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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. How does autoimmune dz cause thromboemboli
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Persistently low O2 tension
Type II pneumocytes - after week 35
Dec

2. What are the SPHERE of complications in lung cancer
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Deoxygenated blood - elastic walls
RALS - righ anterior - left superior

3. What does the respiratory zone consist of and What is its fxn
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Coal miner's - silicosis - abestosis
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

4. What changes at high altitude can result in RVH
IRV + TV + ERV + RV
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Dipalmatoyl phosphatidylcholine
Chronic hypoxic vasocxn

5. Define inspiratory capacity (IC)
Right lung - right main stem bronhus is wider and more vertical
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
IRV + TV
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

6. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Matched - =1 adequate gas exchange
Both highest in the base
0 - negative - prevents pneumothorax

7. What does pulm HTN result in
RV + ERV - volume in lungs after nl expiration
L/S > 2 = lecithin/sphingomyelin
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
N- terminus - carbaminohemoglobin

8. 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
Inoperable - responsive to chemotherapy
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Bronchial obstruction - toward side of lesion

9. What is an association and potential complication of paraseptal emphysema
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Respiratory effort against airway obstruction
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Heart

10. What does the conducting zone consist of...
Dipalmatoyl phosphatidylcholine
Inc excretion of bicarb to compensate for respiratory alkalosis
Centriacinar
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

11. What is the protein content an exudative pleural effusion and What are the potential causes
Chronic hypoxic vasocxn
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Histiocytosis X - Langerhans cells
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

12. What is the imaging test of choice for PE
CT angio
Lower portion of right inferior lobe
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

13. How many lobes does each lung have - and What is the lingula
Opposites
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Hypertrophy of mucus secreting glands in the bronchioles
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

14. What happens to lung volumes in obstructive lung disease
CO2 - acid/altitude - DPG - Exercise - Temperature
Inc
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Respiratory effort against airway obstruction

15. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Persistently low O2 tension
CO2 - acid/altitude - DPG - Exercise - Temperature
Lobar PNA
CO x O2 content of blood

16. What changes in EPO occur at high altitude
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Repeated cycles of lung injury and wound healing with inc collagen

17. What must occur with a exudate pleural effusion
Lost with alveolar walls
Drainage
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

18. Which lung is the more common site for an inhaled foreign body and why
More indolent
Pa > PA > Pv
Right lung - right main stem bronhus is wider and more vertical
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

19. What is central sleep apnea
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Heparin
No respiratory effort
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

20. How happens to the proton from the rxn the created bicarb
FEV1/FVC > 80%
Shunting
It binds to Hb -
Methacholine challenge

21. What layers must CO2 and O2 traverse to complete gas exchange
It binds to Hb -
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Lobar PNA
Loss of elastic fibers

22. What are the findings associated with sarcoidosis
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Defect in coagulative cascace proteins
Pa > PA > Pv
No change - but inc venous CO2 content

23. Define residual volume (RV)
Coal miner's - silicosis - abestosis
Air in lung after maxmimal expiration - cannot be measured on spirometry
Histiocytosis X - Langerhans cells
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

24. How do you prevent DVT
Heparin
Zone 3
Lungs collapse inwards and chest wall spring out
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

25. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Drainage
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

26. In what cells do you find lamellar bodies
DIC - especially postpartum
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Type II cells
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

27. Susceptibility to what infection is increased in silicosis and why
O2 binding x O2 sat + dissolved O2
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
TB - silica disrupt phagolysosomes and impair MACS
Inc to meet O2 demand

28. What is a typical tidal volume
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
500mL
Brings air in and out - warms - humidifies - filters
Inc O2 consumption

29. What is are the symptoms of a pulmonary embolism
Chest pain - tachypnea and dyspnea
Both highest in the base
Ratio from apex to base becomes more uniform
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

30. What kind of space is in the conducting tree and what kind of muscle exists there
Loss of blood flow - impeded arterial flow - reduced venous drainage
Anatomic dead space and smooth muscle
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Surfactant

31. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Upper lobes
Surfactant def leading to inc surfact tension and alveolar collapse
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

32. At what PaO2 does hypoxemia begin
It binds to Hb -
<75
Mismatch
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

33. What is the criteria for chronic bronchitis
20.1 mL O2 /dL
Productive cough for greater than 3 months in at least 2 years
CO2 - acid/altitude - DPG - Exercise - Temperature
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

34. If you aspirate a peanut while upright - where will it go
Lower portion of right inferior lobe
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Mismatch
Dec in the FEV1/FVC

35. What is the course of of pulm HTN
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Trachea and bronchi

36. What is virchow's triad
PVR = (PpulmA - PleftA)/CO
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Stasis - hypercoagulability - endothelial damage
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

37. Lung absecss often reults From what organisms
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
S. aureus or anaerobes
O2 binding x O2 sat + dissolved O2
Tissue hypoxia from dec O2 sat and dec O2 content

38. What is the formula for pulm vasc resistance
Coal miner's - silicosis - abestosis
Repeated cycles of lung injury and wound healing with inc collagen
PVR = (PpulmA - PleftA)/CO
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

39. What does alveolar pressure do to capillaries in the apex of the lung
Opposites
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
High alveolar pressure compresses capillaries
Inc mitochondria

40. How does mitral stenosis cause pulm HTN
Inspiration by diaphragm - expiration is passive
Inc resistance leading to inc pressure
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Dec in lung volumes - FVC - TLC

41. What enzyme increases activity in emphysema
Elastase
FEV1/FVC > 80%
Inc 2 -3- DPG - righward shift
Squamous cell carcinoma - keratin pearls and intracellular bridges

42. What is the characteristic lymphatic pleural effusion
Lowered
Milky fluid with inc TGs
Inc excretion of bicarb to compensate for respiratory alkalosis
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

43. Why do pts with emphysema exhale through pursed lips
Brings air in and out - warms - humidifies - filters
Dorsiflexion of food leads to tender calf muscle
Inc airway pressure to prevent airway collapse during exhalation
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

44. What drug therapy is used to augment the changes in bicarb exretion
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Type II pneumocytes - after week 35
Dec in the FEV1/FVC
Acetazolamide - inhibits CA and acidifies the blood

45. What does each bronchopulmonary segment have in the center and along its border
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Dec in lung volumes - FVC - TLC
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Weight loss - CPAP - surgery

46. What is the ideal V/Q ratio and why
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Matched - =1 adequate gas exchange
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Hypertrophy of mucus secreting glands in the bronchioles

47. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
IRV + TV
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Trachea and bronchi

48. What does a V/Q ratio of 0 indicate
Loss of elastic fibers
Matched - =1 adequate gas exchange
Deoxygenated blood - elastic walls
Airway obstruction (shunt) 100% O2 does not improve PO2

49. What happens with the O2 curve shifts to the right and What does it facilitate
Brings air in and out - warms - humidifies - filters
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Ciliated cells
0 - negative - prevents pneumothorax

50. Why is cesarean delivery a risk factor for neonatal RDS
RALS - righ anterior - left superior
TB - silica disrupt phagolysosomes and impair MACS
Dec release of fetal glucocorticoids
Mesothelioma - pleura - psammoma bodies