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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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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 does a V/Q ratio of infinity indicate
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Right

2. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Inc shear stress leading to endothelial injury
TB - apex
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Pleural effusion

3. What causes primary pulm HTN
Superior portion of right inferior lobe
Small airways
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Coal miner's - silicosis - abestosis

4. What kind of space is in the conducting tree and what kind of muscle exists there
Opposites
Anatomic dead space and smooth muscle
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
CO2 - acid/altitude - DPG - Exercise - Temperature

5. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Tension pneumo - away from lesion
Deoxygenated blood - elastic walls
Centriacinar
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

6. What drug therapy is used to augment the changes in bicarb exretion
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Acetazolamide - inhibits CA and acidifies the blood
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Inc excretion of bicarb to compensate for respiratory alkalosis

7. Why do pts with emphysema exhale through pursed lips
Superior portion of right inferior lobe
High alveolar pressure compresses capillaries
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Inc airway pressure to prevent airway collapse during exhalation

8. What can amniotic fluid emboli lead to...
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
DIC - especially postpartum
Prostaglandins - histamine - ACE - kallikrein

9. Which lung is the more common site for an inhaled foreign body and why
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Right lung - right main stem bronhus is wider and more vertical
Dipalmatoyl phosphatidylcholine

10. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Carcinoid - carcinoid
Gland depth/total thickness of broncial wall - >50%
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

11. What organism causes a lobar PNA and What are the characteristics
Inoperable - responsive to chemotherapy
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

12. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Repeated cycles of lung injury and wound healing with inc collagen
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

13. What are the risk factors for neonatal RDS
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Prematurity - maternal RDS - cesarean delivery
Heparin
Dec - no change

14. What kind of connection exists between endothelial cells in the capilaries
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
20.1 mL O2 /dL
Tight jxns
More indolent

15. What is the formula for resistance
Chest pain - tachypnea and dyspnea
Persistently low O2 tension
L/S < 1.5
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

16. What are the histological findings in asbestosis and what occupations are associated
CO2 - acid/altitude - DPG - Exercise - Temperature
Lowered
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

17. What are mucus secretion swept out by
TB - apex
Productive cough for greater than 3 months in at least 2 years
Ciliated cells
Prostaglandins - histamine - ACE - kallikrein

18. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Air that can still be breathed out after nl expiration
Acute/chronic inc in vent
Positive cooperativity and negative allostery - unlike myoglobin
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

19. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Persistently low O2 tension
Dec - no change
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

20. How happens to the proton from the rxn the created bicarb
Type II cells
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
<75
It binds to Hb -

21. What are fat emboli associated with
Weight loss - CPAP - surgery
Matched - =1 adequate gas exchange
Tight jxns
Long bone fractures and liposuction

22. What is the pathology of asthma

23. What are the findings associated with sarcoidosis
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
PVR = (PpulmA - PleftA)/CO
Superior portion of right inferior lobe
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

24. What do hemoglobin modifacations lead to...
Mismatch
Lungs collapse inwards and chest wall spring out
Tissue hypoxia from dec O2 sat and dec O2 content
Inc

25. What are the various causes of ARDS
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Upper lobes
Coal miner's - silicosis - abestosis

26. What does decreased PAO2 do
Inc excretion of bicarb to compensate for respiratory alkalosis
Dec - due to lactic acidosis
Viral - URIs - allergens and stress
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

27. What does the conducting zone consist of...
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Inc excretion of bicarb to compensate for respiratory alkalosis
Surfactant
IRV + TV + ERV + RV

28. What is the alveolar gas equation approximation
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
PA02 = 150 - PACO2/0.8
N- terminus - carbaminohemoglobin

29. What is used to treat CN poisoning and why
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
Surfactant
PA02 = 150 - PACO2/0.8
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

30. What is surfactant made of...
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Dec dec in FEV1 - dec in FVC
Dipalmatoyl phosphatidylcholine
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

31. What properties determine the combined volumes of the chest wall and lungs
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Tissue hypoxia from dec O2 sat and dec O2 content
Elastic properties
Deoxygenated blood - elastic walls

32. What happens to diffusing capacity in interstiial lung diseases
Carcinoid - carcinoid
Lower portion of right inferior lobe
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Lowered

33. What are the associations with bronchiectasis

34. Define inspiratory capacity (IC)
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Elastic properties
IRV + TV
20.1 mL O2 /dL

35. What doe FAT BAT stand for
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Right shift - favors taut - low affinity for O2 - O2 unloading

36. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
Loss of elastic fibers
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Inc airway pressure to prevent airway collapse during exhalation

37. What is an association and potential complication of paraseptal emphysema
N- terminus - carbaminohemoglobin
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

38. What happens to lung volumes in restrictive lung disease
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Respiratory effort against airway obstruction
Dec

39. What is the pathology of bronchiectasis
Chroniclly tired
Dec
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

40. What changes in lung volunes occur as a result of restrictive lung disease
Inc due to inc CO
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Dec in lung volumes - FVC - TLC
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor

41. What lung product is deficient in neonatal RDS
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Inc EPO leading to erythrocytosis
Lost with alveolar walls
Surfactant

42. Which structures perforate the diaphragm and where
Inc production
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

43. What is the formula for collapsing pressure
Prostaglandins - histamine - ACE - kallikrein
Respiratory bronchioles - clear debris in alveoli - bronchi
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
P = 2ST/radius

44. Which muscles are involved in quiet breathing and What part of respiration do the control
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Dec
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Inspiration by diaphragm - expiration is passive

45. What is fetal hemoglobin made of and why does it have a higher affinity for O2
Inc airway pressure to prevent airway collapse during exhalation
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
L/S > 2 = lecithin/sphingomyelin

46. Define physilogic dead space
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Inc O2 consumption
Prematurity - maternal RDS - cesarean delivery
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

47. What is the formula for O2 content
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Air that can still be breathed out after nl expiration
O2 binding x O2 sat + dissolved O2
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

48. What is a potential test for asthma
Drainage
Methacholine challenge
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Elastase

49. What kind of course does interstitial PNA follow in comparison to bronchoPNA
RALS - righ anterior - left superior
More indolent
Inc excretion of bicarb to compensate for respiratory alkalosis
P = 2ST/radius

50. What is positive cooperativity of hemoglobin refer to...
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Stasis - hypercoagulability - endothelial damage
Person stops breathing for at least 10 seconds repeatedly during sleep
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound