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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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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. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Respiratory bronchioles - clear debris in alveoli - bronchi
<75
Type II pneumocytes - after week 35
Zone 3

2. What is an example of hypercoagulability
Inc O2 consumption
Elastic properties
Defect in coagulative cascace proteins
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

3. What do hemoglobin modifacations lead to...
Tissue hypoxia from dec O2 sat and dec O2 content
Matched - =1 adequate gas exchange
Inc production
Pa > PA > Pv

4. What is hemoglobin composed of...
Air that can still be breathed out after nl expiration
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
4 polypeptide subunits - 2 alpha and 2 beta
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

5. What is the formula for collapsing pressure
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Airways close prematurely resulting in inc RV and dec FVC
P = 2ST/radius
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

6. What happens to lung volumes in restrictive lung disease
Loss of blood flow - impeded arterial flow - reduced venous drainage
O2 binding x O2 sat + dissolved O2
Dec
Productive cough for greater than 3 months in at least 2 years

7. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Long bone fractures and liposuction
Lobar PNA
Surfactant
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

8. What is the pathology of bronchiectasis
TB - silica disrupt phagolysosomes and impair MACS
CO x O2 content of blood
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

9. What is sleep apnea associated with
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Coal miner's - silicosis - abestosis
Alpha1- antitrypsin def - also cirrhosis
C3 - 4 - 6 - phrenic nerve - referred to shoulder

10. What is the response for ventilation of high altitude
Lung cancer
Acute/chronic inc in vent
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Methylene blue

11. What organism causes a lobar PNA and What are the characteristics
Dec in the FEV1/FVC
Type II cells
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Dec cross sectional area of pulm vasc bed

12. What organisms cause interstitial PNA and What are the characteristics
Chest pain - tachypnea and dyspnea
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
Person stops breathing for at least 10 seconds repeatedly during sleep
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

13. What changes in EPO occur at high altitude
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Respiratory effort against airway obstruction
Methacholine challenge
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

14. How many lobes does each lung have - and What is the lingula
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Surfactant
Milky fluid with inc TGs
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)

15. Where are ventilation and perfusion highest in the lung - respectively
Both highest in the base
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Zone 3

16. 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
Carcinoid - carcinoid
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Chronic hypoxic vasocxn
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

17. What is used to treat CN poisoning and why
Inc EPO leading to erythrocytosis
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
Dec in lung volumes - FVC - TLC
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

18. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Activates bradykinin
PAO2 - PaO2 = 10-15 mmHg
Ciliated cells
Pleural effusion

19. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Pleural effusion
Airways close prematurely resulting in inc RV and dec FVC
RALS - righ anterior - left superior

20. What changes in V/Q throughout the lung during exercise
4 polypeptide subunits - 2 alpha and 2 beta
Ratio from apex to base becomes more uniform
Tight jxns
Air that moves into lung with each quiet respiration

21. How does mitral stenosis cause pulm HTN
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Inc resistance leading to inc pressure

22. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Clara cells - type II pneumocytes; multiple densitites on CXR
Methylene blue
Pa > PA > Pv
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

23. Define total lung capcaity
IRV + TV + ERV + RV
Lobar PNA
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
0 - negative - prevents pneumothorax

24. What does PFTs show in COPD
Mismatch
Dec dec in FEV1 - dec in FVC
Trachea and bronchi
Surfactant

25. What findings are associated with emphysema
High alveolar pressure compresses capillaries
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Dec - due to lactic acidosis

26. What direction does an increase in metabolic need shift the O2 dissociation curve
Dec - due to lactic acidosis
Air in excess of tidal volume that moves into lung on maximal inspiration
Tension pneumo - away from lesion
Right

27. What is a chronic complication of sleep apnea
Chroniclly tired
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Persistently low O2 tension
N- terminus - carbaminohemoglobin

28. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
FEV1/FVC > 80%
Alchoholics or epileptics
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
PAO2 - PaO2 = 10-15 mmHg

29. What is the definition of sleep apnea
Fe 2+
Person stops breathing for at least 10 seconds repeatedly during sleep
Lower portion of right inferior lobe
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT

30. Define functional residual capacity (FRC)
RV + ERV - volume in lungs after nl expiration
Loss of blood flow - impeded arterial flow - reduced venous drainage
Lung cancer
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

31. What is the formula for pulm vasc resistance
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Persistently low O2 tension
Inc airway pressure to prevent airway collapse during exhalation
PVR = (PpulmA - PleftA)/CO

32. What kind of emphysema is caused by smoking
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
<60
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Centriacinar

33. What are the two forms of hemoglobin
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Squamous cell carcinoma - keratin pearls and intracellular bridges
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

34. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Superior portion of right inferior lobe
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Gland depth/total thickness of broncial wall - >50%
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

35. Which structures perforate the diaphragm and where
Inoperable - responsive to chemotherapy
Air that can still be breathed out after nl expiration
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

36. What does ACE do
RV + ERV - volume in lungs after nl expiration
Superior portion of right inferior lobe
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
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

37. In which zone of the lung is Pa > Pv >PA
Low resistance and high compliance
Zone 3
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Hyaline membrane disease

38. What is the TX for small cell lung cancer
Matched - =1 adequate gas exchange
Opposites
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Inoperable - responsive to chemotherapy

39. What changes in 2 -3 - DPG occur at high altitude
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Anatomic dead space and smooth muscle
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Shed epithelium from mucus plugs

40. What is methemoglobin
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Dorsiflexion of food leads to tender calf muscle
Positive cooperativity and negative allostery - unlike myoglobin

41. Which pts are at risk for apriation PNA
Activates bradykinin
Alchoholics or epileptics
Matched - =1 adequate gas exchange
In between perfusion limited and diffusion limited

42. What are the causes of ischemia
Methacholine challenge
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Dec - due to lactic acidosis
Loss of blood flow - impeded arterial flow - reduced venous drainage

43. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
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
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Inc mitochondria
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

44. What is tha hallmark finding of COPD
Dec in the FEV1/FVC
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Acetazolamide - inhibits CA and acidifies the blood
Inc production

45. What kind of space is in the conducting tree and what kind of muscle exists there
Inc airway pressure to prevent airway collapse during exhalation
Respiratory effort against airway obstruction
Anatomic dead space and smooth muscle
Right lung - right main stem bronhus is wider and more vertical

46. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Dorsiflexion of food leads to tender calf muscle
Loss of elastic fibers
CO - 200x
Trachea and bronchi

47. In what cells do you find lamellar bodies
Type II cells
Bleomycin - busulfan - anmiodorone
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
IRV + TV

48. What is used to treat methemoglobin
Methylene blue
Deep leg veins
Exposed collagen fibers provides impetus for clotting cascade
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

49. What are the 9 interstitial lung diseases

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50. What lobes does Coal Miner's pneumoconioses affect - and What can it result in

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