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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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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 kind of connection exists between endothelial cells in the capilaries
Air that moves into lung with each quiet respiration
Tight jxns
Surfactant def leading to inc surfact tension and alveolar collapse
Matched - =1 adequate gas exchange

2. What organisms cause a bronchoPNA and What are the characteristics
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
DIC - especially postpartum

3. What lobes are affected in silicosis
L/S < 1.5
Upper lobes
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Dec - no change

4. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
Chest pain - tachypnea and dyspnea
Lobar PNA
Chronic hypoxic vasocxn
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

5. What is used to treat methemoglobin
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
20.1 mL O2 /dL
Methylene blue
Inspiration by diaphragm - expiration is passive

6. What is Homan's sign
Dorsiflexion of food leads to tender calf muscle
Alpha1- antitrypsin def - also cirrhosis
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
P = 2ST/radius

7. Why is endothelial damage a risk factor for DVT
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Exposed collagen fibers provides impetus for clotting cascade
Inc EPO leading to erythrocytosis
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

8. What area of the lung is the largest physiologic contributor of fxnal dead space
Apex of healthy lung
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

9. In which zone of the lung is PA > Pa > Pv
Inc airway pressure to prevent airway collapse during exhalation
Airway obstruction (shunt) 100% O2 does not improve PO2
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Zone 1

10. How do you prevent DVT
Right lung - right main stem bronhus is wider and more vertical
Mismatch
Heparin
Inc mitochondria

11. What is an example of hypercoagulability
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
<75
Defect in coagulative cascace proteins
Right lung - right main stem bronhus is wider and more vertical

12. Define total lung capcaity
Loss of elastic fibers
IRV + TV + ERV + RV
Loss of blood flow - impeded arterial flow - reduced venous drainage
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

13. What are the potential TX for sleep apnea
Bleomycin - busulfan - anmiodorone
Dec - due to lactic acidosis
Weight loss - CPAP - surgery
High alveolar pressure compresses capillaries

14. What ratio is used to measure lung maturity and What is the value is neonatal RDS
L/S < 1.5
Heparin
IRV + TV + ERV + RV
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

15. Which muscles are involved in quiet breathing and What part of respiration do the control
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Inspiration by diaphragm - expiration is passive
Ciliated cells
Fe 2+

16. What is virchow's triad
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Stasis - hypercoagulability - endothelial damage
Anatomic dead space and smooth muscle

17. How does recurrent thromboemboli cause pulm HTN
S. aureus or anaerobes
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
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Dec cross sectional area of pulm vasc bed

18. What are the 9 interstitial lung diseases

19. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Incr - right - dec - left
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Respiratory effort against airway obstruction

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

21. What is methemoglobin
Inspiration by diaphragm - expiration is passive
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-
CO x O2 content of blood

22. What happens as a result of hypoxia in sleep apnea
Inc EPO leading to erythrocytosis
Tension pneumo - away from lesion
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Matched - =1 adequate gas exchange

23. Susceptibility to what infection is increased in silicosis and why
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Dec release of fetal glucocorticoids
TB - silica disrupt phagolysosomes and impair MACS
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

24. What properties determine the combined volumes of the chest wall and lungs
Surfactant
Superior portion of right inferior lobe
Elastic properties
Dipalmatoyl phosphatidylcholine - decreases surface tension

25. What is the protein content an exudative pleural effusion and What are the potential causes
Elastic properties
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Respiratory bronchioles - clear debris in alveoli - bronchi
4 polypeptide subunits - 2 alpha and 2 beta

26. What is carboxyhemoglobin and What does it cause
Inc resistance leading to inc pressure
Dec release of fetal glucocorticoids
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
Acute/chronic inc in vent

27. What is the pathology of ARDS
CT angio
Inc resistance leading to inc pressure
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Repeated cycles of lung injury and wound healing with inc collagen

28. In COPD - what happens to airways at high lung volumes
No respiratory effort
Dipalmatoyl phosphatidylcholine - decreases surface tension
Airways close prematurely resulting in inc RV and dec FVC
Lung cancer

29. At what PaO2 does cyanosis begin
Activates bradykinin
<60
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
RV + ERV - volume in lungs after nl expiration

30. What is a potential test for asthma
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Elastase
Methacholine challenge
Centriacinar

31. What is the formula for A- a gradient - and What is it normally
Air in excess of tidal volume that moves into lung on maximal inspiration
Dipalmatoyl phosphatidylcholine
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
PAO2 - PaO2 = 10-15 mmHg

32. Which pts are at risk for apriation PNA
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
N- terminus - carbaminohemoglobin
Centriacinar
Alchoholics or epileptics

33. What changes in pH occur during strenuous exercise and why
FEV1/FVC > 80%
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Dec - due to lactic acidosis
Retinopathy of maturity

34. What is the main complication of therapeutic supplemental O2?
Both highest in the base
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Retinopathy of maturity
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

35. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Both highest in the base
Lobar PNA
Deoxygenated blood - elastic walls
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

36. What kind of pleural plaques are the result of asbestosis
PA02 = 150 - PACO2/0.8
Ivory white calcified pleural plaques
FEV1/FVC > 80%
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

37. What is the alveolar gas equation approximation
Clara cells - type II pneumocytes; multiple densitites on CXR
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
P = 2ST/radius
PA02 = 150 - PACO2/0.8

38. What happens in perfusion limited circulatioin and which gases does this apply to...
Deoxygenated blood - elastic walls
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Dec - because physiologic shunt dec O2 extraction from ratio
Carcinoid - carcinoid

39. What is the criteria for chronic bronchitis
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Deep leg veins
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Productive cough for greater than 3 months in at least 2 years

40. Define physilogic dead space
Air in lung after maxmimal expiration - cannot be measured on spirometry
More indolent
Brings air in and out - warms - humidifies - filters
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

41. What are the 3 reasons for an increased A- a gradient
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Lungs collapse inwards and chest wall spring out
Inc mitochondria

42. Define functional residual capacity (FRC)
Prostaglandins - histamine - ACE - kallikrein
Respiratory bronchioles - clear debris in alveoli - bronchi
RV + ERV - volume in lungs after nl expiration
Pleural effusion

43. What is an association and potential complication of paraseptal emphysema
FRC - inward pull of lung balanced by outward pull of chest wall
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
CO - 200x
Dec cross sectional area of pulm vasc bed

44. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Acute/chronic inc in vent
Dec - no change
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)

45. What causes neonatal RDS
Surfactant def leading to inc surfact tension and alveolar collapse
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

46. What is fetal hemoglobin made of and why does it have a higher affinity for O2
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

47. Where is cartilage present in the respiratory tree
Trachea and bronchi
Alpha1- antitrypsin def - also cirrhosis
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Mesothelioma - pleura - psammoma bodies

48. What do type II cells do - What is their morphology - when do they proliferate
Hyaline membrane disease
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Positive cooperativity and negative allostery - unlike myoglobin
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

49. How happens to the proton from the rxn the created bicarb
Dipalmatoyl phosphatidylcholine
It binds to Hb -
Matched - =1 adequate gas exchange
DIC - especially postpartum

50. Define tidal volume (TV)
Alchoholics or epileptics
Air that moves into lung with each quiet respiration
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
N- terminus - carbaminohemoglobin