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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 does the conducting zone consist of...
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Mismatch
Positive cooperativity and negative allostery - unlike myoglobin
Chronic hypoxic vasocxn

2. What is the formula for oxygen delivery to tissues
N- terminus - carbaminohemoglobin
Exposed collagen fibers provides impetus for clotting cascade
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
CO x O2 content of blood

3. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
RALS - righ anterior - left superior
Stasis - hypercoagulability - endothelial damage
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Dec - due to lactic acidosis

4. How many lobes does each lung have - and What is the lingula
Elastase
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 PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

5. What changes occur to pulm blood flow during exercise
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Airways close prematurely resulting in inc RV and dec FVC
Inc due to inc CO

6. Define vital capacity (VC)
Bronchial obstruction - toward side of lesion
Lowered
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Everything but RV - TV + IRV + ERV

7. What is carboxyhemoglobin and What does it cause
Hypertrophy of mucus secreting glands in the bronchioles
Repeated cycles of lung injury and wound healing with inc collagen
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
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

8. What lobes are affected in silicosis
Upper lobes
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Respiratory effort against airway obstruction

9. Why is cesarean delivery a risk factor for neonatal RDS
Weight loss - CPAP - surgery
Dec release of fetal glucocorticoids
PA02 = 150 - PACO2/0.8
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

10. What is the pathology of emphysema
Tight jxns
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
N- terminus - carbaminohemoglobin

11. What changes in lung volunes occur as a result of restrictive lung disease
<75
Dec in lung volumes - FVC - TLC
Type II pneumocytes - after week 35
Acute/chronic inc in vent

12. What is the defect in panacinar emphysema - and what else do you see
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Alpha1- antitrypsin def - also cirrhosis
Air that moves into lung with each quiet respiration

13. What are the lab/study findings in adenocarcinoma of the lung
Lung cancer
Chroniclly tired
Clara cells - type II pneumocytes; multiple densitites on CXR
Activates bradykinin

14. What is the leading cause of cancer death
Prostaglandins - histamine - ACE - kallikrein
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Prematurity - maternal RDS - cesarean delivery
Lung cancer

15. What lung product is deficient in neonatal RDS
RV + ERV - volume in lungs after nl expiration
Surfactant
Inc resistance leading to inc pressure
Retinopathy of maturity

16. What is virchow's triad
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Stasis - hypercoagulability - endothelial damage
Heparin
CT angio

17. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Dec dec in FEV1 - dec in FVC
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Tension pneumo - away from lesion
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

18. What is the alveolar gas equation
Everything but RV - TV + IRV + ERV
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Respiratory effort against airway obstruction
Dec release of fetal glucocorticoids

19. 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
Mesothelioma - pleura - psammoma bodies
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

20. Chronic bronchitis is a disease of what kind of airways
Small airways
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Inspiration by diaphragm - expiration is passive

21. What direction does an increase in metabolic need shift the O2 dissociation curve
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Right
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Methacholine challenge

22. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Pa > PA > Pv
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
TB - silica disrupt phagolysosomes and impair MACS
Type II cells

23. What are the 3 forms that CO2 is transported from tissues to lungs
Air in excess of tidal volume that moves into lung on maximal inspiration
Ciliated cells
Zone 3
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

24. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Upper lobes - cor pulmonale - caplan's syndrome
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
FRC - inward pull of lung balanced by outward pull of chest wall
Centriacinar

25. What is the equation for physiologic dead space
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Elastase
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

26. In which zone of the lung is Pa > Pv >PA
Zone 3
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
Lungs collapse inwards and chest wall spring out
Incr - right - dec - left

27. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Pa > PA > Pv
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Mesothelioma - pleura - psammoma bodies
Prostaglandins - histamine - ACE - kallikrein

28. How does left to right shunt cause pulm HTN
Mismatch
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Milky fluid with inc TGs
Inc shear stress leading to endothelial injury

29. What changes in O2 consumption change during exercise
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Inc O2 consumption

30. What is the presentation of lung cancer

31. What is positive cooperativity of hemoglobin refer to...
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Steroids to mom - artificial surfactant and thyroxine to neonate
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging

32. What organism thrives in high O2 and where in the lung does it flourish
TB - apex
Type II cells
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Pleural effusion

33. What is fetal hemoglobin made of and why does it have a higher affinity for O2
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Right
Heart

34. What is a chronic complication of sleep apnea
Chroniclly tired
Histiocytosis X - Langerhans cells
In between perfusion limited and diffusion limited
Inspiration by diaphragm - expiration is passive

35. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Deep leg veins
Inc 2 -3- DPG - righward shift
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Surfactant

36. What must occur with a exudate pleural effusion
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
High alveolar pressure compresses capillaries
Drainage
Dipalmatoyl phosphatidylcholine - decreases surface tension

37. Which lung is the more common site for an inhaled foreign body and why
Right lung - right main stem bronhus is wider and more vertical
Zone 1
Dec
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

38. In which zone of the lung is PA > Pa > Pv
500mL
Loss of elastic fibers
Persistently low O2 tension
Zone 1

39. What is early onset hypoxemia from in chronic bronchitis
Shunting
Right lung - right main stem bronhus is wider and more vertical
Lowered
Surfactant

40. What is the formula for collapsing pressure
Zone 1
Respiratory effort against airway obstruction
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
P = 2ST/radius

41. What is obstructive sleep apnea
Respiratory effort against airway obstruction
Matched - =1 adequate gas exchange
Inc resistance leading to inc pressure
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

42. What are the two forms of hemoglobin
Lowered
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
<60
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

43. What is the characteristic lymphatic pleural effusion
Milky fluid with inc TGs
Defect in coagulative cascace proteins
0 - negative - prevents pneumothorax
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

44. What is a potential test for asthma
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Methacholine challenge
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
S. aureus or anaerobes

45. What ratio is used to measure lung maturity and What is the value is neonatal RDS
L/S < 1.5
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
More indolent
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

46. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Lost with alveolar walls
CT angio
Inc excretion of bicarb to compensate for respiratory alkalosis

47. What is the definition of sleep apnea
Mesothelioma - pleura - psammoma bodies
Person stops breathing for at least 10 seconds repeatedly during sleep
RALS - righ anterior - left superior
Everything but RV - TV + IRV + ERV

48. What is the fxn of the conducting zone
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
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
4 polypeptide subunits - 2 alpha and 2 beta
Brings air in and out - warms - humidifies - filters

49. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Drainage
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

50. What increases the risk of PDA in neonatal RDS
Air in lung after maxmimal expiration - cannot be measured on spirometry
Mesothelioma - pleura - psammoma bodies
Persistently low O2 tension
Low resistance and high compliance