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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 cycle of idiopathic pulmonary fibrosis
Deoxygenated blood - elastic walls
Respiratory effort against airway obstruction
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Repeated cycles of lung injury and wound healing with inc collagen

2. What do hemoglobin modifacations lead to...
Tissue hypoxia from dec O2 sat and dec O2 content
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
FEV1/FVC > 80%
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

3. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
20.1 mL O2 /dL
Steroids to mom - artificial surfactant and thyroxine to neonate
Pa > PA > Pv

4. How do you prevent DVT
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Heparin
Tension pneumo - away from lesion
Ciliated cells

5. What are the subtypes of pneumoconioses

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6. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Tension pneumo - away from lesion
Type II pneumocytes - after week 35
Deoxygenated blood - elastic walls
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

7. In which zone of the lung is Pa > Pv >PA
Zone 3
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Inc

8. What is Homan's sign
Positive cooperativity and negative allostery - unlike myoglobin
Type II cells
Dorsiflexion of food leads to tender calf muscle
Productive cough for greater than 3 months in at least 2 years

9. What does kallikrein do
Positive cooperativity and negative allostery - unlike myoglobin
Activates bradykinin
Dec release of fetal glucocorticoids
Deoxygenated blood - elastic walls

10. What are the causes of hypoxemia
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
500mL
Air in lung after maxmimal expiration - cannot be measured on spirometry
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

11. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
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
L/S < 1.5
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

12. What are the associations with bronchiectasis

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13. If you aspirate a peanut while upright - where will it go
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Lower portion of right inferior lobe
Lobar PNA
No change - but inc venous CO2 content

14. What kind of course does interstitial PNA follow in comparison to bronchoPNA
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
More indolent
S. aureus or anaerobes
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

15. Why is there eventual loss of capillary beds in emphysema
Respiratory effort against airway obstruction
Defect in coagulative cascace proteins
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Lost with alveolar walls

16. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Everything but RV - TV + IRV + ERV
Pa > PA > Pv
Respiratory bronchioles - clear debris in alveoli - bronchi
Gland depth/total thickness of broncial wall - >50%

17. What happens to O2 content and O2 sat as Hb falls
Bleomycin - busulfan - anmiodorone
Fe 2+
Dec - no change
Right

18. What does the respiratory zone consist of and What is its fxn
Dec release of fetal glucocorticoids
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Deep leg veins
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

19. What is sleep apnea associated with
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Deoxygenated blood - elastic walls
On expiration as radius dec
Mismatch

20. What changes at high altitude can result in RVH
Chronic hypoxic vasocxn
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Lower portion of right inferior lobe
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

21. What is occupied in the space that would have been the left middle lobe
Exposed collagen fibers provides impetus for clotting cascade
Histiocytosis X - Langerhans cells
Heart
Apex of healthy lung

22. Define residual volume (RV)
Air in lung after maxmimal expiration - cannot be measured on spirometry
Inc shear stress leading to endothelial injury
Dipalmatoyl phosphatidylcholine
More indolent

23. Define expiratory reserve volume (ERV)
500mL
Hypertrophy of mucus secreting glands in the bronchioles
Steroids to mom - artificial surfactant and thyroxine to neonate
Air that can still be breathed out after nl expiration

24. What changes in ventilation rate occur during exercise
<75
Activates bradykinin
Inc to meet O2 demand
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

25. What is the nl form of iron in hemoglobin
TB - apex
Elastic properties
Fe 2+
Airway obstruction (shunt) 100% O2 does not improve PO2

26. What happens to arterial PO2 in chronic lung disease and why
500mL
S. aureus or anaerobes
Incr - right - dec - left
Dec - because physiologic shunt dec O2 extraction from ratio

27. Susceptibility to what infection is increased in silicosis and why
Air that can still be breathed out after nl expiration
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
TB - silica disrupt phagolysosomes and impair MACS
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

28. What changes in V/Q throughout the lung during exercise
Low resistance and high compliance
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Ratio from apex to base becomes more uniform
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

29. What is a chronic complication of sleep apnea
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Dec in the FEV1/FVC
Chroniclly tired
<60

30. What are the 3 reasons for an increased A- a gradient
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Repeated cycles of lung injury and wound healing with inc collagen

31. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
Bronchial obstruction - toward side of lesion
In between perfusion limited and diffusion limited
Pa > PA > Pv
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

32. What do type II cells do - What is their morphology - when do they proliferate
PVR = (PpulmA - PleftA)/CO
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Respiratory bronchioles - clear debris in alveoli - bronchi
Mismatch

33. What is the formula for pulm vasc resistance
PAO2 - PaO2 = 10-15 mmHg
Productive cough for greater than 3 months in at least 2 years
PVR = (PpulmA - PleftA)/CO
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

34. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Dorsiflexion of food leads to tender calf muscle
<75
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Inc to meet O2 demand

35. What is the pathology of asthma

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36. What cellular changes occur at high altitude
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
S. aureus or anaerobes
Inc mitochondria
Dec - no change

37. What happens to V/Q ratio in COPD
Mismatch
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Methylene blue
Matched - =1 adequate gas exchange

38. What is the alveolar gas equation
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
On expiration as radius dec
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

39. What causes secondary pulm HTN
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Acute/chronic inc in vent
Inc excretion of bicarb to compensate for respiratory alkalosis
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

40. What is surfactant made of...
Alchoholics or epileptics
<75
Dipalmatoyl phosphatidylcholine
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

41. What are mucus secretion swept out by
Ciliated cells
Superior portion of right inferior lobe
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Hyaline membrane disease

42. What is a lung abscess and What does usually result from
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Right lung - right main stem bronhus is wider and more vertical
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

43. What lab ration indicates fetal lung maturity
L/S > 2 = lecithin/sphingomyelin
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Lowered

44. What does each bronchopulmonary segment have in the center and along its border
Milky fluid with inc TGs
Deoxygenated blood - elastic walls
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Lower portion of right inferior lobe

45. What is the tendency of the lungs vs the chest wall
Inc mitochondria
Dec dec in FEV1 - dec in FVC
Lungs collapse inwards and chest wall spring out
Air that moves into lung with each quiet respiration

46. What do pulmonary arteries carry - and how are pulm arterial pressures maintained during the cardiac cycle
Deoxygenated blood - elastic walls
Type II pneumocytes - after week 35
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Inoperable - responsive to chemotherapy

47. Define tidal volume (TV)
Inc 2 -3- DPG - righward shift
CO2 - acid/altitude - DPG - Exercise - Temperature
Air that moves into lung with each quiet respiration
PVR = (PpulmA - PleftA)/CO

48. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
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
Right shift - favors taut - low affinity for O2 - O2 unloading
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

49. What lung abnl is characterized by absent or decreased breath sounds over affected area - dec resonance - dec fremitus - and which side is the trachea deviated towards
Methylene blue
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Steroids to mom - artificial surfactant and thyroxine to neonate
Bronchial obstruction - toward side of lesion

50. Lung cancer in peripheral reason - highly anaplastic - undifferentiated tumor - cancer - histo - TX
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
TB - silica disrupt phagolysosomes and impair MACS
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Inc to meet O2 demand