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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
Stasis - hypercoagulability - endothelial damage
Anatomic dead space and smooth muscle
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
No respiratory effort

2. What are fat emboli associated with
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Respiratory effort against airway obstruction
Long bone fractures and liposuction
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

3. Define expiratory reserve volume (ERV)
Air that can still be breathed out after nl expiration
Mismatch
Air that moves into lung with each quiet respiration
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy

4. Define inspiratory reserve volume (IRV)
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Dec dec in FEV1 - dec in FVC
Air in excess of tidal volume that moves into lung on maximal inspiration
Heparin

5. Why is endothelial damage a risk factor for DVT
Zone 1
Exposed collagen fibers provides impetus for clotting cascade
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Deoxygenated blood - elastic walls

6. What does ACE do
Opposites
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Activates bradykinin
Ciliated cells

7. At what PaO2 does cyanosis begin
Viral - URIs - allergens and stress
Elastic properties
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
<60

8. How does recurrent thromboemboli cause pulm HTN
S. aureus or anaerobes
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
Surfactant
Dec cross sectional area of pulm vasc bed

9. What lung abnl is characterized by absent or decreased breath sounds over affected area - dec resonance - dec fremitus - and which side is the trachea deviated towards
Bronchial obstruction - toward side of lesion
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Dec - because physiologic shunt dec O2 extraction from ratio

10. What direction does an increase in metabolic need shift the O2 dissociation curve
Right
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

11. What does the law of Laplace state about tendency of alveoli to collapse
TB - silica disrupt phagolysosomes and impair MACS
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
On expiration as radius dec

12. What is the presentation of lung cancer

13. What do type II cells do - What is their morphology - when do they proliferate
Inc O2 consumption
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Superior portion of right inferior lobe

14. What is positive cooperativity of hemoglobin refer to...
L/S > 2 = lecithin/sphingomyelin
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

15. What is the formula for O2 content
O2 binding x O2 sat + dissolved O2
IRV + TV
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

16. What is pulmonary surfactant made of - and What does it do
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Dipalmatoyl phosphatidylcholine - decreases surface tension

17. What is used to treat methemoglobin
It binds to Hb -
Centriacinar
Dec - because physiologic shunt dec O2 extraction from ratio
Methylene blue

18. What is methemoglobin
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Airway obstruction (shunt) 100% O2 does not improve PO2

19. What is the formula for A- a gradient - and What is it normally
PAO2 - PaO2 = 10-15 mmHg
Prostaglandins - histamine - ACE - kallikrein
Heart
Metastasis - breast - colon - prostate - bladder -

20. If you aspirate a peanut while supine - where will it go
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Superior portion of right inferior lobe
0 - negative - prevents pneumothorax
Person stops breathing for at least 10 seconds repeatedly during sleep

21. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
N- terminus - carbaminohemoglobin
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

22. How do you prevent DVT
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Ivory white calcified pleural plaques
Upper lobes - cor pulmonale - caplan's syndrome
Heparin

23. What happens to lung volumes in obstructive lung disease
Inc
Deoxygenated blood - elastic walls
Person stops breathing for at least 10 seconds repeatedly during sleep
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

24. What is a chronic complication of sleep apnea
Small airways
In between perfusion limited and diffusion limited
Chroniclly tired
It binds to Hb -

25. Susceptibility to what infection is increased in silicosis and why
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Right shift - favors taut - low affinity for O2 - O2 unloading
TB - silica disrupt phagolysosomes and impair MACS

26. What are the potential TX for sleep apnea
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Weight loss - CPAP - surgery
Inc shear stress leading to endothelial injury
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

27. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
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
Tension pneumo - away from lesion
Small airways
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

28. What does the conducting zone consist of...
Alchoholics or epileptics
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Drainage
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

29. What is the formula for oxygen delivery to tissues
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
More indolent
CO x O2 content of blood
Lost with alveolar walls

30. How does autoimmune dz cause thromboemboli
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Persistently low O2 tension
Fe 2+
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

31. What is a consequence of pulm HTN
Centriacinar
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
IRV + TV
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

32. What muscles are involved in breathing during exercise and What do they control
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Heparin
CT angio

33. How does sleep apnea or high altitude cause pulm HTN
Hypoxic vasocxn
Tension pneumo - away from lesion
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

34. What happens in diffiusion limited pulmonary circulation and what gases does this apply to...
IRV + TV
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Superior portion of right inferior lobe
Inc

35. Define tidal volume (TV)
No respiratory effort
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Air that moves into lung with each quiet respiration
Surfactant

36. What is an association and potential complication of paraseptal emphysema
PVR = (PpulmA - PleftA)/CO
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
L/S > 2 = lecithin/sphingomyelin
Lungs collapse inwards and chest wall spring out

37. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
FEV1/FVC > 80%
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

38. What is early onset hypoxemia from in chronic bronchitis
Shunting
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Histiocytosis X - Langerhans cells
Right

39. What changes in CO2 occur during exercise
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Right shift - favors taut - low affinity for O2 - O2 unloading
Inc production
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia

40. What is the course of of pulm HTN
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Bleomycin - busulfan - anmiodorone
500mL
Inc O2 consumption

41. What is are the symptoms of a pulmonary embolism
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Chest pain - tachypnea and dyspnea
FRC - inward pull of lung balanced by outward pull of chest wall
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

42. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
High alveolar pressure compresses capillaries
Repeated cycles of lung injury and wound healing with inc collagen
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Apex of healthy lung

43. What cellular changes occur at high altitude
Mismatch
Inc mitochondria
Dec - because physiologic shunt dec O2 extraction from ratio
Lower portion of right inferior lobe

44. What is tha hallmark finding of COPD
RV + ERV - volume in lungs after nl expiration
Dec in the FEV1/FVC
Viral - URIs - allergens and stress
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

45. What happens to O2 content and O2 sat as Hb falls
<60
Viral - URIs - allergens and stress
TB - apex
Dec - no change

46. What kind of pleural plaques are the result of asbestosis
Ivory white calcified pleural plaques
4 polypeptide subunits - 2 alpha and 2 beta
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Acetazolamide - inhibits CA and acidifies the blood

47. What is the most common cancerous lesion in the lun
Metastasis - breast - colon - prostate - bladder -
Squamous cell carcinoma - keratin pearls and intracellular bridges
Repeated cycles of lung injury and wound healing with inc collagen
DIC - especially postpartum

48. What are the subtypes of pneumoconioses

49. What is the appoximate O2 binding capacity
20.1 mL O2 /dL
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Gland depth/total thickness of broncial wall - >50%
Methylene blue

50. 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
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 excretion of bicarb to compensate for respiratory alkalosis
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest