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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 happens with the O2 curve shifts to the right and What does it facilitate
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Mesothelioma - pleura - psammoma bodies
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

2. What is the pathology of asthma

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3. What is the leading cause of cancer death
Heparin
Low resistance and high compliance
Lung cancer
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

4. What are the causes of ischemia
Type II pneumocytes - after week 35
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Loss of blood flow - impeded arterial flow - reduced venous drainage
Hypoxic vasocxn

5. What are the risk factors for neonatal RDS
Prematurity - maternal RDS - cesarean delivery
Weight loss - CPAP - surgery
Methacholine challenge
FRC - inward pull of lung balanced by outward pull of chest wall

6. What is Homan's sign
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Everything but RV - TV + IRV + ERV
Dorsiflexion of food leads to tender calf muscle

7. Define total lung capcaity
Loss of elastic fibers
PAO2 - PaO2 = 10-15 mmHg
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
IRV + TV + ERV + RV

8. What is the appoximate O2 binding capacity
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Lower portion of right inferior lobe
Dec - due to lactic acidosis
20.1 mL O2 /dL

9. What is the response for ventilation of high altitude
Acute/chronic inc in vent
Repeated cycles of lung injury and wound healing with inc collagen
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Dipalmatoyl phosphatidylcholine

10. Why is endothelial damage a risk factor for DVT
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Exposed collagen fibers provides impetus for clotting cascade
Air that can still be breathed out after nl expiration
CT angio

11. What is used to treat methemoglobin
Methylene blue
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Hyaline membrane disease
High alveolar pressure compresses capillaries

12. If you aspirate a peanut while upright - where will it go
Lower portion of right inferior lobe
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Zone 3

13. Which lung is the more common site for an inhaled foreign body and why
Positive cooperativity and negative allostery - unlike myoglobin
Acetazolamide - inhibits CA and acidifies the blood
Pleural effusion
Right lung - right main stem bronhus is wider and more vertical

14. What properties determine the combined volumes of the chest wall and lungs
Elastic properties
Airway obstruction (shunt) 100% O2 does not improve PO2
Upper lobes
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor

15. In emphysema - What is increased lung compliance due to...
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
More indolent
Air that can still be breathed out after nl expiration
Loss of elastic fibers

16. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Dipalmatoyl phosphatidylcholine - decreases surface tension
Mismatch
Inspiration by diaphragm - expiration is passive
C3 - 4 - 6 - phrenic nerve - referred to shoulder

17. What does kallikrein do
Activates bradykinin
Brings air in and out - warms - humidifies - filters
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Drainage

18. What changes in V/Q throughout the lung during exercise
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Deoxygenated blood - elastic walls
Ratio from apex to base becomes more uniform

19. What changes in ventilation rate occur during exercise
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Inc to meet O2 demand
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more 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

20. Other than surfactant - what other important substances are produced by the lungs
Prostaglandins - histamine - ACE - kallikrein
IRV + TV + ERV + RV
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

21. Define vital capacity (VC)
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Pa > PA > Pv
Everything but RV - TV + IRV + ERV
Anatomic dead space and smooth muscle

22. At What terminal does CO2 bind the globin molecule
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
Hyaline membrane disease
N- terminus - carbaminohemoglobin
Bleomycin - busulfan - anmiodorone

23. What are the subtypes of pneumoconioses

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24. What happens to bicarb once it is created in an RBC
Milky fluid with inc TGs
Lost with alveolar walls
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

25. What is carboxyhemoglobin and What does it cause
Bleomycin - busulfan - anmiodorone
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
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
CT angio

26. What does the respiratory zone consist of and What is its fxn
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Right

27. If you aspirate a peanut while supine - where will it go
Air in lung after maxmimal expiration - cannot be measured on spirometry
Methylene blue
Superior portion of right inferior lobe
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

28. What are the associations with bronchiectasis

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29. What happens to O2 content and O2 sat as Hb falls
Methylene blue
Dec - no change
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Airways close prematurely resulting in inc RV and dec FVC

30. What cellular changes occur at high altitude
Inc mitochondria
Inc due to inc CO
Prostaglandins - histamine - ACE - kallikrein
Right lung - right main stem bronhus is wider and more vertical

31. What does PFTs show in COPD
Ratio from apex to base becomes more uniform
Dec dec in FEV1 - dec in FVC
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Inc EPO leading to erythrocytosis

32. What do type II cells do - What is their morphology - when do they proliferate
Dorsiflexion of food leads to tender calf muscle
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Activates bradykinin
Small airways

33. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Tight jxns
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
P = 2ST/radius

34. What direction does an increase in metabolic need shift the O2 dissociation curve
PA02 = 150 - PACO2/0.8
Right
Ivory white calcified pleural plaques
Inc resistance leading to inc pressure

35. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Tension pneumo - away from lesion
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Inc 2 -3- DPG - righward shift
Dec cross sectional area of pulm vasc bed

36. What is the defect in panacinar emphysema - and what else do you see
FRC - inward pull of lung balanced by outward pull of chest wall
Shed epithelium from mucus plugs
Alpha1- antitrypsin def - also cirrhosis
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

37. What kind of emphysema is caused by smoking
Centriacinar
Retinopathy of maturity
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Shed epithelium from mucus plugs

38. What changes occur to pulm blood flow during exercise
Inc due to inc CO
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
S. aureus or anaerobes

39. What changes occur to PaO2 and PaCO2
No change - but inc venous CO2 content
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

40. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Stasis - hypercoagulability - endothelial damage
Lobar PNA
Opposites

41. What drug therapy is used to augment the changes in bicarb exretion
Loss of elastic fibers
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Bleomycin - busulfan - anmiodorone
Acetazolamide - inhibits CA and acidifies the blood

42. Define tidal volume (TV)
Persistently low O2 tension
P = 2ST/radius
Air that moves into lung with each quiet respiration
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

43. What is the nl form of iron in hemoglobin
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
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
Fe 2+
Both highest in the base

44. What cells in the lung produce surfactant and What does it do
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
P = 2ST/radius
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
FRC - inward pull of lung balanced by outward pull of chest wall

45. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Tissue hypoxia from dec O2 sat and dec O2 content

46. What kind of pleural plaques are the result of asbestosis
Drainage
Coal miner's - silicosis - abestosis
Ivory white calcified pleural plaques
PVR = (PpulmA - PleftA)/CO

47. What organisms cause a bronchoPNA and What are the characteristics
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more 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

48. What is the protein content an exudative pleural effusion and What are the potential causes
Clara cells - type II pneumocytes; multiple densitites on CXR
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Tissue hypoxia from dec O2 sat and dec O2 content
Loss of blood flow - impeded arterial flow - reduced venous drainage

49. What is tha hallmark finding of COPD
Shunting
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Dec in the FEV1/FVC
Inc mitochondria

50. At what lung volume is system pressure atmospheric and why
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
FRC - inward pull of lung balanced by outward pull of chest wall
Inc 2 -3- DPG - righward shift
CO - 200x