Test your basic knowledge |

Respiratory

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 is the characteristic lymphatic pleural effusion
Upper lobes - cor pulmonale - caplan's syndrome
Milky fluid with inc TGs
Persistently low O2 tension
Inc production

2. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Dec - due to lactic acidosis
Apex of healthy lung
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

3. How does recurrent thromboemboli cause pulm HTN
Dec cross sectional area of pulm vasc bed
Inspiration by diaphragm - expiration is passive
Prostaglandins - histamine - ACE - kallikrein
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

4. How is pulmonary circulation characterized in terms of resistance and compliance
Low resistance and high compliance
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Zone 3
Inc resistance leading to inc pressure

5. What properties determine the combined volumes of the chest wall and lungs
Milky fluid with inc TGs
0 - negative - prevents pneumothorax
Elastic properties
Elastase

6. What are the 9 interstitial lung diseases

7. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
In between perfusion limited and diffusion limited
Deoxygenated blood - elastic walls
Right

8. At what lung volume is system pressure atmospheric and why
Inc due to inc CO
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
FRC - inward pull of lung balanced by outward pull of chest wall
CO2 - acid/altitude - DPG - Exercise - Temperature

9. What is a chronic complication of sleep apnea
Chroniclly tired
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Deep leg veins
Methacholine challenge

10. What are the 3 reasons for an increased A- a gradient
0 - negative - prevents pneumothorax
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Clara cells - type II pneumocytes; multiple densitites on CXR
Tension pneumo - away from lesion

11. What is central sleep apnea
Bleomycin - busulfan - anmiodorone
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
No respiratory effort
500mL

12. In which zone of the lung is Pa > Pv >PA
Zone 3
Bronchial obstruction - toward side of lesion
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Mesothelioma - pleura - psammoma bodies

13. In COPD - what happens to airways at high lung volumes
Airways close prematurely resulting in inc RV and dec FVC
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Matched - =1 adequate gas exchange

14. What is the equation for physiologic dead space
Tissue hypoxia from dec O2 sat and dec O2 content
Airways close prematurely resulting in inc RV and dec FVC
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

15. What are the causes of hypoxemia
Dec cross sectional area of pulm vasc bed
PAO2 - PaO2 = 10-15 mmHg
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

16. What is the cycle of idiopathic pulmonary fibrosis
Acetazolamide - inhibits CA and acidifies the blood
Everything but RV - TV + IRV + ERV
Productive cough for greater than 3 months in at least 2 years
Repeated cycles of lung injury and wound healing with inc collagen

17. How happens to the proton from the rxn the created bicarb
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
It binds to Hb -
Deep leg veins

18. What is the formula for collapsing pressure
P = 2ST/radius
Zone 3
Zone 1
High alveolar pressure compresses capillaries

19. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
TB - silica disrupt phagolysosomes and impair MACS
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
FRC - inward pull of lung balanced by outward pull of chest wall

20. What is the protein content in a transudative pleural effusion and What are the potential causes
Zone 3
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

21. How does autoimmune dz cause thromboemboli
Incr - right - dec - left
Alchoholics or epileptics
Everything but RV - TV + IRV + ERV
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

22. What does each bronchopulmonary segment have in the center and along its border
Respiratory effort against airway obstruction
S. aureus or anaerobes
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

23. What are the 3 forms that CO2 is transported from tissues to lungs
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Heparin
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

24. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
TB - apex
Long bone fractures and liposuction
Pleural effusion
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

25. What is sleep apnea associated with
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Alchoholics or epileptics
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

26. What does the respiratory zone consist of and What is its fxn
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Methylene blue
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
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

27. What kind of space is in the conducting tree and what kind of muscle exists there
Air that moves into lung with each quiet respiration
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Anatomic dead space and smooth muscle
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

28. What cells in the lung produce surfactant and What does it do
Inc airway pressure to prevent airway collapse during exhalation
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
PA02 = 150 - PACO2/0.8
Dec cross sectional area of pulm vasc bed

29. Why is there eventual loss of capillary beds in emphysema
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
<60
Lost with alveolar walls
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

30. What is the criteria for chronic bronchitis
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Productive cough for greater than 3 months in at least 2 years
P = 2ST/radius
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

31. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Anatomic dead space and smooth muscle
Pa > PA > Pv
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
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

32. What is an example of hypercoagulability
Type II cells
Defect in coagulative cascace proteins
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Chroniclly tired

33. What changes at high altitude can result in RVH
Chronic hypoxic vasocxn
CT angio
Ivory white calcified pleural plaques
Deoxygenated blood - elastic walls

34. What is the response for ventilation of high altitude
Brings air in and out - warms - humidifies - filters
Acute/chronic inc in vent
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

35. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
<75
Bronchial obstruction - toward side of lesion
IRV + TV
C3 - 4 - 6 - phrenic nerve - referred to shoulder

36. Which has a greater affinity for hemoglobin - CO or O2 and by how much
CO - 200x
Brings air in and out - warms - humidifies - filters
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Surfactant

37. What is fetal hemoglobin made of and why does it have a higher affinity for O2
Dec dec in FEV1 - dec in FVC
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Long bone fractures and liposuction
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

38. Define total lung capcaity
Respiratory effort against airway obstruction
IRV + TV + ERV + RV
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
O2 binding x O2 sat + dissolved O2

39. What is the alveolar gas equation
<75
Squamous cell carcinoma - keratin pearls and intracellular bridges
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Lobar PNA

40. Why is endothelial damage a risk factor for DVT
Tension pneumo - away from lesion
Inc shear stress leading to endothelial injury
Exposed collagen fibers provides impetus for clotting cascade
Chest pain - tachypnea and dyspnea

41. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
PVR = (PpulmA - PleftA)/CO
Lobar PNA
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Incr - right - dec - left

42. What happens to O2 content and O2 sat as Hb falls
Methylene blue
Dec - no change
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging

43. What is the defect in panacinar emphysema - and what else do you see
Defect in coagulative cascace proteins
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Alpha1- antitrypsin def - also cirrhosis
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

44. What happens to V/Q ratio in COPD
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Milky fluid with inc TGs
Mismatch
Dorsiflexion of food leads to tender calf muscle

45. What does a V/Q ratio of infinity indicate
Dec - no change
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Chronic hypoxic vasocxn
No change - but inc venous CO2 content

46. What organism thrives in high O2 and where in the lung does it flourish
TB - apex
Air that moves into lung with each quiet respiration
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Surfactant

47. In what cells do you find lamellar bodies
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Lungs collapse inwards and chest wall spring out
Inc resistance leading to inc pressure
Type II cells

48. What are the causes of hypoxia
Deoxygenated blood - elastic walls
Lung cancer
0 - negative - prevents pneumothorax
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

49. What is the presentation of lung cancer

50. What is pulmonary surfactant made of - and What does it do
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Inc EPO leading to erythrocytosis
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
Dipalmatoyl phosphatidylcholine - decreases surface tension