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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. At What terminal does CO2 bind the globin molecule
Anatomic dead space and smooth muscle
Airway obstruction (shunt) 100% O2 does not improve PO2
N- terminus - carbaminohemoglobin
Everything but RV - TV + IRV + ERV

2. What is used to treat methemoglobin
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Methylene blue
Pa > PA > Pv

3. What is the tendency of the lungs vs the chest wall
Lungs collapse inwards and chest wall spring out
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
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

4. What does CADET face to the right stand for
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Inc
Elastase
CO2 - acid/altitude - DPG - Exercise - Temperature

5. What muscles are involved in breathing during exercise and What do they control
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Dorsiflexion of food leads to tender calf muscle
Zone 1
Lowered

6. What organism thrives in high O2 and where in the lung does it flourish
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
TB - apex
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

7. What do PFTs show in restrictive lung disease
FEV1/FVC > 80%
Acetazolamide - inhibits CA and acidifies the blood
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Inc

8. What is pulmonary surfactant made of - and What does it do
Repeated cycles of lung injury and wound healing with inc collagen
Inc O2 consumption
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Dipalmatoyl phosphatidylcholine - decreases surface tension

9. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Shed epithelium from mucus plugs
Dec - due to lactic acidosis
Gland depth/total thickness of broncial wall - >50%
Activates bradykinin

10. What causes neonatal RDS
Acute/chronic inc in vent
Tight jxns
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Surfactant def leading to inc surfact tension and alveolar collapse

11. What is the nl form of iron in hemoglobin
20.1 mL O2 /dL
Inc shear stress leading to endothelial injury
Fe 2+
Respiratory bronchioles - clear debris in alveoli - bronchi

12. At what PaO2 does cyanosis begin
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Viral - URIs - allergens and stress
Airways close prematurely resulting in inc RV and dec FVC
<60

13. What is the initial damage of ARDS caused by
Long bone fractures and liposuction
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
More indolent
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

14. What is the most common cancerous lesion in the lun
Metastasis - breast - colon - prostate - bladder -
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Drainage

15. What can amniotic fluid emboli lead to...
Both highest in the base
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
DIC - especially postpartum

16. What are the risk factors for neonatal RDS
Anatomic dead space and smooth muscle
Prematurity - maternal RDS - cesarean delivery
It binds to Hb -
L/S > 2 = lecithin/sphingomyelin

17. If you aspirate a peanut while supine - where will it go
Superior portion of right inferior lobe
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Tension pneumo - away from lesion
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

18. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
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
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

19. Lung absecss often reults From what organisms
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Everything but RV - TV + IRV + ERV
More indolent
S. aureus or anaerobes

20. What do hemoglobin modifacations lead to...
RV + ERV - volume in lungs after nl expiration
Trachea and bronchi
Surfactant
Tissue hypoxia from dec O2 sat and dec O2 content

21. Define total lung capcaity
IRV + TV + ERV + RV
Fe 2+
CO2 - acid/altitude - DPG - Exercise - Temperature
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

22. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Positive cooperativity and negative allostery - unlike myoglobin
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Steroids to mom - artificial surfactant and thyroxine to neonate
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

23. What are the causes of hypoxemia
Deep leg veins
Repeated cycles of lung injury and wound healing with inc collagen
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Steroids to mom - artificial surfactant and thyroxine to neonate

24. Define expiratory reserve volume (ERV)
Air that can still be breathed out after nl expiration
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

25. Which lung is the more common site for an inhaled foreign body and why
Zone 3
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Upper lobes - cor pulmonale - caplan's syndrome
Right lung - right main stem bronhus is wider and more vertical

26. What changes occur to pulm blood flow during exercise
Inc to meet O2 demand
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Inoperable - responsive to chemotherapy
Inc due to inc CO

27. What are the two forms of hemoglobin
Shunting
Bronchial obstruction - toward side of lesion
Zone 1
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

28. What is Homan's sign
Pa > PA > Pv
Acute/chronic inc in vent
Inc production
Dorsiflexion of food leads to tender calf muscle

29. What kind of connection exists between endothelial cells in the capilaries
Acetazolamide - inhibits CA and acidifies the blood
Both highest in the base
Tight jxns
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

30. In emphysema - What is increased lung compliance due to...
CO2 - acid/altitude - DPG - Exercise - Temperature
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Elastic properties
Loss of elastic fibers

31. What is the characteristic lymphatic pleural effusion
Air in lung after maxmimal expiration - cannot be measured on spirometry
Dec - no change
Milky fluid with inc TGs
CO - 200x

32. How does sleep apnea or high altitude cause pulm HTN
On expiration as radius dec
Hypoxic vasocxn
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Pleural effusion

33. What is the main complication of therapeutic supplemental O2?
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Incr - right - dec - left
Retinopathy of maturity
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

34. What is the protein content an exudative pleural effusion and What are the potential causes
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Hyaline membrane disease

35. Why is endothelial damage a risk factor for DVT
CO2 - acid/altitude - DPG - Exercise - Temperature
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Exposed collagen fibers provides impetus for clotting cascade
Positive cooperativity and negative allostery - unlike myoglobin

36. What changes in pH occur during strenuous exercise and why
Dec - due to lactic acidosis
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
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Stasis - hypercoagulability - endothelial damage

37. How do you prevent DVT
N- terminus - carbaminohemoglobin
Ivory white calcified pleural plaques
No respiratory effort
Heparin

38. What is hemoglobin composed of...
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Exposed collagen fibers provides impetus for clotting cascade
Anatomic dead space and smooth muscle
4 polypeptide subunits - 2 alpha and 2 beta

39. What findings are associated with emphysema
Inc to meet O2 demand
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Chest pain - tachypnea and dyspnea
Lower portion of right inferior lobe

40. What organisms cause interstitial PNA and What are the characteristics
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
DIC - especially postpartum

41. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
PVR = (PpulmA - PleftA)/CO
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Weight loss - CPAP - surgery
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

42. What are the lab/study findings in adenocarcinoma of the lung
C3 - 4 - 6 - phrenic nerve - referred to shoulder
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Dorsiflexion of food leads to tender calf muscle
Clara cells - type II pneumocytes; multiple densitites on CXR

43. What are the findings in asthma
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Prostaglandins - histamine - ACE - kallikrein
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

44. What are fat emboli associated with
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Long bone fractures and liposuction
Type II pneumocytes - after week 35
DIC - especially postpartum

45. What does a V/Q ratio of infinity indicate
Ciliated cells
Dipalmatoyl phosphatidylcholine - decreases surface tension
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Ratio from apex to base becomes more uniform

46. Define tidal volume (TV)
Air that moves into lung with each quiet respiration
Airway obstruction (shunt) 100% O2 does not improve PO2
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

47. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
20.1 mL O2 /dL
Long bone fractures and liposuction
Mesothelioma - pleura - psammoma bodies
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

48. What is the formula for A- a gradient - and What is it normally
Activates bradykinin
PAO2 - PaO2 = 10-15 mmHg
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
On expiration as radius dec

49. What happens with the O2 curve shifts to the right and What does it facilitate
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Air that can still be breathed out after nl expiration
Ivory white calcified pleural plaques
Lowered

50. How does recurrent thromboemboli cause pulm HTN
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Inc
CT angio
Dec cross sectional area of pulm vasc bed