Test your basic knowledge |

Respiratory

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. What happens to O2 content and O2 sat as Hb falls
Dec - no change
Anatomic dead space and smooth muscle
Type II cells
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

2. In what cells do you find lamellar bodies
Upper lobes - cor pulmonale - caplan's syndrome
Acute/chronic inc in vent
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Type II cells

3. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
More indolent

4. Where do 95% of PE arise from
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Squamous cell carcinoma - keratin pearls and intracellular bridges
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Deep leg veins

5. What are the two forms of hemoglobin
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
N- terminus - carbaminohemoglobin
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Inc to meet O2 demand

6. What happens to lung volumes in obstructive lung disease
500mL
Ciliated cells
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Inc

7. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Dec release of fetal glucocorticoids
Airways close prematurely resulting in inc RV and dec FVC
Matched - =1 adequate gas exchange
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

8. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Fe 2+
Loss of elastic fibers
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Lobar PNA

9. What is positive cooperativity of hemoglobin refer to...
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
IRV + TV + ERV + RV
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Long bone fractures and liposuction

10. What changes in CO2 occur during exercise
Alpha1- antitrypsin def - also cirrhosis
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Person stops breathing for at least 10 seconds repeatedly during sleep
Inc production

11. What is another name for neonatal RDS
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Hyaline membrane disease
PAO2 - PaO2 = 10-15 mmHg
CO2 - acid/altitude - DPG - Exercise - Temperature

12. What is hemoglobin composed of...
Bleomycin - busulfan - anmiodorone
4 polypeptide subunits - 2 alpha and 2 beta
Inc O2 consumption
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

13. Susceptibility to what infection is increased in silicosis and why
Hypertrophy of mucus secreting glands in the bronchioles
Heart
TB - silica disrupt phagolysosomes and impair MACS
P = 2ST/radius

14. What is the V/Q ratio at the apex and base of the lung
Deoxygenated blood - elastic walls
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Chronic hypoxic vasocxn
FRC - inward pull of lung balanced by outward pull of chest wall

15. What organism causes a lobar PNA and What are the characteristics
4 polypeptide subunits - 2 alpha and 2 beta
FEV1/FVC > 80%
Dec in the FEV1/FVC
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

16. What cellular changes occur at high altitude
Low resistance and high compliance
Inc mitochondria
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
PAO2 - PaO2 = 10-15 mmHg

17. How happens to the proton from the rxn the created bicarb
Bleomycin - busulfan - anmiodorone
Shunting
It binds to Hb -
<60

18. What does each bronchopulmonary segment have in the center and along its border
Histiocytosis X - Langerhans cells
Dec release of fetal glucocorticoids
Inc due to inc CO
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

19. What happens to diffusing capacity in interstiial lung diseases
Lowered
RALS - righ anterior - left superior
DIC - especially postpartum
Milky fluid with inc TGs

20. What direction does an increase in metabolic need shift the O2 dissociation curve
Respiratory bronchioles - clear debris in alveoli - bronchi
Dec in the FEV1/FVC
Right
Dipalmatoyl phosphatidylcholine - decreases surface tension

21. What is early onset hypoxemia from in chronic bronchitis
TB - apex
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Shunting
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

22. What are the causes of hypoxemia
Trachea and bronchi
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
TB - apex
CO2 - acid/altitude - DPG - Exercise - Temperature

23. What does decreased PAO2 do
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Zone 1
Hypertrophy of mucus secreting glands in the bronchioles
IRV + TV + ERV + RV

24. What ratio is used to measure lung maturity and What is the value is neonatal RDS
L/S < 1.5
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Inspiration by diaphragm - expiration is passive
Heart

25. What is carboxyhemoglobin and What does it cause
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
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
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Acetazolamide - inhibits CA and acidifies the blood

26. What are the findings of chronic bronchitis
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Tension pneumo - away from lesion
Type II cells

27. What are mucus secretion swept out by
Upper lobes - cor pulmonale - caplan's syndrome
Ciliated cells
Chest pain - tachypnea and dyspnea
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

28. What do hemoglobin modifacations lead to...
0 - negative - prevents pneumothorax
Tissue hypoxia from dec O2 sat and dec O2 content
Right
Hypertrophy of mucus secreting glands in the bronchioles

29. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Apex of healthy lung
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Elastic properties
Tissue hypoxia from dec O2 sat and dec O2 content

30. What are the 3 reasons for an increased A- a gradient
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
On expiration as radius dec
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Milky fluid with inc TGs

31. What is the imaging test of choice for PE
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
CT angio
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Airway obstruction (shunt) 100% O2 does not improve PO2

32. Why is there eventual loss of capillary beds in emphysema
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Lost with alveolar walls
Brings air in and out - warms - humidifies - filters
High alveolar pressure compresses capillaries

33. What is the ideal V/Q ratio and why
Both highest in the base
Matched - =1 adequate gas exchange
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Histiocytosis X - Langerhans cells

34. At what PaO2 does hypoxemia begin
Elastase
Dec release of fetal glucocorticoids
<75
Defect in coagulative cascace proteins

35. What is a typical tidal volume
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
IRV + TV
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
500mL

36. What are fat emboli associated with
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Long bone fractures and liposuction
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

37. What does pulm HTN result in
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Respiratory effort against airway obstruction
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Inoperable - responsive to chemotherapy

38. What does the conducting zone consist of...
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Surfactant
In between perfusion limited and diffusion limited
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles

39. What is Homan's sign
Dec - due to lactic acidosis
Dorsiflexion of food leads to tender calf muscle
Loss of elastic fibers
Deoxygenated blood - elastic walls

40. Define inspiratory reserve volume (IRV)
Hypoxic vasocxn
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Air that can still be breathed out after nl expiration
Air in excess of tidal volume that moves into lung on maximal inspiration

41. What happens with the O2 curve shifts to the right and What does it facilitate
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
RV + ERV - volume in lungs after nl expiration
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Shed epithelium from mucus plugs

42. Where is cartilage present in the respiratory tree
Inc production
Repeated cycles of lung injury and wound healing with inc collagen
Methacholine challenge
Trachea and bronchi

43. At What terminal does CO2 bind the globin molecule
Air that can still be breathed out after nl expiration
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
N- terminus - carbaminohemoglobin
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

44. What organisms cause interstitial PNA and What are the characteristics
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Acute/chronic inc in vent
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

45. Define tidal volume (TV)
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Lost with alveolar walls
Air that moves into lung with each quiet respiration
Lobar PNA

46. What is the presentation of lung cancer

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

47. What is the pathology of emphysema
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
20.1 mL O2 /dL
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
C3 - 4 - 6 - phrenic nerve - referred to shoulder

48. What is the formula for A- a gradient - and What is it normally
Centriacinar
PAO2 - PaO2 = 10-15 mmHg
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Lobar PNA

49. What are the causes of hypoxia
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
L/S > 2 = lecithin/sphingomyelin
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

50. If you aspirate a peanut while supine - where will it go
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Superior portion of right inferior lobe
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Inc O2 consumption