Test your basic knowledge |

Respiratory

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 lung product is deficient in neonatal RDS
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
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Elastic properties

2. What is the formula for collapsing pressure
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Incr - right - dec - left
P = 2ST/radius
Gland depth/total thickness of broncial wall - >50%

3. What is the pathology of chronic bronchitis
Dec - no change
IRV + TV
Hypertrophy of mucus secreting glands in the bronchioles
No respiratory effort

4. What must occur with a exudate pleural effusion
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Drainage
In between perfusion limited and diffusion limited
Surfactant def leading to inc surfact tension and alveolar collapse

5. What are curschmann's spirals
Shed epithelium from mucus plugs
Lower portion of right inferior lobe
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Inc to meet O2 demand

6. What is occupied in the space that would have been the left middle lobe
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Persistently low O2 tension
Apex of healthy lung
Heart

7. What does the law of Laplace state about tendency of alveoli to collapse
Drainage
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
On expiration as radius dec
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

8. What changes at high altitude can result in RVH
FEV1/FVC > 80%
Air that can still be breathed out after nl expiration
Inc production
Chronic hypoxic vasocxn

9. What is methemoglobin
Metastasis - breast - colon - prostate - bladder -
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Methylene blue
RALS - righ anterior - left superior

10. What TX is the mother given before delivery - and what TXs are given to the infant
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Weight loss - CPAP - surgery
Steroids to mom - artificial surfactant and thyroxine to neonate
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

11. What happens to O2 content and O2 sat as Hb falls
FRC - inward pull of lung balanced by outward pull of chest wall
Dec - no change
Deoxygenated blood - elastic walls
Alpha1- antitrypsin def - also cirrhosis

12. What organisms cause interstitial PNA and What are the characteristics
On expiration as radius dec
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Zone 1

13. What is the alveolar gas equation
Lower portion of right inferior lobe
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Apex of healthy lung

14. In COPD - what happens to airways at high lung volumes
Dec in lung volumes - FVC - TLC
Long bone fractures and liposuction
<75
Airways close prematurely resulting in inc RV and dec FVC

15. Why is there eventual loss of capillary beds in emphysema
Chest pain - tachypnea and dyspnea
S. aureus or anaerobes
Surfactant
Lost with alveolar walls

16. Which has a greater affinity for hemoglobin - CO or O2 and by how much
Heparin
CO - 200x
Pa > PA > Pv
Mesothelioma - pleura - psammoma bodies

17. What is virchow's triad
Inspiration by diaphragm - expiration is passive
Anatomic dead space and smooth muscle
Stasis - hypercoagulability - endothelial damage
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

18. What increases the risk of PDA in neonatal RDS
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Persistently low O2 tension
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
<75

19. What is the main complication of therapeutic supplemental O2?
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Low resistance and high compliance
Retinopathy of maturity
0 - negative - prevents pneumothorax

20. What happens to lung volumes in obstructive lung disease
Pa > PA > Pv
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
Inc
Histiocytosis X - Langerhans cells

21. In which zone of the lung is PA > Pa > Pv
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Persistently low O2 tension
Zone 1
Inc

22. What lab ration indicates fetal lung maturity
Zone 1
Type II cells
Gland depth/total thickness of broncial wall - >50%
L/S > 2 = lecithin/sphingomyelin

23. What is the Reid index and what perfectange is characteristic of chronic bronchitis
Lost with alveolar walls
Dorsiflexion of food leads to tender calf muscle
Gland depth/total thickness of broncial wall - >50%
TB - apex

24. Lung absecss often reults From what organisms
Pleural effusion
S. aureus or anaerobes
Repeated cycles of lung injury and wound healing with inc collagen
High alveolar pressure compresses capillaries

25. What are the potential TX for sleep apnea
Inc resistance leading to inc pressure
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Inc
Weight loss - CPAP - surgery

26. What is an association and potential complication of paraseptal emphysema
More indolent
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Airways close prematurely resulting in inc RV and dec FVC

27. What is the pathology of bronchiectasis
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis
Incr - right - dec - left
Elastase

28. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Dec protein - CHF - nephrotic syndrome - hepatic cirrhosis
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Pa > PA > Pv
CO2 - acid/altitude - DPG - Exercise - Temperature

29. What is the initial damage of ARDS caused by
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Airways close prematurely resulting in inc RV and dec FVC
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals

30. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Type II cells
Milky fluid with inc TGs
L/S < 1.5
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

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
Elastic properties
CO - 200x
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

32. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Airways close prematurely resulting in inc RV and dec FVC
Lobar PNA
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

33. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Lobar PNA
Both highest in the base
Low resistance and high compliance
C3 - 4 - 6 - phrenic nerve - referred to shoulder

34. What happens to lung volumes in restrictive lung disease
Lung cancer
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Dec
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

35. Where do you find type I cells - What is their morphology - and What do they do
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
RALS - righ anterior - left superior
Dec - due to lactic acidosis

36. Define residual volume (RV)
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Inspiration by diaphragm - expiration is passive
Air in lung after maxmimal expiration - cannot be measured on spirometry
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers

37. At What terminal does CO2 bind the globin molecule
N- terminus - carbaminohemoglobin
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Inc due to inc CO
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

38. What happens in perfusion limited circulatioin and which gases does this apply to...
Respiratory bronchioles - clear debris in alveoli - bronchi
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Hypoxic vasocxn
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

39. What drug therapy is used to augment the changes in bicarb exretion
Hypertrophy of mucus secreting glands in the bronchioles
Prostaglandins - histamine - ACE - kallikrein
Carcinoid - carcinoid
Acetazolamide - inhibits CA and acidifies the blood

40. What happens to arterial PO2 in chronic lung disease and why
It binds to Hb -
Dec - because physiologic shunt dec O2 extraction from ratio
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
Centriacinar

41. What is surfactant made of...
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Zone 1
Dipalmatoyl phosphatidylcholine
Opposites

42. 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
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Anatomic dead space and smooth muscle
Type II cells
Bronchial obstruction - toward side of lesion

43. What is the definition of sleep apnea
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
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
Person stops breathing for at least 10 seconds repeatedly during sleep
Chest pain - tachypnea and dyspnea

44. In emphysema - What is increased lung compliance due to...
RV + ERV - volume in lungs after nl expiration
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Loss of elastic fibers

45. Why is endothelial damage a risk factor for DVT
Ratio from apex to base becomes more uniform
Apex of healthy lung
Exposed collagen fibers provides impetus for clotting cascade
Air that can still be breathed out after nl expiration

46. What causes secondary pulm HTN
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
PA02 = 150 - PACO2/0.8
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Inc mitochondria

47. What lobes are affected in silicosis
Alpha1- antitrypsin def - also cirrhosis
Dec release of fetal glucocorticoids
Carcinoid - carcinoid
Upper lobes

48. What does alveolar pressure do to capillaries in the apex of the lung
High alveolar pressure compresses capillaries
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
TB - apex
Prematurity - maternal RDS - cesarean delivery

49. What are the findings associated with sarcoidosis
Clara cells - type II pneumocytes; multiple densitites on CXR
Alpha1- antitrypsin def - also cirrhosis
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

50. What is the pathology of asthma

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183