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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 are the causes of ischemia
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Loss of blood flow - impeded arterial flow - reduced venous drainage
Activates bradykinin
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

2. What does CADET face to the right stand for
CO2 - acid/altitude - DPG - Exercise - Temperature
Respiratory effort against airway obstruction
Inc EPO leading to erythrocytosis
Hyaline membrane disease

3. What do type II cells do - What is their morphology - when do they proliferate
FRC - inward pull of lung balanced by outward pull of chest wall
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Squamous cell carcinoma - keratin pearls and intracellular bridges
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

4. What does kallikrein do
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Activates bradykinin
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

5. Chronic bronchitis is a disease of what kind of airways
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Small airways
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

6. What ratio is used to measure lung maturity and What is the value is neonatal RDS
L/S < 1.5
L/S > 2 = lecithin/sphingomyelin
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

7. Define inspiratory capacity (IC)
PAO2 - PaO2 = 10-15 mmHg
Inc mitochondria
IRV + TV
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

8. What is the main complication of therapeutic supplemental O2?
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Lung cancer
Retinopathy of maturity

9. What are curschmann's spirals
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
Shed epithelium from mucus plugs
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Deep leg veins

10. What drug therapy is used to augment the changes in bicarb exretion
Ratio from apex to base becomes more uniform
Acetazolamide - inhibits CA and acidifies the blood
Dec - because physiologic shunt dec O2 extraction from ratio
Air that can still be breathed out after nl expiration

11. What can amniotic fluid emboli lead to...
Small airways
DIC - especially postpartum
Inc EPO leading to erythrocytosis
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

12. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
0 - negative - prevents pneumothorax
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
L/S > 2 = lecithin/sphingomyelin

13. What does the law of Laplace state about tendency of alveoli to collapse
Alchoholics or epileptics
Matched - =1 adequate gas exchange
On expiration as radius dec
CT angio

14. What are the findings associated with sarcoidosis
Squamous cell carcinoma - keratin pearls and intracellular bridges
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

15. At what lung volume is system pressure atmospheric and why
Steroids to mom - artificial surfactant and thyroxine to neonate
FRC - inward pull of lung balanced by outward pull of chest wall
Deoxygenated blood - elastic walls
Inc

16. What is the imaging test of choice for PE
PAO2 - PaO2 = 10-15 mmHg
CT angio
Metastasis - breast - colon - prostate - bladder -
Small airways

17. What causes secondary pulm HTN
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Surfactant
Ciliated cells

18. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Tight jxns
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
High alveolar pressure compresses capillaries
Gland depth/total thickness of broncial wall - >50%

19. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Matched - =1 adequate gas exchange
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Inc mitochondria
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

20. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
PA02 = 150 - PACO2/0.8
In between perfusion limited and diffusion limited
Inc shear stress leading to endothelial injury
Surfactant

21. What are the SPHERE of complications in lung cancer
Lost with alveolar walls
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
CO2 - acid/altitude - DPG - Exercise - Temperature
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

22. What are the two forms of hemoglobin
Lower portion of right inferior lobe
Airways close prematurely resulting in inc RV and dec FVC
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

23. What are potential triggers for asthma
Air that can still be breathed out after nl expiration
Viral - URIs - allergens and stress
CO x O2 content of blood
Activates bradykinin

24. Define physilogic dead space
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Carcinoid - carcinoid
PA02 = 150 - PACO2/0.8
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

25. What is the protein content an exudative pleural effusion and What are the potential causes
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Lower portion of right inferior lobe
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

26. What is a chronic complication of sleep apnea
L/S < 1.5
Zone 3
Elastase
Chroniclly tired

27. What are the various causes of ARDS
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor

28. What is used to treat methemoglobin
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Squamous cell carcinoma - keratin pearls and intracellular bridges
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Methylene blue

29. What is the formula for collapsing pressure
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
P = 2ST/radius
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Bleomycin - busulfan - anmiodorone

30. What kind of pleural plaques are the result of asbestosis
Ivory white calcified pleural plaques
Squamous cell carcinoma - keratin pearls and intracellular bridges
Apex of healthy lung
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

31. What cells make surfactant and At what week is produced most abundantly
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Lower portion of right inferior lobe
Type II pneumocytes - after week 35
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

32. What does alveolar pressure do to capillaries in the apex of the lung
High alveolar pressure compresses capillaries
Lobar PNA
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Hyaline membrane disease

33. What is the pathology of emphysema
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
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
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

34. Where do 95% of PE arise from
Airway obstruction (shunt) 100% O2 does not improve PO2
Deep leg veins
Air in excess of tidal volume that moves into lung on maximal inspiration
Inc O2 consumption

35. What area of the lung is the largest physiologic contributor of fxnal dead space
Right lung - right main stem bronhus is wider and more vertical
Type II cells
Apex of healthy lung
Brings air in and out - warms - humidifies - filters

36. In emphysema - What is increased lung compliance due to...
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Low resistance and high compliance
Mesothelioma - pleura - psammoma bodies
Loss of elastic fibers

37. In which zone of the lung is PA > Pa > Pv
PAO2 - PaO2 = 10-15 mmHg
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Mismatch
Zone 1

38. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Exposed collagen fibers provides impetus for clotting cascade
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Inspiration by diaphragm - expiration is passive
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

39. What does each bronchopulmonary segment have in the center and along its border
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
FEV1/FVC > 80%
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

40. What are the 3 reasons for an increased A- a gradient
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Anatomic dead space and smooth muscle
Inc resistance leading to inc pressure

41. How does sleep apnea or high altitude cause pulm HTN
Superior portion of right inferior lobe
Hypoxic vasocxn
Both highest in the base
Heart

42. What changes in pH occur during strenuous exercise and why
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Prematurity - maternal RDS - cesarean delivery
Dec - due to lactic acidosis
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

43. If you aspirate a peanut while supine - where will it go
Superior portion of right inferior lobe
Lowered
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Inc excretion of bicarb to compensate for respiratory alkalosis

44. Why is endothelial damage a risk factor for DVT
Elastic properties
Exposed collagen fibers provides impetus for clotting cascade
Deep leg veins
Zone 3

45. Define expiratory reserve volume (ERV)
Bronchial obstruction - toward side of lesion
Low resistance and high compliance
Chroniclly tired
Air that can still be breathed out after nl expiration

46. Why is there eventual loss of capillary beds in emphysema
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Lowered
Lost with alveolar walls
Air in lung after maxmimal expiration - cannot be measured on spirometry

47. What are mucus secretion swept out by
FRC - inward pull of lung balanced by outward pull of chest wall
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Elastic properties
Ciliated cells

48. Why do pts with emphysema exhale through pursed lips
Prematurity - maternal RDS - cesarean delivery
Inc airway pressure to prevent airway collapse during exhalation
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

49. What enzyme increases activity in emphysema
Surfactant
Elastase
Dec - because physiologic shunt dec O2 extraction from ratio
Dipalmatoyl phosphatidylcholine

50. What is the alveolar gas equation approximation
Ivory white calcified pleural plaques
PA02 = 150 - PACO2/0.8
Right shift - favors taut - low affinity for O2 - O2 unloading
Methylene blue