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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 happens in diffiusion limited pulmonary circulation and what gases does this apply to...
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Deep leg veins
IRV + TV
PAO2 - PaO2 = 10-15 mmHg

2. What changes occur to pulm blood flow during exercise
Deoxygenated blood - elastic walls
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Acute/chronic inc in vent
Inc due to inc CO

3. What is obstructive sleep apnea
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Clara cells - type II pneumocytes; multiple densitites on CXR
Respiratory effort against airway obstruction
Dec dec in FEV1 - dec in FVC

4. What is the cycle of idiopathic pulmonary fibrosis
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
4 polypeptide subunits - 2 alpha and 2 beta
Repeated cycles of lung injury and wound healing with inc collagen
Dec in the FEV1/FVC

5. What are the lab/study findings in adenocarcinoma of the lung
Clara cells - type II pneumocytes; multiple densitites on CXR
FEV1/FVC > 80%
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Person stops breathing for at least 10 seconds repeatedly during sleep

6. What is the leading cause of cancer death
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Trachea and bronchi
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
Lung cancer

7. What is hemoglobin composed of...
4 polypeptide subunits - 2 alpha and 2 beta
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Mismatch
Dec cross sectional area of pulm vasc bed

8. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Hypoxic vasocxn
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Persistently low O2 tension
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

9. 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
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
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

10. What is the imaging test of choice for PE
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
CT angio
P = 2ST/radius
TB - apex

11. What is carboxyhemoglobin and What does it cause
Upper lobes
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Acetazolamide - inhibits CA and acidifies the blood
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

12. Lung absecss often reults From what organisms
S. aureus or anaerobes
Inc O2 consumption
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

13. Where does lung cancer met to...
Dec cross sectional area of pulm vasc bed
Heparin
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Respiratory bronchioles - clear debris in alveoli - bronchi

14. Which muscles are involved in quiet breathing and What part of respiration do the control
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Tight jxns
Inspiration by diaphragm - expiration is passive
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

15. What is the characteristic lymphatic pleural effusion
Right shift - favors taut - low affinity for O2 - O2 unloading
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Milky fluid with inc TGs
0 - negative - prevents pneumothorax

16. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
0 - negative - prevents pneumothorax
Zone 3
Type II pneumocytes - after week 35
TB - silica disrupt phagolysosomes and impair MACS

17. What are clara cells What is their morphology and What do they do
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Long bone fractures and liposuction
Inc due to inc CO
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

18. What doe FAT BAT stand for
Centriacinar
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Heart
Dipalmatoyl phosphatidylcholine - decreases surface tension

19. At what PaO2 does cyanosis begin
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
O2 binding x O2 sat + dissolved O2
Repeated cycles of lung injury and wound healing with inc collagen
<60

20. What is the formula for A- a gradient - and What is it normally
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Air that moves into lung with each quiet respiration
PAO2 - PaO2 = 10-15 mmHg

21. What are the findings in asthma
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Dec in the FEV1/FVC

22. What is the alveolar gas equation approximation
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
PA02 = 150 - PACO2/0.8
Tight jxns
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

23. What kind of space is in the conducting tree and what kind of muscle exists there
L/S < 1.5
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Anatomic dead space and smooth muscle
TB - silica disrupt phagolysosomes and impair MACS

24. What happens with the O2 curve shifts to the right and What does it facilitate
FEV1/FVC > 80%
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

25. What is virchow's triad
Stasis - hypercoagulability - endothelial damage
Dec
Ivory white calcified pleural plaques
Exposed collagen fibers provides impetus for clotting cascade

26. What cells make surfactant and At what week is produced most abundantly
Type II pneumocytes - after week 35
Alpha1- antitrypsin def - also cirrhosis
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

27. What causes primary pulm HTN
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Right
N- terminus - carbaminohemoglobin
Incr - right - dec - left

28. Why is cesarean delivery a risk factor for neonatal RDS
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Prematurity - maternal RDS - cesarean delivery
Dec release of fetal glucocorticoids
No respiratory effort

29. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Heparin
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

30. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Alchoholics or epileptics
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Pleural effusion
Inc 2 -3- DPG - righward shift

31. What is pulmonary surfactant made of - and What does it do
4 polypeptide subunits - 2 alpha and 2 beta
Dipalmatoyl phosphatidylcholine - decreases surface tension
0 - negative - prevents pneumothorax
Ciliated cells

32. What does the conducting zone consist of...
4 polypeptide subunits - 2 alpha and 2 beta
Acetazolamide - inhibits CA and acidifies the blood
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
On expiration as radius dec

33. 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
Anatomic dead space and smooth muscle
Bronchial obstruction - toward side of lesion
Productive cough for greater than 3 months in at least 2 years
CO x O2 content of blood

34. What is the alveolar gas equation
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Dipalmatoyl phosphatidylcholine
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

35. What are the causes of ischemia
Elastic properties
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
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
Loss of blood flow - impeded arterial flow - reduced venous drainage

36. What is the defect in panacinar emphysema - and what else do you see
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Steroids to mom - artificial surfactant and thyroxine to neonate
Zone 1
Alpha1- antitrypsin def - also cirrhosis

37. What are the 3 reasons for an increased A- a gradient
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Air in lung after maxmimal expiration - cannot be measured on spirometry
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

38. What are the risk factors for neonatal RDS
Prematurity - maternal RDS - cesarean delivery
IRV + TV + ERV + RV
Matched - =1 adequate gas exchange
Exposed collagen fibers provides impetus for clotting cascade

39. What TX is the mother given before delivery - and what TXs are given to the infant
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Steroids to mom - artificial surfactant and thyroxine to neonate
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

40. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
N- terminus - carbaminohemoglobin
Squamous cell carcinoma - keratin pearls and intracellular bridges
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Brings air in and out - warms - humidifies - filters

41. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Ciliated cells
Airway obstruction (shunt) 100% O2 does not improve PO2
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Dec - due to lactic acidosis

42. Define vital capacity (VC)
Everything but RV - TV + IRV + ERV
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
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Retinopathy of maturity

43. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Persistently low O2 tension
Chest pain - tachypnea and dyspnea
Dipalmatoyl phosphatidylcholine - decreases surface tension
Right shift - favors taut - low affinity for O2 - O2 unloading

44. Why is there eventual loss of capillary beds in emphysema
Viral - URIs - allergens and stress
Lost with alveolar walls
Dec cross sectional area of pulm vasc bed
Airways close prematurely resulting in inc RV and dec FVC

45. What organism causes a lobar PNA and What are the characteristics
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

46. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Long bone fractures and liposuction
Persistently low O2 tension
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

47. What kind of pleural plaques are the result of asbestosis
Ivory white calcified pleural plaques
Gland depth/total thickness of broncial wall - >50%
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
RALS - righ anterior - left superior

48. What is a chronic complication of sleep apnea
Tension pneumo - away from lesion
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Chroniclly tired
Dec dec in FEV1 - dec in FVC

49. What does CADET face to the right stand for
Long bone fractures and liposuction
Positive cooperativity and negative allostery - unlike myoglobin
Airway obstruction (shunt) 100% O2 does not improve PO2
CO2 - acid/altitude - DPG - Exercise - Temperature

50. Define physilogic dead space
L/S > 2 = lecithin/sphingomyelin
Dec release of fetal glucocorticoids
Acute/chronic inc in vent
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli