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Respiratory

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What area of the lung is the largest physiologic contributor of fxnal dead space
Apex of healthy lung
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Activates bradykinin
Everything but RV - TV + IRV + ERV

2. 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
Person stops breathing for at least 10 seconds repeatedly during sleep
Brings air in and out - warms - humidifies - filters
Pleural effusion

3. What is the criteria for chronic bronchitis
Productive cough for greater than 3 months in at least 2 years
Incr - right - dec - left
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

4. In COPD - what happens to airways at high lung volumes
Right lung - right main stem bronhus is wider and more vertical
Air that can still be breathed out after nl expiration
Airways close prematurely resulting in inc RV and dec FVC
Inc production

5. What organisms cause a bronchoPNA and What are the characteristics
Right
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

6. Toxicities of what drugs include interstitial lung disease
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
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
Bleomycin - busulfan - anmiodorone

7. Define tidal volume (TV)
Pa > PA > Pv
Person stops breathing for at least 10 seconds repeatedly during sleep
Air that moves into lung with each quiet respiration
Dec dec in FEV1 - dec in FVC

8. What are the associations with bronchiectasis

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9. Why is cesarean delivery a risk factor for neonatal RDS
Dec release of fetal glucocorticoids
Methacholine challenge
Shed epithelium from mucus plugs
Inc production

10. What muscles are involved in breathing during exercise and What do they control
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

11. What happens as a result of hypoxia in sleep apnea
Lungs collapse inwards and chest wall spring out
DIC - especially postpartum
Inc EPO leading to erythrocytosis
Deoxygenated blood - elastic walls

12. What renal changes occur at high altitude and What are they compensating for
Inc excretion of bicarb to compensate for respiratory alkalosis
P = 2ST/radius
Right lung - right main stem bronhus is wider and more vertical
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

13. 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
N- terminus - carbaminohemoglobin
Fe 2+
Loss of elastic fibers

14. How does mitral stenosis cause pulm HTN
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Inc resistance leading to inc pressure
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

15. At what lung volume is system pressure atmospheric and why
Alpha1- antitrypsin def - also cirrhosis
Stasis - hypercoagulability - endothelial damage
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
FRC - inward pull of lung balanced by outward pull of chest wall

16. What cells in the lung produce surfactant and What does it do
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Inc EPO leading to erythrocytosis

17. What doe FAT BAT stand for
Ratio from apex to base becomes more uniform
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Histiocytosis X - Langerhans cells
Clara cells - type II pneumocytes; multiple densitites on CXR

18. What properties determine the combined volumes of the chest wall and lungs
Elastic properties
Hyaline membrane disease
FRC - inward pull of lung balanced by outward pull of chest wall
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

19. What TX is the mother given before delivery - and what TXs are given to the infant
Fe 2+
Tissue hypoxia from dec O2 sat and dec O2 content
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Steroids to mom - artificial surfactant and thyroxine to neonate

20. What does a V/Q ratio of 0 indicate
CO - 200x
Matched - =1 adequate gas exchange
Airway obstruction (shunt) 100% O2 does not improve PO2
DIC - especially postpartum

21. What must occur with a exudate pleural effusion
Milky fluid with inc TGs
Drainage
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

22. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Inc excretion of bicarb to compensate for respiratory alkalosis
Inc 2 -3- DPG - righward shift
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

23. What is the course of of pulm HTN
N- terminus - carbaminohemoglobin
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Fe 2+
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

24. Define residual volume (RV)
PA02 = 150 - PACO2/0.8
Air in lung after maxmimal expiration - cannot be measured on spirometry
Dec
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

25. What lab ration indicates fetal lung maturity
L/S > 2 = lecithin/sphingomyelin
Trachea and bronchi
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Pa > PA > Pv

26. What is the initial damage of ARDS caused by
L/S > 2 = lecithin/sphingomyelin
CT angio
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Prostaglandins - histamine - ACE - kallikrein

27. What kind of space is in the conducting tree and what kind of muscle exists there
Respiratory effort against airway obstruction
Anatomic dead space and smooth muscle
Inc production
Upper lobes

28. What causes primary pulm HTN
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Inc EPO leading to erythrocytosis
Gland depth/total thickness of broncial wall - >50%

29. In which zone of the lung is PA > Pa > Pv
Zone 1
Ivory white calcified pleural plaques
CT angio
4 polypeptide subunits - 2 alpha and 2 beta

30. What does the respiratory zone consist of and What is its fxn
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Positive cooperativity and negative allostery - unlike myoglobin
Long bone fractures and liposuction
Lobar PNA

31. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
Stasis - hypercoagulability - endothelial damage
RALS - righ anterior - left superior
Inc
Air that moves into lung with each quiet respiration

32. What enzyme increases activity in emphysema
CO2 - acid/altitude - DPG - Exercise - Temperature
Type II pneumocytes - after week 35
Hypertrophy of mucus secreting glands in the bronchioles
Elastase

33. What are curschmann's spirals
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Bronchial obstruction - toward side of lesion
Shed epithelium from mucus plugs
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

34. What are potential triggers for asthma
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Viral - URIs - allergens and stress
Airway obstruction (shunt) 100% O2 does not improve PO2

35. What changes in O2 consumption change during exercise
Inc O2 consumption
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Prematurity - maternal RDS - cesarean delivery
It binds to Hb -

36. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Mesothelioma - pleura - psammoma bodies
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Persistently low O2 tension
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

37. What are the 9 interstitial lung diseases

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38. What kind of pleural plaques are the result of asbestosis
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Inc resistance leading to inc pressure
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Ivory white calcified pleural plaques

39. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
TB - apex
Pleural effusion
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

40. What do type II cells do - What is their morphology - when do they proliferate
Methacholine challenge
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Long bone fractures and liposuction
Ciliated cells

41. What is the TX for small cell lung cancer
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Inoperable - responsive to chemotherapy
Repeated cycles of lung injury and wound healing with inc collagen

42. What is are the symptoms of a pulmonary embolism
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Chest pain - tachypnea and dyspnea

43. What is the formula for oxygen delivery to tissues
Matched - =1 adequate gas exchange
Surfactant
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
CO x O2 content of blood

44. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
Right shift - favors taut - low affinity for O2 - O2 unloading
0 - negative - prevents pneumothorax
Inspiration by diaphragm - expiration is passive
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

45. What are the 3 forms that CO2 is transported from tissues to lungs
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Inc resistance leading to inc pressure
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

46. What is a consequence of pulm HTN
Prematurity - maternal RDS - cesarean delivery
Shed epithelium from mucus plugs
Long bone fractures and liposuction
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

47. What is the formula for A- a gradient - and What is it normally
Airways close prematurely resulting in inc RV and dec FVC
Shed epithelium from mucus plugs
PAO2 - PaO2 = 10-15 mmHg
No change - but inc venous CO2 content

48. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Inc mitochondria
Fe 2+
Retinopathy of maturity
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

49. What does kallikrein do
Zone 1
Dec release of fetal glucocorticoids
Activates bradykinin
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

50. What is the pathology of emphysema
Lowered
Both highest in the base
FEV1/FVC > 80%
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance