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Respiratory

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What are the potential TX for sleep apnea
Weight loss - CPAP - surgery
Chronic hypoxic vasocxn
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

2. What is the main complication of therapeutic supplemental O2?
Dorsiflexion of food leads to tender calf muscle
Tissue hypoxia from dec O2 sat and dec O2 content
Dec cross sectional area of pulm vasc bed
Retinopathy of maturity

3. What is the protein content in a transudative pleural effusion and What are the potential causes
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Dec
Fe 2+
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

4. If you aspirate a peanut while supine - where will it go
Superior portion of right inferior lobe
Milky fluid with inc TGs
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
CO - 200x

5. Which lung is the more common site for an inhaled foreign body and why
Steroids to mom - artificial surfactant and thyroxine to neonate
Lungs collapse inwards and chest wall spring out
Alpha1- antitrypsin def - also cirrhosis
Right lung - right main stem bronhus is wider and more vertical

6. Why is there eventual loss of capillary beds in emphysema
Lost with alveolar walls
Tension pneumo - away from lesion
Lowered
Acute/chronic inc in vent

7. Where is cartilage present in the respiratory tree
Repeated cycles of lung injury and wound healing with inc collagen
CO x O2 content of blood
Trachea and bronchi
Clara cells - type II pneumocytes; multiple densitites on CXR

8. What is an example of hypercoagulability
Alpha1- antitrypsin def - also cirrhosis
Dec in lung volumes - FVC - TLC
Defect in coagulative cascace proteins
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

9. What are the causes of hypoxia
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Everything but RV - TV + IRV + ERV
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

10. What cells in the lung produce surfactant and What does it do
Loss of elastic fibers
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Type II pneumocytes - after week 35
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

11. What kind of emphysema is caused by smoking
Shed epithelium from mucus plugs
Both highest in the base
4 polypeptide subunits - 2 alpha and 2 beta
Centriacinar

12. What is the formula for oxygen delivery to tissues
Loss of blood flow - impeded arterial flow - reduced venous drainage
CO x O2 content of blood
In between perfusion limited and diffusion limited
Dec release of fetal glucocorticoids

13. 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
Deep leg veins
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Zone 1

14. Susceptibility to what infection is increased in silicosis and why
Ciliated cells
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
TB - silica disrupt phagolysosomes and impair MACS
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

15. What cellular changes occur at high altitude
Inc shear stress leading to endothelial injury
Lung cancer
Inc mitochondria
Inoperable - responsive to chemotherapy

16. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Tension pneumo - away from lesion
Lost with alveolar walls
Dec - no change
Surfactant def leading to inc surfact tension and alveolar collapse

17. What cells make surfactant and At what week is produced most abundantly
More indolent
Type II pneumocytes - after week 35
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
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor

18. What happens as a result of hypoxia in sleep apnea
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Inc EPO leading to erythrocytosis
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Dec cross sectional area of pulm vasc bed

19. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
Loss of elastic fibers
Superior portion of right inferior lobe
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
More indolent

20. What is the formula for O2 content
Productive cough for greater than 3 months in at least 2 years
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
O2 binding x O2 sat + dissolved O2
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

21. What are the findings in asthma
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Inc resistance leading to inc pressure

22. What is the most common cancerous lesion in the lun
Dorsiflexion of food leads to tender calf muscle
Metastasis - breast - colon - prostate - bladder -
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

23. What is the V/Q ratio at the apex and base of the lung
Brings air in and out - warms - humidifies - filters
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Viral - URIs - allergens and stress

24. What is the imaging test of choice for PE
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
CT angio
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)

25. At What terminal does CO2 bind the globin molecule
P = 2ST/radius
Inc mitochondria
Alpha1- antitrypsin def - also cirrhosis
N- terminus - carbaminohemoglobin

26. What are the findings of chronic bronchitis
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
RV + ERV - volume in lungs after nl expiration
Dec - no change
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

27. In emphysema - What is increased lung compliance due to...
CT angio
Air that moves into lung with each quiet respiration
Loss of elastic fibers
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

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

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29. What is a consequence of pulm HTN
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Activates bradykinin
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Defect in coagulative cascace proteins

30. What does each bronchopulmonary segment have in the center and along its border
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Zone 1
Mesothelioma - pleura - psammoma bodies
CO2 - acid/altitude - DPG - Exercise - Temperature

31. What is the formula for A- a gradient - and What is it normally
Ivory white calcified pleural plaques
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
PAO2 - PaO2 = 10-15 mmHg
CO x O2 content of blood

32. What is the appoximate O2 binding capacity
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
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
Inc production
20.1 mL O2 /dL

33. What is fetal hemoglobin made of and why does it have a higher affinity for O2
Inc
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

34. What are clara cells What is their morphology and What do they do
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
High alveolar pressure compresses capillaries
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

35. What findings are associated with emphysema
DIC - especially postpartum
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
No respiratory effort
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)

36. What happens to lung volumes in obstructive lung disease
Inc
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Inspiration by diaphragm - expiration is passive
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

37. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Inc EPO leading to erythrocytosis
Pa > PA > Pv
Inspiration by diaphragm - expiration is passive
Air that can still be breathed out after nl expiration

38. What does ACE do
Air that moves into lung with each quiet respiration
500mL
CO2 - acid/altitude - DPG - Exercise - Temperature
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)

39. What organisms cause a bronchoPNA and What are the characteristics
20.1 mL O2 /dL
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
Shunting

40. How do you prevent DVT
Type II cells
In between perfusion limited and diffusion limited
Heparin
Acetazolamide - inhibits CA and acidifies the blood

41. What are the subtypes of pneumoconioses

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42. What is the relation fo the pulmonary artery to the bronchus at each lung hilus
RALS - righ anterior - left superior
It binds to Hb -
O2 binding x O2 sat + dissolved O2
Inc 2 -3- DPG - righward shift

43. 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
Carcinoid - carcinoid
Ivory white calcified pleural plaques
Low resistance and high compliance

44. What does pulm HTN result in
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
DIC - especially postpartum
Right
N- terminus - carbaminohemoglobin

45. Why is endothelial damage a risk factor for DVT
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Exposed collagen fibers provides impetus for clotting cascade
In between perfusion limited and diffusion limited
Lobar PNA

46. What happens in perfusion limited circulatioin and which gases does this apply to...
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Dec in the FEV1/FVC
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

47. What does kallikrein do
Shunting
Activates bradykinin
Pleural effusion
Dec in lung volumes - FVC - TLC

48. What effects do O2 and CO2 have on pulm circulation - in relation to the other
FEV1/FVC > 80%
Trachea and bronchi
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Opposites

49. Toxicities of what drugs include interstitial lung disease
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Bleomycin - busulfan - anmiodorone
Upper lobes - cor pulmonale - caplan's syndrome
Alchoholics or epileptics

50. What is carboxyhemoglobin and What does it cause
Positive cooperativity and negative allostery - unlike myoglobin
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
No change - but inc venous CO2 content
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