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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 protein content an exudative pleural effusion and What are the potential causes
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Airway obstruction (shunt) 100% O2 does not improve PO2

2. What is the presentation of lung cancer

3. What cells make surfactant and At what week is produced most abundantly
RV + ERV - volume in lungs after nl expiration
Type II pneumocytes - after week 35
Retinopathy of maturity
Right

4. What reaction and enzyme create bicarb and Where does it happen
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Inc production
Repeated cycles of lung injury and wound healing with inc collagen
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

5. What are the two forms of hemoglobin
Respiratory bronchioles - clear debris in alveoli - bronchi
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Inc excretion of bicarb to compensate for respiratory alkalosis

6. What does CADET face to the right stand for
O2 binding x O2 sat + dissolved O2
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
CO2 - acid/altitude - DPG - Exercise - Temperature
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

7. What are the causes of ischemia
500mL
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Loss of blood flow - impeded arterial flow - reduced venous drainage
PAO2 - PaO2 = 10-15 mmHg

8. Why do pts with emphysema exhale through pursed lips
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Shed epithelium from mucus plugs
Acute/chronic inc in vent
Inc airway pressure to prevent airway collapse during exhalation

9. What cellular changes occur at high altitude
S. aureus or anaerobes
Inc mitochondria
Bronchial obstruction - toward side of lesion
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)

10. Which pts are at risk for apriation PNA
Alchoholics or epileptics
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
IRV + TV + ERV + RV
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

11. What is the pathology of ARDS
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
4 polypeptide subunits - 2 alpha and 2 beta
Air that moves into lung with each quiet respiration
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

12. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Incr - right - dec - left
Inspiration by diaphragm - expiration is passive

13. What is the equation for physiologic dead space
Dec in the FEV1/FVC
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Carcinoid - carcinoid
DIC - especially postpartum

14. Which muscles are involved in quiet breathing and What part of respiration do the control
Weight loss - CPAP - surgery
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Inspiration by diaphragm - expiration is passive
Dec cross sectional area of pulm vasc bed

15. What happens with the O2 curve shifts to the right and What does it facilitate
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Methacholine challenge
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Form of hemoglobin bound to CO in place of O2 - causes dec O2 binding capacituy with a left shift in the O2 hemoglobin dissociation curve - dec unloading in tissues

16. What findings are associated with emphysema
Air in lung after maxmimal expiration - cannot be measured on spirometry
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

17. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Positive cooperativity and negative allostery - unlike myoglobin
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Dec in the FEV1/FVC
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

18. What renal changes occur at high altitude and What are they compensating for
Opposites
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
L/S > 2 = lecithin/sphingomyelin
Inc excretion of bicarb to compensate for respiratory alkalosis

19. What is tha hallmark finding of COPD
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Dec in the FEV1/FVC
Methacholine challenge
Inc

20. Lung absecss often reults From what organisms
Retinopathy of maturity
S. aureus or anaerobes
Lungs collapse inwards and chest wall spring out
Air that moves into lung with each quiet respiration

21. What happens to bicarb once it is created in an RBC
Loss of elastic fibers
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Acetazolamide - inhibits CA and acidifies the blood
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

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

23. What changes in lung volunes occur as a result of restrictive lung disease
500mL
Dec in lung volumes - FVC - TLC
Bronchial obstruction - toward side of lesion
Air that can still be breathed out after nl expiration

24. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Mesothelioma - pleura - psammoma bodies
Right shift - favors taut - low affinity for O2 - O2 unloading
Zone 1

25. What lab ration indicates fetal lung maturity
Dec dec in FEV1 - dec in FVC
Right
L/S > 2 = lecithin/sphingomyelin
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

26. What are the findings associated with sarcoidosis
Acetazolamide - inhibits CA and acidifies the blood
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Inc airway pressure to prevent airway collapse during exhalation
Dipalmatoyl phosphatidylcholine

27. What are the causes of hypoxemia
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Trachea and bronchi
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

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

29. Define tidal volume (TV)
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Air that moves into lung with each quiet respiration
Dec - because physiologic shunt dec O2 extraction from ratio
Anatomic dead space and smooth muscle

30. What organisms cause interstitial PNA and What are the characteristics
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Brings air in and out - warms - humidifies - filters
Lungs collapse inwards and chest wall spring out
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

31. What doe FAT BAT stand for
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Inc shear stress leading to endothelial injury
Dec dec in FEV1 - dec in FVC
Tension pneumo - away from lesion

32. Other than surfactant - what other important substances are produced by the lungs
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Prostaglandins - histamine - ACE - kallikrein
Dec

33. How does autoimmune dz cause thromboemboli
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
PVR = (PpulmA - PleftA)/CO
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
High alveolar pressure compresses capillaries

34. What is a consequence of pulm HTN
Small airways
Lung cancer
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Viral - URIs - allergens and stress

35. What is a lung abscess and What does usually result from
Viral - URIs - allergens and stress
Methacholine challenge
4 polypeptide subunits - 2 alpha and 2 beta
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

36. What does a V/Q ratio of infinity indicate
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
Lowered
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

37. Where do 95% of PE arise from
Deep leg veins
Acute/chronic inc in vent
Mismatch
500mL

38. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Viral - URIs - allergens and stress
L/S < 1.5
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Inspiration by diaphragm - expiration is passive

39. If you aspirate a peanut while supine - where will it go
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Superior portion of right inferior lobe
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

40. How is pulmonary circulation characterized in terms of resistance and compliance
Squamous cell carcinoma - keratin pearls and intracellular bridges
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Low resistance and high compliance
Long bone fractures and liposuction

41. What is methemoglobin
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
TB - silica disrupt phagolysosomes and impair MACS
Acetazolamide - inhibits CA and acidifies the blood
Tension pneumo - away from lesion

42. If you aspirate a peanut while upright - where will it go
Dec
Lower portion of right inferior lobe
Coal miner's - silicosis - abestosis
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

43. What is the nl form of iron in hemoglobin
Fe 2+
Inc to meet O2 demand
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
TB - silica disrupt phagolysosomes and impair MACS

44. What are the histological findings in asbestosis and what occupations are associated
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Retinopathy of maturity
Lowered
Prostaglandins - histamine - ACE - kallikrein

45. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Small airways
Tension pneumo - away from lesion
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

46. What changes in EPO occur at high altitude
Prostaglandins - histamine - ACE - kallikrein
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Chroniclly tired

47. Where is cartilage present in the respiratory tree
Trachea and bronchi
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Opposites
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

48. How do you prevent DVT
Heparin
Exposed collagen fibers provides impetus for clotting cascade
Coal miner's - silicosis - abestosis
Zone 1

49. What is the V/Q ratio at the apex and base of the lung
Brings air in and out - warms - humidifies - filters
Tension pneumo - away from lesion
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

50. What is the formula for resistance
Low resistance and high compliance
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
On expiration as radius dec
Inc excretion of bicarb to compensate for respiratory alkalosis