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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. Define residual volume (RV)
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Small airways
Air in lung after maxmimal expiration - cannot be measured on spirometry

2. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Inc 2 -3- DPG - righward shift
Persistently low O2 tension
DIC - especially postpartum
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

3. What are curschmann's spirals
Shed epithelium from mucus plugs
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Squamous cell carcinoma - keratin pearls and intracellular bridges
Mismatch

4. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Mesothelioma - pleura - psammoma bodies
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Inc to meet O2 demand

5. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
0 - negative - prevents pneumothorax
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Exposed collagen fibers provides impetus for clotting cascade
Incr - right - dec - left

6. Why is there eventual loss of capillary beds in emphysema
Tissue hypoxia from dec O2 sat and dec O2 content
Lost with alveolar walls
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Matched - =1 adequate gas exchange

7. Define physilogic dead space
Hyaline membrane disease
Dipalmatoyl phosphatidylcholine - decreases surface tension
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Bleomycin - busulfan - anmiodorone

8. Which muscles are involved in quiet breathing and What part of respiration do the control
Hypertrophy of mucus secreting glands in the bronchioles
Inspiration by diaphragm - expiration is passive
20.1 mL O2 /dL
No change - but inc venous CO2 content

9. Which structures perforate the diaphragm and where
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Tension pneumo - away from lesion
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

10. Susceptibility to what infection is increased in silicosis and why
Lungs collapse inwards and chest wall spring out
N- terminus - carbaminohemoglobin
Dec - no change
TB - silica disrupt phagolysosomes and impair MACS

11. What are the causes of hypoxia
Exposed collagen fibers provides impetus for clotting cascade
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

12. What is the response for ventilation of high altitude
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Acute/chronic inc in vent
0 - negative - prevents pneumothorax
Dec release of fetal glucocorticoids

13. What is central sleep apnea
Chroniclly tired
No respiratory effort
Elastic properties
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

14. What is the TX for small cell lung cancer
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Inc resistance leading to inc pressure
Inoperable - responsive to chemotherapy
Inc shear stress leading to endothelial injury

15. In COPD - what happens to airways at high lung volumes
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Inc resistance leading to inc pressure
Airway obstruction (shunt) 100% O2 does not improve PO2
Airways close prematurely resulting in inc RV and dec FVC

16. What is methemoglobin
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Productive cough for greater than 3 months in at least 2 years
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

17. What direction does an increase in metabolic need shift the O2 dissociation curve
Lung cancer
L/S < 1.5
Viral - URIs - allergens and stress
Right

18. What kind of pleural plaques are the result of asbestosis
Inc excretion of bicarb to compensate for respiratory alkalosis
Air that moves into lung with each quiet respiration
Loss of elastic fibers
Ivory white calcified pleural plaques

19. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Viral - URIs - allergens and stress
Right lung - right main stem bronhus is wider and more vertical

20. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
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
Pa > PA > Pv
Trachea and bronchi
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

21. What is the ideal V/Q ratio and why
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
20.1 mL O2 /dL
Air in lung after maxmimal expiration - cannot be measured on spirometry
Matched - =1 adequate gas exchange

22. What happens with the O2 curve shifts to the right and What does it facilitate
Surfactant def leading to inc surfact tension and alveolar collapse
Carcinoid - carcinoid
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

23. What is the defect in panacinar emphysema - and what else do you see
Long bone fractures and liposuction
Inc to meet O2 demand
Dipalmatoyl phosphatidylcholine - decreases surface tension
Alpha1- antitrypsin def - also cirrhosis

24. What is an association and potential complication of paraseptal emphysema
Prematurity - maternal RDS - cesarean delivery
It binds to Hb -
Bronchial obstruction - toward side of lesion
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

25. Other than surfactant - what other important substances are produced by the lungs
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Dipalmatoyl phosphatidylcholine - decreases surface tension
Elastase
Prostaglandins - histamine - ACE - kallikrein

26. What changes at high altitude can result in RVH
Ivory white calcified pleural plaques
Chronic hypoxic vasocxn
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

27. 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
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

28. What lung abnl is characterized by absent or decreased breath sounds over affected area - dec resonance - dec fremitus - and which side is the trachea deviated towards
On expiration as radius dec
TB - apex
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Bronchial obstruction - toward side of lesion

29. How many lobes does each lung have - and What is the lingula
Dec dec in FEV1 - dec in FVC
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Acetazolamide - inhibits CA and acidifies the blood
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

30. What is the characteristic lymphatic pleural effusion
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
No change - but inc venous CO2 content
IRV + TV + ERV + RV
Milky fluid with inc TGs

31. What are clara cells What is their morphology and What do they do
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Superior portion of right inferior lobe

32. What are the causes of hypoxemia
Inc 2 -3- DPG - righward shift
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Inc shear stress leading to endothelial injury
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

33. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Lobar PNA
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Pa > PA > Pv

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

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35. What is virchow's triad
Stasis - hypercoagulability - endothelial damage
DIC - especially postpartum
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
IRV + TV + ERV + RV

36. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Prematurity - maternal RDS - cesarean delivery
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

37. At what lung volume is system pressure atmospheric and why
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
FRC - inward pull of lung balanced by outward pull of chest wall
Inc airway pressure to prevent airway collapse during exhalation
Long bone fractures and liposuction

38. What are the 3 forms that CO2 is transported from tissues to lungs
CO - 200x
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Deoxygenated blood - elastic walls
Methylene blue

39. What happens to diffusing capacity in interstiial lung diseases
Lowered
Tension pneumo - away from lesion
P = 2ST/radius
Chronic hypoxic vasocxn

40. What layers must CO2 and O2 traverse to complete gas exchange
Prostaglandins - histamine - ACE - kallikrein
RV + ERV - volume in lungs after nl expiration
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

41. What cells make surfactant and At what week is produced most abundantly
Type II pneumocytes - after week 35
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Methacholine challenge
L/S < 1.5

42. What lobes are affected in silicosis
DIC - especially postpartum
Upper lobes
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Acute/chronic inc in vent

43. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Squamous cell carcinoma - keratin pearls and intracellular bridges
Gland depth/total thickness of broncial wall - >50%
Dec - no change
Defect in coagulative cascace proteins

44. What is the formula for resistance
Coal miner's - silicosis - abestosis
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
CT angio

45. What is the definition of sleep apnea
Loss of blood flow - impeded arterial flow - reduced venous drainage
Person stops breathing for at least 10 seconds repeatedly during sleep
Low resistance and high compliance
CO x O2 content of blood

46. What is early onset hypoxemia from in chronic bronchitis
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Shunting
Inc due to inc CO
It binds to Hb -

47. What is the appoximate O2 binding capacity
Trachea and bronchi
20.1 mL O2 /dL
Squamous cell carcinoma - keratin pearls and intracellular bridges
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

48. What enzyme increases activity in emphysema
Zone 1
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Elastase

49. What are the 3 reasons for an increased A- a gradient
DIC - especially postpartum
Methylene blue
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Defect in coagulative cascace proteins

50. What is a typical tidal volume
L/S > 2 = lecithin/sphingomyelin
500mL
PVR = (PpulmA - PleftA)/CO
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)