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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 most common cancerous lesion in the lun
TB - apex
Dec dec in FEV1 - dec in FVC
Metastasis - breast - colon - prostate - bladder -
Upper lobes

2. What is surfactant made of...
Lowered
Dipalmatoyl phosphatidylcholine
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
RALS - righ anterior - left superior

3. What is the alveolar gas equation approximation
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
PA02 = 150 - PACO2/0.8
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Positive cooperativity and negative allostery - unlike myoglobin

4. Where do 95% of PE arise from
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Deep leg veins
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

5. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Repeated cycles of lung injury and wound healing with inc collagen
Heart
RALS - righ anterior - left superior

6. What is the pathology of asthma

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7. What ratio is used to measure lung maturity and What is the value is neonatal RDS
PVR = (PpulmA - PleftA)/CO
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Lost with alveolar walls
L/S < 1.5

8. What do PFTs show in restrictive lung disease
Brings air in and out - warms - humidifies - filters
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Loss of elastic fibers
FEV1/FVC > 80%

9. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Methylene blue
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Pa > PA > Pv
Surfactant def leading to inc surfact tension and alveolar collapse

10. Define physilogic dead space
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Inc EPO leading to erythrocytosis
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

11. What is tha hallmark finding of COPD
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
PVR = (PpulmA - PleftA)/CO
Dec in the FEV1/FVC
TB - apex

12. What is the pathology of ARDS
Dec in lung volumes - FVC - TLC
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Airway obstruction (shunt) 100% O2 does not improve PO2
Small airways

13. What is occupied in the space that would have been the left middle lobe
Surfactant
Heart
Dipalmatoyl phosphatidylcholine - decreases surface tension
Dec - no change

14. What are the causes of ischemia
Productive cough for greater than 3 months in at least 2 years
Acute/chronic inc in vent
Loss of blood flow - impeded arterial flow - reduced venous drainage
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

15. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Dec in the FEV1/FVC
Metastasis - breast - colon - prostate - bladder -
4 polypeptide subunits - 2 alpha and 2 beta
Tension pneumo - away from lesion

16. What happens to arterial PO2 in chronic lung disease and why
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
S. aureus or anaerobes
Dec - because physiologic shunt dec O2 extraction from ratio
Dorsiflexion of food leads to tender calf muscle

17. 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
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

18. What is the imaging test of choice for PE
Airway obstruction (shunt) 100% O2 does not improve PO2
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
IRV + TV
CT angio

19. What is the alveolar gas equation
Inc resistance leading to inc pressure
In between perfusion limited and diffusion limited
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Ciliated cells

20. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Airways close prematurely resulting in inc RV and dec FVC
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

21. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
Zone 3
0 - negative - prevents pneumothorax
Pa > PA > Pv
Zone 1

22. What is carboxyhemoglobin and What does it cause
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
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
FRC - inward pull of lung balanced by outward pull of chest wall

23. What is compliance and When is it decrease
Trachea and bronchi
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Ciliated cells
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

24. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Inc to meet O2 demand
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Pleural effusion

25. What changes in EPO occur at high altitude
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Hypertrophy of mucus secreting glands in the bronchioles

26. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Right lung - right main stem bronhus is wider and more vertical
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Opposites
L/S < 1.5

27. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
In between perfusion limited and diffusion limited
Chest pain - tachypnea and dyspnea
Tight jxns

28. At what PaO2 does hypoxemia begin
<75
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Dorsiflexion of food leads to tender calf muscle

29. What muscles are involved in breathing during exercise and What do they control
Right lung - right main stem bronhus is wider and more vertical
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Zone 1
Chronic hypoxic vasocxn

30. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Right lung - right main stem bronhus is wider and more vertical
Respiratory bronchioles - clear debris in alveoli - bronchi
Alpha1- antitrypsin def - also cirrhosis
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

31. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
500mL
Air in lung after maxmimal expiration - cannot be measured on spirometry

32. What lung product is deficient in neonatal RDS
Hypertrophy of mucus secreting glands in the bronchioles
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Right
Surfactant

33. What lobes are affected in silicosis
Upper lobes
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Apex of healthy lung
TB - silica disrupt phagolysosomes and impair MACS

34. What changes in lung volunes occur as a result of restrictive lung disease
L/S < 1.5
Dec in lung volumes - FVC - TLC
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Lost with alveolar walls

35. What is central sleep apnea
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
No respiratory effort
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Hypoxic vasocxn

36. What kind of emphysema is caused by smoking
Air that moves into lung with each quiet respiration
Centriacinar
Tissue hypoxia from dec O2 sat and dec O2 content
More indolent

37. What is the criteria for chronic bronchitis
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Productive cough for greater than 3 months in at least 2 years
Hypertrophy of mucus secreting glands in the bronchioles
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude

38. Chronic bronchitis is a disease of what kind of airways
Gland depth/total thickness of broncial wall - >50%
<75
Small airways
Dec - because physiologic shunt dec O2 extraction from ratio

39. What organism causes a lobar PNA and What are the characteristics
Type II cells
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Positive cooperativity and negative allostery - unlike myoglobin

40. What is an association and potential complication of paraseptal emphysema
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
CO - 200x
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Lower portion of right inferior lobe

41. What are the histological findings in asbestosis and what occupations are associated
Dec in the FEV1/FVC
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Carcinoid - carcinoid

42. What TX is the mother given before delivery - and what TXs are given to the infant
Upper lobes - cor pulmonale - caplan's syndrome
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Steroids to mom - artificial surfactant and thyroxine to neonate

43. What is another name for neonatal RDS
Dec dec in FEV1 - dec in FVC
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Hyaline membrane disease
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

44. Define vital capacity (VC)
Everything but RV - TV + IRV + ERV
Right shift - favors taut - low affinity for O2 - O2 unloading
Dec cross sectional area of pulm vasc bed
Drainage

45. What is the TX for small cell lung cancer
Inoperable - responsive to chemotherapy
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Clara cells - type II pneumocytes; multiple densitites on CXR
Small airways

46. What increases the risk of PDA in neonatal RDS
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Persistently low O2 tension
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude

47. What are the findings associated with sarcoidosis
IRV + TV + ERV + RV
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

48. What happens to bicarb once it is created in an RBC
Airway obstruction (shunt) 100% O2 does not improve PO2
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
FEV1/FVC > 80%
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

49. What is hemoglobin composed of...
4 polypeptide subunits - 2 alpha and 2 beta
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Type II pneumocytes - after week 35
Inc to meet O2 demand

50. What are the associations with bronchiectasis

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