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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. In COPD - what happens to airways at high lung volumes
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Matched - =1 adequate gas exchange
Airways close prematurely resulting in inc RV and dec FVC
Inc 2 -3- DPG - righward shift

2. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Opposites
Type II pneumocytes - after week 35
Air that moves into lung with each quiet respiration
Drainage

3. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Chronic hypoxic vasocxn
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Right lung - right main stem bronhus is wider and more vertical
Lobar PNA

4. What is the formula for pulm vasc resistance
Dec - due to lactic acidosis
PVR = (PpulmA - PleftA)/CO
Squamous cell carcinoma - keratin pearls and intracellular bridges
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

5. What are the findings in asthma
Clara cells - type II pneumocytes; multiple densitites on CXR
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Air in excess of tidal volume that moves into lung on maximal inspiration

6. Where are ventilation and perfusion highest in the lung - respectively
PVR = (PpulmA - PleftA)/CO
Both highest in the base
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Air in excess of tidal volume that moves into lung on maximal inspiration

7. What is hemoglobin composed of...
Histiocytosis X - Langerhans cells
Dec in lung volumes - FVC - TLC
4 polypeptide subunits - 2 alpha and 2 beta
Inc due to inc CO

8. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Dorsiflexion of food leads to tender calf muscle
Clara cells - type II pneumocytes; multiple densitites on CXR
Incr - right - dec - left
Matched - =1 adequate gas exchange

9. Toxicities of what drugs include interstitial lung disease
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Bleomycin - busulfan - anmiodorone
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Inc production

10. What is another name for neonatal RDS
Clara cells - type II pneumocytes; multiple densitites on CXR
Hyaline membrane disease
CO2 - acid/altitude - DPG - Exercise - Temperature
Hypertrophy of mucus secreting glands in the bronchioles

11. What does decreased PAO2 do
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Zone 1
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

12. Define inspiratory capacity (IC)
L/S < 1.5
Deoxygenated blood - elastic walls
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
IRV + TV

13. In which zone of the lung is Pa > Pv >PA
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Small airways
Zone 3

14. What is the formula for resistance
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Inc excretion of bicarb to compensate for respiratory alkalosis
Incr - right - dec - left

15. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Right shift - favors taut - low affinity for O2 - O2 unloading
Weight loss - CPAP - surgery
<75
Inspiration by diaphragm - expiration is passive

16. How does left to right shunt cause pulm HTN
Inc shear stress leading to endothelial injury
Mesothelioma - pleura - psammoma bodies
Inc EPO leading to erythrocytosis
IRV + TV + ERV + RV

17. Why is cesarean delivery a risk factor for neonatal RDS
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Dec release of fetal glucocorticoids
Long bone fractures and liposuction

18. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
L/S < 1.5
Dec in lung volumes - FVC - TLC
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
CO x O2 content of blood

19. What does a V/Q ratio of infinity indicate
Alpha1- antitrypsin def - also cirrhosis
Air in excess of tidal volume that moves into lung on maximal inspiration
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Long bone fractures and liposuction

20. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
<75
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
CO - 200x
0 - negative - prevents pneumothorax

21. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Loss of elastic fibers
Tension pneumo - away from lesion
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
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

22. What changes in ventilation rate occur during exercise
Inc to meet O2 demand
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
P = 2ST/radius
Surfactant

23. What is the defect in panacinar emphysema - and what else do you see
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Alpha1- antitrypsin def - also cirrhosis
Prematurity - maternal RDS - cesarean delivery
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

24. What cells make surfactant and At what week is produced most abundantly
Lowered
RALS - righ anterior - left superior
Metastasis - breast - colon - prostate - bladder -
Type II pneumocytes - after week 35

25. What is a typical tidal volume
Dorsiflexion of food leads to tender calf muscle
Inc 2 -3- DPG - righward shift
Stasis - hypercoagulability - endothelial damage
500mL

26. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Dipalmatoyl phosphatidylcholine
<75
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Hypoxic vasocxn

27. What does the law of Laplace state about tendency of alveoli to collapse
On expiration as radius dec
Squamous cell carcinoma - keratin pearls and intracellular bridges
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

28. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Everything but RV - TV + IRV + ERV
Inc

29. What kind of course does interstitial PNA follow in comparison to bronchoPNA
More indolent
CO2 - acid/altitude - DPG - Exercise - Temperature
Pleural effusion
Mesothelioma - pleura - psammoma bodies

30. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Retinopathy of maturity
Chroniclly tired

31. Define inspiratory reserve volume (IRV)
Weight loss - CPAP - surgery
Air in excess of tidal volume that moves into lung on maximal inspiration
FEV1/FVC > 80%
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

32. Define tidal volume (TV)
Air that moves into lung with each quiet respiration
High alveolar pressure compresses capillaries
Exposed collagen fibers provides impetus for clotting cascade
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

33. What is an example of hypercoagulability
Lungs collapse inwards and chest wall spring out
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Defect in coagulative cascace proteins

34. What cells in the lung produce surfactant and What does it do
Hypoxic vasocxn
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
More indolent
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

35. What happens to lung volumes in restrictive lung disease
Air in excess of tidal volume that moves into lung on maximal inspiration
Dec
Dec cross sectional area of pulm vasc bed
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

36. Which structures perforate the diaphragm and where
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Clara cells - type II pneumocytes; multiple densitites on CXR
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT

37. Why is there eventual loss of capillary beds in emphysema
Lost with alveolar walls
Squamous cell carcinoma - keratin pearls and intracellular bridges
Surfactant def leading to inc surfact tension and alveolar collapse
IRV + TV + ERV + RV

38. What changes in V/Q throughout the lung during exercise
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Ratio from apex to base becomes more uniform

39. What changes at high altitude can result in RVH
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Chronic hypoxic vasocxn
Heart
Respiratory bronchioles - clear debris in alveoli - bronchi

40. How many lobes does each lung have - and What is the lingula
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Inc mitochondria
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Superior portion of right inferior lobe

41. What is the imaging test of choice for PE
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Brings air in and out - warms - humidifies - filters
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
CT angio

42. What is the definition of sleep apnea
Positive cooperativity and negative allostery - unlike myoglobin
Inc due to inc CO
Dec in the FEV1/FVC
Person stops breathing for at least 10 seconds repeatedly during sleep

43. Define expiratory reserve volume (ERV)
Opposites
Air that can still be breathed out after nl expiration
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

44. What are potential triggers for asthma
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Gland depth/total thickness of broncial wall - >50%
Viral - URIs - allergens and stress
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

45. What are the 9 interstitial lung diseases

46. What are the lab/study findings in adenocarcinoma of the lung
Surfactant def leading to inc surfact tension and alveolar collapse
CO x O2 content of blood
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Clara cells - type II pneumocytes; multiple densitites on CXR

47. What is a consequence of pulm HTN
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Inspiration by diaphragm - expiration is passive
Respiratory effort against airway obstruction
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

48. In emphysema - What is increased lung compliance due to...
FRC - inward pull of lung balanced by outward pull of chest wall
500mL
Inspiration by diaphragm - expiration is passive
Loss of elastic fibers

49. What properties determine the combined volumes of the chest wall and lungs
Surfactant def leading to inc surfact tension and alveolar collapse
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Brings air in and out - warms - humidifies - filters
Elastic properties

50. A carcinoma in the apex of the lung can cause what syndrome and What is the tumor called