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 is tha hallmark finding of COPD
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Dec in the FEV1/FVC
O2 binding x O2 sat + dissolved O2
Alchoholics or epileptics

2. What happens to V/Q ratio in COPD
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Mismatch
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
CO - 200x

3. What is virchow's triad
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Zone 1
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Stasis - hypercoagulability - endothelial damage

4. Where does lung cancer met to...
Dorsiflexion of food leads to tender calf muscle
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
L/S > 2 = lecithin/sphingomyelin
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)

5. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Lower portion of right inferior lobe
Pa > PA > Pv
Centriacinar

6. What causes primary pulm HTN
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Chest pain - tachypnea and dyspnea
Bleomycin - busulfan - anmiodorone
Exposed collagen fibers provides impetus for clotting cascade

7. What is used to treat CN poisoning and why
Clara cells - type II pneumocytes; multiple densitites on CXR
Mesothelioma - pleura - psammoma bodies
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
On expiration as radius dec

8. What organism causes a lobar PNA and What are the characteristics
Apex of healthy lung
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

9. What reaction and enzyme create bicarb and Where does it happen
Lobar PNA
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Heparin
Steroids to mom - artificial surfactant and thyroxine to neonate

10. What does the respiratory zone consist of and What is its fxn
CO2 - acid/altitude - DPG - Exercise - Temperature
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Anatomic dead space and smooth muscle
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

11. What is the pathology of chronic bronchitis
Hypertrophy of mucus secreting glands in the bronchioles
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Lobar PNA

12. What is surfactant made of...
Dipalmatoyl phosphatidylcholine
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Elastase
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

13. Other than surfactant - what other important substances are produced by the lungs
Inc to meet O2 demand
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Prostaglandins - histamine - ACE - kallikrein
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

14. What does pulm HTN result in
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
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Inc 2 -3- DPG - righward shift
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

15. What is early onset hypoxemia from in chronic bronchitis
Shunting
Inc
Stasis - hypercoagulability - endothelial damage
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

16. What increases the risk of PDA in neonatal RDS
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Inc due to inc CO
Persistently low O2 tension

17. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Dec
Prostaglandins - histamine - ACE - kallikrein
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Centriacinar

18. What causes neonatal RDS
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Surfactant def leading to inc surfact tension and alveolar collapse
Lobar PNA
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

19. What area of the lung is the largest physiologic contributor of fxnal dead space
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Dec dec in FEV1 - dec in FVC
Apex of healthy lung

20. Define tidal volume (TV)
Bronchial obstruction - toward side of lesion
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Air that moves into lung with each quiet respiration
Inc due to inc CO

21. What happens to O2 content and O2 sat as Hb falls
Defect in coagulative cascace proteins
Dec - no change
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
P = 2ST/radius

22. At what PaO2 does hypoxemia begin
O2 binding x O2 sat + dissolved O2
<75
Exposed collagen fibers provides impetus for clotting cascade
0 - negative - prevents pneumothorax

23. What cells in the lung produce surfactant and What does it do
Hyaline membrane disease
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Methacholine challenge

24. What is used to treat methemoglobin
Methylene blue
Milky fluid with inc TGs
Productive cough for greater than 3 months in at least 2 years
Air in lung after maxmimal expiration - cannot be measured on spirometry

25. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
Airways close prematurely resulting in inc RV and dec FVC
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
In between perfusion limited and diffusion limited
Inc 2 -3- DPG - righward shift

26. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Positive cooperativity and negative allostery - unlike myoglobin
Hypertrophy of mucus secreting glands in the bronchioles
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

27. 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
L/S < 1.5
Elastic properties
Drainage
Carcinoid - carcinoid

28. Which structures perforate the diaphragm and where
P = 2ST/radius
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Acute/chronic inc in vent

29. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Ivory white calcified pleural plaques
Dorsiflexion of food leads to tender calf muscle
L/S < 1.5
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

30. Lung absecss often reults From what organisms
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
<75
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
S. aureus or anaerobes

31. What is central sleep apnea
Inc excretion of bicarb to compensate for respiratory alkalosis
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
No respiratory effort
Anatomic dead space and smooth muscle

32. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Inc 2 -3- DPG - righward shift
Lungs collapse inwards and chest wall spring out
Dorsiflexion of food leads to tender calf muscle
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

33. What happens with the O2 curve shifts to the right and What does it facilitate
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Inc airway pressure to prevent airway collapse during exhalation
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

34. What lobes are affected in silicosis
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Upper lobes
500mL
Heparin

35. How happens to the proton from the rxn the created bicarb
Lower portion of right inferior lobe
Right
TB - apex
It binds to Hb -

36. What changes in lung volunes occur as a result of restrictive lung disease
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Dec in lung volumes - FVC - TLC
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

37. What are the findings associated with sarcoidosis
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Loss of blood flow - impeded arterial flow - reduced venous drainage
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Viral - URIs - allergens and stress

38. What is the equation for physiologic dead space
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Carcinoid - carcinoid
Hyaline membrane disease
Incr - right - dec - left

39. Which has a greater affinity for hemoglobin - CO or O2 and by how much
CO - 200x
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Airways close prematurely resulting in inc RV and dec FVC
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

40. Define total lung capcaity
Incr - right - dec - left
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
IRV + TV + ERV + RV
Elastase

41. What kind of pleural plaques are the result of asbestosis
Histiocytosis X - Langerhans cells
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
PA02 = 150 - PACO2/0.8
Ivory white calcified pleural plaques

42. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Chest pain - tachypnea and dyspnea
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

43. What happens to diffusing capacity in interstiial lung diseases
L/S < 1.5
Lowered
Loss of blood flow - impeded arterial flow - reduced venous drainage
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

44. What doe FAT BAT stand for
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Inc to meet O2 demand
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

45. What does a V/Q ratio of infinity indicate
Anatomic dead space and smooth muscle
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Prostaglandins - histamine - ACE - kallikrein

46. Why is cesarean delivery a risk factor for neonatal RDS
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 release of fetal glucocorticoids
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
CO x O2 content of blood

47. What is the Reid index and what perfectange is characteristic of chronic bronchitis
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
Gland depth/total thickness of broncial wall - >50%
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
RV + ERV - volume in lungs after nl expiration

48. What changes in EPO occur at high altitude
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Shed epithelium from mucus plugs
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Tension pneumo - away from lesion

49. Where do you find type I cells - What is their morphology - and What do they do
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
PAO2 - PaO2 = 10-15 mmHg
Carcinoid - carcinoid

50. What changes at high altitude can result in RVH
TB - apex
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Chronic hypoxic vasocxn
No respiratory effort