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Respiratory

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 is the initial damage of ARDS caused by
Histiocytosis X - Langerhans cells
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Air in excess of tidal volume that moves into lung on maximal inspiration
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

2. What are mucus secretion swept out by
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Right lung - right main stem bronhus is wider and more vertical
Ciliated cells

3. What is the ideal V/Q ratio and why
Matched - =1 adequate gas exchange
Squamous cell carcinoma - keratin pearls and intracellular bridges
Dec dec in FEV1 - dec in FVC
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

4. What is obstructive sleep apnea
Small airways
Respiratory effort against airway obstruction
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

5. What ratio is used to measure lung maturity and What is the value is neonatal RDS
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Superior portion of right inferior lobe
Zone 3
L/S < 1.5

6. What is the characteristic lymphatic pleural effusion
Inoperable - responsive to chemotherapy
Milky fluid with inc TGs
FRC - inward pull of lung balanced by outward pull of chest wall
Coal miner's - silicosis - abestosis

7. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Persistently low O2 tension

8. What is Homan's sign
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
S. aureus or anaerobes
Dorsiflexion of food leads to tender calf muscle

9. What does ACE do
Type II pneumocytes - after week 35
Metastasis - breast - colon - prostate - bladder -
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

10. What is the imaging test of choice for PE
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
Incr - right - dec - left
CT angio
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

11. Define residual volume (RV)
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Air in lung after maxmimal expiration - cannot be measured on spirometry
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

12. Where do you find type I cells - What is their morphology - and What do they do
Brings air in and out - warms - humidifies - filters
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
RV + ERV - volume in lungs after nl expiration

13. Which lung is the more common site for an inhaled foreign body and why
More indolent
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Right lung - right main stem bronhus is wider and more vertical

14. At What terminal does CO2 bind the globin molecule
N- terminus - carbaminohemoglobin
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Long bone fractures and liposuction
Retinopathy of maturity

15. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Zone 1
Inc 2 -3- DPG - righward shift
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Coal miner's - silicosis - abestosis

16. Tumor secreting serotonin causes a syndrome with flushing - diarrhea - wheezing - salvation; fibrous deposits in the right heart valves may lead to tricuspid insuff - pulmonary stenosis - right heart failure - tumor and syndrome
Ivory white calcified pleural plaques
Gland depth/total thickness of broncial wall - >50%
Carcinoid - carcinoid
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

17. How many lobes does each lung have - and What is the lingula
N- terminus - carbaminohemoglobin
Opposites
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

18. What organisms cause interstitial PNA and What are the characteristics
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Opposites
CT angio
Squamous cell carcinoma - keratin pearls and intracellular bridges

19. What is an example of hypercoagulability
Methylene blue
It binds to Hb -
Defect in coagulative cascace proteins
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

20. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Pa > PA > Pv
Right shift - favors taut - low affinity for O2 - O2 unloading
Gland depth/total thickness of broncial wall - >50%
Ivory white calcified pleural plaques

21. What findings are associated with emphysema
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Deep leg veins

22. What is a consequence of pulm HTN
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Dec cross sectional area of pulm vasc bed
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
High alveolar pressure compresses capillaries

23. What kind of pleural plaques are the result of asbestosis
Ivory white calcified pleural plaques
Inc resistance leading to inc pressure
Mismatch
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

24. If you aspirate a peanut while upright - where will it go
Lower portion of right inferior lobe
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Bronchial obstruction - toward side of lesion
Fe 2+

25. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Brings air in and out - warms - humidifies - filters
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Opposites
Pleural effusion

26. What is the defect in panacinar emphysema - and what else do you see
Alpha1- antitrypsin def - also cirrhosis
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Drainage
Acute/chronic inc in vent

27. At what PaO2 does hypoxemia begin
Coal miner's - silicosis - abestosis
<75
Inc resistance leading to inc pressure
Dec cross sectional area of pulm vasc bed

28. What lab ration indicates fetal lung maturity
L/S > 2 = lecithin/sphingomyelin
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Upper lobes - cor pulmonale - caplan's syndrome
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

29. What are fat emboli associated with
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Loss of blood flow - impeded arterial flow - reduced venous drainage
Long bone fractures and liposuction
PVR = (PpulmA - PleftA)/CO

30. Lung absecss often reults From what organisms
Tight jxns
S. aureus or anaerobes
Bronchial obstruction - toward side of lesion
PVR = (PpulmA - PleftA)/CO

31. What are clara cells What is their morphology and What do they do
CT angio
Ratio from apex to base becomes more uniform
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
20.1 mL O2 /dL

32. What are the 9 interstitial lung diseases

33. Where do 95% of PE arise from
Inc shear stress leading to endothelial injury
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Deep leg veins
Bronchial obstruction - toward side of lesion

34. What are the potential TX for sleep apnea
Dec
Weight loss - CPAP - surgery
N- terminus - carbaminohemoglobin
0 - negative - prevents pneumothorax

35. What changes in 2 -3 - DPG occur at high altitude
Retinopathy of maturity
Inc resistance leading to inc pressure
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Chronic hypoxic vasocxn

36. Define physilogic dead space
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Alpha1- antitrypsin def - also cirrhosis
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

37. In COPD - what happens to airways at high lung volumes
Airways close prematurely resulting in inc RV and dec FVC
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
FRC - inward pull of lung balanced by outward pull of chest wall
TB - silica disrupt phagolysosomes and impair MACS

38. What is surfactant made of...
Inc airway pressure to prevent airway collapse during exhalation
Dipalmatoyl phosphatidylcholine
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Chroniclly tired

39. What lung product is deficient in neonatal RDS
Clara cells - type II pneumocytes; multiple densitites on CXR
Dec
Surfactant
Incr - right - dec - left

40. What is positive cooperativity of hemoglobin refer to...
In between perfusion limited and diffusion limited
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Persistently low O2 tension
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

41. How does mitral stenosis cause pulm HTN
CO2 - acid/altitude - DPG - Exercise - Temperature
Inc resistance leading to inc pressure
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Air in lung after maxmimal expiration - cannot be measured on spirometry

42. What happens as a result of hypoxia in sleep apnea
Inc EPO leading to erythrocytosis
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Pa > PA > Pv
Ratio from apex to base becomes more uniform

43. Where is cartilage present in the respiratory tree
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Trachea and bronchi

44. What is a chronic complication of sleep apnea
Right
Trachea and bronchi
Chroniclly tired
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung

45. What changes in pH occur during strenuous exercise and why
Dec - due to lactic acidosis
Type II pneumocytes - after week 35
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Right lung - right main stem bronhus is wider and more vertical

46. What TX is the mother given before delivery - and what TXs are given to the infant
Steroids to mom - artificial surfactant and thyroxine to neonate
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Opposites
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

47. What is the course of of pulm HTN
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Hyaline membrane disease
Dec - no change

48. What organism thrives in high O2 and where in the lung does it flourish
TB - apex
Lower portion of right inferior lobe
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Respiratory effort against airway obstruction

49. What is are the symptoms of a pulmonary embolism
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Chest pain - tachypnea and dyspnea
Mesothelioma - pleura - psammoma bodies
Dec - because physiologic shunt dec O2 extraction from ratio

50. Where are ventilation and perfusion highest in the lung - respectively
Both highest in the base
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Dec - because physiologic shunt dec O2 extraction from ratio