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Respiratory

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Answer 50 questions in 15 minutes.
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1. What is compliance and When is it decrease
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Coal miner's - silicosis - abestosis

2. What kind of space is in the conducting tree and what kind of muscle exists there
Anatomic dead space and smooth muscle
Inc airway pressure to prevent airway collapse during exhalation
Acute/chronic inc in vent
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

3. How is pulmonary circulation characterized in terms of resistance and compliance
Low resistance and high compliance
Milky fluid with inc TGs
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
Inc airway pressure to prevent airway collapse during exhalation

4. What cells in the lung produce surfactant and What does it do
Right shift - favors taut - low affinity for O2 - O2 unloading
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
0 - negative - prevents pneumothorax
Steroids to mom - artificial surfactant and thyroxine to neonate

5. What is the pathology of bronchiectasis
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Pa > PA > Pv
Defect in coagulative cascace proteins
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

6. Define residual volume (RV)
Apex of healthy lung
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Air in lung after maxmimal expiration - cannot be measured on spirometry
Inc excretion of bicarb to compensate for respiratory alkalosis

7. What cellular changes occur at high altitude
Dec release of fetal glucocorticoids
High alveolar pressure compresses capillaries
Inc mitochondria
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma

8. What is tha hallmark finding of COPD
Bronchial obstruction - toward side of lesion
Carcinoid - carcinoid
Dec in the FEV1/FVC
Type II cells

9. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Airways close prematurely resulting in inc RV and dec FVC
Dorsiflexion of food leads to tender calf muscle
CO - 200x
Respiratory bronchioles - clear debris in alveoli - bronchi

10. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Air in lung after maxmimal expiration - cannot be measured on spirometry
Dipalmatoyl phosphatidylcholine
4 polypeptide subunits - 2 alpha and 2 beta
Pleural effusion

11. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Inc airway pressure to prevent airway collapse during exhalation
Pa > PA > Pv

12. What happens to V/Q ratio in COPD
Alchoholics or epileptics
Long bone fractures and liposuction
Mismatch
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

13. What is the initial damage of ARDS caused by
Dec in the FEV1/FVC
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

14. Chronic bronchitis is a disease of what kind of airways
Opposites
Hypertrophy of mucus secreting glands in the bronchioles
Acetazolamide - inhibits CA and acidifies the blood
Small airways

15. What lobes are affected in silicosis
Upper lobes
Inspiration by diaphragm - expiration is passive
Heart
Hypoxic vasocxn

16. What is the nl form of iron in hemoglobin
Clara cells - type II pneumocytes; multiple densitites on CXR
Fe 2+
Superior portion of right inferior lobe
Dorsiflexion of food leads to tender calf muscle

17. What is the formula for O2 content
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
O2 binding x O2 sat + dissolved O2
Brings air in and out - warms - humidifies - filters
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

18. What are the 3 forms that CO2 is transported from tissues to lungs
N- terminus - carbaminohemoglobin
Tension pneumo - away from lesion
Fe 2+
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

19. What are the 3 reasons for an increased A- a gradient
IRV + TV + ERV + RV
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Ciliated cells
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

20. Which muscles are involved in quiet breathing and What part of respiration do the control
Elastase
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Lungs collapse inwards and chest wall spring out
Inspiration by diaphragm - expiration is passive

21. What lobes does Coal Miner's pneumoconioses affect - and What can it result in

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22. What is a lung abscess and What does usually result from
Ratio from apex to base becomes more uniform
Person stops breathing for at least 10 seconds repeatedly during sleep
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Stasis - hypercoagulability - endothelial damage

23. How does mitral stenosis cause pulm HTN
Lower portion of right inferior lobe
Person stops breathing for at least 10 seconds repeatedly during sleep
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Inc resistance leading to inc pressure

24. What ratio is used to measure lung maturity and What is the value is neonatal RDS
RALS - righ anterior - left superior
Lowered
Pleural effusion
L/S < 1.5

25. What is Homan's sign
Right
Dorsiflexion of food leads to tender calf muscle
Tension pneumo - away from lesion
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

26. What are the histological findings in asbestosis and what occupations are associated
Tight jxns
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Inc to meet O2 demand

27. What happens as a result of hypoxia in sleep apnea
Right shift - favors taut - low affinity for O2 - O2 unloading
Inc EPO leading to erythrocytosis
Ratio from apex to base becomes more uniform
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

28. What is the defect in panacinar emphysema - and what else do you see
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
0 - negative - prevents pneumothorax
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Alpha1- antitrypsin def - also cirrhosis

29. What causes neonatal RDS
Air in excess of tidal volume that moves into lung on maximal inspiration
Surfactant def leading to inc surfact tension and alveolar collapse
Exposed collagen fibers provides impetus for clotting cascade
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

30. What is the formula for collapsing pressure
P = 2ST/radius
Air that can still be breathed out after nl expiration
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Coal miner's - silicosis - abestosis

31. Why is cesarean delivery a risk factor for neonatal RDS
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Tissue hypoxia from dec O2 sat and dec O2 content
Dec release of fetal glucocorticoids
Bronchial obstruction - toward side of lesion

32. What findings are associated with emphysema
Dec dec in FEV1 - dec in FVC
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Bronchial obstruction - toward side of lesion

33. What is the pathology of chronic bronchitis
Elastic properties
Hypertrophy of mucus secreting glands in the bronchioles
Person stops breathing for at least 10 seconds repeatedly during sleep
CO2 - acid/altitude - DPG - Exercise - Temperature

34. What does a V/Q ratio of 0 indicate
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Airway obstruction (shunt) 100% O2 does not improve PO2
Chronic hypoxic vasocxn
Inc to meet O2 demand

35. Where do 95% of PE arise from
Steroids to mom - artificial surfactant and thyroxine to neonate
Exposed collagen fibers provides impetus for clotting cascade
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Deep leg veins

36. Where is cartilage present in the respiratory tree
Loss of elastic fibers
Airways close prematurely resulting in inc RV and dec FVC
Milky fluid with inc TGs
Trachea and bronchi

37. What organisms cause a bronchoPNA and What are the characteristics
Apex of healthy lung
Positive cooperativity and negative allostery - unlike myoglobin
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

38. What changes in O2 consumption change during exercise
Inc O2 consumption
Retinopathy of maturity
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Tension pneumo - away from lesion

39. In what cells do you find lamellar bodies
FRC - inward pull of lung balanced by outward pull of chest wall
Hypertrophy of mucus secreting glands in the bronchioles
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Type II cells

40. What are fat emboli associated with
Long bone fractures and liposuction
Viral - URIs - allergens and stress
Squamous cell carcinoma - keratin pearls and intracellular bridges
CO - 200x

41. What are the causes of ischemia
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Loss of blood flow - impeded arterial flow - reduced venous drainage
Alpha1- antitrypsin def - also cirrhosis
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

42. What is the protein content in a transudative pleural effusion and What are the potential causes
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
PA02 = 150 - PACO2/0.8

43. What is hemoglobin composed of...
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
4 polypeptide subunits - 2 alpha and 2 beta
Defect in coagulative cascace proteins
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

44. What is the most common cancerous lesion in the lun
Metastasis - breast - colon - prostate - bladder -
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Persistently low O2 tension
Lungs collapse inwards and chest wall spring out

45. At what PaO2 does cyanosis begin
<60
It binds to Hb -
DIC - especially postpartum
Alchoholics or epileptics

46. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Loss of blood flow - impeded arterial flow - reduced venous drainage
Persistently low O2 tension
Anatomic dead space and smooth muscle

47. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Elastic properties
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Weight loss - CPAP - surgery

48. What does each bronchopulmonary segment have in the center and along its border
Chest pain - tachypnea and dyspnea
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

49. How many lobes does each lung have - and What is the lingula
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Dec cross sectional area of pulm vasc bed
Alpha1- antitrypsin def - also cirrhosis
Alchoholics or epileptics

50. What happens to diffusing capacity in interstiial lung diseases
Steroids to mom - artificial surfactant and thyroxine to neonate
Defect in coagulative cascace proteins
Lowered
Histiocytosis X - Langerhans cells

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Respiratory

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