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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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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 occupied in the space that would have been the left middle lobe
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Heart
Persistently low O2 tension
Productive cough for greater than 3 months in at least 2 years

2. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Metastasis - breast - colon - prostate - bladder -
Air in lung after maxmimal expiration - cannot be measured on spirometry
Pa > PA > Pv
Both highest in the base

3. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Respiratory bronchioles - clear debris in alveoli - bronchi
Inc shear stress leading to endothelial injury
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

4. How do you prevent DVT
Dec - because physiologic shunt dec O2 extraction from ratio
High alveolar pressure compresses capillaries
Heparin
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

5. What are the findings associated with sarcoidosis
Incr - right - dec - left
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Surfactant
Inc excretion of bicarb to compensate for respiratory alkalosis

6. What kind of course does interstitial PNA follow in comparison to bronchoPNA
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Tension pneumo - away from lesion
More indolent

7. What is the alveolar gas equation
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
FRC - inward pull of lung balanced by outward pull of chest wall
Ratio from apex to base becomes more uniform
L/S < 1.5

8. What is the appoximate O2 binding capacity
20.1 mL O2 /dL
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Upper lobes - cor pulmonale - caplan's syndrome
Upper lobes

9. What are the histological findings in asbestosis and what occupations are associated
TB - apex
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
0 - negative - prevents pneumothorax
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

10. At What terminal does CO2 bind the globin molecule
Deep leg veins
Right lung - right main stem bronhus is wider and more vertical
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
N- terminus - carbaminohemoglobin

11. What is sleep apnea associated with
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Airway obstruction (shunt) 100% O2 does not improve PO2
Dec release of fetal glucocorticoids

12. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Acute/chronic inc in vent
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Lowered

13. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Alpha1- antitrypsin def - also cirrhosis
Dec in the FEV1/FVC
Incr - right - dec - left
Metastasis - breast - colon - prostate - bladder -

14. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
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
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Apex of healthy lung

15. 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
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Bronchial obstruction - toward side of lesion
Elastase
<75

16. What does alveolar pressure do to capillaries in the apex of the lung
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Air that can still be breathed out after nl expiration
High alveolar pressure compresses capillaries
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

17. How does recurrent thromboemboli cause pulm HTN
Dec cross sectional area of pulm vasc bed
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
500mL
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

18. What happens to arterial PO2 in chronic lung disease and why
Inc mitochondria
500mL
Dec - because physiologic shunt dec O2 extraction from ratio
C3 - 4 - 6 - phrenic nerve - referred to shoulder

19. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Methacholine challenge
IRV + TV
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

20. 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
Carcinoid - carcinoid
Activates bradykinin
Persistently low O2 tension
Fe 2+

21. 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
20.1 mL O2 /dL
Positive cooperativity and negative allostery - unlike myoglobin
Ciliated cells

22. What kind of connection exists between endothelial cells in the capilaries
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Tight jxns
PAO2 - PaO2 = 10-15 mmHg

23. What are the subtypes of pneumoconioses

24. What is the leading cause of cancer death
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
PVR = (PpulmA - PleftA)/CO
4 polypeptide subunits - 2 alpha and 2 beta
Lung cancer

25. What organism causes a lobar PNA and What are the characteristics
Inc shear stress leading to endothelial injury
Hypoxic vasocxn
Dec - because physiologic shunt dec O2 extraction from ratio
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

26. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Tension pneumo - away from lesion
Inspiration by diaphragm - expiration is passive
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
No respiratory effort

27. What kind of space is in the conducting tree and what kind of muscle exists there
Inc resistance leading to inc pressure
Airway obstruction (shunt) 100% O2 does not improve PO2
Apex of healthy lung
Anatomic dead space and smooth muscle

28. Define inspiratory reserve volume (IRV)
Carcinoid - carcinoid
Air in excess of tidal volume that moves into lung on maximal inspiration
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Inc mitochondria

29. What are the 9 interstitial lung diseases

30. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Chronic hypoxic vasocxn
Type II pneumocytes - after week 35
RALS - righ anterior - left superior

31. Where do you find type I cells - What is their morphology - and What do they do
Upper lobes - cor pulmonale - caplan's syndrome
Carcinoid - carcinoid
20.1 mL O2 /dL
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

32. What is the main complication of therapeutic supplemental O2?
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Fe 2+
Dec - due to lactic acidosis
Retinopathy of maturity

33. What changes in V/Q throughout the lung during exercise
Tissue hypoxia from dec O2 sat and dec O2 content
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Ratio from apex to base becomes more uniform
Drainage

34. What is the imaging test of choice for PE
500mL
Surfactant
CT angio
TB - silica disrupt phagolysosomes and impair MACS

35. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Zone 3
Lobar PNA
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
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

36. What is virchow's triad
Trachea and bronchi
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Stasis - hypercoagulability - endothelial damage
Matched - =1 adequate gas exchange

37. What are the SPHERE of complications in lung cancer
Tight jxns
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
S. aureus or anaerobes

38. What does ACE do
Upper lobes
Dec dec in FEV1 - dec in FVC
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
S. aureus or anaerobes

39. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude

40. What are clara cells What is their morphology and What do they do
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
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Deoxygenated blood - elastic walls
20.1 mL O2 /dL

41. Where do 95% of PE arise from
Deep leg veins
Superior portion of right inferior lobe
DIC - especially postpartum
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

42. What is early onset hypoxemia from in chronic bronchitis
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
CT angio
Shunting
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

43. What is the V/Q ratio at the apex and base of the lung
Matched - =1 adequate gas exchange
Mesothelioma - pleura - psammoma bodies
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

44. Why is endothelial damage a risk factor for DVT
Respiratory bronchioles - clear debris in alveoli - bronchi
Exposed collagen fibers provides impetus for clotting cascade
Respiratory effort against airway obstruction
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

45. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
0 - negative - prevents pneumothorax
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Upper lobes

46. What lobes does Coal Miner's pneumoconioses affect - and What can it result in

47. Which muscles are involved in quiet breathing and What part of respiration do the control
Prematurity - maternal RDS - cesarean delivery
Productive cough for greater than 3 months in at least 2 years
Inspiration by diaphragm - expiration is passive
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

48. What organisms cause interstitial PNA and What are the characteristics
Positive cooperativity and negative allostery - unlike myoglobin
Persistently low O2 tension
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
IRV + TV + ERV + RV

49. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
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
20.1 mL O2 /dL
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Squamous cell carcinoma - keratin pearls and intracellular bridges

50. What is the presentation of lung cancer