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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 V/Q ratio at the apex and base of the lung
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
P = 2ST/radius
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

2. What layers must CO2 and O2 traverse to complete gas exchange
CO - 200x
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
TB - silica disrupt phagolysosomes and impair MACS
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

3. Define functional residual capacity (FRC)
Alpha1- antitrypsin def - also cirrhosis
Exposed collagen fibers provides impetus for clotting cascade
Prostaglandins - histamine - ACE - kallikrein
RV + ERV - volume in lungs after nl expiration

4. What is the ideal V/Q ratio and why
Matched - =1 adequate gas exchange
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Air that moves into lung with each quiet respiration
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

5. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
Surfactant
In between perfusion limited and diffusion limited
Defect in coagulative cascace proteins
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

6. What is another name for neonatal RDS
500mL
Hyaline membrane disease
Tissue hypoxia from dec O2 sat and dec O2 content
Methylene blue

7. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Ivory white calcified pleural plaques
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
RV + ERV - volume in lungs after nl expiration
Coal miner's - silicosis - abestosis

8. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Person stops breathing for at least 10 seconds repeatedly during sleep
20.1 mL O2 /dL
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Histiocytosis X - Langerhans cells

9. What is used to treat CN poisoning and why
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
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
No respiratory effort
Everything but RV - TV + IRV + ERV

10. What do PFTs show in restrictive lung disease
FEV1/FVC > 80%
RALS - righ anterior - left superior
O2 binding x O2 sat + dissolved O2
Inc production

11. How happens to the proton from the rxn the created bicarb
Dec release of fetal glucocorticoids
CT angio
CO2 - acid/altitude - DPG - Exercise - Temperature
It binds to Hb -

12. What is early onset hypoxemia from in chronic bronchitis
Person stops breathing for at least 10 seconds repeatedly during sleep
Lungs collapse inwards and chest wall spring out
Shunting
500mL

13. Why is there eventual loss of capillary beds in emphysema
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Lost with alveolar walls
Weight loss - CPAP - surgery
Activates bradykinin

14. What organism causes a lobar PNA and What are the characteristics
Loss of elastic fibers
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Dec - because physiologic shunt dec O2 extraction from ratio

15. What is a consequence of pulm HTN
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

16. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Hypertrophy of mucus secreting glands in the bronchioles

17. What does decreased PAO2 do
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Inc O2 consumption
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

18. What changes in 2 -3 - DPG occur at high altitude
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Milky fluid with inc TGs
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Zone 1

19. What does CADET face to the right stand for
Dec in lung volumes - FVC - TLC
Pa > PA > Pv
CO2 - acid/altitude - DPG - Exercise - Temperature
No change - but inc venous CO2 content

20. Define physilogic dead space
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Retinopathy of maturity
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

21. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Lowered
Inc O2 consumption
Surfactant def leading to inc surfact tension and alveolar collapse
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

22. What is used to treat methemoglobin
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Viral - URIs - allergens and stress
Drainage
Methylene blue

23. What is the protein content in a transudative pleural effusion and What are the potential causes
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
PVR = (PpulmA - PleftA)/CO
More indolent

24. What kind of pleural plaques are the result of asbestosis
Dec - no change
PVR = (PpulmA - PleftA)/CO
Ivory white calcified pleural plaques
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen

25. What is sleep apnea associated with
Alchoholics or epileptics
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Air that can still be breathed out after nl expiration
Gland depth/total thickness of broncial wall - >50%

26. Which muscles are involved in quiet breathing and What part of respiration do the control
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Inspiration by diaphragm - expiration is passive
Bleomycin - busulfan - anmiodorone
Coal miner's - silicosis - abestosis

27. What are the lab/study findings in adenocarcinoma of the lung
Lobar PNA
On expiration as radius dec
Clara cells - type II pneumocytes; multiple densitites on CXR
Inc production

28. What happens to lung volumes in restrictive lung disease
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Dec
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals

29. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Exposed collagen fibers provides impetus for clotting cascade
Air that moves into lung with each quiet respiration
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
4 polypeptide subunits - 2 alpha and 2 beta

30. What is the leading cause of cancer death
500mL
Lung cancer
Right
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

31. What changes occur to PaO2 and PaCO2
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
No change - but inc venous CO2 content
Low resistance and high compliance
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

32. What is the defect in panacinar emphysema - and what else do you see
Type II pneumocytes - after week 35
O2 binding x O2 sat + dissolved O2
Defect in coagulative cascace proteins
Alpha1- antitrypsin def - also cirrhosis

33. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Drainage
Tension pneumo - away from lesion
On expiration as radius dec
Positive cooperativity and negative allostery - unlike myoglobin

34. Which has a greater affinity for hemoglobin - CO or O2 and by how much
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
CO - 200x
Tension pneumo - away from lesion
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

35. What direction does an increase in metabolic need shift the O2 dissociation curve
Airway obstruction (shunt) 100% O2 does not improve PO2
Right
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
Everything but RV - TV + IRV + ERV

36. What are the findings associated with sarcoidosis
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Retinopathy of maturity
CT angio
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

37. What cells in the lung produce surfactant and What does it do
RV + ERV - volume in lungs after nl expiration
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Dec - due to lactic acidosis
Hypoxic vasocxn

38. What are potential triggers for asthma
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
On expiration as radius dec
Viral - URIs - allergens and stress
Coal miner's - silicosis - abestosis

39. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Mismatch
Squamous cell carcinoma - keratin pearls and intracellular bridges
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Elastase

40. What is the presentation of lung cancer

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41. What are the 3 reasons for an increased A- a gradient
Lost with alveolar walls
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
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
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

42. What lobes are affected in silicosis
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Upper lobes
Metastasis - breast - colon - prostate - bladder -
CO - 200x

43. What does each bronchopulmonary segment have in the center and along its border
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Gland depth/total thickness of broncial wall - >50%
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

44. 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
Retinopathy of maturity
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

45. Other than surfactant - what other important substances are produced by the lungs
Prostaglandins - histamine - ACE - kallikrein
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Surfactant def leading to inc surfact tension and alveolar collapse
Stasis - hypercoagulability - endothelial damage

46. What kind of space is in the conducting tree and what kind of muscle exists there
O2 binding x O2 sat + dissolved O2
Ratio from apex to base becomes more uniform
Anatomic dead space and smooth muscle
Defect in coagulative cascace proteins

47. What can amniotic fluid emboli lead to...
DIC - especially postpartum
500mL
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
CT angio

48. What cellular changes occur at high altitude
Inc mitochondria
Hypoxic vasocxn
P = 2ST/radius
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

49. In emphysema - What is increased lung compliance due to...
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Upper lobes - cor pulmonale - caplan's syndrome
Loss of elastic fibers

50. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Everything but RV - TV + IRV + ERV
Pa > PA > Pv
Respiratory bronchioles - clear debris in alveoli - bronchi