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Respiratory

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What is another name for neonatal RDS
Centriacinar
PVR = (PpulmA - PleftA)/CO
N- terminus - carbaminohemoglobin
Hyaline membrane disease

2. Why is there eventual loss of capillary beds in emphysema
Upper lobes
<75
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Lost with alveolar walls

3. What is the initial damage of ARDS caused by
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Steroids to mom - artificial surfactant and thyroxine to neonate
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

4. What is the nl form of iron in hemoglobin
Prematurity - maternal RDS - cesarean delivery
Fe 2+
Mesothelioma - pleura - psammoma bodies
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

5. What kind of course does interstitial PNA follow in comparison to bronchoPNA
More indolent
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
500mL
Apex of healthy lung

6. What kind of emphysema is caused by smoking
Centriacinar
500mL
Zone 1
Lobar PNA

7. Susceptibility to what infection is increased in silicosis and why
Inc mitochondria
Alchoholics or epileptics
TB - silica disrupt phagolysosomes and impair MACS
Hypoxic vasocxn

8. What are the various causes of ARDS
4 polypeptide subunits - 2 alpha and 2 beta
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
IRV + TV

9. What direction does an increase in metabolic need shift the O2 dissociation curve
RALS - righ anterior - left superior
Steroids to mom - artificial surfactant and thyroxine to neonate
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Right

10. What changes occur to PaO2 and PaCO2
DIC - especially postpartum
Lungs collapse inwards and chest wall spring out
Lost with alveolar walls
No change - but inc venous CO2 content

11. Where do 95% of PE arise from
No change - but inc venous CO2 content
Deep leg veins
Dec - because physiologic shunt dec O2 extraction from ratio
Right lung - right main stem bronhus is wider and more vertical

12. What is sleep apnea associated with
Opposites
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Air in excess of tidal volume that moves into lung on maximal inspiration
TB - silica disrupt phagolysosomes and impair MACS

13. What are the SPHERE of complications in lung cancer
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
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

14. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Shed epithelium from mucus plugs
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
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

15. Which structures perforate the diaphragm and where
Milky fluid with inc TGs
Tension pneumo - away from lesion
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Brings air in and out - warms - humidifies - filters

16. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Lower portion of right inferior lobe
Pa > PA > Pv
Loss of blood flow - impeded arterial flow - reduced venous drainage
DIC - especially postpartum

17. Define total lung capcaity
IRV + TV + ERV + RV
Dec in lung volumes - FVC - TLC
In between perfusion limited and diffusion limited
No change - but inc venous CO2 content

18. What is the most common cancerous lesion in the lun
IRV + TV + ERV + RV
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Metastasis - breast - colon - prostate - bladder -
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

19. What is the defect in panacinar emphysema - and what else do you see
Alpha1- antitrypsin def - also cirrhosis
20.1 mL O2 /dL
Both highest in the base
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. Define expiratory reserve volume (ERV)
Mesothelioma - pleura - psammoma bodies
Trachea and bronchi
Air that can still be breathed out after nl expiration
Gland depth/total thickness of broncial wall - >50%

21. What is the course of of pulm HTN
Inc
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Respiratory effort against airway obstruction
Inc mitochondria

22. What is a consequence of pulm HTN
Person stops breathing for at least 10 seconds repeatedly during sleep
More indolent
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Repeated cycles of lung injury and wound healing with inc collagen

23. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

24. What muscles are involved in breathing during exercise and What do they control
Inc
No change - but inc venous CO2 content
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Respiratory bronchioles - clear debris in alveoli - bronchi

25. What properties determine the combined volumes of the chest wall and lungs
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Elastic properties
Shed epithelium from mucus plugs
Surfactant

26. What is surfactant made of...
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Right shift - favors taut - low affinity for O2 - O2 unloading
Lobar PNA
Dipalmatoyl phosphatidylcholine

27. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Pleural effusion
Right
L/S > 2 = lecithin/sphingomyelin
Milky fluid with inc TGs

28. What is are the symptoms of a pulmonary embolism
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Chest pain - tachypnea and dyspnea
Steroids to mom - artificial surfactant and thyroxine to neonate
Inc O2 consumption

29. Which muscles are involved in quiet breathing and What part of respiration do the control
Inspiration by diaphragm - expiration is passive
FRC - inward pull of lung balanced by outward pull of chest wall
Dorsiflexion of food leads to tender calf muscle
Type II pneumocytes - after week 35

30. What are the causes of ischemia
Productive cough for greater than 3 months in at least 2 years
Inoperable - responsive to chemotherapy
Opposites
Loss of blood flow - impeded arterial flow - reduced venous drainage

31. What changes in ventilation rate occur during exercise
Right lung - right main stem bronhus is wider and more vertical
Inc to meet O2 demand
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
S. aureus or anaerobes

32. What increases the risk of PDA in neonatal RDS
Chroniclly tired
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
4 polypeptide subunits - 2 alpha and 2 beta
Persistently low O2 tension

33. Where are ventilation and perfusion highest in the lung - respectively
Both highest in the base
Inc shear stress leading to endothelial injury
S. aureus or anaerobes
Loss of elastic fibers

34. 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
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Ivory white calcified pleural plaques
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

35. 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
Carcinoid - carcinoid
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
More indolent

36. What does pulm HTN result in
Mesothelioma - pleura - psammoma bodies
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

37. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Lobar PNA
Chest pain - tachypnea and dyspnea
Surfactant def leading to inc surfact tension and alveolar collapse

38. Which has a greater affinity for hemoglobin - CO or O2 and by how much
<60
Elastic properties
CO - 200x
More indolent

39. What kind of pleural plaques are the result of asbestosis
Ivory white calcified pleural plaques
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Apex of healthy lung
0 - negative - prevents pneumothorax

40. What are the causes of hypoxemia
Bronchial obstruction - toward side of lesion
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Inc production
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

41. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Exposed collagen fibers provides impetus for clotting cascade
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

42. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Heart
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Respiratory bronchioles - clear debris in alveoli - bronchi

43. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Methacholine challenge
Opposites
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Elastase

44. What changes occur to pulm blood flow during exercise
FEV1/FVC > 80%
Inc due to inc CO
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Alchoholics or epileptics

45. What does kallikrein do
Right
Activates bradykinin
Air that moves into lung with each quiet respiration
Person stops breathing for at least 10 seconds repeatedly during sleep

46. What changes in EPO occur at high altitude
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Metastasis - breast - colon - prostate - bladder -

47. At What terminal does CO2 bind the globin molecule
Repeated cycles of lung injury and wound healing with inc collagen
N- terminus - carbaminohemoglobin
Squamous cell carcinoma - keratin pearls and intracellular bridges
Dec release of fetal glucocorticoids

48. What happens to bicarb once it is created in an RBC
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

49. What reaction and enzyme create bicarb and Where does it happen
Retinopathy of maturity
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

50. In which zone of the lung is Pa > Pv >PA
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Exposed collagen fibers provides impetus for clotting cascade
Zone 3
Milky fluid with inc TGs