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. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
CT angio
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

2. What is the course of of pulm HTN
Activates bradykinin
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Pa > PA > Pv

3. What are the findings of chronic bronchitis
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Pa > PA > Pv
FRC - inward pull of lung balanced by outward pull of chest wall
Exposed collagen fibers provides impetus for clotting cascade

4. Define total lung capcaity
Dec - due to lactic acidosis
Chroniclly tired
4 polypeptide subunits - 2 alpha and 2 beta
IRV + TV + ERV + RV

5. Why is endothelial damage a risk factor for DVT
500mL
Exposed collagen fibers provides impetus for clotting cascade
L/S < 1.5
Dipalmatoyl phosphatidylcholine

6. What are the subtypes of pneumoconioses

7. What is the appoximate O2 binding capacity
It binds to Hb -
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
20.1 mL O2 /dL
Lost with alveolar walls

8. What is the cycle of idiopathic pulmonary fibrosis
Repeated cycles of lung injury and wound healing with inc collagen
Matched - =1 adequate gas exchange
In between perfusion limited and diffusion limited
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

9. What does ACE do
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Respiratory bronchioles - clear debris in alveoli - bronchi
Deep leg veins
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

10. What is the characteristic lymphatic pleural effusion
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Respiratory effort against airway obstruction
Milky fluid with inc TGs

11. What causes neonatal RDS
Surfactant def leading to inc surfact tension and alveolar collapse
Prostaglandins - histamine - ACE - kallikrein
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals

12. What cells in the lung produce surfactant and What does it do
Hyaline membrane disease
Dipalmatoyl phosphatidylcholine
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

13. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
No respiratory effort
In between perfusion limited and diffusion limited
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

14. In which zone of the lung is Pa > Pv >PA
Zone 3
It binds to Hb -
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Chest pain - tachypnea and dyspnea

15. What is the alveolar gas equation
Clara cells - type II pneumocytes; multiple densitites on CXR
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Type II pneumocytes - after week 35

16. How is pulmonary circulation characterized in terms of resistance and compliance
Low resistance and high compliance
<60
C3 - 4 - 6 - phrenic nerve - referred to shoulder
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

17. How does sleep apnea or high altitude cause pulm HTN
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Heparin
Inc resistance leading to inc pressure
Hypoxic vasocxn

18. What organism causes a lobar PNA and What are the characteristics
O2 binding x O2 sat + dissolved O2
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Dec - due to lactic acidosis
Inc to meet O2 demand

19. How do you prevent DVT
Heparin
<75
Dec - because physiologic shunt dec O2 extraction from ratio
Inc to meet O2 demand

20. Define inspiratory reserve volume (IRV)
Chronic hypoxic vasocxn
Lower portion of right inferior lobe
Air in excess of tidal volume that moves into lung on maximal inspiration
DIC - especially postpartum

21. What does decreased PAO2 do
Right
Clara cells - type II pneumocytes; multiple densitites on CXR
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

22. What is compliance and When is it decrease
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Bronchial obstruction - toward side of lesion

23. What is surfactant made of...
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Heparin
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Dipalmatoyl phosphatidylcholine

24. What does the law of Laplace state about tendency of alveoli to collapse
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
On expiration as radius dec
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

25. What findings are associated with emphysema
PVR = (PpulmA - PleftA)/CO
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
More indolent
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

26. What is the pathology of asthma

27. What area of the lung is the largest physiologic contributor of fxnal dead space
Inc resistance leading to inc pressure
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Apex of healthy lung
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

28. What are mucus secretion swept out by
0 - negative - prevents pneumothorax
Ciliated cells
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
CO - 200x

29. What organisms cause a bronchoPNA and What are the characteristics
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Milky fluid with inc TGs
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT

30. A carcinoma in the apex of the lung can cause what syndrome and What is the tumor called

31. In which zone of the lung is PA > Pa > Pv
Zone 1
Anatomic dead space and smooth muscle
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Small airways

32. How happens to the proton from the rxn the created bicarb
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
It binds to Hb -
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging

33. How does recurrent thromboemboli cause pulm HTN
Dec cross sectional area of pulm vasc bed
Type II cells
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Tight jxns

34. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Gland depth/total thickness of broncial wall - >50%
Dec dec in FEV1 - dec in FVC
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

35. What are the SPHERE of complications in lung cancer
On expiration as radius dec
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
FRC - inward pull of lung balanced by outward pull of chest wall
Drainage

36. What do type II cells do - What is their morphology - when do they proliferate
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
RV + ERV - volume in lungs after nl expiration
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Brings air in and out - warms - humidifies - filters

37. What are the lab/study findings in adenocarcinoma of the lung
Clara cells - type II pneumocytes; multiple densitites on CXR
IRV + TV
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Small airways

38. What are potential triggers for asthma
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
L/S > 2 = lecithin/sphingomyelin
Viral - URIs - allergens and stress

39. What is the alveolar gas equation approximation
Surfactant def leading to inc surfact tension and alveolar collapse
Dec in lung volumes - FVC - TLC
PA02 = 150 - PACO2/0.8
Dec dec in FEV1 - dec in FVC

40. At What terminal does CO2 bind the globin molecule
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Respiratory effort against airway obstruction
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
N- terminus - carbaminohemoglobin

41. What happens with the O2 curve shifts to the right and What does it facilitate
Dec release of fetal glucocorticoids
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Inoperable - responsive to chemotherapy

42. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Dec - because physiologic shunt dec O2 extraction from ratio
Lower portion of right inferior lobe
Dorsiflexion of food leads to tender calf muscle
CO - 200x

43. Define residual volume (RV)
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Dec - no change
Air in lung after maxmimal expiration - cannot be measured on spirometry
Dec - because physiologic shunt dec O2 extraction from ratio

44. What renal changes occur at high altitude and What are they compensating for
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Inc to meet O2 demand
Inc excretion of bicarb to compensate for respiratory alkalosis
Heart

45. What is a typical tidal volume
Dec - due to lactic acidosis
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
In between perfusion limited and diffusion limited
500mL

46. What kind of course does interstitial PNA follow in comparison to bronchoPNA
Prostaglandins - histamine - ACE - kallikrein
More indolent
Zone 1
Viral - URIs - allergens and stress

47. Define inspiratory capacity (IC)
IRV + TV
Inoperable - responsive to chemotherapy
Type II cells
Heparin

48. What layers must CO2 and O2 traverse to complete gas exchange
L/S < 1.5
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

49. What do hemoglobin modifacations lead to...
Inc due to inc CO
Tissue hypoxia from dec O2 sat and dec O2 content
It binds to Hb -
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

50. What must occur with a exudate pleural effusion
Tight jxns
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Drainage