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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 is sleep apnea associated with
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
500mL

2. In which zone of the lung is Pa > Pv >PA
Opposites
Inc mitochondria
Zone 3
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

3. What changes in EPO occur at high altitude
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Brings air in and out - warms - humidifies - filters
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

4. What is surfactant made of...
Air in lung after maxmimal expiration - cannot be measured on spirometry
Hypoxic vasocxn
Dipalmatoyl phosphatidylcholine
Inc

5. What changes occur to PaO2 and PaCO2
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Milky fluid with inc TGs
No change - but inc venous CO2 content

6. What is the definition of sleep apnea
Squamous cell carcinoma - keratin pearls and intracellular bridges
Person stops breathing for at least 10 seconds repeatedly during sleep
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Inc airway pressure to prevent airway collapse during exhalation

7. What is the pathology of bronchiectasis
L/S > 2 = lecithin/sphingomyelin
Opposites
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

8. How happens to the proton from the rxn the created bicarb
Type II pneumocytes - after week 35
Type II cells
It binds to Hb -
TB - silica disrupt phagolysosomes and impair MACS

9. What reaction and enzyme create bicarb and Where does it happen
Exposed collagen fibers provides impetus for clotting cascade
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
P = 2ST/radius
L/S < 1.5

10. What is methemoglobin
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Hypertrophy of mucus secreting glands in the bronchioles
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

11. What is an example of hypercoagulability
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Defect in coagulative cascace proteins
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

12. What are the causes of hypoxemia
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
20.1 mL O2 /dL
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

13. In emphysema - What is increased lung compliance due to...
Positive cooperativity and negative allostery - unlike myoglobin
Ratio from apex to base becomes more uniform
Lung cancer
Loss of elastic fibers

14. What does the respiratory zone consist of and What is its fxn
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Coal miner's - silicosis - abestosis
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
No change - but inc venous CO2 content

15. What is carboxyhemoglobin and What does it cause
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
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
Upper lobes - cor pulmonale - caplan's syndrome
Air that can still be breathed out after nl expiration

16. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
L/S < 1.5
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Right shift - favors taut - low affinity for O2 - O2 unloading

17. What are the lab/study findings in adenocarcinoma of the lung
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Shed epithelium from mucus plugs
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Clara cells - type II pneumocytes; multiple densitites on CXR

18. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
In between perfusion limited and diffusion limited
Lobar PNA
Apex of healthy lung
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

19. What is the defect in panacinar emphysema - and what else do you see
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Alpha1- antitrypsin def - also cirrhosis
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

20. What are the 3 reasons for an increased A- a gradient
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Ciliated cells
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
No change - but inc venous CO2 content

21. 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
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

22. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
P = 2ST/radius
Inc
Superior portion of right inferior lobe
0 - negative - prevents pneumothorax

23. What does decreased PAO2 do
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Milky fluid with inc TGs
Dec
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

24. What happens with the O2 curve shifts to the right and What does it facilitate
Gland depth/total thickness of broncial wall - >50%
Tight jxns
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

25. What is the formula for A- a gradient - and What is it normally
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Dec in the FEV1/FVC
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
PAO2 - PaO2 = 10-15 mmHg

26. What findings are associated with emphysema
<75
Dec in the FEV1/FVC
Lowered
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

27. What changes in O2 consumption change during exercise
Long bone fractures and liposuction
DIC - especially postpartum
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
Inc O2 consumption

28. What organisms cause a bronchoPNA and What are the characteristics
Acetazolamide - inhibits CA and acidifies the blood
Prostaglandins - histamine - ACE - kallikrein
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

29. What cellular changes occur at high altitude
Loss of blood flow - impeded arterial flow - reduced venous drainage
Inc mitochondria
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Persistently low O2 tension

30. What is the main complication of therapeutic supplemental O2?
Tissue hypoxia from dec O2 sat and dec O2 content
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Retinopathy of maturity
Upper lobes

31. What kind of emphysema is caused by smoking
TB - apex
Positive cooperativity and negative allostery - unlike myoglobin
0 - negative - prevents pneumothorax
Centriacinar

32. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Methacholine challenge
RV + ERV - volume in lungs after nl expiration
Low resistance and high compliance
Squamous cell carcinoma - keratin pearls and intracellular bridges

33. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
In between perfusion limited and diffusion limited
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Inc shear stress leading to endothelial injury
Ivory white calcified pleural plaques

34. What doe FAT BAT stand for
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Histiocytosis X - Langerhans cells
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
No change - but inc venous CO2 content

35. What are the SPHERE of complications in lung cancer
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Defect in coagulative cascace proteins
Dec - no change
Inc mitochondria

36. 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
Milky fluid with inc TGs
No respiratory effort
Hypertrophy of mucus secreting glands in the bronchioles

37. What does the conducting zone consist of...
RV + ERV - volume in lungs after nl expiration
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Viral - URIs - allergens and stress
Lower portion of right inferior lobe

38. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Inc 2 -3- DPG - righward shift
Dec - because physiologic shunt dec O2 extraction from ratio
Deoxygenated blood - elastic walls

39. What happens to O2 content and O2 sat as Hb falls
Upper lobes - cor pulmonale - caplan's syndrome
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Heart
Dec - no change

40. What kind of pleural plaques are the result of asbestosis
Squamous cell carcinoma - keratin pearls and intracellular bridges
Deep leg veins
Ivory white calcified pleural plaques
Upper lobes - cor pulmonale - caplan's syndrome

41. In which zone of the lung is PA > Pa > Pv
Zone 1
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Deoxygenated blood - elastic walls
Brings air in and out - warms - humidifies - filters

42. How does mitral stenosis cause pulm HTN
Inc resistance leading to inc pressure
Airways close prematurely resulting in inc RV and dec FVC
Pleural effusion
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

43. What do type II cells do - What is their morphology - when do they proliferate
Chroniclly tired
Hyaline membrane disease
Upper lobes
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

44. What are the 3 forms that CO2 is transported from tissues to lungs
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Persistently low O2 tension
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

45. What is the TX for small cell lung cancer
Dec - because physiologic shunt dec O2 extraction from ratio
Lost with alveolar walls
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Inoperable - responsive to chemotherapy

46. What kind of space is in the conducting tree and what kind of muscle exists there
Anatomic dead space and smooth muscle
Respiratory effort against airway obstruction
Persistently low O2 tension
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

47. What is the characteristic lymphatic pleural effusion
N- terminus - carbaminohemoglobin
Milky fluid with inc TGs
Zone 3
Deoxygenated blood - elastic walls

48. What is the pathology of emphysema
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
It binds to Hb -
Chroniclly tired

49. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Right shift - favors taut - low affinity for O2 - O2 unloading
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Inc mitochondria
Deep leg veins

50. What muscles are involved in breathing during exercise and What do they control
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
IRV + TV
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Air in excess of tidal volume that moves into lung on maximal inspiration