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Respiratory

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Answer 50 questions in 15 minutes.
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1. What do PFTs show in restrictive lung disease
L/S < 1.5
Clara cells - type II pneumocytes; multiple densitites on CXR
FEV1/FVC > 80%
Pa > PA > Pv

2. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
RALS - righ anterior - left superior
Hypertrophy of mucus secreting glands in the bronchioles
PA02 = 150 - PACO2/0.8

3. What is the appoximate O2 binding capacity
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Gland depth/total thickness of broncial wall - >50%
Lobar PNA
20.1 mL O2 /dL

4. Where is cartilage present in the respiratory tree
Respiratory bronchioles - clear debris in alveoli - bronchi
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Methylene blue
Trachea and bronchi

5. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Dec
Positive cooperativity and negative allostery - unlike myoglobin
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Mesothelioma - pleura - psammoma bodies

6. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
RV + ERV - volume in lungs after nl expiration
Lobar PNA
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Retinopathy of maturity

7. What TX is the mother given before delivery - and what TXs are given to the infant
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Positive cooperativity and negative allostery - unlike myoglobin
Tissue hypoxia from dec O2 sat and dec O2 content
Steroids to mom - artificial surfactant and thyroxine to neonate

8. What is a lung abscess and What does usually result from
Loss of blood flow - impeded arterial flow - reduced venous drainage
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

9. What lobes are affected in silicosis
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
PAO2 - PaO2 = 10-15 mmHg
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Upper lobes

10. What happens to bicarb once it is created in an RBC
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Airway obstruction (shunt) 100% O2 does not improve PO2
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

11. What are the associations with bronchiectasis

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12. What organism thrives in high O2 and where in the lung does it flourish
TB - apex
Gland depth/total thickness of broncial wall - >50%
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

13. What organisms cause interstitial PNA and What are the characteristics
Inc shear stress leading to endothelial injury
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Air in excess of tidal volume that moves into lung on maximal inspiration

14. What can amniotic fluid emboli lead to...
DIC - especially postpartum
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Gland depth/total thickness of broncial wall - >50%
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

15. Chronic bronchitis is a disease of what kind of airways
More indolent
IRV + TV + ERV + RV
Shed epithelium from mucus plugs
Small airways

16. How does sleep apnea or high altitude cause pulm HTN
DIC - especially postpartum
Lowered
Dipalmatoyl phosphatidylcholine - decreases surface tension
Hypoxic vasocxn

17. What are the findings associated with sarcoidosis
Hypoxic vasocxn
TB - apex
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
It binds to Hb -

18. What happens to lung volumes in obstructive lung disease
Zone 1
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Lower portion of right inferior lobe
Inc

19. What kind of emphysema is caused by smoking
Inc
Elastic properties
IRV + TV + ERV + RV
Centriacinar

20. What does a V/Q ratio of infinity indicate
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Mesothelioma - pleura - psammoma bodies
Gland depth/total thickness of broncial wall - >50%

21. What is hemoglobin composed of...
Methylene blue
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
4 polypeptide subunits - 2 alpha and 2 beta
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

22. What is the formula for resistance
Loss of blood flow - impeded arterial flow - reduced venous drainage
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
TB - apex
Right shift - favors taut - low affinity for O2 - O2 unloading

23. What does each bronchopulmonary segment have in the center and along its border
Dipalmatoyl phosphatidylcholine - decreases surface tension
Carcinoid - carcinoid
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

24. What is another name for neonatal RDS
Hyaline membrane disease
Drainage
PVR = (PpulmA - PleftA)/CO
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

25. What is the formula for collapsing pressure
CO x O2 content of blood
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Histiocytosis X - Langerhans cells
P = 2ST/radius

26. What are the histological findings in asbestosis and what occupations are associated
Air in excess of tidal volume that moves into lung on maximal inspiration
Prostaglandins - histamine - ACE - kallikrein
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Dec in the FEV1/FVC

27. What changes in pH occur during strenuous exercise and why
Anatomic dead space and smooth muscle
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Dec - due to lactic acidosis
Tissue hypoxia from dec O2 sat and dec O2 content

28. What happens with the O2 curve shifts to the right and What does it facilitate
Both highest in the base
Coal miner's - silicosis - abestosis
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Dec dec in FEV1 - dec in FVC

29. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Chronic hypoxic vasocxn
Right lung - right main stem bronhus is wider and more vertical
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Pleural effusion

30. What is occupied in the space that would have been the left middle lobe
Hypertrophy of mucus secreting glands in the bronchioles
Dec dec in FEV1 - dec in FVC
Air in excess of tidal volume that moves into lung on maximal inspiration
Heart

31. What do hemoglobin modifacations lead to...
Milky fluid with inc TGs
Tissue hypoxia from dec O2 sat and dec O2 content
Pa > PA > Pv
Exposed collagen fibers provides impetus for clotting cascade

32. What causes secondary pulm HTN
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Centriacinar
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude

33. What is the pathology of asthma

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34. What is the alveolar gas equation approximation
Ivory white calcified pleural plaques
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
PA02 = 150 - PACO2/0.8

35. Define physilogic dead space
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Viral - URIs - allergens and stress

36. Define inspiratory reserve volume (IRV)
Air in excess of tidal volume that moves into lung on maximal inspiration
Incr - right - dec - left
Inc production
Shunting

37. Which lung is the more common site for an inhaled foreign body and why
Right lung - right main stem bronhus is wider and more vertical
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
<60
TB - apex

38. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Deoxygenated blood - elastic walls
P = 2ST/radius

39. What must occur with a exudate pleural effusion
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Drainage
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Opposites

40. What do pulmonary arteries carry - and how are pulm arterial pressures maintained during the cardiac cycle
Stasis - hypercoagulability - endothelial damage
P = 2ST/radius
0 - negative - prevents pneumothorax
Deoxygenated blood - elastic walls

41. Toxicities of what drugs include interstitial lung disease
Bleomycin - busulfan - anmiodorone
Inc EPO leading to erythrocytosis
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
Acute/chronic inc in vent

42. What is an association and potential complication of paraseptal emphysema
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
<75
Carcinoid - carcinoid

43. At what PaO2 does cyanosis begin
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Exposed collagen fibers provides impetus for clotting cascade
<60
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

44. What is the main complication of therapeutic supplemental O2?
Fe 2+
Respiratory effort against airway obstruction
Retinopathy of maturity
Zone 1

45. What is pulmonary surfactant made of - and What does it do
L/S < 1.5
Inc EPO leading to erythrocytosis
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Dipalmatoyl phosphatidylcholine - decreases surface tension

46. What are the causes of ischemia
Loss of blood flow - impeded arterial flow - reduced venous drainage
Zone 1
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

47. What are the risk factors for neonatal RDS
Prematurity - maternal RDS - cesarean delivery
Inc 2 -3- DPG - righward shift
IRV + TV + ERV + RV
Lower portion of right inferior lobe

48. What does alveolar pressure do to capillaries in the apex of the lung
Dec release of fetal glucocorticoids
Methylene blue
High alveolar pressure compresses capillaries
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

49. Other than surfactant - what other important substances are produced by the lungs
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Prostaglandins - histamine - ACE - kallikrein
Zone 1
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

50. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Lobar PNA
Histiocytosis X - Langerhans cells
Upper lobes - cor pulmonale - caplan's syndrome
Centriacinar

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