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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 hemoglobin composed of...
4 polypeptide subunits - 2 alpha and 2 beta
Respiratory effort against airway obstruction
Anatomic dead space and smooth muscle
Loss of blood flow - impeded arterial flow - reduced venous drainage

2. What is carboxyhemoglobin and What does it cause
Chronic hypoxic vasocxn
Airway obstruction (shunt) 100% O2 does not improve PO2
Both highest in the base
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

3. Define inspiratory reserve volume (IRV)
Air in excess of tidal volume that moves into lung on maximal inspiration
Dec in lung volumes - FVC - TLC
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Deep leg veins

4. What is surfactant made of...
Surfactant def leading to inc surfact tension and alveolar collapse
Elastase
No respiratory effort
Dipalmatoyl phosphatidylcholine

5. What is the most common cancerous lesion in the lun
Lower portion of right inferior lobe
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
L/S < 1.5
Metastasis - breast - colon - prostate - bladder -

6. Where do you find type I cells - What is their morphology - and What do they do
Low resistance and high compliance
TB - silica disrupt phagolysosomes and impair MACS
PVR = (PpulmA - PleftA)/CO
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

7. Define total lung capcaity
IRV + TV + ERV + RV
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Inspiration by diaphragm - expiration is passive
N- terminus - carbaminohemoglobin

8. What happens to lung volumes in restrictive lung disease
Dec
On expiration as radius dec
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Low resistance and high compliance

9. What is the cycle of idiopathic pulmonary fibrosis
Inc to meet O2 demand
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Repeated cycles of lung injury and wound healing with inc collagen

10. What are the causes of ischemia
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Alpha1- antitrypsin def - also cirrhosis
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Loss of blood flow - impeded arterial flow - reduced venous drainage

11. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Lost with alveolar walls
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
PAO2 - PaO2 = 10-15 mmHg
Air that moves into lung with each quiet respiration

12. Define tidal volume (TV)
Bleomycin - busulfan - anmiodorone
Mismatch
Inoperable - responsive to chemotherapy
Air that moves into lung with each quiet respiration

13. What are the findings of chronic bronchitis
Zone 3
P = 2ST/radius
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

14. What doe FAT BAT stand for
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Dipalmatoyl phosphatidylcholine

15. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
<60
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

16. What happens to bicarb once it is created in an RBC
Heparin
Air that moves into lung with each quiet respiration
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

17. What happens to arterial PO2 in chronic lung disease and why
Dec - because physiologic shunt dec O2 extraction from ratio
Gland depth/total thickness of broncial wall - >50%
Dec
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

18. What is pulmonary surfactant made of - and What does it do
Dipalmatoyl phosphatidylcholine - decreases surface tension
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Steroids to mom - artificial surfactant and thyroxine to neonate
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

19. What is are the symptoms of a pulmonary embolism
On expiration as radius dec
Chest pain - tachypnea and dyspnea
Air in excess of tidal volume that moves into lung on maximal inspiration
Dec - no change

20. What happens to diffusing capacity in interstiial lung diseases
Elastase
Lowered
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
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

21. What are potential triggers for asthma
Inc airway pressure to prevent airway collapse during exhalation
Viral - URIs - allergens and stress
No change - but inc venous CO2 content
Mismatch

22. What do pulmonary arteries carry - and how are pulm arterial pressures maintained during the cardiac cycle
Incr - right - dec - left
Deoxygenated blood - elastic walls
Brings air in and out - warms - humidifies - filters
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

23. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
CT angio
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

24. What is the response for ventilation of high altitude
Acute/chronic inc in vent
Air in excess of tidal volume that moves into lung on maximal inspiration
High alveolar pressure compresses capillaries
Trachea and bronchi

25. Where is cartilage present in the respiratory tree
Trachea and bronchi
TB - silica disrupt phagolysosomes and impair MACS
IRV + TV
Inoperable - responsive to chemotherapy

26. What organisms cause a bronchoPNA and What are the characteristics
20.1 mL O2 /dL
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Dipalmatoyl phosphatidylcholine - decreases surface tension
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

27. What is the protein content an exudative pleural effusion and What are the potential causes
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Productive cough for greater than 3 months in at least 2 years

28. In COPD - what happens to airways at high lung volumes
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Small airways
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Airways close prematurely resulting in inc RV and dec FVC

29. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Metastasis - breast - colon - prostate - bladder -
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Pleural effusion

30. What does ACE do
Both highest in the base
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Air that moves into lung with each quiet respiration
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

31. What cellular changes occur at high altitude
Clara cells - type II pneumocytes; multiple densitites on CXR
Tight jxns
Inc mitochondria
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

32. What lab ration indicates fetal lung maturity
L/S > 2 = lecithin/sphingomyelin
CO - 200x
Lowered
Inc due to inc CO

33. Define inspiratory capacity (IC)
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
O2 binding x O2 sat + dissolved O2
IRV + TV

34. What does the respiratory zone consist of and What is its fxn
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Clara cells - type II pneumocytes; multiple densitites on CXR
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

35. At what PaO2 does hypoxemia begin
<75
Drainage
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

36. What does the law of Laplace state about tendency of alveoli to collapse
Lost with alveolar walls
Exposed collagen fibers provides impetus for clotting cascade
On expiration as radius dec
Carcinoid - carcinoid

37. What do hemoglobin modifacations lead to...
FEV1/FVC > 80%
Tissue hypoxia from dec O2 sat and dec O2 content
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

38. What does the conducting zone consist of...
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Tension pneumo - away from lesion
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
TB - silica disrupt phagolysosomes and impair MACS

39. What does a V/Q ratio of infinity indicate
TB - apex
Inc mitochondria
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
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

40. What is fetal hemoglobin made of and why does it have a higher affinity for O2
Inc
PAO2 - PaO2 = 10-15 mmHg
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

41. Chronic bronchitis is a disease of what kind of airways
CO - 200x
Small airways
Dec dec in FEV1 - dec in FVC
Shed epithelium from mucus plugs

42. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Tension pneumo - away from lesion
Fe 2+
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Dec - because physiologic shunt dec O2 extraction from ratio

43. What is obstructive sleep apnea
Respiratory effort against airway obstruction
It binds to Hb -
PVR = (PpulmA - PleftA)/CO
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

44. What is the protein content in a transudative pleural effusion and What are the potential causes
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
<60
Inc production

45. How does recurrent thromboemboli cause pulm HTN
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Dec cross sectional area of pulm vasc bed
P = 2ST/radius

46. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
Heart
TB - apex
Steroids to mom - artificial surfactant and thyroxine to neonate
In between perfusion limited and diffusion limited

47. What layers must CO2 and O2 traverse to complete gas exchange
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Apex of healthy lung
PVR = (PpulmA - PleftA)/CO
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

48. What are the lab/study findings in adenocarcinoma of the lung
Bleomycin - busulfan - anmiodorone
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Ivory white calcified pleural plaques
Clara cells - type II pneumocytes; multiple densitites on CXR

49. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Gland depth/total thickness of broncial wall - >50%
Viral - URIs - allergens and stress
Milky fluid with inc TGs
Trachea and bronchi

50. What changes occur to PaO2 and PaCO2
No change - but inc venous CO2 content
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Prematurity - maternal RDS - cesarean delivery
Dipalmatoyl phosphatidylcholine