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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 used to treat CN poisoning and why
Inc 2 -3- DPG - righward shift
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
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
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

2. What happens to arterial PO2 in chronic lung disease and why
Inc production
PVR = (PpulmA - PleftA)/CO
Dec - because physiologic shunt dec O2 extraction from ratio
Tissue hypoxia from dec O2 sat and dec O2 content

3. What can amniotic fluid emboli lead to...
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
DIC - especially postpartum
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

4. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Respiratory effort against airway obstruction
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Tissue hypoxia from dec O2 sat and dec O2 content
Inc to meet O2 demand

5. What is the formula for A- a gradient - and What is it normally
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
PAO2 - PaO2 = 10-15 mmHg
Viral - URIs - allergens and stress
Tension pneumo - away from lesion

6. What area of the lung is the largest physiologic contributor of fxnal dead space
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Apex of healthy lung
Squamous cell carcinoma - keratin pearls and intracellular bridges
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

7. A carcinoma in the apex of the lung can cause what syndrome and What is the tumor called

8. Other than surfactant - what other important substances are produced by the lungs
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Prostaglandins - histamine - ACE - kallikrein
Productive cough for greater than 3 months in at least 2 years
Dorsiflexion of food leads to tender calf muscle

9. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Long bone fractures and liposuction
Matched - =1 adequate gas exchange
Chroniclly tired
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

10. What are the two forms of hemoglobin
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Histiocytosis X - Langerhans cells
Everything but RV - TV + IRV + ERV

11. What cellular changes occur at high altitude
Dipalmatoyl phosphatidylcholine
Anatomic dead space and smooth muscle
Inc mitochondria
Right lung - right main stem bronhus is wider and more vertical

12. Define expiratory reserve volume (ERV)
Air that can still be breathed out after nl expiration
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Gland depth/total thickness of broncial wall - >50%
CO2 - acid/altitude - DPG - Exercise - Temperature

13. What happens in perfusion limited circulatioin and which gases does this apply to...
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Chest pain - tachypnea and dyspnea
Methacholine challenge
Histiocytosis X - Langerhans cells

14. What is the alveolar gas equation
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Acetazolamide - inhibits CA and acidifies the blood
Prostaglandins - histamine - ACE - kallikrein
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

15. What is the characteristic lymphatic pleural effusion
Milky fluid with inc TGs
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
PAO2 - PaO2 = 10-15 mmHg
Ivory white calcified pleural plaques

16. What does pulm HTN result in
Zone 1
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Pleural effusion
Trachea and bronchi

17. What is the formula for O2 content
Airway obstruction (shunt) 100% O2 does not improve PO2
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
O2 binding x O2 sat + dissolved O2

18. What is the formula for pulm vasc resistance
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
PVR = (PpulmA - PleftA)/CO
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

19. What is a lung abscess and What does usually result from
CO - 200x
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Shed epithelium from mucus plugs
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

20. What changes in O2 consumption change during exercise
No change - but inc venous CO2 content
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Inc O2 consumption

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

22. What kind of connection exists between endothelial cells in the capilaries
Tight jxns
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Shunting
Drainage

23. What increases the risk of PDA in neonatal RDS
Persistently low O2 tension
Deep leg veins
Drainage
Inc resistance leading to inc pressure

24. What are the various causes of ARDS
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

25. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Inc to meet O2 demand
Incr - right - dec - left
Tight jxns
Histiocytosis X - Langerhans cells

26. What are the causes of ischemia
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Loss of blood flow - impeded arterial flow - reduced venous drainage
DIC - especially postpartum

27. What are potential triggers for asthma
Respiratory effort against airway obstruction
Fe 2+
Viral - URIs - allergens and stress
CO - 200x

28. What must occur with a exudate pleural effusion
PAO2 - PaO2 = 10-15 mmHg
Drainage
O2 binding x O2 sat + dissolved O2
Long bone fractures and liposuction

29. What kind of emphysema is caused by smoking
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Centriacinar
RALS - righ anterior - left superior
In between perfusion limited and diffusion limited

30. What is fetal hemoglobin made of and why does it have a higher affinity for O2
Incr - right - dec - left
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Prematurity - maternal RDS - cesarean delivery
Mesothelioma - pleura - psammoma bodies

31. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

32. What are the 3 reasons for an increased A- a gradient
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Persistently low O2 tension
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

33. How does left to right shunt cause pulm HTN
Inc shear stress leading to endothelial injury
Chest pain - tachypnea and dyspnea
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Lowered

34. What is an association and potential complication of paraseptal emphysema
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
IRV + TV

35. At what lung volume is system pressure atmospheric and why
FRC - inward pull of lung balanced by outward pull of chest wall
Histiocytosis X - Langerhans cells
Everything but RV - TV + IRV + ERV
Air that moves into lung with each quiet respiration

36. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Inc 2 -3- DPG - righward shift
Airways close prematurely resulting in inc RV and dec FVC
Right shift - favors taut - low affinity for O2 - O2 unloading
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

37. What is the pathology of chronic bronchitis
Hypertrophy of mucus secreting glands in the bronchioles
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

38. Where does lung cancer met to...
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Matched - =1 adequate gas exchange
Loss of elastic fibers
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

39. Define total lung capcaity
RALS - righ anterior - left superior
IRV + TV + ERV + RV
Long bone fractures and liposuction
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

40. What happens as a result of hypoxia in sleep apnea
Anatomic dead space and smooth muscle
Lost with alveolar walls
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Inc EPO leading to erythrocytosis

41. Why do pts with emphysema exhale through pursed lips
DIC - especially postpartum
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Inc airway pressure to prevent airway collapse during exhalation
FRC - inward pull of lung balanced by outward pull of chest wall

42. What changes in V/Q throughout the lung during exercise
Ratio from apex to base becomes more uniform
Mesothelioma - pleura - psammoma bodies
RV + ERV - volume in lungs after nl expiration
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

43. Where do 95% of PE arise from
Inc production
Deep leg veins
Low resistance and high compliance
Superior portion of right inferior lobe

44. What are the findings in asthma
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Inc O2 consumption
Deep leg veins
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

45. What changes occur to pulm blood flow during exercise
TB - silica disrupt phagolysosomes and impair MACS
Inc due to inc CO
Ratio from apex to base becomes more uniform
Type II pneumocytes - after week 35

46. If you aspirate a peanut while supine - where will it go
Superior portion of right inferior lobe
Retinopathy of maturity
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Air in lung after maxmimal expiration - cannot be measured on spirometry

47. Where do you find type I cells - What is their morphology - and What do they do
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
IRV + TV + ERV + RV
Inc production
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

48. What muscles are involved in breathing during exercise and What do they control
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Stasis - hypercoagulability - endothelial damage
Inc resistance leading to inc pressure

49. What changes in CO2 occur during exercise
Hyaline membrane disease
Inc production
Inc EPO leading to erythrocytosis
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

50. Define inspiratory reserve volume (IRV)
Prostaglandins - histamine - ACE - kallikrein
Dec dec in FEV1 - dec in FVC
Air in excess of tidal volume that moves into lung on maximal inspiration
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals