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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 drug therapy is used to augment the changes in bicarb exretion
Persistently low O2 tension
<60
Acetazolamide - inhibits CA and acidifies the blood
Hypoxic vasocxn

2. What are the histological findings in asbestosis and what occupations are associated
DIC - especially postpartum
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

3. What is the formula for pulm vasc resistance
Heart
Lung cancer
PVR = (PpulmA - PleftA)/CO
CO2 - acid/altitude - DPG - Exercise - Temperature

4. What does CADET face to the right stand for
500mL
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
CO2 - acid/altitude - DPG - Exercise - Temperature
CT angio

5. What happens to lung volumes in obstructive lung disease
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Inc
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Respiratory effort against airway obstruction

6. How many lobes does each lung have - and What is the lingula
Both highest in the base
Chronic hypoxic vasocxn
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

7. 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
L/S < 1.5
Inc 2 -3- DPG - righward shift
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude

8. At what PaO2 does cyanosis begin
<60
CO - 200x
Anatomic dead space and smooth muscle
Hyaline membrane disease

9. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Elastic properties
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Dec in the FEV1/FVC
Squamous cell carcinoma - keratin pearls and intracellular bridges

10. What properties determine the combined volumes of the chest wall and lungs
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
Steroids to mom - artificial surfactant and thyroxine to neonate
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Elastic properties

11. What must occur with a exudate pleural effusion
Drainage
Matched - =1 adequate gas exchange
Small airways
Right

12. What doe FAT BAT stand for
Lung cancer
PVR = (PpulmA - PleftA)/CO
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

13. In COPD - what happens to airways at high lung volumes
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Airways close prematurely resulting in inc RV and dec FVC
Brings air in and out - warms - humidifies - filters

14. What does pulm HTN result in
Dec
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Coal miner's - silicosis - abestosis
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

15. What is the nl form of iron in hemoglobin
Airway obstruction (shunt) 100% O2 does not improve PO2
Fe 2+
<75
Acetazolamide - inhibits CA and acidifies the blood

16. In what cells do you find lamellar bodies
Air that moves into lung with each quiet respiration
Inc 2 -3- DPG - righward shift
Repeated cycles of lung injury and wound healing with inc collagen
Type II cells

17. At what lung volume is system pressure atmospheric and why
FRC - inward pull of lung balanced by outward pull of chest wall
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Air in lung after maxmimal expiration - cannot be measured on spirometry
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

18. How does left to right shunt cause pulm HTN
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Inc shear stress leading to endothelial injury
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

19. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Acute/chronic inc in vent
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

20. What does alveolar pressure do to capillaries in the apex of the lung
On expiration as radius dec
Histiocytosis X - Langerhans cells
High alveolar pressure compresses capillaries
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

21. What causes secondary pulm HTN
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Anatomic dead space and smooth muscle
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude

22. What is central sleep apnea
Upper lobes
Inc shear stress leading to endothelial injury
No respiratory effort
CO2 - acid/altitude - DPG - Exercise - Temperature

23. Where is cartilage present in the respiratory tree
Alpha1- antitrypsin def - also cirrhosis
Trachea and bronchi
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Ciliated cells

24. What organisms cause interstitial PNA and What are the characteristics
Chroniclly tired
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
CO - 200x
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

25. Define inspiratory reserve volume (IRV)
Shunting
Air in excess of tidal volume that moves into lung on maximal inspiration
Lungs collapse inwards and chest wall spring out
Carcinoid - carcinoid

26. What is the initial damage of ARDS caused by
PAO2 - PaO2 = 10-15 mmHg
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Persistently low O2 tension

27. What is the formula for resistance
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Coal miner's - silicosis - abestosis
Histiocytosis X - Langerhans cells

28. What does the respiratory zone consist of and What is its fxn
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
RV + ERV - volume in lungs after nl expiration
Hyaline membrane disease
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor

29. What are clara cells What is their morphology and What do they do
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Centriacinar
Dorsiflexion of food leads to tender calf muscle
Air that can still be breathed out after nl expiration

30. What is the ideal V/Q ratio and why
Matched - =1 adequate gas exchange
Incr - right - dec - left
P = 2ST/radius
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

31. Where does lung cancer met to...
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Inoperable - responsive to chemotherapy
Type II pneumocytes - after week 35
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

32. Other than surfactant - what other important substances are produced by the lungs
O2 binding x O2 sat + dissolved O2
Dec dec in FEV1 - dec in FVC
Prostaglandins - histamine - ACE - kallikrein
Air in excess of tidal volume that moves into lung on maximal inspiration

33. What is an association and potential complication of paraseptal emphysema
Surfactant
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

34. What is the definition of sleep apnea
Lowered
Airways close prematurely resulting in inc RV and dec FVC
Person stops breathing for at least 10 seconds repeatedly during sleep
Loss of blood flow - impeded arterial flow - reduced venous drainage

35. How do you prevent DVT
Trachea and bronchi
Elastic properties
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Heparin

36. What does ACE do
DIC - especially postpartum
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

37. What can amniotic fluid emboli lead to...
DIC - especially postpartum
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
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

38. What is the TX for small cell lung cancer
Inoperable - responsive to chemotherapy
Inc to meet O2 demand
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Brings air in and out - warms - humidifies - filters

39. What is obstructive sleep apnea
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Coal miner's - silicosis - abestosis
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Respiratory effort against airway obstruction

40. What changes in CO2 occur during exercise
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
Inc production
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

41. What are the causes of hypoxemia
Inspiration by diaphragm - expiration is passive
Alchoholics or epileptics
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Trachea and bronchi

42. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
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
Right shift - favors taut - low affinity for O2 - O2 unloading
Zone 1

43. What is the protein content in a transudative pleural effusion and What are the potential causes
Lungs collapse inwards and chest wall spring out
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Drainage
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

44. What causes neonatal RDS
Dipalmatoyl phosphatidylcholine - decreases surface tension
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Surfactant def leading to inc surfact tension and alveolar collapse
Inc 2 -3- DPG - righward shift

45. What happens to arterial PO2 in chronic lung disease and why
Methylene blue
Dec - because physiologic shunt dec O2 extraction from ratio
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

46. Susceptibility to what infection is increased in silicosis and why
TB - silica disrupt phagolysosomes and impair MACS
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Centriacinar

47. What cells in the lung produce surfactant and What does it do
Low resistance and high compliance
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Zone 1
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

48. What changes in O2 consumption change during exercise
Dec in lung volumes - FVC - TLC
Retinopathy of maturity
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Inc O2 consumption

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

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50. At what PaO2 does hypoxemia begin
Long bone fractures and liposuction
Inc to meet O2 demand
<75
Lobar PNA