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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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1. What is the pathology of asthma

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2. What kind of emphysema is caused by smoking
Inc EPO leading to erythrocytosis
Centriacinar
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
L/S < 1.5

3. What are the two forms of hemoglobin
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Dec release of fetal glucocorticoids
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

4. What organisms cause interstitial PNA and What are the characteristics
Low resistance and high compliance
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
High alveolar pressure compresses capillaries
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

5. How does left to right shunt cause pulm HTN
Anatomic dead space and smooth muscle
Low resistance and high compliance
Inc shear stress leading to endothelial injury
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

6. What are the histological findings in asbestosis and what occupations are associated
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
No change - but inc venous CO2 content
Right shift - favors taut - low affinity for O2 - O2 unloading

7. What is a lung abscess and What does usually result from
Dipalmatoyl phosphatidylcholine - decreases surface tension
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Type II pneumocytes - after week 35

8. What is an example of hypercoagulability
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Prostaglandins - histamine - ACE - kallikrein
Zone 3
Defect in coagulative cascace proteins

9. Define total lung capcaity
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Pa > PA > Pv
IRV + TV + ERV + RV
Hypertrophy of mucus secreting glands in the bronchioles

10. What is used to treat CN poisoning and why
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
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Zone 3
Low resistance and high compliance

11. In COPD - what happens to airways at high lung volumes
Airways close prematurely resulting in inc RV and dec FVC
Lower portion of right inferior lobe
Methylene blue
Chest pain - tachypnea and dyspnea

12. How does autoimmune dz cause thromboemboli
Retinopathy of maturity
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Methacholine challenge

13. Which has a greater affinity for hemoglobin - CO or O2 and by how much
FRC - inward pull of lung balanced by outward pull of chest wall
Small airways
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
CO - 200x

14. Define vital capacity (VC)
TB - apex
Everything but RV - TV + IRV + ERV
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

15. What is the fxn of the conducting zone
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Chronic hypoxic vasocxn
Brings air in and out - warms - humidifies - filters
L/S > 2 = lecithin/sphingomyelin

16. What ratio is used to measure lung maturity and What is the value is neonatal RDS
RALS - righ anterior - left superior
N- terminus - carbaminohemoglobin
L/S < 1.5
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

17. What does a V/Q ratio of 0 indicate
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Airway obstruction (shunt) 100% O2 does not improve PO2
Inc to meet O2 demand
Deoxygenated blood - elastic walls

18. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Type II pneumocytes - after week 35

19. What are the various causes of ARDS
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Hyaline membrane disease

20. If you aspirate a peanut while upright - where will it go
Dec in the FEV1/FVC
Elastic properties
Lower portion of right inferior lobe
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

21. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
L/S > 2 = lecithin/sphingomyelin
0 - negative - prevents pneumothorax
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Positive cooperativity and negative allostery - unlike myoglobin

22. What are fat emboli associated with
Hyaline membrane disease
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Elastase
Long bone fractures and liposuction

23. At what PaO2 does cyanosis begin
Deoxygenated blood - elastic walls
Exposed collagen fibers provides impetus for clotting cascade
<60
Lobar PNA

24. Define expiratory reserve volume (ERV)
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Air that can still be breathed out after nl expiration
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

25. What is the protein content in a transudative pleural effusion and What are the potential causes
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

26. Why is cesarean delivery a risk factor for neonatal RDS
Chronic hypoxic vasocxn
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
CO2 - acid/altitude - DPG - Exercise - Temperature
Dec release of fetal glucocorticoids

27. 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
Dec in lung volumes - FVC - TLC
Chronic hypoxic vasocxn
L/S < 1.5

28. What do hemoglobin modifacations lead to...
Clara cells - type II pneumocytes; multiple densitites on CXR
Inc
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Tissue hypoxia from dec O2 sat and dec O2 content

29. What does decreased PAO2 do
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Lung cancer
Dec in the FEV1/FVC

30. What are the causes of ischemia
Clara cells - type II pneumocytes; multiple densitites on CXR
Inspiration by diaphragm - expiration is passive
Loss of blood flow - impeded arterial flow - reduced venous drainage
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

31. What happens to diffusing capacity in interstiial lung diseases
Air that can still be breathed out after nl expiration
Opposites
Lowered
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

32. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Apex of healthy lung
Inc to meet O2 demand
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

33. What causes secondary pulm HTN
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
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Dipalmatoyl phosphatidylcholine
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

34. What organism causes a lobar PNA and What are the characteristics
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Ratio from apex to base becomes more uniform
Methylene blue

35. What causes primary pulm HTN
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Both highest in the base
Airways close prematurely resulting in inc RV and dec FVC
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

36. What are the 3 forms that CO2 is transported from tissues to lungs
Fe 2+
Weight loss - CPAP - surgery
Upper lobes
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

37. What cellular changes occur at high altitude
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Stasis - hypercoagulability - endothelial damage
Inc mitochondria

38. How happens to the proton from the rxn the created bicarb
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Inc excretion of bicarb to compensate for respiratory alkalosis
0 - negative - prevents pneumothorax
It binds to Hb -

39. Chronic bronchitis is a disease of what kind of airways
Ivory white calcified pleural plaques
Anatomic dead space and smooth muscle
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Small airways

40. What cells make surfactant and At what week is produced most abundantly
PVR = (PpulmA - PleftA)/CO
Opposites
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Type II pneumocytes - after week 35

41. What is carboxyhemoglobin and What does it cause
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Metastasis - breast - colon - prostate - bladder -
0 - negative - prevents pneumothorax
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

42. In which zone of the lung is Pa > Pv >PA
Acetazolamide - inhibits CA and acidifies the blood
Zone 3
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Gland depth/total thickness of broncial wall - >50%

43. What is the TX for small cell lung cancer
Inoperable - responsive to chemotherapy
Inc
Prematurity - maternal RDS - cesarean delivery
O2 binding x O2 sat + dissolved O2

44. What does the conducting zone consist of...
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Gland depth/total thickness of broncial wall - >50%
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Respiratory effort against airway obstruction

45. Which lung is the more common site for an inhaled foreign body and why
Long bone fractures and liposuction
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Right lung - right main stem bronhus is wider and more vertical

46. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
C3 - 4 - 6 - phrenic nerve - referred to shoulder
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Surfactant
Lower portion of right inferior lobe

47. What changes in EPO occur at high altitude
No respiratory effort
Respiratory effort against airway obstruction
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

48. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Dec release of fetal glucocorticoids
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

49. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Prostaglandins - histamine - ACE - kallikrein
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Tension pneumo - away from lesion
PVR = (PpulmA - PleftA)/CO

50. Susceptibility to what infection is increased in silicosis and why
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
TB - silica disrupt phagolysosomes and impair MACS
Defect in coagulative cascace proteins
Inc airway pressure to prevent airway collapse during exhalation