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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 the SPHERE of complications in lung cancer
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Dec
Ivory white calcified pleural plaques
Pa > PA > Pv

2. What are the causes of ischemia
CO2 - acid/altitude - DPG - Exercise - Temperature
Squamous cell carcinoma - keratin pearls and intracellular bridges
Loss of blood flow - impeded arterial flow - reduced venous drainage
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

3. What do hemoglobin modifacations lead to...
Loss of blood flow - impeded arterial flow - reduced venous drainage
Tissue hypoxia from dec O2 sat and dec O2 content
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Acetazolamide - inhibits CA and acidifies the blood

4. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Pleural effusion
Centriacinar
O2 binding x O2 sat + dissolved O2
In between perfusion limited and diffusion limited

5. What enzyme increases activity in emphysema
Positive cooperativity and negative allostery - unlike myoglobin
PA02 = 150 - PACO2/0.8
Everything but RV - TV + IRV + ERV
Elastase

6. What changes in V/Q throughout the lung during exercise
Dec - due to lactic acidosis
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Right shift - favors taut - low affinity for O2 - O2 unloading
Ratio from apex to base becomes more uniform

7. What are potential triggers for asthma
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Viral - URIs - allergens and stress
Superior portion of right inferior lobe
No change - but inc venous CO2 content

8. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Alpha1- antitrypsin def - also cirrhosis
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
CO2 - acid/altitude - DPG - Exercise - Temperature

9. What is the fxn of the conducting zone
Type II cells
Dec dec in FEV1 - dec in FVC
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Brings air in and out - warms - humidifies - filters

10. What happens to V/Q ratio in COPD
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Mismatch
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Tight jxns

11. What changes in lung volunes occur as a result of restrictive lung disease
Heparin
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Dec in lung volumes - FVC - TLC
Chroniclly tired

12. What are the histological findings in asbestosis and what occupations are associated
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Surfactant
Inc mitochondria
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

13. What are the 3 reasons for an increased A- a gradient
Coal miner's - silicosis - abestosis
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
FEV1/FVC > 80%

14. If you aspirate a peanut while supine - where will it go
Superior portion of right inferior lobe
Ciliated cells
Bronchial obstruction - toward side of lesion
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

15. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Histiocytosis X - Langerhans cells
Squamous cell carcinoma - keratin pearls and intracellular bridges
Hypoxic vasocxn
Exposed collagen fibers provides impetus for clotting cascade

16. What is the pathology of emphysema
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Dec - due to lactic acidosis
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

17. What is the criteria for chronic bronchitis
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
CO - 200x
Productive cough for greater than 3 months in at least 2 years
Steroids to mom - artificial surfactant and thyroxine to neonate

18. What are the various causes of ARDS
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Surfactant def leading to inc surfact tension and alveolar collapse

19. What are the 9 interstitial lung diseases

20. What cells in the lung produce surfactant and What does it do
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Tension pneumo - away from lesion
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
CO2 - acid/altitude - DPG - Exercise - Temperature

21. What muscles are involved in breathing during exercise and What do they control
DIC - especially postpartum
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

22. What is the protein content an exudative pleural effusion and What are the potential causes
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Dec release of fetal glucocorticoids
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
DIC - especially postpartum

23. What is an example of hypercoagulability
Defect in coagulative cascace proteins
Clara cells - type II pneumocytes; multiple densitites on CXR
TB - silica disrupt phagolysosomes and impair MACS
In between perfusion limited and diffusion limited

24. What does the law of Laplace state about tendency of alveoli to collapse
Hypoxic vasocxn
On expiration as radius dec
TB - apex
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis

25. What is the ideal V/Q ratio and why
Inspiration by diaphragm - expiration is passive
Inc to meet O2 demand
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Matched - =1 adequate gas exchange

26. Which muscles are involved in quiet breathing and What part of respiration do the control
4 polypeptide subunits - 2 alpha and 2 beta
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Clara cells - type II pneumocytes; multiple densitites on CXR
Inspiration by diaphragm - expiration is passive

27. What is used to treat methemoglobin
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Methylene blue
PAO2 - PaO2 = 10-15 mmHg
Opposites

28. What happens to bicarb once it is created in an RBC
Bronchial obstruction - toward side of lesion
Mesothelioma - pleura - psammoma bodies
Lungs collapse inwards and chest wall spring out
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

29. What kind of space is in the conducting tree and what kind of muscle exists there
Anatomic dead space and smooth muscle
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Dec in the FEV1/FVC
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

30. What happens in perfusion limited circulatioin and which gases does this apply to...
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Chronic hypoxic vasocxn
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

31. What is the tendency of the lungs vs the chest wall
Clara cells - type II pneumocytes; multiple densitites on CXR
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Lungs collapse inwards and chest wall spring out

32. What changes in 2 -3 - DPG occur at high altitude
Chronic hypoxic vasocxn
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
FRC - inward pull of lung balanced by outward pull of chest wall
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

33. What changes in ventilation rate occur during exercise
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Lobar PNA
Shunting
Inc to meet O2 demand

34. What is the protein content in a transudative pleural effusion and What are the potential causes
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Airways close prematurely resulting in inc RV and dec FVC
IRV + TV + ERV + RV

35. What is virchow's triad
Stasis - hypercoagulability - endothelial damage
TB - silica disrupt phagolysosomes and impair MACS
Bronchial obstruction - toward side of lesion
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

36. Other than surfactant - what other important substances are produced by the lungs
Prostaglandins - histamine - ACE - kallikrein
Inc
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

37. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Squamous cell carcinoma - keratin pearls and intracellular bridges
Tension pneumo - away from lesion
CO - 200x
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

38. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
L/S > 2 = lecithin/sphingomyelin

39. What lab ration indicates fetal lung maturity
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
L/S > 2 = lecithin/sphingomyelin
Air in lung after maxmimal expiration - cannot be measured on spirometry
Repeated cycles of lung injury and wound healing with inc collagen

40. What kind of pleural plaques are the result of asbestosis
Methylene blue
Weight loss - CPAP - surgery
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Ivory white calcified pleural plaques

41. What kind of connection exists between endothelial cells in the capilaries
Mesothelioma - pleura - psammoma bodies
Respiratory effort against airway obstruction
Tight jxns
IRV + TV + ERV + RV

42. What is sleep apnea associated with
CO - 200x
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Right

43. What renal changes occur at high altitude and What are they compensating for
Metastasis - breast - colon - prostate - bladder -
Surfactant
Inc excretion of bicarb to compensate for respiratory alkalosis
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging

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

45. What is the cycle of idiopathic pulmonary fibrosis
Loss of elastic fibers
Hyaline membrane disease
Repeated cycles of lung injury and wound healing with inc collagen
IRV + TV

46. What changes in CO2 occur during exercise
Dorsiflexion of food leads to tender calf muscle
Inc production
Brings air in and out - warms - humidifies - filters
PAO2 - PaO2 = 10-15 mmHg

47. What organism thrives in high O2 and where in the lung does it flourish
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Surfactant
TB - apex

48. What is a chronic complication of sleep apnea
Chroniclly tired
Dec release of fetal glucocorticoids
Dec in lung volumes - FVC - TLC
Ciliated cells

49. What organism causes a lobar PNA and What are the characteristics
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Upper lobes - cor pulmonale - caplan's syndrome

50. What is a potential test for asthma
Methacholine challenge
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Elastic properties