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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 are the lab/study findings in adenocarcinoma of the lung
Clara cells - type II pneumocytes; multiple densitites on CXR
Acute/chronic inc in vent
Inc excretion of bicarb to compensate for respiratory alkalosis
Loss of elastic fibers

2. What increases the risk of PDA in neonatal RDS
Hypertrophy of mucus secreting glands in the bronchioles
Lost with alveolar walls
Zone 1
Persistently low O2 tension

3. What changes in O2 consumption change during exercise
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Respiratory bronchioles - clear debris in alveoli - bronchi
Mesothelioma - pleura - psammoma bodies
Inc O2 consumption

4. How many lobes does each lung have - and What is the lingula
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
C3 - 4 - 6 - phrenic nerve - referred to shoulder
CT angio

5. What must occur with a exudate pleural effusion
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Air that moves into lung with each quiet respiration
Drainage

6. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Inc O2 consumption
Chronic hypoxic vasocxn
Tension pneumo - away from lesion
Activates bradykinin

7. What lobes are affected in silicosis
Upper lobes
Dec in the FEV1/FVC
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Chronic hypoxic vasocxn

8. What organisms cause interstitial PNA and What are the characteristics
Right lung - right main stem bronhus is wider and more vertical
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Long bone fractures and liposuction
Tissue hypoxia from dec O2 sat and dec O2 content

9. What happens to lung volumes in restrictive lung disease
Dec
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

10. Susceptibility to what infection is increased in silicosis and why
Activates bradykinin
<60
TB - silica disrupt phagolysosomes and impair MACS
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

11. How is pulmonary circulation characterized in terms of resistance and compliance
Low resistance and high compliance
Deoxygenated blood - elastic walls
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Dec

12. What are the findings associated with sarcoidosis
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Drainage

13. At What terminal does CO2 bind the globin molecule
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Low resistance and high compliance
N- terminus - carbaminohemoglobin
Inc mitochondria

14. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Acetazolamide - inhibits CA and acidifies the blood
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Gland depth/total thickness of broncial wall - >50%

15. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Small airways
High alveolar pressure compresses capillaries
Bronchial obstruction - toward side of lesion

16. How do you prevent DVT
Superior portion of right inferior lobe
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Heparin
<75

17. What changes occur to pulm blood flow during exercise
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Inc due to inc CO
Tension pneumo - away from lesion
Inc resistance leading to inc pressure

18. What does pulm HTN result in
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Inspiration by diaphragm - expiration is passive
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

19. What are the SPHERE of complications in lung cancer
High alveolar pressure compresses capillaries
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
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Methylene blue

20. How does recurrent thromboemboli cause pulm HTN
Deoxygenated blood - elastic walls
Stasis - hypercoagulability - endothelial damage
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Dec cross sectional area of pulm vasc bed

21. What is the equation for physiologic dead space
Respiratory bronchioles - clear debris in alveoli - bronchi
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

22. What cells make surfactant and At what week is produced most abundantly
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
No change - but inc venous CO2 content
Type II pneumocytes - after week 35
RV + ERV - volume in lungs after nl expiration

23. What is the criteria for chronic bronchitis
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Productive cough for greater than 3 months in at least 2 years
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

24. What changes occur to PaO2 and PaCO2
Right
No change - but inc venous CO2 content
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Dec in lung volumes - FVC - TLC

25. How does left to right shunt cause pulm HTN
Type II cells
Inc shear stress leading to endothelial injury
Drainage
Dec in lung volumes - FVC - TLC

26. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
More indolent
Mismatch
N- terminus - carbaminohemoglobin
Respiratory bronchioles - clear debris in alveoli - bronchi

27. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

28. What is the imaging test of choice for PE
Dec
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Shed epithelium from mucus plugs
CT angio

29. What is the formula for A- a gradient - and What is it normally
PAO2 - PaO2 = 10-15 mmHg
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
TB - silica disrupt phagolysosomes and impair MACS
Everything but RV - TV + IRV + ERV

30. What is the protein content an exudative pleural effusion and What are the potential causes
Milky fluid with inc TGs
CO - 200x
TB - silica disrupt phagolysosomes and impair MACS
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

31. What are mucus secretion swept out by
Persistently low O2 tension
Ciliated cells
Ivory white calcified pleural plaques
Activates bradykinin

32. What is tha hallmark finding of COPD
Type II cells
IRV + TV + ERV + RV
Dec in the FEV1/FVC
Elastic properties

33. What is the alveolar gas equation approximation
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Tissue hypoxia from dec O2 sat and dec O2 content
Centriacinar
PA02 = 150 - PACO2/0.8

34. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Lobar PNA
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Loss of blood flow - impeded arterial flow - reduced venous drainage
Methacholine challenge

35. What changes in CO2 occur during exercise
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Right
Upper lobes - cor pulmonale - caplan's syndrome
Inc production

36. What is the nl form of iron in hemoglobin
Right lung - right main stem bronhus is wider and more vertical
Fe 2+
Upper lobes
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

37. What is the response for ventilation of high altitude
Shed epithelium from mucus plugs
Acute/chronic inc in vent
Chronic hypoxic vasocxn
Inc mitochondria

38. Where are ventilation and perfusion highest in the lung - respectively
FRC - inward pull of lung balanced by outward pull of chest wall
Lobar PNA
Zone 3
Both highest in the base

39. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

40. What is the TX for small cell lung cancer
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Air in excess of tidal volume that moves into lung on maximal inspiration
S. aureus or anaerobes
Inoperable - responsive to chemotherapy

41. What organism thrives in high O2 and where in the lung does it flourish
Inc airway pressure to prevent airway collapse during exhalation
TB - apex
Airway obstruction (shunt) 100% O2 does not improve PO2
Air in lung after maxmimal expiration - cannot be measured on spirometry

42. What cells in the lung produce surfactant and What does it do
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Air that can still be breathed out after nl expiration
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Dec dec in FEV1 - dec in FVC

43. What is the alveolar gas equation
Drainage
Dec
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
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

44. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Both highest in the base
More indolent
Stasis - hypercoagulability - endothelial damage

45. What is a chronic complication of sleep apnea
Upper lobes - cor pulmonale - caplan's syndrome
Chroniclly tired
Shunting
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

46. What is a typical tidal volume
500mL
Bronchial obstruction - toward side of lesion
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Trachea and bronchi

47. What are the 3 reasons for an increased A- a gradient
Lower portion of right inferior lobe
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
N- terminus - carbaminohemoglobin

48. What are the potential TX for sleep apnea
Person stops breathing for at least 10 seconds repeatedly during sleep
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Weight loss - CPAP - surgery
Carcinoid - carcinoid

49. What changes in V/Q throughout the lung during exercise
Steroids to mom - artificial surfactant and thyroxine to neonate
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Ratio from apex to base becomes more uniform

50. What does CADET face to the right stand for
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
CO2 - acid/altitude - DPG - Exercise - Temperature
Repeated cycles of lung injury and wound healing with inc collagen