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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 a consequence of pulm HTN
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Type II pneumocytes - after week 35

2. What is a lung abscess and What does usually result from
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Lung cancer
Upper lobes
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

3. What are the findings of chronic bronchitis
Upper lobes - cor pulmonale - caplan's syndrome
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Lowered

4. How does left to right shunt cause pulm HTN
Prostaglandins - histamine - ACE - kallikrein
Inc shear stress leading to endothelial injury
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Inc excretion of bicarb to compensate for respiratory alkalosis

5. What does pulm HTN result in
Bronchial obstruction - toward side of lesion
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
P = 2ST/radius
Dec in lung volumes - FVC - TLC

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

7. What is the pathology of chronic bronchitis
Hypertrophy of mucus secreting glands in the bronchioles
Respiratory effort against airway obstruction
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Inspiration by diaphragm - expiration is passive

8. What are the various causes of ARDS
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Inc resistance leading to inc pressure
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

9. What is the protein content an exudative pleural effusion and What are the potential causes
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Lowered
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Zone 3

10. What do PFTs show in restrictive lung disease
Chest pain - tachypnea and dyspnea
FEV1/FVC > 80%
Inc 2 -3- DPG - righward shift
Zone 3

11. In what cells do you find lamellar bodies
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Type II cells
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

12. Tumor secreting serotonin causes a syndrome with flushing - diarrhea - wheezing - salvation; fibrous deposits in the right heart valves may lead to tricuspid insuff - pulmonary stenosis - right heart failure - tumor and syndrome
Air in excess of tidal volume that moves into lung on maximal inspiration
Air in lung after maxmimal expiration - cannot be measured on spirometry
Person stops breathing for at least 10 seconds repeatedly during sleep
Carcinoid - carcinoid

13. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
Inc to meet O2 demand
Dec - no change
0 - negative - prevents pneumothorax
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

14. What enzyme increases activity in emphysema
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Elastase
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

15. What changes in V/Q throughout the lung during exercise
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Positive cooperativity and negative allostery - unlike myoglobin
Ratio from apex to base becomes more uniform

16. What is a typical tidal volume
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
500mL
Exposed collagen fibers provides impetus for clotting cascade

17. What are the 9 interstitial lung diseases

18. What is the protein content in a transudative pleural effusion and What are the potential causes
Pa > PA > Pv
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Dec in lung volumes - FVC - TLC
Bronchial obstruction - toward side of lesion

19. Which structures perforate the diaphragm and where
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Positive cooperativity and negative allostery - unlike myoglobin
Prematurity - maternal RDS - cesarean delivery
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

20. How does mitral stenosis cause pulm HTN
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Inc resistance leading to inc pressure
Milky fluid with inc TGs
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

21. What is the defect in panacinar emphysema - and what else do you see
Alpha1- antitrypsin def - also cirrhosis
N- terminus - carbaminohemoglobin
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Ciliated cells

22. What does ACE do
Exposed collagen fibers provides impetus for clotting cascade
Weight loss - CPAP - surgery
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Activates bradykinin

23. What drug therapy is used to augment the changes in bicarb exretion
Hypertrophy of mucus secreting glands in the bronchioles
Tight jxns
Inc mitochondria
Acetazolamide - inhibits CA and acidifies the blood

24. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Coal miner's - silicosis - abestosis
Mesothelioma - pleura - psammoma bodies
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Dec - no change

25. What is the main complication of therapeutic supplemental O2?
Retinopathy of maturity
Upper lobes - cor pulmonale - caplan's syndrome
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Pa > PA > Pv

26. How is pulmonary circulation characterized in terms of resistance and compliance
Low resistance and high compliance
Inc
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
It binds to Hb -

27. What is the cycle of idiopathic pulmonary fibrosis
Methylene blue
Repeated cycles of lung injury and wound healing with inc collagen
Surfactant
Airways close prematurely resulting in inc RV and dec FVC

28. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Heart
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
CT angio
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

29. Where does lung cancer met to...
Ivory white calcified pleural plaques
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Mesothelioma - pleura - psammoma bodies

30. Define physilogic 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
Milky fluid with inc TGs
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Clara cells - type II pneumocytes; multiple densitites on CXR

31. What is sleep apnea associated with
Prematurity - maternal RDS - cesarean delivery
Lowered
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

32. What changes in 2 -3 - DPG occur at high altitude
Air in excess of tidal volume that moves into lung on maximal inspiration
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Type II cells
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

33. What happens to O2 content and O2 sat as Hb falls
Loss of elastic fibers
Weight loss - CPAP - surgery
Dec - no change
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

34. In which zone of the lung is Pa > Pv >PA
Zone 3
DIC - especially postpartum
Type II pneumocytes - after week 35
Dec - due to lactic acidosis

35. What is used to treat methemoglobin
Surfactant def leading to inc surfact tension and alveolar collapse
Upper lobes
500mL
Methylene blue

36. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Zone 1
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Weight loss - CPAP - surgery

37. How happens to the proton from the rxn the created bicarb
Chest pain - tachypnea and dyspnea
Carcinoid - carcinoid
CO2 - acid/altitude - DPG - Exercise - Temperature
It binds to Hb -

38. What is the imaging test of choice for PE
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
More indolent
CT angio
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

39. What are curschmann's spirals
Shed epithelium from mucus plugs
FRC - inward pull of lung balanced by outward pull of chest wall
DIC - especially postpartum
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

40. Toxicities of what drugs include interstitial lung disease
Bleomycin - busulfan - anmiodorone
Tight jxns
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Loss of elastic fibers

41. Why do pts with emphysema exhale through pursed lips
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Inc airway pressure to prevent airway collapse during exhalation
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

42. What is the definition of sleep apnea
Lungs collapse inwards and chest wall spring out
Person stops breathing for at least 10 seconds repeatedly during sleep
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

43. Where are ventilation and perfusion highest in the lung - respectively
Both highest in the base
Deoxygenated blood - elastic walls
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

44. What does the law of Laplace state about tendency of alveoli to collapse
On expiration as radius dec
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Heart
Lost with alveolar walls

45. What are potential triggers for asthma
Apex of healthy lung
Tension pneumo - away from lesion
Inc to meet O2 demand
Viral - URIs - allergens and stress

46. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Right shift - favors taut - low affinity for O2 - O2 unloading
Inc mitochondria
Lowered

47. What is the pathology of asthma

48. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Inc mitochondria
FEV1/FVC > 80%
Gland depth/total thickness of broncial wall - >50%
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

49. What changes in lung volunes occur as a result of restrictive lung disease
Dec in lung volumes - FVC - TLC
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Apex of healthy lung

50. What are the potential TX for sleep apnea
Weight loss - CPAP - surgery
0 - negative - prevents pneumothorax
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning