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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 spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Defect in coagulative cascace proteins

2. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Inc EPO leading to erythrocytosis
CO - 200x
No respiratory effort

3. 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 release of fetal glucocorticoids
It binds to Hb -
N- terminus - carbaminohemoglobin

4. What is an association and potential complication of paraseptal emphysema
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Bronchial obstruction - toward side of lesion
Inc
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

5. What is surfactant made of...
DIC - especially postpartum
Dipalmatoyl phosphatidylcholine
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

6. What kind of connection exists between endothelial cells in the capilaries
Acute/chronic inc in vent
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Tight jxns
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

7. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Methacholine challenge
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

8. What are potential triggers for asthma
Viral - URIs - allergens and stress
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
O2 binding x O2 sat + dissolved O2
Methylene blue

9. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Viral - URIs - allergens and stress
Prostaglandins - histamine - ACE - kallikrein
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

10. Where are ventilation and perfusion highest in the lung - respectively
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Persistently low O2 tension
Dipalmatoyl phosphatidylcholine - decreases surface tension
Both highest in the base

11. What direction does an increase in metabolic need shift the O2 dissociation curve
Surfactant
Person stops breathing for at least 10 seconds repeatedly during sleep
IRV + TV
Right

12. What changes in pH occur during strenuous exercise and why
Dec - due to lactic acidosis
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

13. Which pts are at risk for apriation PNA
Dipalmatoyl phosphatidylcholine
Alchoholics or epileptics
Activates bradykinin
Matched - =1 adequate gas exchange

14. What are the associations with bronchiectasis

15. What are clara cells What is their morphology and What do they do
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Squamous cell carcinoma - keratin pearls and intracellular bridges
RALS - righ anterior - left superior
Air that can still be breathed out after nl expiration

16. How is pulmonary circulation characterized in terms of resistance and compliance
Low resistance and high compliance
Trachea and bronchi
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Chest pain - tachypnea and dyspnea

17. What happens to O2 content and O2 sat as Hb falls
Dec - no change
Small airways
RALS - righ anterior - left superior
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

18. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Lobar PNA
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
N- terminus - carbaminohemoglobin

19. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Squamous cell carcinoma - keratin pearls and intracellular bridges
Dec release of fetal glucocorticoids
Tight jxns

20. How does left to right shunt cause pulm HTN
Inc 2 -3- DPG - righward shift
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
Inc shear stress leading to endothelial injury
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

21. 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
Dec in lung volumes - FVC - TLC
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Respiratory bronchioles - clear debris in alveoli - bronchi
Carcinoid - carcinoid

22. In which zone of the lung is Pa > Pv >PA
Zone 3
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Shunting
Inc O2 consumption

23. What increases the risk of PDA in neonatal RDS
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Persistently low O2 tension
CO2 - acid/altitude - DPG - Exercise - Temperature
Inc excretion of bicarb to compensate for respiratory alkalosis

24. What is the ideal V/Q ratio and why
Matched - =1 adequate gas exchange
FRC - inward pull of lung balanced by outward pull of chest wall
Apex of healthy lung
Lungs collapse inwards and chest wall spring out

25. Lung absecss often reults From what organisms
Alpha1- antitrypsin def - also cirrhosis
Shed epithelium from mucus plugs
S. aureus or anaerobes
Lowered

26. What is tha hallmark finding of COPD
Lost with alveolar walls
Dec in the FEV1/FVC
Matched - =1 adequate gas exchange
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

27. How many lobes does each lung have - and What is the lingula
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Right shift - favors taut - low affinity for O2 - O2 unloading
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Person stops breathing for at least 10 seconds repeatedly during sleep

28. Why is there eventual loss of capillary beds in emphysema
Histiocytosis X - Langerhans cells
Prematurity - maternal RDS - cesarean delivery
Lost with alveolar walls
Gland depth/total thickness of broncial wall - >50%

29. What layers must CO2 and O2 traverse to complete gas exchange
Chronic hypoxic vasocxn
Acute/chronic inc in vent
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

30. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
CT angio
Inc resistance leading to inc pressure

31. Define tidal volume (TV)
Alpha1- antitrypsin def - also cirrhosis
Dec
Drainage
Air that moves into lung with each quiet respiration

32. What changes occur to PaO2 and PaCO2
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
No change - but inc venous CO2 content
Lower portion of right inferior lobe
Inc production

33. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Respiratory bronchioles - clear debris in alveoli - bronchi
<75
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

34. What is virchow's triad
Stasis - hypercoagulability - endothelial damage
Upper lobes
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

35. What is positive cooperativity of hemoglobin refer to...
Chroniclly tired
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Tissue hypoxia from dec O2 sat and dec O2 content
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

36. What is Homan's sign
Inc airway pressure to prevent airway collapse during exhalation
Matched - =1 adequate gas exchange
Dorsiflexion of food leads to tender calf muscle
In between perfusion limited and diffusion limited

37. Define functional residual capacity (FRC)
RV + ERV - volume in lungs after nl expiration
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
No respiratory effort
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

38. What does the respiratory zone consist of and What is its fxn
Dec dec in FEV1 - dec in FVC
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Inc
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

39. What does alveolar pressure do to capillaries in the apex of the lung
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Zone 3
High alveolar pressure compresses capillaries
Acetazolamide - inhibits CA and acidifies the blood

40. What properties determine the combined volumes of the chest wall and lungs
Bronchial obstruction - toward side of lesion
Inoperable - responsive to chemotherapy
Bleomycin - busulfan - anmiodorone
Elastic properties

41. What is occupied in the space that would have been the left middle lobe
Heart
No change - but inc venous CO2 content
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Dorsiflexion of food leads to tender calf muscle

42. Toxicities of what drugs include interstitial lung disease
Bleomycin - busulfan - anmiodorone
Incr - right - dec - left
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Superior portion of right inferior lobe

43. What is the presentation of lung cancer

44. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Mesothelioma - pleura - psammoma bodies
Methacholine challenge
Long bone fractures and liposuction
Pleural effusion

45. What is the pathology of bronchiectasis
Viral - URIs - allergens and stress
Ciliated cells
P = 2ST/radius
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

46. What is a lung abscess and What does usually result from
Elastic properties
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

47. If you aspirate a peanut while supine - where will it go
Right
Superior portion of right inferior lobe
O2 binding x O2 sat + dissolved O2
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

48. What is the formula for collapsing pressure
Coal miner's - silicosis - abestosis
Histiocytosis X - Langerhans cells
P = 2ST/radius
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

49. What is a potential test for asthma
Methacholine challenge
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Inc excretion of bicarb to compensate for respiratory alkalosis
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

50. What is the leading cause of cancer death
N- terminus - carbaminohemoglobin
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Lung cancer
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]