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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 kind of pleural plaques are the result of asbestosis
Chest pain - tachypnea and dyspnea
Prematurity - maternal RDS - cesarean delivery
No respiratory effort
Ivory white calcified pleural plaques

2. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Ciliated cells
Persistently low O2 tension
Brings air in and out - warms - humidifies - filters
Histiocytosis X - Langerhans cells

3. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
<75
Chest pain - tachypnea and dyspnea
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Pa > PA > Pv

4. What is the protein content in a transudative pleural effusion and What are the potential causes
No respiratory effort
0 - negative - prevents pneumothorax
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Inc

5. What is hemoglobin composed of...
Everything but RV - TV + IRV + ERV
4 polypeptide subunits - 2 alpha and 2 beta
Dorsiflexion of food leads to tender calf muscle
L/S > 2 = lecithin/sphingomyelin

6. Where do you find type I cells - What is their morphology - and What do they do
500mL
Elastic properties
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Inc airway pressure to prevent airway collapse during exhalation

7. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Positive cooperativity and negative allostery - unlike myoglobin
Inc airway pressure to prevent airway collapse during exhalation
CT angio
Long bone fractures and liposuction

8. What is the fxn of the conducting zone
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Brings air in and out - warms - humidifies - filters
Dec release of fetal glucocorticoids
Weight loss - CPAP - surgery

9. What does decreased PAO2 do
Tight jxns
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
PA02 = 150 - PACO2/0.8
Low resistance and high compliance

10. Where are ventilation and perfusion highest in the lung - respectively
Right
Loss of elastic fibers
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
Both highest in the base

11. What must occur with a exudate pleural effusion
Zone 3
Clara cells - type II pneumocytes; multiple densitites on CXR
Superior portion of right inferior lobe
Drainage

12. What does kallikrein do
Dec release of fetal glucocorticoids
Activates bradykinin
Deoxygenated blood - elastic walls
<60

13. What area of the lung is the largest physiologic contributor of fxnal dead space
Apex of healthy lung
Acetazolamide - inhibits CA and acidifies the blood
Dec dec in FEV1 - dec in FVC
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

14. What changes in CO2 occur during exercise
Histiocytosis X - Langerhans cells
PAO2 - PaO2 = 10-15 mmHg
Inc production
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

15. What is carboxyhemoglobin and What does it cause
Shunting
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
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
Long bone fractures and liposuction

16. What is the nl form of iron in hemoglobin
Lowered
Fe 2+
Airway obstruction (shunt) 100% O2 does not improve PO2
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

17. What is the pathology of bronchiectasis
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Ratio from apex to base becomes more uniform
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

18. Why is cesarean delivery a risk factor for neonatal RDS
No respiratory effort
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Dec release of fetal glucocorticoids
Ivory white calcified pleural plaques

19. What properties determine the combined volumes of the chest wall and lungs
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Elastic properties
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Upper lobes

20. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

21. What is pulmonary surfactant made of - and What does it do
Dipalmatoyl phosphatidylcholine - decreases surface tension
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Hypoxic vasocxn
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

22. What does the law of Laplace state about tendency of alveoli to collapse
Squamous cell carcinoma - keratin pearls and intracellular bridges
DIC - especially postpartum
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
On expiration as radius dec

23. If you aspirate a peanut while upright - where will it go
Lower portion of right inferior lobe
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
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

24. At What terminal does CO2 bind the globin molecule
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Small airways
N- terminus - carbaminohemoglobin
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

25. What is a potential test for asthma
CT angio
Methacholine challenge
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

26. What is the V/Q ratio at the apex and base of the lung
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Air that can still be breathed out after nl expiration
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

27. How happens to the proton from the rxn the created bicarb
Hyaline membrane disease
It binds to Hb -
Tight jxns
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

28. What organisms cause a bronchoPNA and What are the characteristics
Inc excretion of bicarb to compensate for respiratory alkalosis
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
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

29. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Squamous cell carcinoma - keratin pearls and intracellular bridges
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Mesothelioma - pleura - psammoma bodies

30. What is tha hallmark finding of COPD
Type II pneumocytes - after week 35
Elastic properties
Dec in the FEV1/FVC
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

31. How does recurrent thromboemboli cause pulm HTN
Airway obstruction (shunt) 100% O2 does not improve PO2
Air that can still be breathed out after nl expiration
Dec cross sectional area of pulm vasc bed
Brings air in and out - warms - humidifies - filters

32. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
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
Chest pain - tachypnea and dyspnea
Tension pneumo - away from lesion

33. What are the potential TX for sleep apnea
Weight loss - CPAP - surgery
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
More indolent
No respiratory effort

34. What is a chronic complication of sleep apnea
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Chroniclly tired
Type II cells
Mesothelioma - pleura - psammoma bodies

35. What is surfactant made of...
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Dec
Dipalmatoyl phosphatidylcholine

36. Which muscles are involved in quiet breathing and What part of respiration do the control
Anatomic dead space and smooth muscle
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Inspiration by diaphragm - expiration is passive
Loss of elastic fibers

37. What changes in 2 -3 - DPG occur at high altitude
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Surfactant def leading to inc surfact tension and alveolar collapse
Upper lobes

38. What is the pathology of asthma

39. How many lobes does each lung have - and What is the lingula
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Acute/chronic inc in vent
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

40. What changes in O2 consumption change during exercise
DIC - especially postpartum
In between perfusion limited and diffusion limited
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Inc O2 consumption

41. Which structures perforate the diaphragm and where
L/S > 2 = lecithin/sphingomyelin
Inc shear stress leading to endothelial injury
IRV + TV
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

42. What happens to bicarb once it is created in an RBC
Long bone fractures and liposuction
Zone 3
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Bronchial obstruction - toward side of lesion

43. What cellular changes occur at high altitude
Dec in lung volumes - FVC - TLC
Respiratory bronchioles - clear debris in alveoli - bronchi
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Inc mitochondria

44. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Low resistance and high compliance
Alchoholics or epileptics
Right shift - favors taut - low affinity for O2 - O2 unloading
Repeated cycles of lung injury and wound healing with inc collagen

45. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Respiratory bronchioles - clear debris in alveoli - bronchi
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
Inc to meet O2 demand
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

46. What organisms cause interstitial PNA and What are the characteristics
Persistently low O2 tension
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

47. Susceptibility to what infection is increased in silicosis and why
4 polypeptide subunits - 2 alpha and 2 beta
CO - 200x
Activates bradykinin
TB - silica disrupt phagolysosomes and impair MACS

48. What changes in EPO occur at high altitude
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
On expiration as radius dec

49. What are the lab/study findings in adenocarcinoma of the lung
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Mesothelioma - pleura - psammoma bodies
Clara cells - type II pneumocytes; multiple densitites on CXR
Shed epithelium from mucus plugs

50. What kind of emphysema is caused by smoking
Centriacinar
Methacholine challenge
Dec release of fetal glucocorticoids
<75