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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 changes in CO2 occur during exercise
Inc mitochondria
Inc production
Shunting
Pa > PA > Pv

2. Define inspiratory capacity (IC)
Long bone fractures and liposuction
IRV + TV
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

3. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Bronchial obstruction - toward side of lesion
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Air that moves into lung with each quiet respiration

4. What increases the risk of PDA in neonatal RDS
Persistently low O2 tension
Apex of healthy lung
More indolent
Weight loss - CPAP - surgery

5. What is the defect in panacinar emphysema - and what else do you see
Matched - =1 adequate gas exchange
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Shunting
Alpha1- antitrypsin def - also cirrhosis

6. What are the subtypes of pneumoconioses

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7. At what lung volume is system pressure atmospheric and why
Inoperable - responsive to chemotherapy
FRC - inward pull of lung balanced by outward pull of chest wall
Inc O2 consumption
Dec in the FEV1/FVC

8. What changes occur to pulm blood flow during exercise
Inc due to inc CO
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Opposites
0 - negative - prevents pneumothorax

9. What is the presentation of lung cancer

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10. At what PaO2 does hypoxemia begin
Elastic properties
<60
<75
It binds to Hb -

11. Which structures perforate the diaphragm and where
PAO2 - PaO2 = 10-15 mmHg
<75
Weight loss - CPAP - surgery
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

12. What is the imaging test of choice for PE
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Ratio from apex to base becomes more uniform
Prematurity - maternal RDS - cesarean delivery
CT angio

13. What TX is the mother given before delivery - and what TXs are given to the infant
Inc shear stress leading to endothelial injury
S. aureus or anaerobes
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Steroids to mom - artificial surfactant and thyroxine to neonate

14. What is the initial damage of ARDS caused by
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Shunting
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

15. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
FEV1/FVC > 80%
Inoperable - responsive to chemotherapy
Incr - right - dec - left

16. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Inc O2 consumption
Dec dec in FEV1 - dec in FVC
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Positive cooperativity and negative allostery - unlike myoglobin

17. What is the ideal V/Q ratio and why
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
FEV1/FVC > 80%
Matched - =1 adequate gas exchange
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

18. What area of the lung is the largest physiologic contributor of fxnal dead space
Lobar PNA
Alchoholics or epileptics
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Apex of healthy lung

19. What lung product is deficient in neonatal RDS
S. aureus or anaerobes
Gland depth/total thickness of broncial wall - >50%
Right
Surfactant

20. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Inc due to inc CO
Tension pneumo - away from lesion
Ratio from apex to base becomes more uniform
CO - 200x

21. What causes neonatal RDS
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Loss of elastic fibers
Surfactant def leading to inc surfact tension and alveolar collapse

22. What is an association and potential complication of paraseptal emphysema
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Activates bradykinin
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

23. What kind of pleural plaques are the result of asbestosis
Ivory white calcified pleural plaques
Drainage
Inc due to inc CO
Acetazolamide - inhibits CA and acidifies the blood

24. What is are the symptoms of a pulmonary embolism
Viral - URIs - allergens and stress
Coal miner's - silicosis - abestosis
Pa > PA > Pv
Chest pain - tachypnea and dyspnea

25. Toxicities of what drugs include interstitial lung disease
Bleomycin - busulfan - anmiodorone
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
IRV + TV
Airway obstruction (shunt) 100% O2 does not improve PO2

26. What cells make surfactant and At what week is produced most abundantly
Lower portion of right inferior lobe
Type II pneumocytes - after week 35
Prostaglandins - histamine - ACE - kallikrein
<60

27. What do type II cells do - What is their morphology - when do they proliferate
Opposites
Person stops breathing for at least 10 seconds repeatedly during sleep
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
20.1 mL O2 /dL

28. What happens to V/Q ratio in COPD
L/S > 2 = lecithin/sphingomyelin
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
Mismatch
Acute/chronic inc in vent

29. How does mitral stenosis cause pulm HTN
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
TB - silica disrupt phagolysosomes and impair MACS
Chroniclly tired
Inc resistance leading to inc pressure

30. Define functional residual capacity (FRC)
<60
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Both highest in the base
RV + ERV - volume in lungs after nl expiration

31. What are the potential TX for sleep apnea
TB - apex
Weight loss - CPAP - surgery
Dec - because physiologic shunt dec O2 extraction from ratio
Person stops breathing for at least 10 seconds repeatedly during sleep

32. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Airways close prematurely resulting in inc RV and dec FVC
Inoperable - responsive to chemotherapy
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Gland depth/total thickness of broncial wall - >50%

33. How does left to right shunt cause pulm HTN
IRV + TV
Dec in the FEV1/FVC
Clara cells - type II pneumocytes; multiple densitites on CXR
Inc shear stress leading to endothelial injury

34. What is the nl form of iron in hemoglobin
Inc production
Deoxygenated blood - elastic walls
Inc EPO leading to erythrocytosis
Fe 2+

35. What is the alveolar gas equation approximation
Low resistance and high compliance
PAO2 - PaO2 = 10-15 mmHg
PA02 = 150 - PACO2/0.8
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

36. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
Methylene blue
Histiocytosis X - Langerhans cells
RALS - righ anterior - left superior
Loss of elastic fibers

37. What is an example of hypercoagulability
Shed epithelium from mucus plugs
Defect in coagulative cascace proteins
On expiration as radius dec
CO2 - acid/altitude - DPG - Exercise - Temperature

38. What is another name for neonatal RDS
Hyaline membrane disease
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

39. Where does lung cancer met to...
Dec dec in FEV1 - dec in FVC
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Hyaline membrane disease
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)

40. What changes in O2 consumption change during exercise
Air that can still be breathed out after nl expiration
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Inc O2 consumption
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

41. What are the risk factors for neonatal RDS
O2 binding x O2 sat + dissolved O2
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Prematurity - maternal RDS - cesarean delivery

42. What is the V/Q ratio at the apex and base of the lung
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Lost with alveolar walls
Upper lobes
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

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

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44. Which pts are at risk for apriation PNA
L/S > 2 = lecithin/sphingomyelin
Alchoholics or epileptics
Elastase
Inc 2 -3- DPG - righward shift

45. How happens to the proton from the rxn the created bicarb
Stasis - hypercoagulability - endothelial damage
It binds to Hb -
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

46. What does a V/Q ratio of 0 indicate
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Airway obstruction (shunt) 100% O2 does not improve PO2
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Low resistance and high compliance

47. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
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
Dec - due to lactic acidosis
Air that moves into lung with each quiet respiration
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

48. What is the appoximate O2 binding capacity
Upper lobes
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
Chronic hypoxic vasocxn
20.1 mL O2 /dL

49. What is hemoglobin composed of...
4 polypeptide subunits - 2 alpha and 2 beta
Dec in the FEV1/FVC
Methylene blue
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

50. What happens to lung volumes in restrictive lung disease
Inc 2 -3- DPG - righward shift
Activates bradykinin
Elastase
Dec