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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 Reid index and what perfectange is characteristic of chronic bronchitis
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Weight loss - CPAP - surgery
Gland depth/total thickness of broncial wall - >50%
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

2. What doe FAT BAT stand for
Dec - no change
S. aureus or anaerobes
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Anatomic dead space and smooth muscle

3. What kind of connection exists between endothelial cells in the capilaries
Bronchial obstruction - toward side of lesion
Tight jxns
0 - negative - prevents pneumothorax
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

4. What is a potential test for asthma
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Bronchial obstruction - toward side of lesion
Methacholine challenge
Milky fluid with inc TGs

5. What causes primary pulm HTN
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Dipalmatoyl phosphatidylcholine

6. What is a typical tidal volume
Incr - right - dec - left
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
500mL
Heparin

7. What are the SPHERE of complications in lung cancer
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
0 - negative - prevents pneumothorax
Respiratory bronchioles - clear debris in alveoli - bronchi
Stasis - hypercoagulability - endothelial damage

8. What is carboxyhemoglobin and What does it cause
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
No respiratory effort
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

9. What changes in O2 consumption change during exercise
Right lung - right main stem bronhus is wider and more vertical
Inc O2 consumption
Type II pneumocytes - after week 35
Upper lobes

10. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
FRC - inward pull of lung balanced by outward pull of chest wall
Pleural effusion
Viral - URIs - allergens and stress
Inc 2 -3- DPG - righward shift

11. How does autoimmune dz cause thromboemboli
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
No respiratory effort
Brings air in and out - warms - humidifies - filters

12. What happens in perfusion limited circulatioin and which gases does this apply to...
Inc resistance leading to inc pressure
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Hypertrophy of mucus secreting glands in the bronchioles
O2 binding x O2 sat + dissolved O2

13. What is the defect in panacinar emphysema - and what else do you see
Repeated cycles of lung injury and wound healing with inc collagen
Alpha1- antitrypsin def - also cirrhosis
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

14. Lung absecss often reults From what organisms
Loss of blood flow - impeded arterial flow - reduced venous drainage
Acute/chronic inc in vent
Dec in lung volumes - FVC - TLC
S. aureus or anaerobes

15. What area of the lung is the largest physiologic contributor of fxnal dead space
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Dorsiflexion of food leads to tender calf muscle
Apex of healthy lung
FRC - inward pull of lung balanced by outward pull of chest wall

16. What does CADET face to the right stand for
CO2 - acid/altitude - DPG - Exercise - Temperature
Right
Histiocytosis X - Langerhans cells
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

17. What is central sleep apnea
Acute/chronic inc in vent
No respiratory effort
Inc resistance leading to inc pressure
Retinopathy of maturity

18. What is fetal hemoglobin made of and why does it have a higher affinity for O2
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Incr - right - dec - left

19. Where does lung cancer met to...
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Methylene blue
Prematurity - maternal RDS - cesarean delivery
Deep leg veins

20. What is the V/Q ratio at the apex and base of the lung
Tension pneumo - away from lesion
Prostaglandins - histamine - ACE - kallikrein
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

21. What increases the risk of PDA in neonatal RDS
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Persistently low O2 tension
Steroids to mom - artificial surfactant and thyroxine to neonate
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude

22. What are potential triggers for asthma
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Acute/chronic inc in vent
In between perfusion limited and diffusion limited
Viral - URIs - allergens and stress

23. What does the law of Laplace state about tendency of alveoli to collapse
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
In between perfusion limited and diffusion limited
On expiration as radius dec
FEV1/FVC > 80%

24. What does PFTs show in COPD
Dec dec in FEV1 - dec in FVC
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Air in lung after maxmimal expiration - cannot be measured on spirometry
More indolent

25. How does left to right shunt cause pulm HTN
RALS - righ anterior - left superior
Inc shear stress leading to endothelial injury
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Airways close prematurely resulting in inc RV and dec FVC

26. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
On expiration as radius dec
Positive cooperativity and negative allostery - unlike myoglobin
Stasis - hypercoagulability - endothelial damage

27. What is the tendency of the lungs vs the chest wall
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
L/S > 2 = lecithin/sphingomyelin
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Lungs collapse inwards and chest wall spring out

28. Why is cesarean delivery a risk factor for neonatal RDS
Ciliated cells
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Prematurity - maternal RDS - cesarean delivery
Dec release of fetal glucocorticoids

29. What cells in the lung produce surfactant and What does it do
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

30. What is the pathology of emphysema
Inc EPO leading to erythrocytosis
Centriacinar
Low resistance and high compliance
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

31. What is obstructive sleep apnea
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Respiratory effort against airway obstruction
Type II cells
Loss of elastic fibers

32. What does the respiratory zone consist of and What is its fxn
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Productive cough for greater than 3 months in at least 2 years
Airways close prematurely resulting in inc RV and dec FVC
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

33. Where are ventilation and perfusion highest in the lung - respectively
Superior portion of right inferior lobe
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Both highest in the base

34. What is positive cooperativity of hemoglobin refer to...
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Carcinoid - carcinoid
Ciliated cells
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

35. What happens to diffusing capacity in interstiial lung diseases
Superior portion of right inferior lobe
Lowered
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
Ciliated cells

36. What cells make surfactant and At what week is produced most abundantly
Dec release of fetal glucocorticoids
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
Type II pneumocytes - after week 35
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals

37. What kind of course does interstitial PNA follow in comparison to bronchoPNA
Metastasis - breast - colon - prostate - bladder -
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Both highest in the base
More indolent

38. What are the 3 reasons for an increased A- a gradient
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
IRV + TV
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Inc resistance leading to inc pressure

39. What happens to lung volumes in obstructive lung disease
Squamous cell carcinoma - keratin pearls and intracellular bridges
Inc
Deep leg veins
Hypoxic vasocxn

40. A carcinoma in the apex of the lung can cause what syndrome and What is the tumor called

41. Where do you find type I cells - What is their morphology - and What do they do
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Prostaglandins - histamine - ACE - kallikrein
Squamous cell carcinoma - keratin pearls and intracellular bridges

42. Chronic bronchitis is a disease of what kind of airways
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Small airways
Tissue hypoxia from dec O2 sat and dec O2 content

43. What is the protein content an exudative pleural effusion and What are the potential causes
Elastase
TB - silica disrupt phagolysosomes and impair MACS
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
C3 - 4 - 6 - phrenic nerve - referred to shoulder

44. What does the conducting zone consist of...
IRV + TV
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Tissue hypoxia from dec O2 sat and dec O2 content

45. Other than surfactant - what other important substances are produced by the lungs
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Long bone fractures and liposuction
Defect in coagulative cascace proteins
Prostaglandins - histamine - ACE - kallikrein

46. What is the protein content in a transudative pleural effusion and What are the potential causes
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
TB - silica disrupt phagolysosomes and impair MACS
CT angio
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

47. Toxicities of what drugs include interstitial lung disease
Low resistance and high compliance
Bleomycin - busulfan - anmiodorone
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)

48. What changes in 2 -3 - DPG occur at high altitude
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

49. How does mitral stenosis cause pulm HTN
Inc resistance leading to inc pressure
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

50. What is methemoglobin
IRV + TV + ERV + RV
Elastic properties
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-