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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 is the formula for resistance
Airway obstruction (shunt) 100% O2 does not improve PO2
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Bleomycin - busulfan - anmiodorone
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

2. Define expiratory reserve volume (ERV)
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Air that can still be breathed out after nl expiration
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

3. What changes in CO2 occur during exercise
Inc production
Inc excretion of bicarb to compensate for respiratory alkalosis
20.1 mL O2 /dL
Lowered

4. What is a potential test for asthma
Air that moves into lung with each quiet respiration
Dec in lung volumes - FVC - TLC
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Methacholine challenge

5. How does mitral stenosis cause pulm HTN
Person stops breathing for at least 10 seconds repeatedly during sleep
Bleomycin - busulfan - anmiodorone
Inc resistance leading to inc pressure
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT

6. Which pts are at risk for apriation PNA
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Alchoholics or epileptics
Alpha1- antitrypsin def - also cirrhosis

7. What layers must CO2 and O2 traverse to complete gas exchange
Inc shear stress leading to endothelial injury
Exposed collagen fibers provides impetus for clotting cascade
Dec
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

8. At What terminal does CO2 bind the globin molecule
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
N- terminus - carbaminohemoglobin
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Small airways

9. What do pulmonary arteries carry - and how are pulm arterial pressures maintained during the cardiac cycle
PA02 = 150 - PACO2/0.8
IRV + TV + ERV + RV
Deoxygenated blood - elastic walls
Small airways

10. Why is there eventual loss of capillary beds in emphysema
Lost with alveolar walls
<75
Defect in coagulative cascace proteins
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

11. What kind of pleural plaques are the result of asbestosis
Pa > PA > Pv
Ivory white calcified pleural plaques
Opposites
Acetazolamide - inhibits CA and acidifies the blood

12. Why do pts with emphysema exhale through pursed lips
Hyaline membrane disease
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Inc airway pressure to prevent airway collapse during exhalation
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging

13. What is the ideal V/Q ratio and why
Alchoholics or epileptics
Matched - =1 adequate gas exchange
Centriacinar
Opposites

14. How does left to right shunt cause pulm HTN
Inc shear stress leading to endothelial injury
Dec dec in FEV1 - dec in FVC
Squamous cell carcinoma - keratin pearls and intracellular bridges
FEV1/FVC > 80%

15. What lab ration indicates fetal lung maturity
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
L/S > 2 = lecithin/sphingomyelin
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Alpha1- antitrypsin def - also cirrhosis

16. What lobes are affected in silicosis
Inc mitochondria
Airways close prematurely resulting in inc RV and dec FVC
Upper lobes
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

17. What is used to treat CN poisoning and why
Clara cells - type II pneumocytes; multiple densitites on CXR
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
Hypoxic vasocxn
Right

18. What are the causes of hypoxemia
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
N- terminus - carbaminohemoglobin
L/S > 2 = lecithin/sphingomyelin
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

19. Chronic bronchitis is a disease of what kind of airways
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
L/S < 1.5
Small airways
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

20. What are the findings associated with sarcoidosis
Methylene blue
Type II cells
Inc airway pressure to prevent airway collapse during exhalation
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

21. Define inspiratory reserve volume (IRV)
Inoperable - responsive to chemotherapy
Air in excess of tidal volume that moves into lung on maximal inspiration
Chroniclly tired
Bleomycin - busulfan - anmiodorone

22. 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
Weight loss - CPAP - surgery
Carcinoid - carcinoid
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
In between perfusion limited and diffusion limited

23. Define inspiratory capacity (IC)
Elastase
IRV + TV
Dorsiflexion of food leads to tender calf muscle
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

24. Other than surfactant - what other important substances are produced by the lungs
Loss of elastic fibers
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Prostaglandins - histamine - ACE - kallikrein
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

25. What lung abnl is characterized by absent or decreased breath sounds over affected area - dec resonance - dec fremitus - and which side is the trachea deviated towards
Bronchial obstruction - toward side of lesion
TB - silica disrupt phagolysosomes and impair MACS
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Alpha1- antitrypsin def - also cirrhosis

26. What happens to diffusing capacity in interstiial lung diseases
RV + ERV - volume in lungs after nl expiration
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Lowered
<60

27. What is the characteristic lymphatic pleural effusion
N- terminus - carbaminohemoglobin
No change - but inc venous CO2 content
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Milky fluid with inc TGs

28. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Viral - URIs - allergens and stress
No change - but inc venous CO2 content
Dec - because physiologic shunt dec O2 extraction from ratio
CO - 200x

29. What is the pathology of ARDS
S. aureus or anaerobes
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

30. What do type II cells do - What is their morphology - when do they proliferate
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Exposed collagen fibers provides impetus for clotting cascade
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Inc

31. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Inc 2 -3- DPG - righward shift
Airway obstruction (shunt) 100% O2 does not improve PO2
Elastic properties
Inc O2 consumption

32. How does sleep apnea or high altitude cause pulm HTN
Hypoxic vasocxn
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Repeated cycles of lung injury and wound healing with inc collagen
Tight jxns

33. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
4 polypeptide subunits - 2 alpha and 2 beta
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Pleural effusion
Positive cooperativity and negative allostery - unlike myoglobin

34. What is fetal hemoglobin made of and why does it have a higher affinity for O2
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Inc production
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

35. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
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
Lungs collapse inwards and chest wall spring out
Bleomycin - busulfan - anmiodorone

36. Why is endothelial damage a risk factor for DVT
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Prematurity - maternal RDS - cesarean delivery
Exposed collagen fibers provides impetus for clotting cascade
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

37. What increases the risk of PDA in neonatal RDS
CO - 200x
Persistently low O2 tension
PAO2 - PaO2 = 10-15 mmHg
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

38. What are the lab/study findings in adenocarcinoma of the lung
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Clara cells - type II pneumocytes; multiple densitites on CXR
Acute/chronic inc in vent
Ivory white calcified pleural plaques

39. What is the presentation of lung cancer

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40. What muscles are involved in breathing during exercise and What do they control
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
PVR = (PpulmA - PleftA)/CO
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

41. What changes occur to pulm blood flow during exercise
Tension pneumo - away from lesion
Inc due to inc CO
In between perfusion limited and diffusion limited
Inc 2 -3- DPG - righward shift

42. How does recurrent thromboemboli cause pulm HTN
Dec
Dec cross sectional area of pulm vasc bed
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Acute/chronic inc in vent

43. What are the 9 interstitial lung diseases

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44. What area of the lung is the largest physiologic contributor of fxnal dead space
Small airways
Apex of healthy lung
Dorsiflexion of food leads to tender calf muscle
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

45. What is the leading cause of cancer death
Everything but RV - TV + IRV + ERV
Lung cancer
Squamous cell carcinoma - keratin pearls and intracellular bridges
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

46. What changes in lung volunes occur as a result of restrictive lung disease
RV + ERV - volume in lungs after nl expiration
Dec in lung volumes - FVC - TLC
DIC - especially postpartum
Lobar PNA

47. What changes in pH occur during strenuous exercise and why
Activates bradykinin
Tight jxns
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Dec - due to lactic acidosis

48. What are curschmann's spirals
Shed epithelium from mucus plugs
Zone 3
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

49. What is the defect in panacinar emphysema - and what else do you see
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
S. aureus or anaerobes
Centriacinar
Alpha1- antitrypsin def - also cirrhosis

50. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Histiocytosis X - Langerhans cells
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Activates bradykinin
Inc mitochondria