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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 organisms cause a bronchoPNA and What are the characteristics
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Incr - right - dec - left

2. What is the formula for A- a gradient - and What is it normally
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
PAO2 - PaO2 = 10-15 mmHg
Tight jxns
N- terminus - carbaminohemoglobin

3. What reaction and enzyme create bicarb and Where does it happen
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
Prematurity - maternal RDS - cesarean delivery
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

4. What is obstructive sleep apnea
Air that moves into lung with each quiet respiration
Respiratory effort against airway obstruction
Lower portion of right inferior lobe
Tension pneumo - away from lesion

5. What is the criteria for chronic bronchitis
CO x O2 content of blood
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Productive cough for greater than 3 months in at least 2 years
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

6. What TX is the mother given before delivery - and what TXs are given to the infant
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Steroids to mom - artificial surfactant and thyroxine to neonate
Inc EPO leading to erythrocytosis

7. Which muscles are involved in quiet breathing and What part of respiration do the control
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Tension pneumo - away from lesion
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Inspiration by diaphragm - expiration is passive

8. In COPD - what happens to airways at high lung volumes
Chronic hypoxic vasocxn
S. aureus or anaerobes
Inc mitochondria
Airways close prematurely resulting in inc RV and dec FVC

9. At what lung volume is system pressure atmospheric and why
FRC - inward pull of lung balanced by outward pull of chest wall
CO2 - acid/altitude - DPG - Exercise - Temperature
Shed epithelium from mucus plugs
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

10. What organism causes a lobar PNA and What are the characteristics
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Dec in the FEV1/FVC
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

11. What are potential triggers for asthma
Viral - URIs - allergens and stress
Centriacinar
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
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

12. What happens to V/Q ratio in COPD
Loss of elastic fibers
Mismatch
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

13. Other than surfactant - what other important substances are produced by the lungs
Prostaglandins - histamine - ACE - kallikrein
Loss of elastic fibers
Inc due to inc CO
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

14. What enzyme increases activity in emphysema
Elastase
Dec dec in FEV1 - dec in FVC
Lung cancer
Surfactant

15. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Tension pneumo - away from lesion
Opposites
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
No respiratory effort

16. What is tha hallmark finding of COPD
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Dec in the FEV1/FVC
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
TB - silica disrupt phagolysosomes and impair MACS

17. What area of the lung is the largest physiologic contributor of fxnal dead space
0 - negative - prevents pneumothorax
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Apex of healthy lung
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

18. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Exposed collagen fibers provides impetus for clotting cascade
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

19. What does the conducting zone consist of...
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Inc 2 -3- DPG - righward shift
No change - but inc venous CO2 content
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

20. What kind of course does interstitial PNA follow in comparison to bronchoPNA
RV + ERV - volume in lungs after nl expiration
More indolent
Methylene blue
RALS - righ anterior - left superior

21. What is the pathology of chronic bronchitis
FEV1/FVC > 80%
Hypertrophy of mucus secreting glands in the bronchioles
S. aureus or anaerobes
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

22. What is the formula for collapsing pressure
P = 2ST/radius
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Weight loss - CPAP - surgery
Right

23. What are the causes of hypoxemia
Viral - URIs - allergens and stress
Centriacinar
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

24. What are fat emboli associated with
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Inc production
Long bone fractures and liposuction
Shed epithelium from mucus plugs

25. What is the protein content an exudative pleural effusion and What are the potential causes
CT angio
Apex of healthy lung
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

26. Toxicities of what drugs include interstitial lung disease
Low resistance and high compliance
IRV + TV
Surfactant def leading to inc surfact tension and alveolar collapse
Bleomycin - busulfan - anmiodorone

27. What is occupied in the space that would have been the left middle lobe
Dec - no change
Heart
Inc O2 consumption
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

28. 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
Viral - URIs - allergens and stress
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

29. How does mitral stenosis cause pulm HTN
Incr - right - dec - left
Inc resistance leading to inc pressure
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

30. What is early onset hypoxemia from in chronic bronchitis
Shunting
Pleural effusion
DIC - especially postpartum
TB - apex

31. What is fetal hemoglobin made of and why does it have a higher affinity for O2
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Inc excretion of bicarb to compensate for respiratory alkalosis
Airways close prematurely resulting in inc RV and dec FVC
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

32. What is central sleep apnea
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Persistently low O2 tension
No respiratory effort
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

33. What happens to bicarb once it is created in an RBC
Low resistance and high compliance
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Shed epithelium from mucus plugs
On expiration as radius dec

34. What lab ration indicates fetal lung maturity
L/S > 2 = lecithin/sphingomyelin
DIC - especially postpartum
Surfactant
Repeated cycles of lung injury and wound healing with inc collagen

35. What is surfactant made of...
TB - silica disrupt phagolysosomes and impair MACS
Dipalmatoyl phosphatidylcholine
PA02 = 150 - PACO2/0.8
Upper lobes

36. What does ACE do
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
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
DIC - especially postpartum
4 polypeptide subunits - 2 alpha and 2 beta

37. Which pts are at risk for apriation PNA
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Alchoholics or epileptics
Defect in coagulative cascace proteins
Drainage

38. How many lobes does each lung have - and What is the lingula
High alveolar pressure compresses capillaries
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
No change - but inc venous CO2 content
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. What is a consequence of pulm HTN
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
RV + ERV - volume in lungs after nl expiration
More indolent
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

40. How is pulmonary circulation characterized in terms of resistance and compliance
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Type II cells
Low resistance and high compliance

41. What is a typical tidal volume
Productive cough for greater than 3 months in at least 2 years
500mL
Shed epithelium from mucus plugs
4 polypeptide subunits - 2 alpha and 2 beta

42. What changes in pH occur during strenuous exercise and why
20.1 mL O2 /dL
Squamous cell carcinoma - keratin pearls and intracellular bridges
Hyaline membrane disease
Dec - due to lactic acidosis

43. Define functional residual capacity (FRC)
RV + ERV - volume in lungs after nl expiration
Bleomycin - busulfan - anmiodorone
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Carcinoid - carcinoid

44. What is the fxn of the conducting zone
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Brings air in and out - warms - humidifies - filters
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Lung cancer

45. What cellular changes occur at high altitude
Clara cells - type II pneumocytes; multiple densitites on CXR
Alchoholics or epileptics
Inc mitochondria
Air in excess of tidal volume that moves into lung on maximal inspiration

46. Define physilogic dead space
Alpha1- antitrypsin def - also cirrhosis
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
Air that moves into lung with each quiet respiration
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

47. Define expiratory reserve volume (ERV)
Air that can still be breathed out after nl expiration
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Viral - URIs - allergens and stress
TB - apex

48. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Inc to meet O2 demand
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
Pleural effusion
Upper lobes

49. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Squamous cell carcinoma - keratin pearls and intracellular bridges
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

50. What is the alveolar gas equation approximation
CT angio
PA02 = 150 - PACO2/0.8
Dec in lung volumes - FVC - TLC
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males