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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 functional residual capacity (FRC)
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
RV + ERV - volume in lungs after nl expiration
Inc production

2. What is the protein content an exudative pleural effusion and What are the potential causes
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Exposed collagen fibers provides impetus for clotting cascade
Activates bradykinin
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

3. What happens to diffusing capacity in interstiial lung diseases
Upper lobes - cor pulmonale - caplan's syndrome
Inc shear stress leading to endothelial injury
Inc to meet O2 demand
Lowered

4. What can amniotic fluid emboli lead to...
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Ratio from apex to base becomes more uniform
Inc
DIC - especially postpartum

5. What does the conducting zone consist of...
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Inc mitochondria

6. What are mucus secretion swept out by
Inc 2 -3- DPG - righward shift
Zone 3
Right lung - right main stem bronhus is wider and more vertical
Ciliated cells

7. What is the formula for resistance
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

8. What must occur with a exudate pleural effusion
Inc airway pressure to prevent airway collapse during exhalation
RV + ERV - volume in lungs after nl expiration
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Drainage

9. What happens to O2 content and O2 sat as Hb falls
Mismatch
Dec
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Dec - no change

10. What is the pathology of bronchiectasis
500mL
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Inc
Alpha1- antitrypsin def - also cirrhosis

11. Toxicities of what drugs include interstitial lung disease
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Incr - right - dec - left
Bleomycin - busulfan - anmiodorone
Inc EPO leading to erythrocytosis

12. Define tidal volume (TV)
Airway obstruction (shunt) 100% O2 does not improve PO2
Retinopathy of maturity
Air that moves into lung with each quiet respiration
Tissue hypoxia from dec O2 sat and dec O2 content

13. What is pulmonary surfactant made of - and What does it do
Dec - due to lactic acidosis
Deoxygenated blood - elastic walls
IRV + TV + ERV + RV
Dipalmatoyl phosphatidylcholine - decreases surface tension

14. What causes primary pulm HTN
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Tissue hypoxia from dec O2 sat and dec O2 content
<60
Dec cross sectional area of pulm vasc bed

15. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Hypoxic vasocxn
Persistently low O2 tension
Positive cooperativity and negative allostery - unlike myoglobin
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

16. What are the causes of ischemia
Right lung - right main stem bronhus is wider and more vertical
Loss of blood flow - impeded arterial flow - reduced venous drainage
CO - 200x
O2 binding x O2 sat + dissolved O2

17. Where is cartilage present in the respiratory tree
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
No respiratory effort
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Trachea and bronchi

18. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
No change - but inc venous CO2 content
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Pa > PA > Pv
Lungs collapse inwards and chest wall spring out

19. What happens to bicarb once it is created in an RBC
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

20. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Inc to meet O2 demand
CO - 200x
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Both highest in the base

21. What is methemoglobin
Low resistance and high compliance
Lobar PNA
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

22. What is the formula for pulm vasc resistance
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Deep leg veins
PVR = (PpulmA - PleftA)/CO
Type II cells

23. Define vital capacity (VC)
IRV + TV + ERV + RV
Everything but RV - TV + IRV + ERV
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

24. What organisms cause a bronchoPNA and What are the characteristics
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Low resistance and high compliance
Steroids to mom - artificial surfactant and thyroxine to neonate
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

25. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
FRC - inward pull of lung balanced by outward pull of chest wall
Superior portion of right inferior lobe
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

26. What is an association and potential complication of paraseptal emphysema
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Methacholine challenge
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

27. What is the tendency of the lungs vs the chest wall
Lungs collapse inwards and chest wall spring out
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Persistently low O2 tension
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

28. What is the equation for physiologic dead space
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Upper lobes - cor pulmonale - caplan's syndrome
Inc mitochondria
Right lung - right main stem bronhus is wider and more vertical

29. What happens as a result of hypoxia in sleep apnea
Inc EPO leading to erythrocytosis
It binds to Hb -
Deoxygenated blood - elastic walls
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

30. What is a consequence of pulm HTN
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Long bone fractures and liposuction
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Gland depth/total thickness of broncial wall - >50%

31. How does mitral stenosis cause pulm HTN
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Dec dec in FEV1 - dec in FVC
Inc resistance leading to inc pressure

32. What happens to V/Q ratio in COPD
Mismatch
CO - 200x
Apex of healthy lung
It binds to Hb -

33. What happens to lung volumes in obstructive lung disease
Heparin
Ciliated cells
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Inc

34. Tumor secreting serotonin causes a syndrome with flushing - diarrhea - wheezing - salvation; fibrous deposits in the right heart valves may lead to tricuspid insuff - pulmonary stenosis - right heart failure - tumor and syndrome
Exposed collagen fibers provides impetus for clotting cascade
Productive cough for greater than 3 months in at least 2 years
L/S < 1.5
Carcinoid - carcinoid

35. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Clara cells - type II pneumocytes; multiple densitites on CXR
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

36. What is the initial damage of ARDS caused by
Pleural effusion
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Alpha1- antitrypsin def - also cirrhosis

37. What is the course of of pulm HTN
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
O2 binding x O2 sat + dissolved O2
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

38. What is the imaging test of choice for PE
Drainage
Deoxygenated blood - elastic walls
CT angio
Air in lung after maxmimal expiration - cannot be measured on spirometry

39. How do you prevent DVT
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Heparin
Histiocytosis X - Langerhans cells
Type II cells

40. What is the TX for small cell lung cancer
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
L/S < 1.5
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Inoperable - responsive to chemotherapy

41. Define inspiratory reserve volume (IRV)
Air in excess of tidal volume that moves into lung on maximal inspiration
L/S < 1.5
Everything but RV - TV + IRV + ERV
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

42. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Shed epithelium from mucus plugs
Respiratory bronchioles - clear debris in alveoli - bronchi
Air that moves into lung with each quiet respiration
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

43. What is the characteristic lymphatic pleural effusion
Retinopathy of maturity
Milky fluid with inc TGs
Histiocytosis X - Langerhans cells
N- terminus - carbaminohemoglobin

44. What is the formula for oxygen delivery to tissues
Dec in the FEV1/FVC
Inc production
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
CO x O2 content of blood

45. What are the lab/study findings in adenocarcinoma of the lung
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Persistently low O2 tension
Zone 1
Clara cells - type II pneumocytes; multiple densitites on CXR

46. What is hemoglobin composed of...
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
4 polypeptide subunits - 2 alpha and 2 beta
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

47. Why do pts with emphysema exhale through pursed lips
Inc airway pressure to prevent airway collapse during exhalation
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Metastasis - breast - colon - prostate - bladder -
Coal miner's - silicosis - abestosis

48. What are potential triggers for asthma
Viral - URIs - allergens and stress
Persistently low O2 tension
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Chroniclly tired

49. What are fat emboli associated with
Zone 1
Surfactant
Inc excretion of bicarb to compensate for respiratory alkalosis
Long bone fractures and liposuction

50. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
IRV + TV + ERV + RV
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Squamous cell carcinoma - keratin pearls and intracellular bridges
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis