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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 is the fxn of the conducting zone
<60
Gland depth/total thickness of broncial wall - >50%
Brings air in and out - warms - humidifies - filters
CT angio

2. Why is there eventual loss of capillary beds in emphysema
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Lost with alveolar walls
Prostaglandins - histamine - ACE - kallikrein

3. Define expiratory reserve volume (ERV)
Inc shear stress leading to endothelial injury
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Air that can still be breathed out after nl expiration
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

4. 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
P = 2ST/radius
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
S. aureus or anaerobes

5. In what cells do you find lamellar bodies
Alpha1- antitrypsin def - also cirrhosis
Type II cells
Matched - =1 adequate gas exchange
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

6. What direction does an increase in metabolic need shift the O2 dissociation curve
Right
Inc due to inc CO
No change - but inc venous CO2 content
Mesothelioma - pleura - psammoma bodies

7. What changes occur to PaO2 and PaCO2
Drainage
FEV1/FVC > 80%
No change - but inc venous CO2 content
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

8. At what lung volume is system pressure atmospheric and why
Upper lobes
TB - apex
FRC - inward pull of lung balanced by outward pull of chest wall
Fe 2+

9. What changes in lung volunes occur as a result of restrictive lung disease
Carcinoid - carcinoid
Inc 2 -3- DPG - righward shift
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Dec in lung volumes - FVC - TLC

10. What causes secondary pulm HTN
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Ciliated cells
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

11. At what PaO2 does cyanosis begin
Elastic properties
<60
CO2 - acid/altitude - DPG - Exercise - Temperature
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

12. What enzyme increases activity in emphysema
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
Elastase
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
RALS - righ anterior - left superior

13. What are the histological findings in asbestosis and what occupations are associated
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Hypoxic vasocxn
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

14. What reaction and enzyme create bicarb and Where does it happen
Defect in coagulative cascace proteins
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Loss of blood flow - impeded arterial flow - reduced venous drainage

15. What is an example of hypercoagulability
Acetazolamide - inhibits CA and acidifies the blood
Dipalmatoyl phosphatidylcholine
Defect in coagulative cascace proteins
Dec in the FEV1/FVC

16. In which zone of the lung is Pa > Pv >PA
Zone 3
Opposites
Dipalmatoyl phosphatidylcholine - decreases surface tension
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

17. What kind of connection exists between endothelial cells in the capilaries
Exposed collagen fibers provides impetus for clotting cascade
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Tight jxns
Heart

18. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Centriacinar
CT angio
C3 - 4 - 6 - phrenic nerve - referred to shoulder
FEV1/FVC > 80%

19. What is the pathology of ARDS
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Loss of blood flow - impeded arterial flow - reduced venous drainage
Deep leg veins

20. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Gland depth/total thickness of broncial wall - >50%
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
<75

21. What is the leading cause of cancer death
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Lung cancer
Viral - URIs - allergens and stress
Deoxygenated blood - elastic walls

22. What is the characteristic lymphatic pleural effusion
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Milky fluid with inc TGs
Airways close prematurely resulting in inc RV and dec FVC
TB - apex

23. What happens to diffusing capacity in interstiial lung diseases
Dec in lung volumes - FVC - TLC
Lowered
RV + ERV - volume in lungs after nl expiration
More indolent

24. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Inc O2 consumption
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Right
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

25. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Methylene blue
Respiratory bronchioles - clear debris in alveoli - bronchi
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

26. What changes at high altitude can result in RVH
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Shunting
Chronic hypoxic vasocxn
Inc excretion of bicarb to compensate for respiratory alkalosis

27. What are clara cells What is their morphology and What do they do
Matched - =1 adequate gas exchange
CO - 200x
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Elastase

28. What changes in EPO occur at high altitude
Methylene blue
Dec cross sectional area of pulm vasc bed
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

29. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Inoperable - responsive to chemotherapy
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Retinopathy of maturity

30. What drug therapy is used to augment the changes in bicarb exretion
Retinopathy of maturity
Acetazolamide - inhibits CA and acidifies the blood
Everything but RV - TV + IRV + ERV
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

31. Define residual volume (RV)
CT angio
Air in lung after maxmimal expiration - cannot be measured on spirometry
On expiration as radius dec
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

32. What are mucus secretion swept out by
500mL
On expiration as radius dec
Methylene blue
Ciliated cells

33. What changes in ventilation rate occur during exercise
Hypertrophy of mucus secreting glands in the bronchioles
Chroniclly tired
Inc to meet O2 demand
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

34. What does the respiratory zone consist of and What is its fxn
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Lowered
No change - but inc venous CO2 content
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

35. In emphysema - What is increased lung compliance due to...
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Loss of elastic fibers
Air that moves into lung with each quiet respiration
Inc 2 -3- DPG - righward shift

36. What is another name for neonatal RDS
Hyaline membrane disease
Viral - URIs - allergens and stress
Bleomycin - busulfan - anmiodorone
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

37. Which structures perforate the diaphragm and where
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
<75
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

38. What does a V/Q ratio of infinity indicate
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Upper lobes
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

39. Which lung is the more common site for an inhaled foreign body and why
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
CT angio
Dipalmatoyl phosphatidylcholine
Right lung - right main stem bronhus is wider and more vertical

40. What are curschmann's spirals
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Shed epithelium from mucus plugs
Upper lobes - cor pulmonale - caplan's syndrome

41. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Apex of healthy lung
Bleomycin - busulfan - anmiodorone
Opposites
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

42. What does decreased PAO2 do
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Trachea and bronchi

43. Why is cesarean delivery a risk factor for neonatal RDS
L/S > 2 = lecithin/sphingomyelin
More indolent
Lowered
Dec release of fetal glucocorticoids

44. What happens with the O2 curve shifts to the right and What does it facilitate
Inc 2 -3- DPG - righward shift
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Repeated cycles of lung injury and wound healing with inc collagen
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

45. At What terminal does CO2 bind the globin molecule
Inc excretion of bicarb to compensate for respiratory alkalosis
N- terminus - carbaminohemoglobin
Dec - due to lactic acidosis
Brings air in and out - warms - humidifies - filters

46. What changes in CO2 occur during exercise
Lobar PNA
Inc production
Dec cross sectional area of pulm vasc bed
Clara cells - type II pneumocytes; multiple densitites on CXR

47. What are the SPHERE of complications in lung cancer
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Dorsiflexion of food leads to tender calf muscle
Coal miner's - silicosis - abestosis

48. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Long bone fractures and liposuction
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
Milky fluid with inc TGs
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

49. What are the findings in asthma
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Type II pneumocytes - after week 35
Alchoholics or epileptics

50. What is positive cooperativity of hemoglobin refer to...
Repeated cycles of lung injury and wound healing with inc collagen
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Anatomic dead space and smooth muscle