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Respiratory

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Answer 50 questions in 15 minutes.
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1. What are the 3 forms that CO2 is transported from tissues to lungs
Ciliated cells
Metastasis - breast - colon - prostate - bladder -
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

2. What happens to O2 content and O2 sat as Hb falls
Dec - no change
Carcinoid - carcinoid
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
It binds to Hb -

3. What does a V/Q ratio of 0 indicate
Inc shear stress leading to endothelial injury
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Airway obstruction (shunt) 100% O2 does not improve PO2
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

4. What is an association and potential complication of paraseptal emphysema
Deoxygenated blood - elastic walls
Coal miner's - silicosis - abestosis
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

5. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Pleural effusion
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Milky fluid with inc TGs
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

6. What happens as a result of hypoxia in sleep apnea
Inc EPO leading to erythrocytosis
Heart
Mismatch
Brings air in and out - warms - humidifies - filters

7. Why do pts with emphysema exhale through pursed lips
Inc airway pressure to prevent airway collapse during exhalation
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
CT angio

8. What is early onset hypoxemia from in chronic bronchitis
Shunting
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Dec - because physiologic shunt dec O2 extraction from ratio
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

9. What changes occur to pulm blood flow during exercise
Lost with alveolar walls
Inc due to inc CO
Trachea and bronchi
Dorsiflexion of food leads to tender calf muscle

10. At what PaO2 does hypoxemia begin
Upper lobes
<75
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Air that moves into lung with each quiet respiration

11. What changes in CO2 occur during exercise
Gland depth/total thickness of broncial wall - >50%
Person stops breathing for at least 10 seconds repeatedly during sleep
Inc production
Opposites

12. What is a chronic complication of sleep apnea
Weight loss - CPAP - surgery
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Bronchial obstruction - toward side of lesion
Chroniclly tired

13. What is the equation for physiologic dead space
Opposites
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
No change - but inc venous CO2 content
Surfactant def leading to inc surfact tension and alveolar collapse

14. What is the main complication of therapeutic supplemental O2?
Shed epithelium from mucus plugs
Retinopathy of maturity
Brings air in and out - warms - humidifies - filters
Dec in the FEV1/FVC

15. Where does lung cancer met to...
Inc production
Right lung - right main stem bronhus is wider and more vertical
Inspiration by diaphragm - expiration is passive
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)

16. What enzyme increases activity in emphysema
Elastase
Positive cooperativity and negative allostery - unlike myoglobin
Hypertrophy of mucus secreting glands in the bronchioles
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

17. What is are the symptoms of a pulmonary embolism
Defect in coagulative cascace proteins
Bronchial obstruction - toward side of lesion
Stasis - hypercoagulability - endothelial damage
Chest pain - tachypnea and dyspnea

18. In which zone of the lung is Pa > Pv >PA
Zone 3
<75
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Lobar PNA

19. What does the conducting zone consist of...
Incr - right - dec - left
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Surfactant
RALS - righ anterior - left superior

20. If you aspirate a peanut while supine - where will it go
Carcinoid - carcinoid
Dec dec in FEV1 - dec in FVC
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Superior portion of right inferior lobe

21. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Lobar PNA
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Both highest in the base

22. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Chronic hypoxic vasocxn
Inc EPO leading to erythrocytosis
Tension pneumo - away from lesion

23. What doe FAT BAT stand for
Ratio from apex to base becomes more uniform
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
No change - but inc venous CO2 content

24. Lung absecss often reults From what organisms
Surfactant
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Pa > PA > Pv
S. aureus or anaerobes

25. What is the formula for A- a gradient - and What is it normally
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
PAO2 - PaO2 = 10-15 mmHg
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
FEV1/FVC > 80%

26. Define residual volume (RV)
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Tissue hypoxia from dec O2 sat and dec O2 content
Air in lung after maxmimal expiration - cannot be measured on spirometry
FRC - inward pull of lung balanced by outward pull of chest wall

27. What changes at high altitude can result in RVH
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Chronic hypoxic vasocxn
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Gland depth/total thickness of broncial wall - >50%

28. What is used to treat methemoglobin
PVR = (PpulmA - PleftA)/CO
Methylene blue
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Tight jxns

29. What is an example of hypercoagulability
Defect in coagulative cascace proteins
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Lungs collapse inwards and chest wall spring out
L/S > 2 = lecithin/sphingomyelin

30. What is central sleep apnea
No respiratory effort
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Inspiration by diaphragm - expiration is passive
Dec dec in FEV1 - dec in FVC

31. What organism causes a lobar PNA and What are the characteristics
Chest pain - tachypnea and dyspnea
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

32. What can amniotic fluid emboli lead to...
Repeated cycles of lung injury and wound healing with inc collagen
DIC - especially postpartum
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Superior portion of right inferior lobe

33. What does CADET face to the right stand for
Mesothelioma - pleura - psammoma bodies
Gland depth/total thickness of broncial wall - >50%
CO2 - acid/altitude - DPG - Exercise - Temperature
CO - 200x

34. What do pulmonary arteries carry - and how are pulm arterial pressures maintained during the cardiac cycle
Zone 3
Deoxygenated blood - elastic walls
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Gland depth/total thickness of broncial wall - >50%

35. Where is cartilage present in the respiratory tree
Dipalmatoyl phosphatidylcholine
On expiration as radius dec
Trachea and bronchi
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

36. What muscles are involved in breathing during exercise and What do they control
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Dec dec in FEV1 - dec in FVC
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

37. What drug therapy is used to augment the changes in bicarb exretion
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Acetazolamide - inhibits CA and acidifies the blood
Prematurity - maternal RDS - cesarean delivery
RALS - righ anterior - left superior

38. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Alchoholics or epileptics
Activates bradykinin
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
CO - 200x

39. What is positive cooperativity of hemoglobin refer to...
Tight jxns
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Upper lobes

40. What do hemoglobin modifacations lead to...
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
4 polypeptide subunits - 2 alpha and 2 beta
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Tissue hypoxia from dec O2 sat and dec O2 content

41. 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
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Elastase
P = 2ST/radius

42. What is compliance and When is it decrease
C3 - 4 - 6 - phrenic nerve - referred to shoulder
CO x O2 content of blood
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Lung cancer

43. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Ratio from apex to base becomes more uniform
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
Long bone fractures and liposuction

44. How happens to the proton from the rxn the created bicarb
Inc shear stress leading to endothelial injury
Zone 1
Heparin
It binds to Hb -

45. What is the alveolar gas equation approximation
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
PA02 = 150 - PACO2/0.8
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

46. What is the response for ventilation of high altitude
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Air that moves into lung with each quiet respiration
Acute/chronic inc in vent

47. How do you prevent DVT
Heparin
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Dorsiflexion of food leads to tender calf muscle
Inc mitochondria

48. What organism thrives in high O2 and where in the lung does it flourish
S. aureus or anaerobes
TB - apex
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Lobar PNA

49. What are the causes of ischemia
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Loss of blood flow - impeded arterial flow - reduced venous drainage

50. What direction does an increase in metabolic need shift the O2 dissociation curve
Zone 3
Tension pneumo - away from lesion
Right
Methacholine challenge

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