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 does pulm HTN result in
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Type II pneumocytes - after week 35
Dec in lung volumes - FVC - TLC
On expiration as radius dec

2. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Lung cancer
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Dec - no change

3. Which pts are at risk for apriation PNA
Matched - =1 adequate gas exchange
Bronchial obstruction - toward side of lesion
Dipalmatoyl phosphatidylcholine - decreases surface tension
Alchoholics or epileptics

4. What is a consequence of pulm HTN
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Histiocytosis X - Langerhans cells

5. What are fat emboli associated with
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Long bone fractures and liposuction
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

6. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Elastase
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
PA02 = 150 - PACO2/0.8

7. What does decreased PAO2 do
Hypoxic vasocxn
DIC - especially postpartum
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

8. In emphysema - What is increased lung compliance due to...
Loss of elastic fibers
FRC - inward pull of lung balanced by outward pull of chest wall
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

9. What are the histological findings in asbestosis and what occupations are associated
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Fe 2+
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Inc to meet O2 demand

10. Why is endothelial damage a risk factor for DVT
In between perfusion limited and diffusion limited
Loss of elastic fibers
Positive cooperativity and negative allostery - unlike myoglobin
Exposed collagen fibers provides impetus for clotting cascade

11. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Dorsiflexion of food leads to tender calf muscle
Bleomycin - busulfan - anmiodorone
CO x O2 content of blood
Respiratory bronchioles - clear debris in alveoli - bronchi

12. What are the subtypes of pneumoconioses

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

14. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Squamous cell carcinoma - keratin pearls and intracellular bridges
Lobar PNA
<75

15. 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
Tension pneumo - away from lesion
Lower portion of right inferior lobe
Opposites

16. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
Airway obstruction (shunt) 100% O2 does not improve PO2
In between perfusion limited and diffusion limited
Apex of healthy lung
CO - 200x

17. At what lung volume is system pressure atmospheric and why
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Ratio from apex to base becomes more uniform
FRC - inward pull of lung balanced by outward pull of chest wall
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

18. What is the formula for oxygen delivery to tissues
Methylene blue
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Drainage
CO x O2 content of blood

19. What changes occur to PaO2 and PaCO2
S. aureus or anaerobes
No change - but inc venous CO2 content
Inc airway pressure to prevent airway collapse during exhalation
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

20. What lobes are affected in silicosis
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Inc shear stress leading to endothelial injury
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Upper lobes

21. Define functional residual capacity (FRC)
RV + ERV - volume in lungs after nl expiration
Viral - URIs - allergens and stress
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

22. What direction does an increase in metabolic need shift the O2 dissociation curve
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
CO2 - acid/altitude - DPG - Exercise - Temperature
Right
L/S > 2 = lecithin/sphingomyelin

23. What is the formula for O2 content
On expiration as radius dec
O2 binding x O2 sat + dissolved O2
Right lung - right main stem bronhus is wider and more vertical
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

24. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Dipalmatoyl phosphatidylcholine
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

25. What does each bronchopulmonary segment have in the center and along its border
Dec - no change
Dec dec in FEV1 - dec in FVC
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

26. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Ciliated cells
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

27. Other than surfactant - what other important substances are produced by the lungs
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Prostaglandins - histamine - ACE - kallikrein
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
<60

28. What is positive cooperativity of hemoglobin refer to...
Person stops breathing for at least 10 seconds repeatedly during sleep
Milky fluid with inc TGs
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Inc due to inc CO

29. What is a lung abscess and What does usually result from
Inc production
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Inc shear stress leading to endothelial injury
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

30. What is the initial damage of ARDS caused by
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Inc excretion of bicarb to compensate for respiratory alkalosis
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

31. What are mucus secretion swept out by
Steroids to mom - artificial surfactant and thyroxine to neonate
<60
Ciliated cells
N- terminus - carbaminohemoglobin

32. What happens as a result of hypoxia in sleep apnea
Inc EPO leading to erythrocytosis
Long bone fractures and liposuction
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

33. What is the cycle of idiopathic pulmonary fibrosis
Bleomycin - busulfan - anmiodorone
Repeated cycles of lung injury and wound healing with inc collagen
<75
Respiratory bronchioles - clear debris in alveoli - bronchi

34. In which zone of the lung is Pa > Pv >PA
On expiration as radius dec
PVR = (PpulmA - PleftA)/CO
Zone 3
Opposites

35. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Dec - due to lactic acidosis
Mesothelioma - pleura - psammoma bodies
Heart
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

36. Susceptibility to what infection is increased in silicosis and why
Airways close prematurely resulting in inc RV and dec FVC
Inc O2 consumption
TB - silica disrupt phagolysosomes and impair MACS
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)

37. What enzyme increases activity in emphysema
Tissue hypoxia from dec O2 sat and dec O2 content
Elastase
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Chest pain - tachypnea and dyspnea

38. What is tha hallmark finding of COPD
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Dec in the FEV1/FVC
Opposites
High alveolar pressure compresses capillaries

39. What is early onset hypoxemia from in chronic bronchitis
IRV + TV + ERV + RV
Shunting
Person stops breathing for at least 10 seconds repeatedly during sleep
Exposed collagen fibers provides impetus for clotting cascade

40. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
PA02 = 150 - PACO2/0.8
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

41. What is a potential test for asthma
DIC - especially postpartum
Inc
Repeated cycles of lung injury and wound healing with inc collagen
Methacholine challenge

42. What changes in 2 -3 - DPG occur at high altitude
Tissue hypoxia from dec O2 sat and dec O2 content
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
RV + ERV - volume in lungs after nl expiration
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

43. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Elastase
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Everything but RV - TV + IRV + ERV

44. What is a typical tidal volume
500mL
Surfactant def leading to inc surfact tension and alveolar collapse
Methylene blue
Drainage

45. If you aspirate a peanut while supine - where will it go
Viral - URIs - allergens and stress
Superior portion of right inferior lobe
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

46. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
CT angio
Dec release of fetal glucocorticoids
Centriacinar
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

47. What changes in ventilation rate occur during exercise
Inc to meet O2 demand
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
CO x O2 content of blood
CT angio

48. What do pulmonary arteries carry - and how are pulm arterial pressures maintained during the cardiac cycle
Deoxygenated blood - elastic walls
S. aureus or anaerobes
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Upper lobes - cor pulmonale - caplan's syndrome

49. What is carboxyhemoglobin and What does it cause
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Form of hemoglobin bound to CO in place of O2 - causes dec O2 binding capacituy with a left shift in the O2 hemoglobin dissociation curve - dec unloading in tissues
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

50. What changes in O2 consumption change during exercise
Inc O2 consumption
CT angio
It binds to Hb -
Small airways