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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 organism thrives in high O2 and where in the lung does it flourish
PVR = (PpulmA - PleftA)/CO
TB - apex
Dec cross sectional area of pulm vasc bed
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

2. What is the definition of sleep apnea
Mesothelioma - pleura - psammoma bodies
Prostaglandins - histamine - ACE - kallikrein
Person stops breathing for at least 10 seconds repeatedly during sleep
Air in excess of tidal volume that moves into lung on maximal inspiration

3. What changes in lung volunes occur as a result of restrictive lung disease
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Dec in lung volumes - FVC - TLC
PA02 = 150 - PACO2/0.8
N- terminus - carbaminohemoglobin

4. What increases the risk of PDA in neonatal RDS
Persistently low O2 tension
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
Hypertrophy of mucus secreting glands in the bronchioles
0 - negative - prevents pneumothorax

5. In which zone of the lung is Pa > Pv >PA
Zone 3
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Inc mitochondria
Inc production

6. What are the 9 interstitial lung diseases

7. What reaction and enzyme create bicarb and Where does it happen
Dorsiflexion of food leads to tender calf muscle
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism

8. What is the pathology of asthma

9. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Inc to meet O2 demand
Ratio from apex to base becomes more uniform
Squamous cell carcinoma - keratin pearls and intracellular bridges
Gland depth/total thickness of broncial wall - >50%

10. Which muscles are involved in quiet breathing and What part of respiration do the control
Inspiration by diaphragm - expiration is passive
Defect in coagulative cascace proteins
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

11. Where are ventilation and perfusion highest in the lung - respectively
Both highest in the base
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Inc shear stress leading to endothelial injury
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

12. What does pulm HTN result in
Squamous cell carcinoma - keratin pearls and intracellular bridges
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Persistently low O2 tension

13. What causes primary pulm HTN
Mismatch
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Upper lobes - cor pulmonale - caplan's syndrome

14. Why is cesarean delivery a risk factor for neonatal RDS
Shunting
Long bone fractures and liposuction
Clara cells - type II pneumocytes; multiple densitites on CXR
Dec release of fetal glucocorticoids

15. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Right
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Lost with alveolar walls

16. How is pulmonary circulation characterized in terms of resistance and compliance
20.1 mL O2 /dL
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Right shift - favors taut - low affinity for O2 - O2 unloading
Low resistance and high compliance

17. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Lobar PNA
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Activates bradykinin

18. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Inc shear stress leading to endothelial injury
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

19. What are the 3 forms that CO2 is transported from tissues to lungs
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Inc EPO leading to erythrocytosis
Chroniclly tired

20. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
CO x O2 content of blood
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
L/S < 1.5
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

21. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Upper lobes - cor pulmonale - caplan's syndrome
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
CO x O2 content of blood
Squamous cell carcinoma - keratin pearls and intracellular bridges

22. What does the law of Laplace state about tendency of alveoli to collapse
Lowered
Superior portion of right inferior lobe
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
On expiration as radius dec

23. How do you prevent DVT
Inspiration by diaphragm - expiration is passive
Inc resistance leading to inc pressure
Heparin
Defect in coagulative cascace proteins

24. 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
P = 2ST/radius
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance

25. What organism causes a lobar PNA and What are the characteristics
Dec - no change
Dec - due to lactic acidosis
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Carcinoid - carcinoid

26. What layers must CO2 and O2 traverse to complete gas exchange
CO - 200x
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
PVR = (PpulmA - PleftA)/CO

27. What is the imaging test of choice for PE
CT angio
Dec - due to lactic acidosis
Both highest in the base
Airways close prematurely resulting in inc RV and dec FVC

28. What is the presentation of lung cancer

29. What are the findings of chronic bronchitis
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Opposites
Anatomic dead space and smooth muscle
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

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

31. How happens to the proton from the rxn the created bicarb
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
It binds to Hb -
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

32. Susceptibility to what infection is increased in silicosis and why
Inc resistance leading to inc pressure
TB - silica disrupt phagolysosomes and impair MACS
Lowered
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

33. What is the formula for oxygen delivery to tissues
Productive cough for greater than 3 months in at least 2 years
CO x O2 content of blood
Lobar PNA
Inc shear stress leading to endothelial injury

34. What renal changes occur at high altitude and What are they compensating for
Inc excretion of bicarb to compensate for respiratory alkalosis
Dec release of fetal glucocorticoids
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Type II cells

35. 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
Centriacinar
Tissue hypoxia from dec O2 sat and dec O2 content
Acetazolamide - inhibits CA and acidifies the blood

36. What is the leading cause of cancer death
Lung cancer
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
<75
Deep leg veins

37. What causes neonatal RDS
Surfactant def leading to inc surfact tension and alveolar collapse
Air in lung after maxmimal expiration - cannot be measured on spirometry
Dorsiflexion of food leads to tender calf muscle
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

38. At What terminal does CO2 bind the globin molecule
Clara cells - type II pneumocytes; multiple densitites on CXR
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
N- terminus - carbaminohemoglobin
CO - 200x

39. What changes in O2 consumption change during exercise
Alpha1- antitrypsin def - also cirrhosis
Inc O2 consumption
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

40. What lab ration indicates fetal lung maturity
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
L/S > 2 = lecithin/sphingomyelin
Surfactant def leading to inc surfact tension and alveolar collapse

41. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
No change - but inc venous CO2 content
Elastase
Acetazolamide - inhibits CA and acidifies the blood
Histiocytosis X - Langerhans cells

42. Other than surfactant - what other important substances are produced by the lungs
Prostaglandins - histamine - ACE - kallikrein
Dec cross sectional area of pulm vasc bed
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Loss of elastic fibers

43. Define residual volume (RV)
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Air in lung after maxmimal expiration - cannot be measured on spirometry
In between perfusion limited and diffusion limited

44. What is the pathology of chronic bronchitis
More indolent
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
PAO2 - PaO2 = 10-15 mmHg
Hypertrophy of mucus secreting glands in the bronchioles

45. What is the ideal V/Q ratio and why
Hyaline membrane disease
Matched - =1 adequate gas exchange
Carcinoid - carcinoid
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

46. Define inspiratory reserve volume (IRV)
Everything but RV - TV + IRV + ERV
Air in excess of tidal volume that moves into lung on maximal inspiration
Persistently low O2 tension
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

47. What is the most common cancerous lesion in the lun
Alchoholics or epileptics
Metastasis - breast - colon - prostate - bladder -
500mL
O2 binding x O2 sat + dissolved O2

48. If you aspirate a peanut while upright - where will it go
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
CO x O2 content of blood
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Lower portion of right inferior lobe

49. What is the formula for A- a gradient - and What is it normally
PAO2 - PaO2 = 10-15 mmHg
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Air in lung after maxmimal expiration - cannot be measured on spirometry
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

50. Which pts are at risk for apriation PNA
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Alchoholics or epileptics
Lung cancer
PVR = (PpulmA - PleftA)/CO