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 are the causes of hypoxia
TB - silica disrupt phagolysosomes and impair MACS
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

2. What is the most common cancerous lesion in the lun
Histiocytosis X - Langerhans cells
Metastasis - breast - colon - prostate - bladder -
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Tissue hypoxia from dec O2 sat and dec O2 content

3. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Prostaglandins - histamine - ACE - kallikrein
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Elastase
TB - silica disrupt phagolysosomes and impair MACS

4. What is the formula for pulm vasc resistance
Heparin
PVR = (PpulmA - PleftA)/CO
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

5. What are fat emboli associated with
Lost with alveolar walls
Long bone fractures and liposuction
Heparin
Loss of elastic fibers

6. What happens in perfusion limited circulatioin and which gases does this apply to...
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
Tension pneumo - away from lesion
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

7. What cells make surfactant and At what week is produced most abundantly
Mismatch
TB - silica disrupt phagolysosomes and impair MACS
Type II pneumocytes - after week 35
Methylene blue

8. Chronic bronchitis is a disease of what kind of airways
Right lung - right main stem bronhus is wider and more vertical
Small airways
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

9. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Mismatch
Loss of elastic fibers
0 - negative - prevents pneumothorax

10. What causes secondary pulm HTN
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
N- terminus - carbaminohemoglobin
Shed epithelium from mucus plugs
Heparin

11. What is central sleep apnea
No respiratory effort
Inc 2 -3- DPG - righward shift
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Activates bradykinin

12. What kind of connection exists between endothelial cells in the capilaries
RV + ERV - volume in lungs after nl expiration
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Tight jxns
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

13. What is positive cooperativity of hemoglobin refer to...
Dec - because physiologic shunt dec O2 extraction from ratio
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Inc excretion of bicarb to compensate for respiratory alkalosis
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

14. What is the main complication of therapeutic supplemental O2?
Retinopathy of maturity
Defect in coagulative cascace proteins
Respiratory bronchioles - clear debris in alveoli - bronchi
Inc 2 -3- DPG - righward shift

15. How is pulmonary circulation characterized in terms of resistance and compliance
Ivory white calcified pleural plaques
Inspiration by diaphragm - expiration is passive
Dec - because physiologic shunt dec O2 extraction from ratio
Low resistance and high compliance

16. What increases the risk of PDA in neonatal RDS
Incr - right - dec - left
Apex of healthy lung
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Persistently low O2 tension

17. What organism thrives in high O2 and where in the lung does it flourish
Weight loss - CPAP - surgery
S. aureus or anaerobes
Bleomycin - busulfan - anmiodorone
TB - apex

18. What kind of pleural plaques are the result of asbestosis
Inc to meet O2 demand
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Ivory white calcified pleural plaques
Methacholine challenge

19. What area of the lung is the largest physiologic contributor of fxnal dead space
Apex of healthy lung
Both highest in the base
Coal miner's - silicosis - abestosis
Lungs collapse inwards and chest wall spring out

20. What cells in the lung produce surfactant and What does it do
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Carcinoid - carcinoid
Methylene blue
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

21. What is a lung abscess and What does usually result from
Weight loss - CPAP - surgery
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

22. In which zone of the lung is Pa > Pv >PA
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Zone 3
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
IRV + TV

23. What is surfactant made of...
Alpha1- antitrypsin def - also cirrhosis
Loss of blood flow - impeded arterial flow - reduced venous drainage
Ratio from apex to base becomes more uniform
Dipalmatoyl phosphatidylcholine

24. What is the ideal V/Q ratio and why
Matched - =1 adequate gas exchange
Positive cooperativity and negative allostery - unlike myoglobin
Elastic properties
Inspiration by diaphragm - expiration is passive

25. What lab ration indicates fetal lung maturity
L/S > 2 = lecithin/sphingomyelin
Trachea and bronchi
No change - but inc venous CO2 content
Mismatch

26. What does the law of Laplace state about tendency of alveoli to collapse
Repeated cycles of lung injury and wound healing with inc collagen
P = 2ST/radius
On expiration as radius dec
Type II cells

27. A carcinoma in the apex of the lung can cause what syndrome and What is the tumor called

28. What is the appoximate O2 binding capacity
Loss of elastic fibers
Acetazolamide - inhibits CA and acidifies the blood
20.1 mL O2 /dL
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

29. Susceptibility to what infection is increased in silicosis and why
TB - silica disrupt phagolysosomes and impair MACS
Gland depth/total thickness of broncial wall - >50%
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

30. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Weight loss - CPAP - surgery
Hypertrophy of mucus secreting glands in the bronchioles
Incr - right - dec - left
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

31. Which structures perforate the diaphragm and where
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Tissue hypoxia from dec O2 sat and dec O2 content

32. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Loss of blood flow - impeded arterial flow - reduced venous drainage
Positive cooperativity and negative allostery - unlike myoglobin
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Tension pneumo - away from lesion

33. How do you prevent DVT
P = 2ST/radius
Heparin
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Inc mitochondria

34. Where are ventilation and perfusion highest in the lung - respectively
Prematurity - maternal RDS - cesarean delivery
Both highest in the base
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Dec - no change

35. What is pulmonary surfactant made of - and What does it do
Lower portion of right inferior lobe
Dipalmatoyl phosphatidylcholine - decreases surface tension
Matched - =1 adequate gas exchange
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

36. What is hemoglobin composed of...
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
4 polypeptide subunits - 2 alpha and 2 beta
Bronchial obstruction - toward side of lesion
FEV1/FVC > 80%

37. What is the course of of pulm HTN
Dec dec in FEV1 - dec in FVC
Air that moves into lung with each quiet respiration
Tissue hypoxia from dec O2 sat and dec O2 content
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

38. What do hemoglobin modifacations lead to...
Tissue hypoxia from dec O2 sat and dec O2 content
Loss of elastic fibers
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Prostaglandins - histamine - ACE - kallikrein

39. How does recurrent thromboemboli cause pulm HTN
Dec cross sectional area of pulm vasc bed
Ratio from apex to base becomes more uniform
Air in lung after maxmimal expiration - cannot be measured on spirometry
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

40. What is the criteria for chronic bronchitis
Deoxygenated blood - elastic walls
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Productive cough for greater than 3 months in at least 2 years

41. Define expiratory reserve volume (ERV)
Air that can still be breathed out after nl expiration
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Metastasis - breast - colon - prostate - bladder -
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

42. What happens to bicarb once it is created in an RBC
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
0 - negative - prevents pneumothorax
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Dec - no change

43. What cellular changes occur at high altitude
Both highest in the base
Exposed collagen fibers provides impetus for clotting cascade
Tissue hypoxia from dec O2 sat and dec O2 content
Inc mitochondria

44. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Weight loss - CPAP - surgery
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

45. 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%
Chroniclly tired
TB - silica disrupt phagolysosomes and impair MACS

46. Other than surfactant - what other important substances are produced by the lungs
Hypoxic vasocxn
Persistently low O2 tension
Prostaglandins - histamine - ACE - kallikrein
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

47. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
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
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)

48. What kind of space is in the conducting tree and what kind of muscle exists there
Anatomic dead space and smooth muscle
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Bleomycin - busulfan - anmiodorone
TB - apex

49. Define total lung capcaity
IRV + TV + ERV + RV
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Both highest in the base
Acute/chronic inc in vent

50. What does the conducting zone consist of...
4 polypeptide subunits - 2 alpha and 2 beta
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
RALS - righ anterior - left superior
Productive cough for greater than 3 months in at least 2 years