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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 formula for pulm vasc resistance
Methylene blue
Drainage
PVR = (PpulmA - PleftA)/CO
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

2. What area of the lung is the largest physiologic contributor of fxnal dead space
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Apex of healthy lung
Respiratory effort against airway obstruction
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

3. What cells make surfactant and At what week is produced most abundantly
Respiratory effort against airway obstruction
Type II pneumocytes - after week 35
Air that moves into lung with each quiet respiration
Productive cough for greater than 3 months in at least 2 years

4. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Pleural effusion
Prostaglandins - histamine - ACE - kallikrein
Dec - because physiologic shunt dec O2 extraction from ratio
Inc excretion of bicarb to compensate for respiratory alkalosis

5. Other than surfactant - what other important substances are produced by the lungs
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Prostaglandins - histamine - ACE - kallikrein
N- terminus - carbaminohemoglobin
No change - but inc venous CO2 content

6. Why is there eventual loss of capillary beds in emphysema
Bronchial obstruction - toward side of lesion
Lost with alveolar walls
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Histiocytosis X - Langerhans cells

7. Where do you find type I cells - What is their morphology - and What do they do
Drainage
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Positive cooperativity and negative allostery - unlike myoglobin

8. What is surfactant made of...
N- terminus - carbaminohemoglobin
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Dipalmatoyl phosphatidylcholine
It binds to Hb -

9. What drug therapy is used to augment the changes in bicarb exretion
Airway obstruction (shunt) 100% O2 does not improve PO2
Fe 2+
Acetazolamide - inhibits CA and acidifies the blood
Clara cells - type II pneumocytes; multiple densitites on CXR

10. What reaction and enzyme create bicarb and Where does it happen
Inc mitochondria
Surfactant
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

11. 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%
Deoxygenated blood - elastic walls
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

12. What enzyme increases activity in emphysema
Elastase
Exposed collagen fibers provides impetus for clotting cascade
Prostaglandins - histamine - ACE - kallikrein
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

13. What does pulm HTN result in
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Persistently low O2 tension
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

14. What is the V/Q ratio at the apex and base of the lung
Milky fluid with inc TGs
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

15. What is the characteristic lymphatic pleural effusion
Milky fluid with inc TGs
Drainage
Bronchial obstruction - toward side of lesion
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

16. At what lung volume is system pressure atmospheric and why
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
FRC - inward pull of lung balanced by outward pull of chest wall
Type II cells
RALS - righ anterior - left superior

17. What are curschmann's spirals
Zone 3
Shed epithelium from mucus plugs
Squamous cell carcinoma - keratin pearls and intracellular bridges
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

18. How does autoimmune dz cause thromboemboli
Inc due to inc CO
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Inoperable - responsive to chemotherapy
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

19. In which zone of the lung is Pa > Pv >PA
It binds to Hb -
Zone 3
Defect in coagulative cascace proteins
Inc resistance leading to inc pressure

20. What organisms cause interstitial PNA and What are the characteristics
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
RV + ERV - volume in lungs after nl expiration
Opposites

21. Define tidal volume (TV)
Alpha1- antitrypsin def - also cirrhosis
Inc 2 -3- DPG - righward shift
Air that moves into lung with each quiet respiration
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

22. What organisms cause a bronchoPNA and What are the characteristics
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Inc excretion of bicarb to compensate for respiratory alkalosis
Coal miner's - silicosis - abestosis

23. Chronic bronchitis is a disease of what kind of airways
Small airways
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

24. Define vital capacity (VC)
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Mismatch
Everything but RV - TV + IRV + ERV

25. What is the appoximate O2 binding capacity
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
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
20.1 mL O2 /dL
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

26. What is the pathology of emphysema
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Centriacinar

27. What is a typical tidal volume
Incr - right - dec - left
PA02 = 150 - PACO2/0.8
Lungs collapse inwards and chest wall spring out
500mL

28. What is the formula for collapsing pressure
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
P = 2ST/radius
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

29. What is the protein content an exudative pleural effusion and What are the potential causes
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Everything but RV - TV + IRV + ERV
Stasis - hypercoagulability - endothelial damage
Type II cells

30. What is compliance and When is it decrease
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Apex of healthy lung
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

31. What lab ration indicates fetal lung maturity
Both highest in the base
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
L/S > 2 = lecithin/sphingomyelin
Persistently low O2 tension

32. What organism causes a lobar PNA and What are the characteristics
No change - but inc venous CO2 content
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

33. What happens in perfusion limited circulatioin and which gases does this apply to...
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
DIC - especially postpartum
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
IRV + TV + ERV + RV

34. What does each bronchopulmonary segment have in the center and along its border
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Inc
Air in excess of tidal volume that moves into lung on maximal inspiration
Shunting

35. What happens to diffusing capacity in interstiial lung diseases
Lowered
Prostaglandins - histamine - ACE - kallikrein
Dec - because physiologic shunt dec O2 extraction from ratio
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

36. What are the lab/study findings in adenocarcinoma of the lung
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Clara cells - type II pneumocytes; multiple densitites on CXR
PAO2 - PaO2 = 10-15 mmHg
Prostaglandins - histamine - ACE - kallikrein

37. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Heparin
Trachea and bronchi
More indolent
L/S < 1.5

38. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Ciliated cells

39. What kind of course does interstitial PNA follow in comparison to bronchoPNA
More indolent
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Elastic properties
Weight loss - CPAP - surgery

40. What is the alveolar gas equation approximation
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
PVR = (PpulmA - PleftA)/CO
Airway obstruction (shunt) 100% O2 does not improve PO2
PA02 = 150 - PACO2/0.8

41. What kind of emphysema is caused by smoking
Inc to meet O2 demand
RALS - righ anterior - left superior
Inc resistance leading to inc pressure
Centriacinar

42. What is positive cooperativity of hemoglobin refer to...
Repeated cycles of lung injury and wound healing with inc collagen
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Coal miner's - silicosis - abestosis
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

43. What do type II cells do - What is their morphology - when do they proliferate
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Loss of blood flow - impeded arterial flow - reduced venous drainage
Persistently low O2 tension

44. What is a consequence of pulm HTN
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Airway obstruction (shunt) 100% O2 does not improve PO2
Pa > PA > Pv

45. What is the tendency of the lungs vs the chest wall
Weight loss - CPAP - surgery
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Lungs collapse inwards and chest wall spring out

46. What is hemoglobin composed of...
Long bone fractures and liposuction
Inc airway pressure to prevent airway collapse during exhalation
Dec - because physiologic shunt dec O2 extraction from ratio
4 polypeptide subunits - 2 alpha and 2 beta

47. What causes secondary pulm HTN
Dec dec in FEV1 - dec in FVC
PA02 = 150 - PACO2/0.8
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Anatomic dead space and smooth muscle

48. At What terminal does CO2 bind the globin molecule
IRV + TV
N- terminus - carbaminohemoglobin
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

49. Why is endothelial damage a risk factor for DVT
Dorsiflexion of food leads to tender calf muscle
Exposed collagen fibers provides impetus for clotting cascade
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Lobar PNA

50. What is an example of hypercoagulability
Airway obstruction (shunt) 100% O2 does not improve PO2
Defect in coagulative cascace proteins
Heart
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals