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Respiratory
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Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
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 cells make surfactant and At what week is produced most abundantly
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Drainage
Type II pneumocytes - after week 35
2. Why is there eventual loss of capillary beds in emphysema
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Inc to meet O2 demand
FEV1/FVC > 80%
Lost with alveolar walls
3. What are the 3 reasons for an increased A- a gradient
Matched - =1 adequate gas exchange
Opposites
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Inspiration by diaphragm - expiration is passive
4. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Dec in the FEV1/FVC
5. What does the law of Laplace state about tendency of alveoli to collapse
On expiration as radius dec
Weight loss - CPAP - surgery
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Mesothelioma - pleura - psammoma bodies
6. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
Surfactant
Ratio from apex to base becomes more uniform
PA02 = 150 - PACO2/0.8
0 - negative - prevents pneumothorax
7. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Low resistance and high compliance
Inspiration by diaphragm - expiration is passive
S. aureus or anaerobes
Lobar PNA
8. What are the causes of hypoxemia
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Hypertrophy of mucus secreting glands in the bronchioles
<60
9. What is a lung abscess and What does usually result from
20.1 mL O2 /dL
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
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
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
10. Where do you find type I cells - What is their morphology - and What do they do
Respiratory effort against airway obstruction
Tight jxns
Zone 1
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
11. What is are the symptoms of a pulmonary embolism
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Steroids to mom - artificial surfactant and thyroxine to neonate
IRV + TV + ERV + RV
Chest pain - tachypnea and dyspnea
12. What does ACE do
CO - 200x
Methacholine challenge
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
13. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Acetazolamide - inhibits CA and acidifies the blood
Squamous cell carcinoma - keratin pearls and intracellular bridges
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Superior portion of right inferior lobe
14. What does a V/Q ratio of infinity indicate
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
CO - 200x
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
15. Define physilogic dead space
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Lost with alveolar walls
0 - negative - prevents pneumothorax
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
16. What does the conducting zone consist of...
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Clara cells - type II pneumocytes; multiple densitites on CXR
Everything but RV - TV + IRV + ERV
17. Why is endothelial damage a risk factor for DVT
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Lowered
Exposed collagen fibers provides impetus for clotting cascade
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
18. What is the pathology of ARDS
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Ciliated cells
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
19. What are the SPHERE of complications in lung cancer
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
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
O2 binding x O2 sat + dissolved O2
Shunting
20. What doe FAT BAT stand for
Right
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
21. How does sleep apnea or high altitude cause pulm HTN
Defect in coagulative cascace proteins
Hypoxic vasocxn
Inspiration by diaphragm - expiration is passive
It binds to Hb -
22. How many lobes does each lung have - and What is the lingula
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Lower portion of right inferior lobe
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
23. What are the causes of hypoxia
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
L/S < 1.5
Pleural effusion
500mL
24. What happens to arterial PO2 in chronic lung disease and why
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Dec - because physiologic shunt dec O2 extraction from ratio
25. What is the criteria for chronic bronchitis
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Loss of blood flow - impeded arterial flow - reduced venous drainage
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Productive cough for greater than 3 months in at least 2 years
26. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
20.1 mL O2 /dL
Mesothelioma - pleura - psammoma bodies
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
27. Where is cartilage present in the respiratory tree
Dec
Person stops breathing for at least 10 seconds repeatedly during sleep
Trachea and bronchi
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
28. What changes in 2 -3 - DPG occur at high altitude
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
S. aureus or anaerobes
PA02 = 150 - PACO2/0.8
Pleural effusion
29. What does decreased PAO2 do
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Deoxygenated blood - elastic walls
Exposed collagen fibers provides impetus for clotting cascade
Metastasis - breast - colon - prostate - bladder -
30. What changes at high altitude can result in RVH
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Chronic hypoxic vasocxn
31. What is a typical tidal volume
500mL
Inc airway pressure to prevent airway collapse during exhalation
Persistently low O2 tension
Air in lung after maxmimal expiration - cannot be measured on spirometry
32. At What terminal does CO2 bind the globin molecule
N- terminus - carbaminohemoglobin
FRC - inward pull of lung balanced by outward pull of chest wall
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
33. What causes secondary pulm HTN
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Small airways
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
34. What is a consequence of pulm HTN
Type II pneumocytes - after week 35
L/S < 1.5
Inc 2 -3- DPG - righward shift
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
35. What are the potential TX for sleep apnea
High alveolar pressure compresses capillaries
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Weight loss - CPAP - surgery
Inc EPO leading to erythrocytosis
36. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Alpha1- antitrypsin def - also cirrhosis
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
37. What is the alveolar gas equation approximation
O2 binding x O2 sat + dissolved O2
Upper lobes
Air that moves into lung with each quiet respiration
PA02 = 150 - PACO2/0.8
38. Define residual volume (RV)
PVR = (PpulmA - PleftA)/CO
Air in lung after maxmimal expiration - cannot be measured on spirometry
Inc due to inc CO
L/S > 2 = lecithin/sphingomyelin
39. What changes in lung volunes occur as a result of restrictive lung disease
Inc excretion of bicarb to compensate for respiratory alkalosis
Prostaglandins - histamine - ACE - kallikrein
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Dec in lung volumes - FVC - TLC
40. 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
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Tissue hypoxia from dec O2 sat and dec O2 content
Carcinoid - carcinoid
Hypoxic vasocxn
41. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Inc 2 -3- DPG - righward shift
Inc mitochondria
Surfactant
42. What are the risk factors for neonatal RDS
High alveolar pressure compresses capillaries
Elastic properties
Lower portion of right inferior lobe
Prematurity - maternal RDS - cesarean delivery
43. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
Defect in coagulative cascace proteins
Deoxygenated blood - elastic walls
RALS - righ anterior - left superior
Hypertrophy of mucus secreting glands in the bronchioles
44. What lobes are affected in silicosis
Lost with alveolar walls
Upper lobes
Inspiration by diaphragm - expiration is passive
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
45. What reaction and enzyme create bicarb and Where does it happen
Dec - no change
L/S > 2 = lecithin/sphingomyelin
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Air in excess of tidal volume that moves into lung on maximal inspiration
46. What is pulmonary surfactant made of - and What does it do
Dipalmatoyl phosphatidylcholine - decreases surface tension
Loss of blood flow - impeded arterial flow - reduced venous drainage
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Inc 2 -3- DPG - righward shift
47. Which structures perforate the diaphragm and where
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Chest pain - tachypnea and dyspnea
Dipalmatoyl phosphatidylcholine
48. What does alveolar pressure do to capillaries in the apex of the lung
<75
High alveolar pressure compresses capillaries
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
49. In what cells do you find lamellar bodies
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Type II cells
Shed epithelium from mucus plugs
50. What is carboxyhemoglobin and What does it cause
L/S > 2 = lecithin/sphingomyelin
Carcinoid - carcinoid
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
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
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