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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 hemoglobin composed of...
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
4 polypeptide subunits - 2 alpha and 2 beta

2. What kind of course does interstitial PNA follow in comparison to bronchoPNA
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
DIC - especially postpartum
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
More indolent

3. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

4. What lab ration indicates fetal lung maturity
RV + ERV - volume in lungs after nl expiration
L/S > 2 = lecithin/sphingomyelin
Heparin
Matched - =1 adequate gas exchange

5. What drug therapy is used to augment the changes in bicarb exretion
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Inc EPO leading to erythrocytosis
Acetazolamide - inhibits CA and acidifies the blood
Lower portion of right inferior lobe

6. What must occur with a exudate pleural effusion
Drainage
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Inc shear stress leading to endothelial injury
Inc EPO leading to erythrocytosis

7. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Hypertrophy of mucus secreting glands in the bronchioles
Type II cells
Chroniclly tired
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

8. What direction does an increase in metabolic need shift the O2 dissociation curve
Right shift - favors taut - low affinity for O2 - O2 unloading
Clara cells - type II pneumocytes; multiple densitites on CXR
Right
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

9. In COPD - what happens to airways at high lung volumes
Airways close prematurely resulting in inc RV and dec FVC
Lower portion of right inferior lobe
Low resistance and high compliance
Clara cells - type II pneumocytes; multiple densitites on CXR

10. What is the course of of pulm HTN
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Histiocytosis X - Langerhans cells
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging

11. What is compliance and When is it decrease
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Dec in lung volumes - FVC - TLC
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

12. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Alchoholics or epileptics
No change - but inc venous CO2 content

13. What does decreased PAO2 do
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
CO2 - acid/altitude - DPG - Exercise - Temperature
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Lower portion of right inferior lobe

14. What is the formula for pulm vasc resistance
PVR = (PpulmA - PleftA)/CO
Inspiration by diaphragm - expiration is passive
Carcinoid - carcinoid
Lobar PNA

15. What does each bronchopulmonary segment have in the center and along its border
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Dec dec in FEV1 - dec in FVC
Right lung - right main stem bronhus is wider and more vertical
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

16. What does the respiratory zone consist of and What is its fxn
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Tissue hypoxia from dec O2 sat and dec O2 content
Prematurity - maternal RDS - cesarean delivery
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

17. What is early onset hypoxemia from in chronic bronchitis
Shunting
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Dorsiflexion of food leads to tender calf muscle
Incr - right - dec - left

18. What are the causes of hypoxia
L/S > 2 = lecithin/sphingomyelin
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
C3 - 4 - 6 - phrenic nerve - referred to shoulder

19. What is occupied in the space that would have been the left middle lobe
Heart
Dec
Weight loss - CPAP - surgery
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

20. What are the risk factors for neonatal RDS
Inc to meet O2 demand
Inspiration by diaphragm - expiration is passive
Prematurity - maternal RDS - cesarean delivery
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

21. What kind of connection exists between endothelial cells in the capilaries
Tight jxns
Upper lobes
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Methylene blue

22. What is the formula for collapsing pressure
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
P = 2ST/radius
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Inc resistance leading to inc pressure

23. What are the causes of ischemia
Inoperable - responsive to chemotherapy
No change - but inc venous CO2 content
Loss of blood flow - impeded arterial flow - reduced venous drainage
S. aureus or anaerobes

24. What do hemoglobin modifacations lead to...
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
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
Tissue hypoxia from dec O2 sat and dec O2 content

25. What do PFTs show in restrictive lung disease
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
FEV1/FVC > 80%
<60

26. How does mitral stenosis cause pulm HTN
Mismatch
Inc resistance leading to inc pressure
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 protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

27. Why do pts with emphysema exhale through pursed lips
Dorsiflexion of food leads to tender calf muscle
Inc airway pressure to prevent airway collapse during exhalation
Dec - no change
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude

28. What is the formula for resistance
Defect in coagulative cascace proteins
Dec in lung volumes - FVC - TLC
Superior portion of right inferior lobe
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

29. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
IRV + TV
Repeated cycles of lung injury and wound healing with inc collagen
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

30. What is carboxyhemoglobin and What does it cause
Lowered
Lost with alveolar walls
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
RV + ERV - volume in lungs after nl expiration

31. What is the Reid index and what perfectange is characteristic of chronic bronchitis
No respiratory effort
S. aureus or anaerobes
More indolent
Gland depth/total thickness of broncial wall - >50%

32. What is virchow's triad
20.1 mL O2 /dL
Stasis - hypercoagulability - endothelial damage
IRV + TV + ERV + RV
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

33. Which has a greater affinity for hemoglobin - CO or O2 and by how much
CO - 200x
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Air that moves into lung with each quiet respiration
Ivory white calcified pleural plaques

34. What is the fxn of the conducting zone
Upper lobes
O2 binding x O2 sat + dissolved O2
Brings air in and out - warms - humidifies - filters
Inc resistance leading to inc pressure

35. What changes at high altitude can result in RVH
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Inc EPO leading to erythrocytosis
S. aureus or anaerobes
Chronic hypoxic vasocxn

36. What organisms cause a bronchoPNA and What are the characteristics
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
No respiratory effort
Tension pneumo - away from lesion
Heart

37. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Respiratory bronchioles - clear debris in alveoli - bronchi
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Brings air in and out - warms - humidifies - filters

38. What kind of emphysema is caused by smoking
More indolent
Centriacinar
Tension pneumo - away from lesion
Ciliated cells

39. Why is cesarean delivery a risk factor for neonatal RDS
Defect in coagulative cascace proteins
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
P = 2ST/radius
Dec release of fetal glucocorticoids

40. What does a V/Q ratio of infinity indicate
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
<60
Everything but RV - TV + IRV + ERV
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

41. What happens to V/Q ratio in COPD
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
L/S > 2 = lecithin/sphingomyelin
Mismatch
Right lung - right main stem bronhus is wider and more vertical

42. What are the findings in asthma
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Low resistance and high compliance

43. What is a typical tidal volume
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
500mL
Exposed collagen fibers provides impetus for clotting cascade
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

44. What is the most common cancerous lesion in the lun
Repeated cycles of lung injury and wound healing with inc collagen
Metastasis - breast - colon - prostate - bladder -
Lost with alveolar walls
Productive cough for greater than 3 months in at least 2 years

45. At What terminal does CO2 bind the globin molecule
20.1 mL O2 /dL
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
N- terminus - carbaminohemoglobin

46. In what cells do you find lamellar bodies
Mismatch
Inc 2 -3- DPG - righward shift
Type II cells
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

47. How many lobes does each lung have - and What is the lingula
Upper lobes - cor pulmonale - caplan's syndrome
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Upper lobes
<60

48. Toxicities of what drugs include interstitial lung disease
L/S > 2 = lecithin/sphingomyelin
Long bone fractures and liposuction
Bleomycin - busulfan - anmiodorone
Lowered

49. What area of the lung is the largest physiologic contributor of fxnal dead space
Inc resistance leading to inc pressure
TB - silica disrupt phagolysosomes and impair MACS
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
Apex of healthy lung

50. What is are the symptoms of a pulmonary embolism
DIC - especially postpartum
Lost with alveolar walls
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Chest pain - tachypnea and dyspnea