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Test your basic knowledge |
Respiratory
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Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
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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. Where does lung cancer met to...
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
Matched - =1 adequate gas exchange
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
2. What is positive cooperativity of hemoglobin refer to...
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Deep leg veins
Air that moves into lung with each quiet respiration
3. Other than surfactant - what other important substances are produced by the lungs
Exposed collagen fibers provides impetus for clotting cascade
L/S < 1.5
Persistently low O2 tension
Prostaglandins - histamine - ACE - kallikrein
4. Why is endothelial damage a risk factor for DVT
CO - 200x
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Exposed collagen fibers provides impetus for clotting cascade
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
5. What do hemoglobin modifacations lead to...
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Tissue hypoxia from dec O2 sat and dec O2 content
Right
Inc resistance leading to inc pressure
6. What organisms cause a bronchoPNA and What are the characteristics
Shunting
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
7. What reaction and enzyme create bicarb and Where does it happen
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Low resistance and high compliance
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
8. What changes occur to pulm blood flow during exercise
Inc due to inc CO
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Dec release of fetal glucocorticoids
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
9. What does decreased PAO2 do
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Chronic hypoxic vasocxn
PVR = (PpulmA - PleftA)/CO
10. How many lobes does each lung have - and What is the lingula
Lost with alveolar walls
Dec cross sectional area of pulm vasc bed
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Milky fluid with inc TGs
11. What can amniotic fluid emboli lead to...
Inc excretion of bicarb to compensate for respiratory alkalosis
DIC - especially postpartum
PAO2 - PaO2 = 10-15 mmHg
Right lung - right main stem bronhus is wider and more vertical
12. What is the equation for physiologic dead space
Dorsiflexion of food leads to tender calf muscle
Lowered
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
13. What are the risk factors for neonatal RDS
Prematurity - maternal RDS - cesarean delivery
Dipalmatoyl phosphatidylcholine
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Milky fluid with inc TGs
14. What are clara cells What is their morphology and What do they do
Lost with alveolar walls
Hypertrophy of mucus secreting glands in the bronchioles
Dec in lung volumes - FVC - TLC
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
15. What happens to bicarb once it is created in an RBC
Long bone fractures and liposuction
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
16. What lobes are affected in silicosis
Small airways
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
N- terminus - carbaminohemoglobin
Upper lobes
17. What does pulm HTN result in
Anatomic dead space and smooth muscle
Squamous cell carcinoma - keratin pearls and intracellular bridges
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
18. What is a typical tidal volume
500mL
Brings air in and out - warms - humidifies - filters
Clara cells - type II pneumocytes; multiple densitites on CXR
No respiratory effort
19. How does recurrent thromboemboli cause pulm HTN
Lost with alveolar walls
Acetazolamide - inhibits CA and acidifies the blood
Type II pneumocytes - after week 35
Dec cross sectional area of pulm vasc bed
20. What changes in EPO occur at high altitude
Tissue hypoxia from dec O2 sat and dec O2 content
500mL
Inc production
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
21. What is the formula for resistance
Acute/chronic inc in vent
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Inc excretion of bicarb to compensate for respiratory alkalosis
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
22. What is a chronic complication of sleep apnea
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Methylene blue
Chroniclly tired
Centriacinar
23. What is the pathology of ARDS
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Air in excess of tidal volume that moves into lung on maximal inspiration
24. What changes in V/Q throughout the lung during exercise
Air in excess of tidal volume that moves into lung on maximal inspiration
High alveolar pressure compresses capillaries
Ratio from apex to base becomes more uniform
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
25. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
PVR = (PpulmA - PleftA)/CO
Prostaglandins - histamine - ACE - kallikrein
Histiocytosis X - Langerhans cells
Dec in the FEV1/FVC
26. Which lung is the more common site for an inhaled foreign body and why
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Small airways
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Right lung - right main stem bronhus is wider and more vertical
27. What is compliance and When is it decrease
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Airways close prematurely resulting in inc RV and dec FVC
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
28. Which muscles are involved in quiet breathing and What part of respiration do the control
Small airways
Inspiration by diaphragm - expiration is passive
Positive cooperativity and negative allostery - unlike myoglobin
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
29. Toxicities of what drugs include interstitial lung disease
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Bleomycin - busulfan - anmiodorone
Surfactant def leading to inc surfact tension and alveolar collapse
30. What happens to O2 content and O2 sat as Hb falls
TB - apex
Inc due to inc CO
Dec - no change
High alveolar pressure compresses capillaries
31. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Anatomic dead space and smooth muscle
L/S < 1.5
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Gland depth/total thickness of broncial wall - >50%
32. What causes neonatal RDS
Surfactant def leading to inc surfact tension and alveolar collapse
Hyaline membrane disease
Inc excretion of bicarb to compensate for respiratory alkalosis
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
33. What do PFTs show in restrictive lung disease
Acute/chronic inc in vent
Steroids to mom - artificial surfactant and thyroxine to neonate
FEV1/FVC > 80%
PAO2 - PaO2 = 10-15 mmHg
34. What happens to V/Q ratio in COPD
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Incr - right - dec - left
Mismatch
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
35. What properties determine the combined volumes of the chest wall and lungs
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Loss of blood flow - impeded arterial flow - reduced venous drainage
Elastic properties
36. What is the protein content an exudative pleural effusion and What are the potential causes
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Ciliated cells
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Inc excretion of bicarb to compensate for respiratory alkalosis
37. What is methemoglobin
Tension pneumo - away from lesion
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Small airways
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
38. What does each bronchopulmonary segment have in the center and along its border
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Air that can still be breathed out after nl expiration
Stasis - hypercoagulability - endothelial damage
39. If you aspirate a peanut while supine - where will it go
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Apex of healthy lung
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Superior portion of right inferior lobe
40. What is the ideal V/Q ratio and why
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Trachea and bronchi
Matched - =1 adequate gas exchange
Dec - due to lactic acidosis
41. What is the course of of pulm HTN
Prematurity - maternal RDS - cesarean delivery
Carcinoid - carcinoid
L/S > 2 = lecithin/sphingomyelin
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
42. What is the formula for oxygen delivery to tissues
More indolent
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
CO x O2 content of blood
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
43. What cells in the lung produce surfactant and What does it do
S. aureus or anaerobes
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Dec - because physiologic shunt dec O2 extraction from ratio
Shed epithelium from mucus plugs
44. What is the pathology of asthma
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45. What happens with the O2 curve shifts to the right and What does it facilitate
Inspiration by diaphragm - expiration is passive
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
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
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
46. What is the alveolar gas equation
Histiocytosis X - Langerhans cells
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Hypoxic vasocxn
47. What is a consequence of pulm HTN
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Tissue hypoxia from dec O2 sat and dec O2 content
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
48. What changes in ventilation rate occur during exercise
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Retinopathy of maturity
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Inc to meet O2 demand
49. What is the formula for collapsing pressure
FRC - inward pull of lung balanced by outward pull of chest wall
Air in lung after maxmimal expiration - cannot be measured on spirometry
P = 2ST/radius
C3 - 4 - 6 - phrenic nerve - referred to shoulder
50. What is a lung abscess and What does usually result from
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Surfactant def leading to inc surfact tension and alveolar collapse
Inc mitochondria
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
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