Test your basic knowledge |

Respiratory

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Which lung is the more common site for an inhaled foreign body and why
Drainage
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Right lung - right main stem bronhus is wider and more vertical
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

2. What kind of connection exists between endothelial cells in the capilaries
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Tight jxns
Methylene blue
Coal miner's - silicosis - abestosis

3. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Everything but RV - TV + IRV + ERV
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
CO - 200x

4. What does a V/Q ratio of 0 indicate
Airway obstruction (shunt) 100% O2 does not improve PO2
IRV + TV + ERV + RV
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Centriacinar

5. What is the imaging test of choice for PE
Lower portion of right inferior lobe
CT angio
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
Shed epithelium from mucus plugs

6. At what PaO2 does cyanosis begin
Elastase
Respiratory effort against airway obstruction
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
<60

7. What are the findings in asthma
Lowered
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Positive cooperativity and negative allostery - unlike myoglobin

8. How many lobes does each lung have - and What is the lingula
Lost with alveolar walls
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Hyaline membrane disease
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

9. Which muscles are involved in quiet breathing and What part of respiration do the control
Prematurity - maternal RDS - cesarean delivery
Incr - right - dec - left
Lungs collapse inwards and chest wall spring out
Inspiration by diaphragm - expiration is passive

10. What is a chronic complication of sleep apnea
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Dorsiflexion of food leads to tender calf muscle
Chroniclly tired
Dec - because physiologic shunt dec O2 extraction from ratio

11. What does the conducting zone consist of...
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
No change - but inc venous CO2 content
CO x O2 content of blood

12. Define inspiratory capacity (IC)
IRV + TV
Zone 1
Trachea and bronchi
IRV + TV + ERV + RV

13. What is the definition of sleep apnea
In between perfusion limited and diffusion limited
Person stops breathing for at least 10 seconds repeatedly during sleep
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

14. What is an association and potential complication of paraseptal emphysema
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
RV + ERV - volume in lungs after nl expiration
Dec in lung volumes - FVC - TLC
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

15. What does alveolar pressure do to capillaries in the apex of the lung
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Metastasis - breast - colon - prostate - bladder -
High alveolar pressure compresses capillaries
Everything but RV - TV + IRV + ERV

16. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Pleural effusion
Gland depth/total thickness of broncial wall - >50%
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

17. What is surfactant made of...
Dipalmatoyl phosphatidylcholine
Zone 1
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Inspiration by diaphragm - expiration is passive

18. What changes in V/Q throughout the lung during exercise
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Ratio from apex to base becomes more uniform

19. Susceptibility to what infection is increased in silicosis and why
Surfactant
TB - silica disrupt phagolysosomes and impair MACS
No respiratory effort
Dec cross sectional area of pulm vasc bed

20. What is the criteria for chronic bronchitis
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Inspiration by diaphragm - expiration is passive
Productive cough for greater than 3 months in at least 2 years

21. 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
Carcinoid - carcinoid
Alpha1- antitrypsin def - also cirrhosis
Inc to meet O2 demand

22. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Dec cross sectional area of pulm vasc bed
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

23. What kind of pleural plaques are the result of asbestosis
Zone 3
Inc
RV + ERV - volume in lungs after nl expiration
Ivory white calcified pleural plaques

24. What reaction and enzyme create bicarb and Where does it happen
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Prematurity - maternal RDS - cesarean delivery
Alchoholics or epileptics
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

25. How does recurrent thromboemboli cause pulm HTN
Type II pneumocytes - after week 35
Dec cross sectional area of pulm vasc bed
Dec in lung volumes - FVC - TLC
Pleural effusion

26. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Inc O2 consumption
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Dec - no change

27. What are the two forms of hemoglobin
More indolent
Inc 2 -3- DPG - righward shift
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Dec dec in FEV1 - dec in FVC

28. What is carboxyhemoglobin and What does it cause
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
Respiratory bronchioles - clear debris in alveoli - bronchi
PAO2 - PaO2 = 10-15 mmHg
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

29. What happens to diffusing capacity in interstiial lung diseases
500mL
Lowered
Exposed collagen fibers provides impetus for clotting cascade
Inc O2 consumption

30. How does sleep apnea or high altitude cause pulm HTN
Activates bradykinin
Right lung - right main stem bronhus is wider and more vertical
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Hypoxic vasocxn

31. What are the risk factors for neonatal RDS
Carcinoid - carcinoid
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Mesothelioma - pleura - psammoma bodies
Prematurity - maternal RDS - cesarean delivery

32. Where is cartilage present in the respiratory tree
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Trachea and bronchi
Dec
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

33. What do PFTs show in restrictive lung disease
FEV1/FVC > 80%
Carcinoid - carcinoid
Mismatch
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

34. What TX is the mother given before delivery - and what TXs are given to the infant
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Steroids to mom - artificial surfactant and thyroxine to neonate
<60
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

35. What changes in ventilation rate occur during exercise
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Lower portion of right inferior lobe
Inc to meet O2 demand
4 polypeptide subunits - 2 alpha and 2 beta

36. What does the respiratory zone consist of and What is its fxn
RALS - righ anterior - left superior
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
No change - but inc venous CO2 content

37. What is a potential test for asthma
Methacholine challenge
Elastic properties
Carcinoid - carcinoid
Respiratory bronchioles - clear debris in alveoli - bronchi

38. What are the causes of ischemia
Metastasis - breast - colon - prostate - bladder -
Mesothelioma - pleura - psammoma bodies
Right lung - right main stem bronhus is wider and more vertical
Loss of blood flow - impeded arterial flow - reduced venous drainage

39. Where do 95% of PE arise from
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
No change - but inc venous CO2 content
Deep leg veins

40. What do hemoglobin modifacations lead to...
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Tissue hypoxia from dec O2 sat and dec O2 content
Dec - no change
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

41. What is the cycle of idiopathic pulmonary fibrosis
Repeated cycles of lung injury and wound healing with inc collagen
Hyaline membrane disease
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

42. What changes in pH occur during strenuous exercise and why
Repeated cycles of lung injury and wound healing with inc collagen
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Dec - due to lactic acidosis
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

43. Toxicities of what drugs include interstitial lung disease
Bleomycin - busulfan - anmiodorone
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
DIC - especially postpartum
Chest pain - tachypnea and dyspnea

44. What are the various causes of ARDS
Clara cells - type II pneumocytes; multiple densitites on CXR
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Air that can still be breathed out after nl expiration
Heart

45. What is the V/Q ratio at the apex and base of the lung
Methacholine challenge
Air in lung after maxmimal expiration - cannot be measured on spirometry
Small airways
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

46. What organisms cause interstitial PNA and What are the characteristics
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Air in excess of tidal volume that moves into lung on maximal inspiration

47. What can amniotic fluid emboli lead to...
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
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
DIC - especially postpartum

48. How does mitral stenosis cause pulm HTN
Hyaline membrane disease
Inc resistance leading to inc pressure
Inc mitochondria
In between perfusion limited and diffusion limited

49. What is another name for neonatal RDS
Retinopathy of maturity
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Hyaline membrane disease
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

50. Lung absecss often reults From what organisms
S. aureus or anaerobes
Dipalmatoyl phosphatidylcholine
Zone 3
Dec - due to lactic acidosis