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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 are potential triggers for asthma
Viral - URIs - allergens and stress
Inc O2 consumption
L/S > 2 = lecithin/sphingomyelin
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

2. What is the formula for A- a gradient - and What is it normally
PAO2 - PaO2 = 10-15 mmHg
TB - apex
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Inc O2 consumption

3. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Acute/chronic inc in vent
IRV + TV + ERV + RV
Inc resistance leading to inc pressure
CO - 200x

4. What are the risk factors for neonatal RDS
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Prematurity - maternal RDS - cesarean delivery
Everything but RV - TV + IRV + ERV
Lowered

5. What muscles are involved in breathing during exercise and What do they control
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Right lung - right main stem bronhus is wider and more vertical
500mL
Persistently low O2 tension

6. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
More indolent
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Dorsiflexion of food leads to tender calf muscle

7. What kind of connection exists between endothelial cells in the capilaries
Ciliated cells
Inspiration by diaphragm - expiration is passive
Tight jxns
Dec - because physiologic shunt dec O2 extraction from ratio

8. What are the 3 reasons for an increased A- a gradient
IRV + TV + ERV + RV
PA02 = 150 - PACO2/0.8
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

9. What is occupied in the space that would have been the left middle lobe
Carcinoid - carcinoid
Heart
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Inc excretion of bicarb to compensate for respiratory alkalosis

10. What are the associations with bronchiectasis

11. What causes neonatal RDS
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Productive cough for greater than 3 months in at least 2 years
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Surfactant def leading to inc surfact tension and alveolar collapse

12. What is central sleep apnea
Lower portion of right inferior lobe
Shed epithelium from mucus plugs
Dec in the FEV1/FVC
No respiratory effort

13. What is the formula for oxygen delivery to tissues
Mesothelioma - pleura - psammoma bodies
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Inspiration by diaphragm - expiration is passive
CO x O2 content of blood

14. What changes in V/Q throughout the lung during exercise
Shunting
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Ratio from apex to base becomes more uniform
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

15. What is the defect in panacinar emphysema - and what else do you see
Tight jxns
Air in excess of tidal volume that moves into lung on maximal inspiration
TB - apex
Alpha1- antitrypsin def - also cirrhosis

16. Why is endothelial damage a risk factor for DVT
Exposed collagen fibers provides impetus for clotting cascade
Airway obstruction (shunt) 100% O2 does not improve PO2
Positive cooperativity and negative allostery - unlike myoglobin
Everything but RV - TV + IRV + ERV

17. What are mucus secretion swept out by
P = 2ST/radius
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Ciliated cells
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

18. What is the characteristic lymphatic pleural effusion
Milky fluid with inc TGs
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Centriacinar
RV + ERV - volume in lungs after nl expiration

19. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Tight jxns
Deep leg veins
L/S < 1.5
<60

20. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Heparin
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Prostaglandins - histamine - ACE - kallikrein
Respiratory bronchioles - clear debris in alveoli - bronchi

21. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Inc excretion of bicarb to compensate for respiratory alkalosis
Opposites
Right shift - favors taut - low affinity for O2 - O2 unloading
Apex of healthy lung

22. What is a potential test for asthma
Apex of healthy lung
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Heparin
Methacholine challenge

23. Which lung is the more common site for an inhaled foreign body and why
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Right lung - right main stem bronhus is wider and more vertical

24. What is tha hallmark finding of COPD
Mesothelioma - pleura - psammoma bodies
Dec in the FEV1/FVC
Lost with alveolar walls
Metastasis - breast - colon - prostate - bladder -

25. Which structures perforate the diaphragm and where
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Inc O2 consumption
Ratio from apex to base becomes more uniform

26. 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
Deoxygenated blood - elastic walls
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Inoperable - responsive to chemotherapy

27. What is the definition of sleep apnea
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Person stops breathing for at least 10 seconds repeatedly during sleep
Air in lung after maxmimal expiration - cannot be measured on spirometry
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

28. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Right
0 - negative - prevents pneumothorax

29. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Inc 2 -3- DPG - righward shift
Pa > PA > Pv
N- terminus - carbaminohemoglobin
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

30. 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)
Loss of elastic fibers
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Brings air in and out - warms - humidifies - filters

31. What is Homan's sign
Shunting
Dorsiflexion of food leads to tender calf muscle
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

32. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Tight jxns
P = 2ST/radius
Pleural effusion

33. What are the SPHERE of complications in lung cancer
Clara cells - type II pneumocytes; multiple densitites on CXR
Dipalmatoyl phosphatidylcholine - decreases surface tension
Long bone fractures and liposuction
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

34. How does sleep apnea or high altitude cause pulm HTN
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Hypoxic vasocxn
Air that moves into lung with each quiet respiration

35. Where do you find type I cells - What is their morphology - and What do they do
Persistently low O2 tension
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Apex of healthy lung

36. Malignancy associated with asbestosis - results in hemorrhagic effusions and pleural thickening - cancer - location - histo finding
Apex of healthy lung
Trachea and bronchi
Milky fluid with inc TGs
Mesothelioma - pleura - psammoma bodies

37. What is the formula for collapsing pressure
Dec dec in FEV1 - dec in FVC
Centriacinar
Dipalmatoyl phosphatidylcholine
P = 2ST/radius

38. What is a consequence of pulm HTN
CO2 - acid/altitude - DPG - Exercise - Temperature
Lost with alveolar walls
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly

39. What happens as a result of hypoxia in sleep apnea
Dec release of fetal glucocorticoids
Inc EPO leading to erythrocytosis
Airways close prematurely resulting in inc RV and dec FVC
Ratio from apex to base becomes more uniform

40. Define total lung capcaity
Prematurity - maternal RDS - cesarean delivery
IRV + TV + ERV + RV
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Inspiration by diaphragm - expiration is passive

41. Lung absecss often reults From what organisms
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
S. aureus or anaerobes
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Elastic properties

42. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
PA02 = 150 - PACO2/0.8
Air that can still be breathed out after nl expiration
Dec in the FEV1/FVC
In between perfusion limited and diffusion limited

43. Define functional residual capacity (FRC)
Pleural effusion
Alpha1- antitrypsin def - also cirrhosis
RV + ERV - volume in lungs after nl expiration
Clara cells - type II pneumocytes; multiple densitites on CXR

44. What does decreased PAO2 do
Dipalmatoyl phosphatidylcholine - decreases surface tension
Deoxygenated blood - elastic walls
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

45. What reaction and enzyme create bicarb and Where does it happen
Inc mitochondria
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Chest pain - tachypnea and dyspnea
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes

46. What changes in pH occur during strenuous exercise and why
Dec - due to lactic acidosis
Exposed collagen fibers provides impetus for clotting cascade
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

47. What is the course of of pulm HTN
Surfactant
Inc production
Activates bradykinin
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

48. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
0 - negative - prevents pneumothorax

49. What is are the symptoms of a pulmonary embolism
Dec - no change
Inc airway pressure to prevent airway collapse during exhalation
Chest pain - tachypnea and dyspnea
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

50. If you aspirate a peanut while supine - where will it go
Superior portion of right inferior lobe
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Weight loss - CPAP - surgery
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-