Test your basic knowledge |

Respiratory

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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 is the pathology of ARDS
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Type II cells
CT angio

2. In which zone of the lung is PA > Pa > Pv
Respiratory effort against airway obstruction
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Zone 1
Deep leg veins

3. What changes in 2 -3 - DPG occur at high altitude
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Inc due to inc CO
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

4. 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
Air in excess of tidal volume that moves into lung on maximal inspiration
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Shed epithelium from mucus plugs

5. What does the conducting zone consist of...
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Clara cells - type II pneumocytes; multiple densitites on CXR
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

6. What happens to bicarb once it is created in an RBC
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
CO2 - acid/altitude - DPG - Exercise - Temperature
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Squamous cell carcinoma - keratin pearls and intracellular bridges

7. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Viral - URIs - allergens and stress
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Both highest in the base
Incr - right - dec - left

8. What does pulm HTN result in
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Dec - due to lactic acidosis
Apex of healthy lung

9. What does CADET face to the right stand for
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Drainage
DIC - especially postpartum
CO2 - acid/altitude - DPG - Exercise - Temperature

10. How happens to the proton from the rxn the created bicarb
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Tissue hypoxia from dec O2 sat and dec O2 content
Everything but RV - TV + IRV + ERV
It binds to Hb -

11. What is the formula for pulm vasc resistance
PVR = (PpulmA - PleftA)/CO
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Dec cross sectional area of pulm vasc bed
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

12. What is the protein content an exudative pleural effusion and What are the potential causes
Gland depth/total thickness of broncial wall - >50%
Clara cells - type II pneumocytes; multiple densitites on CXR
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
DIC - especially postpartum

13. What happens with the O2 curve shifts to the right and What does it facilitate
Superior portion of right inferior lobe
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Zone 1
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

14. What do type II cells do - What is their morphology - when do they proliferate
Lowered
RV + ERV - volume in lungs after nl expiration
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

15. What happens as a result of hypoxia in sleep apnea
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Inc EPO leading to erythrocytosis
Defect in coagulative cascace proteins
Drainage

16. What drug therapy is used to augment the changes in bicarb exretion
Ciliated cells
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
L/S < 1.5
Acetazolamide - inhibits CA and acidifies the blood

17. What is positive cooperativity of hemoglobin refer to...
Inc 2 -3- DPG - righward shift
Lobar PNA
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
<60

18. What is used to treat methemoglobin
Methylene blue
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
CO - 200x
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

19. At what PaO2 does hypoxemia begin
<75
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Dorsiflexion of food leads to tender calf muscle
Heart

20. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Mismatch
Airway obstruction (shunt) 100% O2 does not improve PO2
Squamous cell carcinoma - keratin pearls and intracellular bridges
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

21. What changes in lung volunes occur as a result of restrictive lung disease
Dec in lung volumes - FVC - TLC
Trachea and bronchi
DIC - especially postpartum
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor

22. At What terminal does CO2 bind the globin molecule
Airways close prematurely resulting in inc RV and dec FVC
N- terminus - carbaminohemoglobin
Chest pain - tachypnea and dyspnea
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

23. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Low resistance and high compliance
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

24. Define tidal volume (TV)
Hyaline membrane disease
Viral - URIs - allergens and stress
Air that moves into lung with each quiet respiration
Lungs collapse inwards and chest wall spring out

25. If you aspirate a peanut while supine - where will it go
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Person stops breathing for at least 10 seconds repeatedly during sleep
Superior portion of right inferior lobe
Inc excretion of bicarb to compensate for respiratory alkalosis

26. Why is there eventual loss of capillary beds in emphysema
Lost with alveolar walls
Repeated cycles of lung injury and wound healing with inc collagen
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

27. How does recurrent thromboemboli cause pulm HTN
It binds to Hb -
Bleomycin - busulfan - anmiodorone
Inc
Dec cross sectional area of pulm vasc bed

28. What is the fxn of the conducting zone
Lobar PNA
Elastic properties
P = 2ST/radius
Brings air in and out - warms - humidifies - filters

29. What causes neonatal RDS
Dorsiflexion of food leads to tender calf muscle
Long bone fractures and liposuction
O2 binding x O2 sat + dissolved O2
Surfactant def leading to inc surfact tension and alveolar collapse

30. What changes occur to PaO2 and PaCO2
Inc 2 -3- DPG - righward shift
Deep leg veins
Persistently low O2 tension
No change - but inc venous CO2 content

31. What is the V/Q ratio at the apex and base of the lung
Airways close prematurely resulting in inc RV and dec FVC
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Chronic hypoxic vasocxn

32. Define functional residual capacity (FRC)
Brings air in and out - warms - humidifies - filters
Incr - right - dec - left
RV + ERV - volume in lungs after nl expiration
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

33. What is the pathology of bronchiectasis
Prematurity - maternal RDS - cesarean delivery
<60
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

34. What are the causes of ischemia
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Loss of blood flow - impeded arterial flow - reduced venous drainage
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Zone 3

35. What kind of connection exists between endothelial cells in the capilaries
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Inc shear stress leading to endothelial injury
FRC - inward pull of lung balanced by outward pull of chest wall
Tight jxns

36. What area of the lung is the largest physiologic contributor of fxnal dead space
Apex of healthy lung
Lowered
Dorsiflexion of food leads to tender calf muscle
Deep leg veins

37. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
P = 2ST/radius
Tight jxns
Apex of healthy lung

38. What changes in EPO occur at high altitude
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Apex of healthy lung
Dec dec in FEV1 - dec in FVC
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

39. What is the main complication of therapeutic supplemental O2?
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Retinopathy of maturity
L/S < 1.5
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

40. What is the nl form of iron in hemoglobin
DIC - especially postpartum
Fe 2+
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Exposed collagen fibers provides impetus for clotting cascade

41. What is surfactant made of...
0 - negative - prevents pneumothorax
Centriacinar
Dipalmatoyl phosphatidylcholine
Inc 2 -3- DPG - righward shift

42. What is methemoglobin
Opposites
Right lung - right main stem bronhus is wider and more vertical
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Dec dec in FEV1 - dec in FVC

43. What are the two forms of hemoglobin
Dec - no change
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Shunting

44. What is the imaging test of choice for PE
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
CT angio
Dec
Exposed collagen fibers provides impetus for clotting cascade

45. What are the SPHERE of complications in lung cancer
<60
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Dorsiflexion of food leads to tender calf muscle
CO2 - acid/altitude - DPG - Exercise - Temperature

46. Why is cesarean delivery a risk factor for neonatal RDS
Shed epithelium from mucus plugs
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Dec release of fetal glucocorticoids

47. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Incr - right - dec - left
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Pa > PA > Pv
4 polypeptide subunits - 2 alpha and 2 beta

48. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

49. At what PaO2 does cyanosis begin
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
<60
Inc due to inc CO
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

50. What is the initial damage of ARDS caused by
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Surfactant def leading to inc surfact tension and alveolar collapse
Dec - due to lactic acidosis
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound