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Respiratory

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What is the alveolar gas equation approximation
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
PA02 = 150 - PACO2/0.8
Repeated cycles of lung injury and wound healing with inc collagen
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

2. What are the causes of ischemia
Elastase
Loss of blood flow - impeded arterial flow - reduced venous drainage
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
FRC - inward pull of lung balanced by outward pull of chest wall

3. What is are the symptoms of a pulmonary embolism
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Chest pain - tachypnea and dyspnea
Deoxygenated blood - elastic walls

4. What is the alveolar gas equation
Dec - no change
Activates bradykinin
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

5. Which structures perforate the diaphragm and where
Respiratory effort against airway obstruction
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Tight jxns
Long bone fractures and liposuction

6. What lung product is deficient in neonatal RDS
CO - 200x
Surfactant
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Stasis - hypercoagulability - endothelial damage

7. What is the initial damage of ARDS caused by
Airway obstruction (shunt) 100% O2 does not improve PO2
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Steroids to mom - artificial surfactant and thyroxine to neonate

8. What does the law of Laplace state about tendency of alveoli to collapse
Dec
Right lung - right main stem bronhus is wider and more vertical
On expiration as radius dec
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

9. In what cells do you find lamellar bodies
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
FRC - inward pull of lung balanced by outward pull of chest wall
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Type II cells

10. What cells in the lung produce surfactant and What does it do
Exposed collagen fibers provides impetus for clotting cascade
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Hypoxic vasocxn

11. What is a potential test for asthma
Methacholine challenge
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Dec - because physiologic shunt dec O2 extraction from ratio

12. What is hemoglobin composed of...
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
TB - apex
4 polypeptide subunits - 2 alpha and 2 beta

13. Where are ventilation and perfusion highest in the lung - respectively
No change - but inc venous CO2 content
Inc EPO leading to erythrocytosis
Shed epithelium from mucus plugs
Both highest in the base

14. How is pulmonary circulation characterized in terms of resistance and compliance
Persistently low O2 tension
Low resistance and high compliance
On expiration as radius dec
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

15. What is the formula for O2 content
Inc excretion of bicarb to compensate for respiratory alkalosis
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
O2 binding x O2 sat + dissolved O2

16. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Alchoholics or epileptics
Dipalmatoyl phosphatidylcholine

17. What are the SPHERE of complications in lung cancer
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
TB - silica disrupt phagolysosomes and impair MACS
Dorsiflexion of food leads to tender calf muscle

18. What is the pathology of bronchiectasis
N- terminus - carbaminohemoglobin
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Heparin
Steroids to mom - artificial surfactant and thyroxine to neonate

19. What changes in 2 -3 - DPG occur at high altitude
Anatomic dead space and smooth muscle
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

20. How do you prevent DVT
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Heparin
No change - but inc venous CO2 content
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

21. Which pts are at risk for apriation PNA
L/S < 1.5
Respiratory effort against airway obstruction
Alchoholics or epileptics
CO2 - acid/altitude - DPG - Exercise - Temperature

22. How does mitral stenosis cause pulm HTN
L/S < 1.5
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Inc resistance leading to inc pressure
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

23. What doe FAT BAT stand for
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Low resistance and high compliance
Loss of elastic fibers
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

24. What organism causes a lobar PNA and What are the characteristics
Zone 1
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Dipalmatoyl phosphatidylcholine - decreases surface tension
No respiratory effort

25. Why is there eventual loss of capillary beds in emphysema
Metastasis - breast - colon - prostate - bladder -
Right
Lost with alveolar walls
P = 2ST/radius

26. What is a lung abscess and What does usually result from
IRV + TV + ERV + RV
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
CO - 200x
Inspiration by diaphragm - expiration is passive

27. What lobes does Coal Miner's pneumoconioses affect - and What can it result in

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28. What happens to V/Q ratio in COPD
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Mismatch
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
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

29. What are clara cells What is their morphology and What do they do
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Gland depth/total thickness of broncial wall - >50%
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

30. What is central sleep apnea
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
No respiratory effort
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging

31. What is early onset hypoxemia from in chronic bronchitis
Shunting
Respiratory effort against airway obstruction
Zone 3
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

32. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
RV + ERV - volume in lungs after nl expiration
FEV1/FVC > 80%
20.1 mL O2 /dL
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

33. Why do pts with emphysema exhale through pursed lips
0 - negative - prevents pneumothorax
Right shift - favors taut - low affinity for O2 - O2 unloading
Trachea and bronchi
Inc airway pressure to prevent airway collapse during exhalation

34. What is the ideal V/Q ratio and why
Matched - =1 adequate gas exchange
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

35. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
PAO2 - PaO2 = 10-15 mmHg
PVR = (PpulmA - PleftA)/CO
Tension pneumo - away from lesion
Gland depth/total thickness of broncial wall - >50%

36. What is the nl form of iron in hemoglobin
Chest pain - tachypnea and dyspnea
Mesothelioma - pleura - psammoma bodies
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Fe 2+

37. What are the subtypes of pneumoconioses

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38. What kind of pleural plaques are the result of asbestosis
Deoxygenated blood - elastic walls
Superior portion of right inferior lobe
Hyaline membrane disease
Ivory white calcified pleural plaques

39. What is the criteria for chronic bronchitis
Productive cough for greater than 3 months in at least 2 years
Prostaglandins - histamine - ACE - kallikrein
Lobar PNA
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

40. What are mucus secretion swept out by
Productive cough for greater than 3 months in at least 2 years
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Ciliated cells
Methylene blue

41. What is the main complication of therapeutic supplemental O2?
Surfactant def leading to inc surfact tension and alveolar collapse
Right shift - favors taut - low affinity for O2 - O2 unloading
<60
Retinopathy of maturity

42. What lobes are affected in silicosis
Upper lobes
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
500mL
Anatomic dead space and smooth muscle

43. What changes in O2 consumption change during exercise
Stasis - hypercoagulability - endothelial damage
High alveolar pressure compresses capillaries
Inc O2 consumption
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

44. What does CADET face to the right stand for
O2 binding x O2 sat + dissolved O2
Positive cooperativity and negative allostery - unlike myoglobin
Inc EPO leading to erythrocytosis
CO2 - acid/altitude - DPG - Exercise - Temperature

45. What is the formula for collapsing pressure
Inc O2 consumption
P = 2ST/radius
Bronchial obstruction - toward side of lesion
Upper lobes - cor pulmonale - caplan's syndrome

46. Where is cartilage present in the respiratory tree
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Trachea and bronchi
Inspiration by diaphragm - expiration is passive
Stasis - hypercoagulability - endothelial damage

47. What is the pathology of emphysema
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Inc mitochondria
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Exposed collagen fibers provides impetus for clotting cascade

48. Susceptibility to what infection is increased in silicosis and why
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
TB - silica disrupt phagolysosomes and impair MACS
Steroids to mom - artificial surfactant and thyroxine to neonate
Inc mitochondria

49. Where do you find type I cells - What is their morphology - and What do they do
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Histiocytosis X - Langerhans cells
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Dec in the FEV1/FVC

50. What is the cycle of idiopathic pulmonary fibrosis
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Repeated cycles of lung injury and wound healing with inc collagen
CT angio
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc