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Respiratory

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What is the criteria for chronic bronchitis
Productive cough for greater than 3 months in at least 2 years
Elastase
Clara cells - type II pneumocytes; multiple densitites on CXR
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

2. What causes primary pulm HTN
Hypoxic vasocxn
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
More indolent
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

3. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Tension pneumo - away from lesion
Dec - no change
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
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

4. What is the most common cancerous lesion in the lun
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Metastasis - breast - colon - prostate - bladder -
Lost with alveolar walls
Chronic hypoxic vasocxn

5. What does alveolar pressure do to capillaries in the apex of the lung
Small airways
High alveolar pressure compresses capillaries
RALS - righ anterior - left superior
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

6. What is the equation for physiologic dead space
Loss of blood flow - impeded arterial flow - reduced venous drainage
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

7. Define functional residual capacity (FRC)
RV + ERV - volume in lungs after nl expiration
Inspiration by diaphragm - expiration is passive
Type II cells
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

8. What TX is the mother given before delivery - and what TXs are given to the infant
Steroids to mom - artificial surfactant and thyroxine to neonate
Inc shear stress leading to endothelial injury
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Dec in lung volumes - FVC - TLC

9. Why do pts with emphysema exhale through pursed lips
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Inc airway pressure to prevent airway collapse during exhalation
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

10. 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
Prostaglandins - histamine - ACE - kallikrein
Zone 1
Activates bradykinin

11. What do hemoglobin modifacations lead to...
Heart
Centriacinar
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Tissue hypoxia from dec O2 sat and dec O2 content

12. What is the ideal V/Q ratio and why
Loss of blood flow - impeded arterial flow - reduced venous drainage
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Matched - =1 adequate gas exchange
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

13. What are the findings associated with sarcoidosis
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Deoxygenated blood - elastic walls
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

14. What is central sleep apnea
No respiratory effort
Person stops breathing for at least 10 seconds repeatedly during sleep
Stasis - hypercoagulability - endothelial damage
L/S < 1.5

15. 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
Hyaline membrane disease
Lung cancer
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
Carcinoid - carcinoid

16. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
IRV + TV
Exposed collagen fibers provides impetus for clotting cascade

17. What is are the symptoms of a pulmonary embolism
Inc 2 -3- DPG - righward shift
Chest pain - tachypnea and dyspnea
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

18. Where are ventilation and perfusion highest in the lung - respectively
Lungs collapse inwards and chest wall spring out
Inc mitochondria
Air that moves into lung with each quiet respiration
Both highest in the base

19. What is the presentation of lung cancer

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20. What is pulmonary surfactant made of - and What does it do
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Dipalmatoyl phosphatidylcholine - decreases surface tension
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Upper lobes - cor pulmonale - caplan's syndrome

21. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
S. aureus or anaerobes
<75
Incr - right - dec - left

22. What does a V/Q ratio of infinity indicate
Bronchial obstruction - toward side of lesion
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
IRV + TV
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

23. What organism thrives in high O2 and where in the lung does it flourish
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
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
TB - apex

24. What is the pathology of emphysema
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Apex of healthy lung
Dec - due to lactic acidosis
Inspiration by diaphragm - expiration is passive

25. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Histiocytosis X - Langerhans cells
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Inc EPO leading to erythrocytosis
Lobar PNA

26. At what PaO2 does cyanosis begin
<60
Dec dec in FEV1 - dec in FVC
Inspiration by diaphragm - expiration is passive
Right shift - favors taut - low affinity for O2 - O2 unloading

27. What is the initial damage of ARDS caused by
Exposed collagen fibers provides impetus for clotting cascade
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

28. Where do 95% of PE arise from
Upper lobes
Deep leg veins
Hypertrophy of mucus secreting glands in the bronchioles
Bronchial obstruction - toward side of lesion

29. What cells in the lung produce surfactant and What does it do
Acetazolamide - inhibits CA and acidifies the blood
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Respiratory effort against airway obstruction
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

30. Why is cesarean delivery a risk factor for neonatal RDS
Upper lobes - cor pulmonale - caplan's syndrome
Dec release of fetal glucocorticoids
Exposed collagen fibers provides impetus for clotting cascade
Acetazolamide - inhibits CA and acidifies the blood

31. How happens to the proton from the rxn the created bicarb
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
It binds to Hb -
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

32. How does recurrent thromboemboli cause pulm HTN
O2 binding x O2 sat + dissolved O2
Shed epithelium from mucus plugs
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Dec cross sectional area of pulm vasc bed

33. What does CADET face to the right stand for
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
CO2 - acid/altitude - DPG - Exercise - Temperature
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Elastase

34. If you aspirate a peanut while supine - where will it go
Zone 3
Anatomic dead space and smooth muscle
Superior portion of right inferior lobe
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

35. What kind of space is in the conducting tree and what kind of muscle exists there
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Apex of healthy lung
Anatomic dead space and smooth muscle
Zone 3

36. What is virchow's triad
Opposites
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
Surfactant
Stasis - hypercoagulability - endothelial damage

37. What is a lung abscess and What does usually result from
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Anatomic dead space and smooth muscle
Dec dec in FEV1 - dec in FVC
Hypertrophy of mucus secreting glands in the bronchioles

38. What must occur with a exudate pleural effusion
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Heart
Squamous cell carcinoma - keratin pearls and intracellular bridges
Drainage

39. What is the main complication of therapeutic supplemental O2?
Alchoholics or epileptics
Retinopathy of maturity
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Loss of blood flow - impeded arterial flow - reduced venous drainage

40. What changes in CO2 occur during exercise
Pleural effusion
Lower portion of right inferior lobe
Hyaline membrane disease
Inc production

41. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Surfactant def leading to inc surfact tension and alveolar collapse
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Mesothelioma - pleura - psammoma bodies
Air that moves into lung with each quiet respiration

42. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Acetazolamide - inhibits CA and acidifies the blood
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Lungs collapse inwards and chest wall spring out
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

43. What do type II cells do - What is their morphology - when do they proliferate
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
More indolent
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

44. What is the course of of pulm HTN
Lost with alveolar walls
Incr - right - dec - left
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Inc mitochondria

45. What is a consequence of pulm HTN
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Dec in the FEV1/FVC
Both highest in the base

46. What is the nl form of iron in hemoglobin
Fe 2+
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Dorsiflexion of food leads to tender calf muscle
Inc to meet O2 demand

47. What is hemoglobin composed of...
Hypertrophy of mucus secreting glands in the bronchioles
4 polypeptide subunits - 2 alpha and 2 beta
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging

48. What is the alveolar gas equation approximation
FEV1/FVC > 80%
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Tight jxns
PA02 = 150 - PACO2/0.8

49. What doe FAT BAT stand for
Long bone fractures and liposuction
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

50. What kind of connection exists between endothelial cells in the capilaries
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Tight jxns