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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 the TX for small cell lung cancer
Dec - no change
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Inoperable - responsive to chemotherapy
20.1 mL O2 /dL

2. Define inspiratory reserve volume (IRV)
Inc production
Air in excess of tidal volume that moves into lung on maximal inspiration
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

3. What TX is the mother given before delivery - and what TXs are given to the infant
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Steroids to mom - artificial surfactant and thyroxine to neonate
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Zone 1

4. What cellular changes occur at high altitude
Metastasis - breast - colon - prostate - bladder -
Dipalmatoyl phosphatidylcholine - decreases surface tension
Inc mitochondria
Air in lung after maxmimal expiration - cannot be measured on spirometry

5. What are the risk factors for neonatal RDS
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Prematurity - maternal RDS - cesarean delivery
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

6. In which zone of the lung is Pa > Pv >PA
Shunting
Repeated cycles of lung injury and wound healing with inc collagen
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Zone 3

7. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
CO - 200x
Activates bradykinin

8. What is are the symptoms of a pulmonary embolism
Small airways
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Chest pain - tachypnea and dyspnea

9. What is the main complication of therapeutic supplemental O2?
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Retinopathy of maturity
Hypertrophy of mucus secreting glands in the bronchioles
Both highest in the base

10. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Zone 3
Metastasis - breast - colon - prostate - bladder -
0 - negative - prevents pneumothorax

11. At what lung volume is system pressure atmospheric and why
Lung cancer
FRC - inward pull of lung balanced by outward pull of chest wall
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
L/S > 2 = lecithin/sphingomyelin

12. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Steroids to mom - artificial surfactant and thyroxine to neonate
Mesothelioma - pleura - psammoma bodies
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

13. What is the ideal V/Q ratio and why
Dec - because physiologic shunt dec O2 extraction from ratio
Loss of elastic fibers
Matched - =1 adequate gas exchange
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

14. What are the findings associated with sarcoidosis
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Everything but RV - TV + IRV + ERV
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

15. Where is cartilage present in the respiratory tree
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Trachea and bronchi
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

16. Which structures perforate the diaphragm and where
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Stasis - hypercoagulability - endothelial damage
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

17. What cells make surfactant and At what week is produced most abundantly
Type II pneumocytes - after week 35
Long bone fractures and liposuction
P = 2ST/radius
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

18. How does left to right shunt cause pulm HTN
CO x O2 content of blood
Inc shear stress leading to endothelial injury
DIC - especially postpartum
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

19. Define residual volume (RV)
PVR = (PpulmA - PleftA)/CO
Alpha1- antitrypsin def - also cirrhosis
Air in lung after maxmimal expiration - cannot be measured on spirometry
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

20. Lung absecss often reults From what organisms
S. aureus or anaerobes
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Stasis - hypercoagulability - endothelial damage
Inc O2 consumption

21. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
In between perfusion limited and diffusion limited
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
Airways close prematurely resulting in inc RV and dec FVC
Loss of blood flow - impeded arterial flow - reduced venous drainage

22. What do type II cells do - What is their morphology - when do they proliferate
Hypoxic vasocxn
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Dec in the FEV1/FVC

23. What happens to bicarb once it is created in an RBC
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Zone 1

24. What are the causes of ischemia
Tight jxns
Lowered
Loss of blood flow - impeded arterial flow - reduced venous drainage
P = 2ST/radius

25. What is the characteristic lymphatic pleural effusion
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Milky fluid with inc TGs

26. What is the presentation of lung cancer

27. How does sleep apnea or high altitude cause pulm HTN
Pleural effusion
Upper lobes
Hypoxic vasocxn
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

28. What causes secondary pulm HTN
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Retinopathy of maturity
Brings air in and out - warms - humidifies - filters

29. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Type II cells
Squamous cell carcinoma - keratin pearls and intracellular bridges
Clara cells - type II pneumocytes; multiple densitites on CXR
Air in excess of tidal volume that moves into lung on maximal inspiration

30. What is the pathology of ARDS
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
<75
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

31. What is obstructive sleep apnea
Dipalmatoyl phosphatidylcholine
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Respiratory effort against airway obstruction
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

32. How do you prevent DVT
IRV + TV
Heparin
Right
Mismatch

33. What can amniotic fluid emboli lead to...
Hypoxic vasocxn
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Anatomic dead space and smooth muscle
DIC - especially postpartum

34. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Pleural effusion
Respiratory bronchioles - clear debris in alveoli - bronchi
PVR = (PpulmA - PleftA)/CO

35. What cells in the lung produce surfactant and What does it do
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
CO2 - acid/altitude - DPG - Exercise - Temperature
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

36. What happens to lung volumes in restrictive lung disease
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Lobar PNA
Type II cells
Dec

37. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
RALS - righ anterior - left superior
Mismatch
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

38. What kind of emphysema is caused by smoking
Centriacinar
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Tight jxns
Prostaglandins - histamine - ACE - kallikrein

39. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Air in excess of tidal volume that moves into lung on maximal inspiration
Clara cells - type II pneumocytes; multiple densitites on CXR
Opposites

40. What does the conducting zone consist of...
L/S > 2 = lecithin/sphingomyelin
Activates bradykinin
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor

41. What are the causes of hypoxia
Centriacinar
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Matched - =1 adequate gas exchange
Ciliated cells

42. What are the subtypes of pneumoconioses

43. What changes occur to PaO2 and PaCO2
No change - but inc venous CO2 content
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Shed epithelium from mucus plugs
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT

44. What does a V/Q ratio of 0 indicate
No respiratory effort
Chroniclly tired
Airway obstruction (shunt) 100% O2 does not improve PO2
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

45. What is a potential test for asthma
IRV + TV + ERV + RV
Apex of healthy lung
Methacholine challenge
Prostaglandins - histamine - ACE - kallikrein

46. What renal changes occur at high altitude and What are they compensating for
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Repeated cycles of lung injury and wound healing with inc collagen
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
Inc excretion of bicarb to compensate for respiratory alkalosis

47. Which pts are at risk for apriation PNA
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Alchoholics or epileptics
Steroids to mom - artificial surfactant and thyroxine to neonate
No respiratory effort

48. What happens to O2 content and O2 sat as Hb falls
Lung cancer
Upper lobes - cor pulmonale - caplan's syndrome
Dec - no change
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

49. What changes occur to pulm blood flow during exercise
Coal miner's - silicosis - abestosis
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Inc due to inc CO
TB - apex

50. What does kallikrein do
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Activates bradykinin
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing