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. What is the most common cancerous lesion in the lun
Inc O2 consumption
Chroniclly tired
Activates bradykinin
Metastasis - breast - colon - prostate - bladder -

2. What does pulm HTN result in
Lobar PNA
Right
Pa > PA > Pv
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

3. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
TB - silica disrupt phagolysosomes and impair MACS
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
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
Milky fluid with inc TGs

4. What are the SPHERE of complications in lung cancer
Matched - =1 adequate gas exchange
Gland depth/total thickness of broncial wall - >50%
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

5. How is pulmonary circulation characterized in terms of resistance and compliance
Low resistance and high compliance
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Inc mitochondria
Zone 3

6. Define expiratory reserve volume (ERV)
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Air that can still be breathed out after nl expiration

7. In which zone of the lung is PA > Pa > Pv
Weight loss - CPAP - surgery
Upper lobes - cor pulmonale - caplan's syndrome
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Zone 1

8. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Tension pneumo - away from lesion
Inc production
Dipalmatoyl phosphatidylcholine - decreases surface tension
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

9. What lung abnl is characterized by absent or decreased breath sounds over affected area - dec resonance - dec fremitus - and which side is the trachea deviated towards
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Carcinoid - carcinoid
Bronchial obstruction - toward side of lesion
Zone 3

10. Where do 95% of PE arise from
Anatomic dead space and smooth muscle
Heart
Deep leg veins
Inc shear stress leading to endothelial injury

11. What does the respiratory zone consist of and What is its fxn
Chest pain - tachypnea and dyspnea
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

12. What properties determine the combined volumes of the chest wall and lungs
Centriacinar
Elastic properties
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
PA02 = 150 - PACO2/0.8

13. What lung product is deficient in neonatal RDS
Pa > PA > Pv
Clara cells - type II pneumocytes; multiple densitites on CXR
Surfactant
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

14. What does decreased PAO2 do
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
CO2 - acid/altitude - DPG - Exercise - Temperature
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Shunting

15. What is the alveolar gas equation approximation
Upper lobes
PA02 = 150 - PACO2/0.8
On expiration as radius dec
Trachea and bronchi

16. What lab ration indicates fetal lung maturity
N- terminus - carbaminohemoglobin
Clara cells - type II pneumocytes; multiple densitites on CXR
Person stops breathing for at least 10 seconds repeatedly during sleep
L/S > 2 = lecithin/sphingomyelin

17. What can amniotic fluid emboli lead to...
DIC - especially postpartum
Surfactant def leading to inc surfact tension and alveolar collapse
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

18. Toxicities of what drugs include interstitial lung disease
Viral - URIs - allergens and stress
Bleomycin - busulfan - anmiodorone
Lobar PNA
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

19. What is hemoglobin composed of...
4 polypeptide subunits - 2 alpha and 2 beta
Inc production
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Steroids to mom - artificial surfactant and thyroxine to neonate

20. Define tidal volume (TV)
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
P = 2ST/radius
Air that moves into lung with each quiet respiration
Inc to meet O2 demand

21. Where are ventilation and perfusion highest in the lung - respectively
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Superior portion of right inferior lobe
Both highest in the base
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

22. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Fe 2+
Tissue hypoxia from dec O2 sat and dec O2 content
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

23. How many lobes does each lung have - and What is the lingula
Lost with alveolar walls
Chest pain - tachypnea and dyspnea
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT

24. What is tha hallmark finding of COPD
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Deep leg veins
Dec in the FEV1/FVC
Inc airway pressure to prevent airway collapse during exhalation

25. Other than surfactant - what other important substances are produced by the lungs
Matched - =1 adequate gas exchange
Hypertrophy of mucus secreting glands in the bronchioles
Prostaglandins - histamine - ACE - kallikrein
Mesothelioma - pleura - psammoma bodies

26. What is another name for neonatal RDS
Heparin
Repeated cycles of lung injury and wound healing with inc collagen
Hyaline membrane disease
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

27. What is the course of of pulm HTN
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

28. What must occur with a exudate pleural effusion
Elastase
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Drainage
0 - negative - prevents pneumothorax

29. What are the associations with bronchiectasis

30. What does ACE do
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Gland depth/total thickness of broncial wall - >50%
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Centriacinar

31. What does a V/Q ratio of infinity indicate
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Hypertrophy of mucus secreting glands in the bronchioles
Air in excess of tidal volume that moves into lung on maximal inspiration

32. What organism causes a lobar PNA and What are the characteristics
Inc to meet O2 demand
Metastasis - breast - colon - prostate - bladder -
Hyaline membrane disease
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

33. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
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
In between perfusion limited and diffusion limited

34. What is a potential test for asthma
Mesothelioma - pleura - psammoma bodies
CT angio
Methacholine challenge
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

35. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
Superior portion of right inferior lobe
Lungs collapse inwards and chest wall spring out
Air that can still be breathed out after nl expiration
0 - negative - prevents pneumothorax

36. What cells in the lung produce surfactant and What does it do
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
IRV + TV + ERV + RV
Surfactant
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

37. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Deep leg veins
L/S < 1.5

38. What does a V/Q ratio of 0 indicate
Acute/chronic inc in vent
Airway obstruction (shunt) 100% O2 does not improve PO2
Elastic properties
Inc resistance leading to inc pressure

39. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Heart
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
In between perfusion limited and diffusion limited

40. Where do you find type I cells - What is their morphology - and What do they do
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Long bone fractures and liposuction
Clara cells - type II pneumocytes; multiple densitites on CXR
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

41. How does recurrent thromboemboli cause pulm HTN
<60
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Dec cross sectional area of pulm vasc bed

42. At what PaO2 does hypoxemia begin
Type II pneumocytes - after week 35
<75
Dec - because physiologic shunt dec O2 extraction from ratio
Fe 2+

43. What drug therapy is used to augment the changes in bicarb exretion
Inc airway pressure to prevent airway collapse during exhalation
Shunting
CO2 - acid/altitude - DPG - Exercise - Temperature
Acetazolamide - inhibits CA and acidifies the blood

44. If you aspirate a peanut while supine - where will it go
Heparin
Superior portion of right inferior lobe
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

45. What is Homan's sign
Coal miner's - silicosis - abestosis
Dorsiflexion of food leads to tender calf muscle
0 - negative - prevents pneumothorax
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

46. What are curschmann's spirals
TB - silica disrupt phagolysosomes and impair MACS
Shed epithelium from mucus plugs
CO x O2 content of blood
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

47. What is the formula for A- a gradient - and What is it normally
PAO2 - PaO2 = 10-15 mmHg
High alveolar pressure compresses capillaries
Metastasis - breast - colon - prostate - bladder -
L/S > 2 = lecithin/sphingomyelin

48. What does CADET face to the right stand for
Anatomic dead space and smooth muscle
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Upper lobes - cor pulmonale - caplan's syndrome
CO2 - acid/altitude - DPG - Exercise - Temperature

49. In which zone of the lung is Pa > Pv >PA
Zone 3
Type II pneumocytes - after week 35
Pa > PA > Pv
Carcinoid - carcinoid

50. What is an example of hypercoagulability
Zone 1
Dec cross sectional area of pulm vasc bed
Inc to meet O2 demand
Defect in coagulative cascace proteins