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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 defect in panacinar emphysema - and what else do you see
Alpha1- antitrypsin def - also cirrhosis
Trachea and bronchi
Dorsiflexion of food leads to tender calf muscle
Everything but RV - TV + IRV + ERV

2. What are the subtypes of pneumoconioses

3. What area of the lung is the largest physiologic contributor of fxnal dead space
Heart
Apex of healthy lung
Both highest in the base
Acute/chronic inc in vent

4. What is an association and potential complication of paraseptal emphysema
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Right lung - right main stem bronhus is wider and more vertical
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

5. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Dec
Tension pneumo - away from lesion

6. What is the formula for oxygen delivery to tissues
IRV + TV + ERV + RV
CO x O2 content of blood
Mismatch
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

7. At What terminal does CO2 bind the globin molecule
Dec in lung volumes - FVC - TLC
PAO2 - PaO2 = 10-15 mmHg
N- terminus - carbaminohemoglobin
Long bone fractures and liposuction

8. What organism thrives in high O2 and where in the lung does it flourish
Type II cells
Deep leg veins
Dec
TB - apex

9. What organisms cause a bronchoPNA and What are the characteristics
Shunting
Lung cancer
Mesothelioma - pleura - psammoma bodies
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

10. What happens to arterial PO2 in chronic lung disease and why
Activates bradykinin
Dec - because physiologic shunt dec O2 extraction from ratio
Air that moves into lung with each quiet respiration
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

11. How does mitral stenosis cause pulm HTN
Inc resistance leading to inc pressure
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
0 - negative - prevents pneumothorax
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

12. What layers must CO2 and O2 traverse to complete gas exchange
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Inc due to inc CO
CO x O2 content of blood
O2 binding x O2 sat + dissolved O2

13. What do hemoglobin modifacations lead to...
Tissue hypoxia from dec O2 sat and dec O2 content
Stasis - hypercoagulability - endothelial damage
Mismatch
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

14. What does the conducting zone consist of...
Opposites
Dec in the FEV1/FVC
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

15. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Drainage
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Fe 2+

16. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Mesothelioma - pleura - psammoma bodies
Ivory white calcified pleural plaques
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Lungs collapse inwards and chest wall spring out

17. What is a chronic complication of sleep apnea
Chroniclly tired
Tight jxns
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

18. What does alveolar pressure do to capillaries in the apex of the lung
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
High alveolar pressure compresses capillaries
Person stops breathing for at least 10 seconds repeatedly during sleep
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

19. What is the equation for physiologic dead space
Lost with alveolar walls
Retinopathy of maturity
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

20. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Pleural effusion
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Coal miner's - silicosis - abestosis

21. What happens to lung volumes in restrictive lung disease
Dec
Air in excess of tidal volume that moves into lung on maximal inspiration
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Inc

22. What are potential triggers for asthma
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
Air that can still be breathed out after nl expiration
Ratio from apex to base becomes more uniform
Viral - URIs - allergens and stress

23. What changes in EPO occur at high altitude
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Anatomic dead space and smooth muscle
Lost with alveolar walls

24. What is are the symptoms of a pulmonary embolism
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Chest pain - tachypnea and dyspnea
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

25. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Mesothelioma - pleura - psammoma bodies
Methylene blue
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Inc O2 consumption

26. What enzyme increases activity in emphysema
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
Elastase
Defect in coagulative cascace proteins
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

27. What are the causes of hypoxemia
Respiratory effort against airway obstruction
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Chroniclly tired

28. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Squamous cell carcinoma - keratin pearls and intracellular bridges
High alveolar pressure compresses capillaries
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

29. Why is cesarean delivery a risk factor for neonatal RDS
O2 binding x O2 sat + dissolved O2
500mL
Dec release of fetal glucocorticoids
Mismatch

30. What are the lab/study findings in adenocarcinoma of the lung
Superior portion of right inferior lobe
Steroids to mom - artificial surfactant and thyroxine to neonate
Clara cells - type II pneumocytes; multiple densitites on CXR
Shunting

31. What is early onset hypoxemia from in chronic bronchitis
Shunting
Everything but RV - TV + IRV + ERV
Respiratory effort against airway obstruction
Milky fluid with inc TGs

32. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
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

33. How happens to the proton from the rxn the created bicarb
It binds to Hb -
TB - silica disrupt phagolysosomes and impair MACS
Right lung - right main stem bronhus is wider and more vertical
Ciliated cells

34. What is a lung abscess and What does usually result from
Right lung - right main stem bronhus is wider and more vertical
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Trachea and bronchi
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals

35. What happens to V/Q ratio in COPD
Opposites
Mismatch
Hypoxic vasocxn
Dipalmatoyl phosphatidylcholine

36. What is the characteristic lymphatic pleural effusion
Hypoxic vasocxn
Milky fluid with inc TGs
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Person stops breathing for at least 10 seconds repeatedly during sleep

37. How many lobes does each lung have - and What is the lingula
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Air that moves into lung with each quiet respiration

38. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Repeated cycles of lung injury and wound healing with inc collagen
Pa > PA > Pv
Airway obstruction (shunt) 100% O2 does not improve PO2
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

39. What is Homan's sign
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Dorsiflexion of food leads to tender calf muscle
O2 binding x O2 sat + dissolved O2
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

40. What is the formula for A- a gradient - and What is it normally
PAO2 - PaO2 = 10-15 mmHg
TB - silica disrupt phagolysosomes and impair MACS
Person stops breathing for at least 10 seconds repeatedly during sleep
Matched - =1 adequate gas exchange

41. What changes in 2 -3 - DPG occur at high altitude
Dec cross sectional area of pulm vasc bed
Prostaglandins - histamine - ACE - kallikrein
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

42. What are the associations with bronchiectasis

43. What is compliance and When is it decrease
Elastic properties
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Histiocytosis X - Langerhans cells

44. What happens to diffusing capacity in interstiial lung diseases
Metastasis - breast - colon - prostate - bladder -
Fe 2+
Lowered
IRV + TV + ERV + RV

45. What are fat emboli associated with
Long bone fractures and liposuction
Coal miner's - silicosis - abestosis
No respiratory effort
Exposed collagen fibers provides impetus for clotting cascade

46. At what lung volume is system pressure atmospheric and why
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
FRC - inward pull of lung balanced by outward pull of chest wall
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

47. What is the pathology of bronchiectasis
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
High alveolar pressure compresses capillaries
Positive cooperativity and negative allostery - unlike myoglobin
Long bone fractures and liposuction

48. What is the pathology of asthma

49. What drug therapy is used to augment the changes in bicarb exretion
Acetazolamide - inhibits CA and acidifies the blood
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Upper lobes - cor pulmonale - caplan's syndrome
C3 - 4 - 6 - phrenic nerve - referred to shoulder

50. Why is there eventual loss of capillary beds in emphysema
Lost with alveolar walls
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
Productive cough for greater than 3 months in at least 2 years
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity