it flourish
TB - apex
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Bronchial obstruction - toward side of lesion
Type II cells

14. What is the nl form of iron in hemoglobin
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Fe 2+
Pa > PA > Pv
L/S > 2 = lecithin/sphingomyelin

15. In which zone of the lung is PA > Pa > Pv
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Zone 1
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

16. Define residual volume (RV)
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Air in lung after maxmimal expiration - cannot be measured on spirometry
Lung cancer
Incr - right - dec - left

17. Define inspiratory capacity (IC)
Zone 1
More indolent
IRV + TV
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

18. What causes primary pulm HTN
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Elastase
Inc O2 consumption
Small airways

19. What are the causes of ischemia
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Loss of blood flow - impeded arterial flow - reduced venous drainage
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Inc 2 -3- DPG - righward shift

20. Where is cartilage present in the respiratory tree
Trachea and bronchi
Retinopathy of maturity
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Ratio from apex to base becomes more uniform

21. What are the findings of chronic bronchitis
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
DIC - especially postpartum
Productive cough for greater than 3 months in at least 2 years

22. What is a typical tidal volume
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Dec in lung volumes - FVC - TLC
500mL
Anatomic dead space and smooth muscle

23. Define vital capacity (VC)
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Everything but RV - TV + IRV + ERV
Productive cough for greater than 3 months in at least 2 years
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

24. What is positive cooperativity of hemoglobin refer to...
0 - negative - prevents pneumothorax
Inc 2 -3- DPG - righward shift
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
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

25. What is the criteria for chronic bronchitis
Productive cough for greater than 3 months in at least 2 years
Inc due to inc CO
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Steroids to mom - artificial surfactant and thyroxine to neonate

26. Which pts are at risk for apriation PNA
Zone 1
Apex of healthy lung
Alchoholics or epileptics
Inspiration by diaphragm - expiration is passive

27. What changes in pH occur during strenuous exercise and why
RV + ERV - volume in lungs after nl expiration
<60
Bleomycin - busulfan - anmiodorone
Dec - due to lactic acidosis

28. What happens to lung volumes in restrictive lung disease
Dec
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Type II pneumocytes - after week 35
Airway obstruction (shunt) 100% O2 does not improve PO2

29. What is carboxyhemoglobin and What does it cause
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Inc O2 consumption
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
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

30. What findings are associated with emphysema
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Inc EPO leading to erythrocytosis
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals

31. What is occupied in the space that would have been the left middle lobe
Dec in lung volumes - FVC - TLC
4 polypeptide subunits - 2 alpha and 2 beta
Heart
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

32. What happens to bicarb once it is created in an RBC
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Dec dec in FEV1 - dec in FVC
Repeated cycles of lung injury and wound healing with inc collagen
Zone 1

33. What lobes are affected in silicosis
Repeated cycles of lung injury and wound healing with inc collagen
Person stops breathing for at least 10 seconds repeatedly during sleep
Upper lobes
Lung cancer

34. Why is endothelial damage a risk factor for DVT
N- terminus - carbaminohemoglobin
PAO2 - PaO2 = 10-15 mmHg
Exposed collagen fibers provides impetus for clotting cascade
Positive cooperativity and negative allostery - unlike myoglobin

35. What does the conducting zone consist of...
Right shift - favors taut - low affinity for O2 - O2 unloading
Squamous cell carcinoma - keratin pearls and intracellular bridges
L/S > 2 = lecithin/sphingomyelin
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

36. What causes secondary pulm HTN
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Right shift - favors taut - low affinity for O2 - O2 unloading

37. What changes in EPO occur at high altitude
Bleomycin - busulfan - anmiodorone
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Respiratory effort against airway obstruction
Clara cells - type II pneumocytes; multiple densitites on CXR

38. What happens in perfusion limited circulatioin and which gases does this apply to...
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
CO - 200x

39. What is the initial damage of ARDS caused by
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Ivory white calcified pleural plaques
Alchoholics or epileptics
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

40. What is an association and potential complication of paraseptal emphysema
Trachea and bronchi
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Incr - right - dec - left
Lower portion of right inferior lobe

41. What changes in 2 -3 - DPG occur at high altitude
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Mesothelioma - pleura - psammoma bodies
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Inc O2 consumption

42. What enzyme increases activity in emphysema
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
L/S > 2 = lecithin/sphingomyelin
Elastase
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

43. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Prematurity - maternal RDS - cesarean delivery
Respiratory bronchioles - clear debris in alveoli - bronchi
Everything but RV - TV + IRV + ERV

44. What renal changes occur at high altitude and What are they compensating for
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Deoxygenated blood - elastic walls
Inc excretion of bicarb to compensate for respiratory alkalosis
Loss of blood flow - impeded arterial flow - reduced venous drainage

45. What are the 9 interstitial lung diseases

46. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
In between perfusion limited and diffusion limited
Opposites
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

47. What is the ideal V/Q ratio and why
Matched - =1 adequate gas exchange
TB - silica disrupt phagolysosomes and impair MACS
Right lung - right main stem bronhus is wider and more vertical
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

48. What changes in lung volunes occur as a result of restrictive lung disease
Lung cancer
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Dec in lung volumes - FVC - TLC
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

49. What area of the lung is the largest physiologic contributor of fxnal dead space
Type II cells
Inc to meet O2 demand
Apex of healthy lung
Drainage

50. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
RALS - righ anterior - left superior
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis