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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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1. What happens to arterial PO2 in chronic lung disease and why
Inc O2 consumption
Dec - because physiologic shunt dec O2 extraction from ratio
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

2. Define total lung capcaity
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
IRV + TV + ERV + RV
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

3. What changes in CO2 occur during exercise
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Both highest in the base
Inc production
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

4. What is the pathology of emphysema
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Dorsiflexion of food leads to tender calf muscle
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

5. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Weight loss - CPAP - surgery
Hypoxic vasocxn
No respiratory effort
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

6. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Anatomic dead space and smooth muscle
Defect in coagulative cascace proteins
No respiratory effort
L/S < 1.5

7. What is carboxyhemoglobin and What does it cause
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
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
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Mismatch

8. What changes in O2 consumption change during exercise
Chest pain - tachypnea and dyspnea
Airway obstruction (shunt) 100% O2 does not improve PO2
<75
Inc O2 consumption

9. What kind of course does interstitial PNA follow in comparison to bronchoPNA
Dorsiflexion of food leads to tender calf muscle
More indolent
Upper lobes - cor pulmonale - caplan's syndrome
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

10. What cells in the lung produce surfactant and What does it do
Superior portion of right inferior lobe
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
500mL
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

11. What is the V/Q ratio at the apex and base of the lung
Pleural effusion
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
No change - but inc venous CO2 content
CO2 - acid/altitude - DPG - Exercise - Temperature

12. Other than surfactant - what other important substances are produced by the lungs
Metastasis - breast - colon - prostate - bladder -
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Prostaglandins - histamine - ACE - kallikrein
TB - silica disrupt phagolysosomes and impair MACS

13. What happens to lung volumes in restrictive lung disease
L/S > 2 = lecithin/sphingomyelin
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Dec
Inc production

14. What kind of space is in the conducting tree and what kind of muscle exists there
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
DIC - especially postpartum
Anatomic dead space and smooth muscle
PAO2 - PaO2 = 10-15 mmHg

15. Susceptibility to what infection is increased in silicosis and why
Dec dec in FEV1 - dec in FVC
TB - silica disrupt phagolysosomes and impair MACS
Dec - no change
S. aureus or anaerobes

16. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Type II cells
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
CO - 200x
Inspiration by diaphragm - expiration is passive

17. What do type II cells do - What is their morphology - when do they proliferate
Inc to meet O2 demand
P = 2ST/radius
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

18. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Incr - right - dec - left
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

19. What happens to O2 content and O2 sat as Hb falls
Lowered
Dec - no change
No respiratory effort
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

20. What is the ideal V/Q ratio and why
Long bone fractures and liposuction
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
CO - 200x
Matched - =1 adequate gas exchange

21. If you aspirate a peanut while upright - where will it go
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Lower portion of right inferior lobe
Dec dec in FEV1 - dec in FVC
O2 binding x O2 sat + dissolved O2

22. What is the pathology of asthma

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23. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

24. What does ACE do
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Respiratory bronchioles - clear debris in alveoli - bronchi
Respiratory effort against airway obstruction
Metastasis - breast - colon - prostate - bladder -

25. What direction does an increase in metabolic need shift the O2 dissociation curve
Right
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Centriacinar
Chronic hypoxic vasocxn

26. Which structures perforate the diaphragm and where
Inspiration by diaphragm - expiration is passive
Chronic hypoxic vasocxn
Incr - right - dec - left
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

27. What changes in ventilation rate occur during exercise
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Inc to meet O2 demand
S. aureus or anaerobes

28. What are the associations with bronchiectasis

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29. What changes in lung volunes occur as a result of restrictive lung disease
Inoperable - responsive to chemotherapy
Dec cross sectional area of pulm vasc bed
Inc to meet O2 demand
Dec in lung volumes - FVC - TLC

30. What TX is the mother given before delivery - and what TXs are given to the infant
Histiocytosis X - Langerhans cells
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Steroids to mom - artificial surfactant and thyroxine to neonate

31. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Opposites
IRV + TV
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Deoxygenated blood - elastic walls

32. What are fat emboli associated with
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Long bone fractures and liposuction
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Loss of blood flow - impeded arterial flow - reduced venous drainage

33. What lobes are affected in silicosis
Low resistance and high compliance
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Upper lobes
Type II pneumocytes - after week 35

34. What reaction and enzyme create bicarb and Where does it happen
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

35. What are the causes of hypoxemia
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
CO - 200x
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Zone 3

36. What kind of pleural plaques are the result of asbestosis
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Shunting
Ivory white calcified pleural plaques
Air that moves into lung with each quiet respiration

37. How does sleep apnea or high altitude cause pulm HTN
Hypoxic vasocxn
Dipalmatoyl phosphatidylcholine - decreases surface tension
Anatomic dead space and smooth muscle
Long bone fractures and liposuction

38. What is the appoximate O2 binding capacity
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Tension pneumo - away from lesion
Methylene blue
20.1 mL O2 /dL

39. What is early onset hypoxemia from in chronic bronchitis
Shunting
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
0 - negative - prevents pneumothorax
CT angio

40. What does the conducting zone consist of...
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Right shift - favors taut - low affinity for O2 - O2 unloading
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
S. aureus or anaerobes

41. At what PaO2 does hypoxemia begin
<75
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Alpha1- antitrypsin def - also cirrhosis
Right lung - right main stem bronhus is wider and more vertical

42. What happens with the O2 curve shifts to the right and What does it facilitate
Inc
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Centriacinar
Heart

43. What is a typical tidal volume
N- terminus - carbaminohemoglobin
4 polypeptide subunits - 2 alpha and 2 beta
500mL
Repeated cycles of lung injury and wound healing with inc collagen

44. What is the protein content in a transudative pleural effusion and What are the potential causes
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Inc resistance leading to inc pressure
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

45. What does the law of Laplace state about tendency of alveoli to collapse
Shed epithelium from mucus plugs
L/S < 1.5
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
On expiration as radius dec

46. If you aspirate a peanut while supine - where will it go
Fe 2+
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Superior portion of right inferior lobe
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT

47. What changes in pH occur during strenuous exercise and why
Alpha1- antitrypsin def - also cirrhosis
Inc O2 consumption
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Dec - due to lactic acidosis

48. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Centriacinar
Pleural effusion
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

49. At what PaO2 does cyanosis begin
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Dec - due to lactic acidosis
<60
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

50. What are the 9 interstitial lung diseases

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