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. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Respiratory bronchioles - clear debris in alveoli - bronchi
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Drainage
Surfactant

2. What is are the symptoms of a pulmonary embolism
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
It binds to Hb -
Chest pain - tachypnea and dyspnea

3. What changes in ventilation rate occur during exercise
Chroniclly tired
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Inc to meet O2 demand
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

4. What is fetal hemoglobin made of and why does it have a higher affinity for O2
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Methacholine challenge
Dec - no change
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

5. What are clara cells What is their morphology and What do they do
Loss of elastic fibers
Exposed collagen fibers provides impetus for clotting cascade
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

6. What organism thrives in high O2 and where in the lung does it flourish
TB - apex
No respiratory effort
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Lung cancer

7. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Inc mitochondria
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Hypertrophy of mucus secreting glands in the bronchioles
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

8. What does decreased PAO2 do
No change - but inc venous CO2 content
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Dec
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

9. How do you prevent DVT
Bronchial obstruction - toward side of lesion
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Dipalmatoyl phosphatidylcholine - decreases surface tension
Heparin

10. What causes secondary pulm HTN
Type II pneumocytes - after week 35
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude

11. What is the formula for O2 content
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
O2 binding x O2 sat + dissolved O2
Trachea and bronchi
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

12. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
Metastasis - breast - colon - prostate - bladder -
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
4 polypeptide subunits - 2 alpha and 2 beta
Right

13. What is a potential test for asthma
Methacholine challenge
Both highest in the base
Tissue hypoxia from dec O2 sat and dec O2 content
Chest pain - tachypnea and dyspnea

14. In emphysema - What is increased lung compliance due to...
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Loss of elastic fibers
Gland depth/total thickness of broncial wall - >50%
Inc resistance leading to inc pressure

15. How does autoimmune dz cause thromboemboli
Prostaglandins - histamine - ACE - kallikrein
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Dec release of fetal glucocorticoids
Long bone fractures and liposuction

16. What is virchow's triad
Trachea and bronchi
Stasis - hypercoagulability - endothelial damage
Methacholine challenge
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

17. Chronic bronchitis is a disease of what kind of airways
Hypertrophy of mucus secreting glands in the bronchioles
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Small airways
500mL

18. What are the findings associated with sarcoidosis
CO2 - acid/altitude - DPG - Exercise - Temperature
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Metastasis - breast - colon - prostate - bladder -
Upper lobes - cor pulmonale - caplan's syndrome

19. What is a consequence of pulm HTN
Right
Chronic hypoxic vasocxn
Airway obstruction (shunt) 100% O2 does not improve PO2
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

20. What is the formula for A- a gradient - and What is it normally
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Inc excretion of bicarb to compensate for respiratory alkalosis
Lowered
PAO2 - PaO2 = 10-15 mmHg

21. What are the various causes of ARDS
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution 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
Ivory white calcified pleural plaques
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

22. What causes neonatal RDS
TB - apex
Surfactant def leading to inc surfact tension and alveolar collapse
Histiocytosis X - Langerhans cells
Elastic properties

23. What causes primary pulm HTN
Tension pneumo - away from lesion
Deep leg veins
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
FEV1/FVC > 80%

24. What are the associations with bronchiectasis

25. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
In between perfusion limited and diffusion limited
Fe 2+
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Ciliated cells

26. What does the conducting zone consist of...
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Dec in the FEV1/FVC

27. 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
Bronchial obstruction - toward side of lesion
Airway obstruction (shunt) 100% O2 does not improve PO2
Respiratory bronchioles - clear debris in alveoli - bronchi
20.1 mL O2 /dL

28. What happens as a result of hypoxia in sleep apnea
Defect in coagulative cascace proteins
Ciliated cells
Right lung - right main stem bronhus is wider and more vertical
Inc EPO leading to erythrocytosis

29. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
L/S < 1.5
Hyaline membrane disease
DIC - especially postpartum

30. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Chronic hypoxic vasocxn
0 - negative - prevents pneumothorax
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

31. How many lobes does each lung have - and What is the lingula
In between perfusion limited and diffusion limited
Loss of blood flow - impeded arterial flow - reduced venous drainage
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

32. What are curschmann's spirals
Shed epithelium from mucus plugs
Trachea and bronchi
Loss of elastic fibers
Defect in coagulative cascace proteins

33. What does the respiratory zone consist of and What is its fxn
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
<60
Ciliated cells
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

34. What is the TX for small cell lung cancer
Prematurity - maternal RDS - cesarean delivery
Inoperable - responsive to chemotherapy
Lower portion of right inferior lobe
L/S < 1.5

35. What happens to diffusing capacity in interstiial lung diseases
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Air in lung after maxmimal expiration - cannot be measured on spirometry
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
Lowered

36. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Inoperable - responsive to chemotherapy

37. What is the ideal V/Q ratio and why
Matched - =1 adequate gas exchange
FEV1/FVC > 80%
Respiratory effort against airway obstruction
Everything but RV - TV + IRV + ERV

38. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Everything but RV - TV + IRV + ERV
DIC - especially postpartum
P = 2ST/radius
Gland depth/total thickness of broncial wall - >50%

39. What is occupied in the space that would have been the left middle lobe
Hypoxic vasocxn
Dorsiflexion of food leads to tender calf muscle
Heart
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

40. What are the causes of hypoxemia
RALS - righ anterior - left superior
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Metastasis - breast - colon - prostate - bladder -
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

41. What is the most common cancerous lesion in the lun
Shed epithelium from mucus plugs
Air in lung after maxmimal expiration - cannot be measured on spirometry
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Metastasis - breast - colon - prostate - bladder -

42. What is the formula for resistance
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
L/S < 1.5
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

43. What is the pathology of chronic bronchitis
Viral - URIs - allergens and stress
Hypertrophy of mucus secreting glands in the bronchioles
Lung cancer
Chest pain - tachypnea and dyspnea

44. Why is there eventual loss of capillary beds in emphysema
Gland depth/total thickness of broncial wall - >50%
Lost with alveolar walls
CO2 - acid/altitude - DPG - Exercise - Temperature
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

45. What changes in CO2 occur during exercise
Lobar PNA
Inc production
Centriacinar
Dipalmatoyl phosphatidylcholine

46. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Histiocytosis X - Langerhans cells
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Clara cells - type II pneumocytes; multiple densitites on CXR

47. What happens to lung volumes in obstructive lung disease
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Dec cross sectional area of pulm vasc bed
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Inc

48. What changes in lung volunes occur as a result of restrictive lung disease
Chroniclly tired
Upper lobes
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Dec in lung volumes - FVC - TLC

49. What is hemoglobin composed of...
4 polypeptide subunits - 2 alpha and 2 beta
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Elastic properties
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

50. What is methemoglobin
Repeated cycles of lung injury and wound healing with inc collagen
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Matched - =1 adequate gas exchange
<60