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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 the cycle of idiopathic pulmonary fibrosis
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Repeated cycles of lung injury and wound healing with inc collagen
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
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

2. What does CADET face to the right stand for
Air that can still be breathed out after nl expiration
Type II pneumocytes - after week 35
CO2 - acid/altitude - DPG - Exercise - Temperature
Dec dec in FEV1 - dec in FVC

3. What are the 3 reasons for an increased A- a gradient
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
CO2 - acid/altitude - DPG - Exercise - Temperature
Retinopathy of maturity

4. What is the response for ventilation of high altitude
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
DIC - especially postpartum
Acute/chronic inc in vent
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

5. What is occupied in the space that would have been the left middle lobe
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Heart

6. How do you prevent DVT
Alchoholics or epileptics
Viral - URIs - allergens and stress
Heparin
Mismatch

7. What kind of course does interstitial PNA follow in comparison to bronchoPNA
More indolent
No respiratory effort
Productive cough for greater than 3 months in at least 2 years
CO2 - acid/altitude - DPG - Exercise - Temperature

8. What area of the lung is the largest physiologic contributor of fxnal dead space
Apex of healthy lung
Steroids to mom - artificial surfactant and thyroxine to neonate
Inc
0 - negative - prevents pneumothorax

9. Define total lung capcaity
Pleural effusion
IRV + TV + ERV + RV
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

10. What increases the risk of PDA in neonatal RDS
FRC - inward pull of lung balanced by outward pull of chest wall
Persistently low O2 tension
Inc to meet O2 demand
It binds to Hb -

11. What is the imaging test of choice for PE
CT angio
Upper lobes
PA02 = 150 - PACO2/0.8
Anatomic dead space and smooth muscle

12. What is a potential test for asthma
Methacholine challenge
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Right
Right shift - favors taut - low affinity for O2 - O2 unloading

13. Where do you find type I cells - What is their morphology - and What do they do
Dorsiflexion of food leads to tender calf muscle
Prematurity - maternal RDS - cesarean delivery
0 - negative - prevents pneumothorax
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

14. At what lung volume is system pressure atmospheric and why
Metastasis - breast - colon - prostate - bladder -
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
FRC - inward pull of lung balanced by outward pull of chest wall

15. What is hemoglobin composed of...
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
4 polypeptide subunits - 2 alpha and 2 beta
Trachea and bronchi
Lowered

16. What TX is the mother given before delivery - and what TXs are given to the infant
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Steroids to mom - artificial surfactant and thyroxine to neonate
Deoxygenated blood - elastic walls
Dec release of fetal glucocorticoids

17. What cellular changes occur at high altitude
Zone 1
Inc mitochondria
Inc EPO leading to erythrocytosis
Dec - no change

18. What is a chronic complication of sleep apnea
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Both highest in the base
Lung cancer
Chroniclly tired

19. What renal changes occur at high altitude and What are they compensating for
No respiratory effort
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Inc excretion of bicarb to compensate for respiratory alkalosis
Dec in the FEV1/FVC

20. How does left to right shunt cause pulm HTN
O2 binding x O2 sat + dissolved O2
Tension pneumo - away from lesion
Inc shear stress leading to endothelial injury
Inc excretion of bicarb to compensate for respiratory alkalosis

21. Where is cartilage present in the respiratory tree
Inc mitochondria
Lobar PNA
Inc resistance leading to inc pressure
Trachea and bronchi

22. What changes in lung volunes occur as a result of restrictive lung disease
On expiration as radius dec
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Dec in lung volumes - FVC - TLC
Acetazolamide - inhibits CA and acidifies the blood

23. What kind of space is in the conducting tree and what kind of muscle exists there
O2 binding x O2 sat + dissolved O2
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Anatomic dead space and smooth muscle
500mL

24. What are the potential TX for sleep apnea
Chronic hypoxic vasocxn
Weight loss - CPAP - surgery
Inc EPO leading to erythrocytosis
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

25. What is the alveolar gas equation
Long bone fractures and liposuction
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Viral - URIs - allergens and stress
Brings air in and out - warms - humidifies - filters

26. Define physilogic dead space
Alpha1- antitrypsin def - also cirrhosis
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
FEV1/FVC > 80%
RV + ERV - volume in lungs after nl expiration

27. What is are the symptoms of a pulmonary embolism
Alpha1- antitrypsin def - also cirrhosis
Mesothelioma - pleura - psammoma bodies
Chest pain - tachypnea and dyspnea
Positive cooperativity and negative allostery - unlike myoglobin

28. What doe FAT BAT stand for
L/S < 1.5
DIC - especially postpartum
4 polypeptide subunits - 2 alpha and 2 beta
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

29. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Inc EPO leading to erythrocytosis
Chroniclly tired
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Inc 2 -3- DPG - righward shift

30. What drug therapy is used to augment the changes in bicarb exretion
S. aureus or anaerobes
Lower portion of right inferior lobe
Acetazolamide - inhibits CA and acidifies the blood
Positive cooperativity and negative allostery - unlike myoglobin

31. What is the V/Q ratio at the apex and base of the lung
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
TB - apex
Bleomycin - busulfan - anmiodorone
Viral - URIs - allergens and stress

32. What do hemoglobin modifacations lead to...
Methacholine challenge
Lowered
Tissue hypoxia from dec O2 sat and dec O2 content
20.1 mL O2 /dL

33. What are the findings in asthma
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Small airways
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
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

34. What does a V/Q ratio of 0 indicate
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Squamous cell carcinoma - keratin pearls and intracellular bridges
Elastase
Airway obstruction (shunt) 100% O2 does not improve PO2

35. In which zone of the lung is Pa > Pv >PA
Tissue hypoxia from dec O2 sat and dec O2 content
Zone 3
Ivory white calcified pleural plaques
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

36. Define expiratory reserve volume (ERV)
Centriacinar
Air that can still be breathed out after nl expiration
Heart
Elastic properties

37. What does the conducting zone consist of...
Inc due to inc CO
0 - negative - prevents pneumothorax
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Histiocytosis X - Langerhans cells

38. What is a typical tidal volume
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Exposed collagen fibers provides impetus for clotting cascade
500mL

39. What are the subtypes of pneumoconioses

40. What is used to treat CN poisoning and why
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
Right shift - favors taut - low affinity for O2 - O2 unloading
4 polypeptide subunits - 2 alpha and 2 beta
Air in lung after maxmimal expiration - cannot be measured on spirometry

41. What causes primary pulm HTN
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
S. aureus or anaerobes
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Dec

42. What layers must CO2 and O2 traverse to complete gas exchange
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

43. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Repeated cycles of lung injury and wound healing with inc collagen
Prematurity - maternal RDS - cesarean delivery
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Pleural effusion

44. What are the SPHERE of complications in lung cancer
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Ciliated cells
Prostaglandins - histamine - ACE - kallikrein
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

45. Which pts are at risk for apriation PNA
Alchoholics or epileptics
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Dec
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

46. What is the formula for pulm vasc resistance
Lungs collapse inwards and chest wall spring out
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
PVR = (PpulmA - PleftA)/CO
TB - silica disrupt phagolysosomes and impair MACS

47. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
More indolent
Activates bradykinin
Right
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

48. Why do pts with emphysema exhale through pursed lips
Inc airway pressure to prevent airway collapse during exhalation
Right
PAO2 - PaO2 = 10-15 mmHg
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

49. What does decreased PAO2 do
Heparin
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Small airways
Incr - right - dec - left

50. What changes in pH occur during strenuous exercise and why
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Lowered
Chroniclly tired
Dec - due to lactic acidosis