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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 airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
0 - negative - prevents pneumothorax
Chronic hypoxic vasocxn
Tension pneumo - away from lesion
Inc resistance leading to inc pressure

2. Toxicities of what drugs include interstitial lung disease
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Bleomycin - busulfan - anmiodorone
RV + ERV - volume in lungs after nl expiration
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

3. Which structures perforate the diaphragm and where
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Dec
TB - apex
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

4. What are the findings associated with sarcoidosis
Zone 3
Histiocytosis X - Langerhans cells
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Bronchial obstruction - toward side of lesion

5. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Chest pain - tachypnea and dyspnea
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy

6. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
O2 binding x O2 sat + dissolved O2
Weight loss - CPAP - surgery
In between perfusion limited and diffusion limited

7. Define functional residual capacity (FRC)
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
RV + ERV - volume in lungs after nl expiration
Apex of healthy lung
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

8. What is the fxn of the conducting zone
Ciliated cells
Brings air in and out - warms - humidifies - filters
No change - but inc venous CO2 content
Inc resistance leading to inc pressure

9. What is early onset hypoxemia from in chronic bronchitis
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Prematurity - maternal RDS - cesarean delivery
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Shunting

10. What are clara cells What is their morphology and What do they do
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
O2 binding x O2 sat + dissolved O2
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Shed epithelium from mucus plugs

11. Where do 95% of PE arise from
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Deep leg veins
Loss of elastic fibers

12. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Positive cooperativity and negative allostery - unlike myoglobin

13. What is an example of hypercoagulability
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Dorsiflexion of food leads to tender calf muscle
Loss of elastic fibers
Defect in coagulative cascace proteins

14. Susceptibility to what infection is increased in silicosis and why
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
TB - silica disrupt phagolysosomes and impair MACS
Lowered
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

15. What is the nl form of iron in hemoglobin
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
L/S < 1.5
Inc excretion of bicarb to compensate for respiratory alkalosis
Fe 2+

16. What is the formula for oxygen delivery to tissues
Dec in lung volumes - FVC - TLC
Apex of healthy lung
CO x O2 content of blood
Inc excretion of bicarb to compensate for respiratory alkalosis

17. What is fetal hemoglobin made of and why does it have a higher affinity for O2
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
It binds to Hb -
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

18. What organism thrives in high O2 and where in the lung does it flourish
Inc to meet O2 demand
CO2 - acid/altitude - DPG - Exercise - Temperature
Both highest in the base
TB - apex

19. What are the histological findings in asbestosis and what occupations are associated
Zone 3
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Deep leg veins
<60

20. What organisms cause interstitial PNA and What are the characteristics
Incr - right - dec - left
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

21. What are the risk factors for neonatal RDS
Dipalmatoyl phosphatidylcholine - decreases surface tension
Mismatch
Inc 2 -3- DPG - righward shift
Prematurity - maternal RDS - cesarean delivery

22. What is the pathology of asthma

23. Define vital capacity (VC)
Histiocytosis X - Langerhans cells
Everything but RV - TV + IRV + ERV
Inc resistance leading to inc pressure
CO - 200x

24. What happens to O2 content and O2 sat as Hb falls
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Dec - no change
On expiration as radius dec
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

25. What is the equation for physiologic dead space
Deoxygenated blood - elastic walls
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
PAO2 - PaO2 = 10-15 mmHg

26. What kind of pleural plaques are the result of asbestosis
0 - negative - prevents pneumothorax
Weight loss - CPAP - surgery
Coal miner's - silicosis - abestosis
Ivory white calcified pleural plaques

27. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
More indolent
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Person stops breathing for at least 10 seconds repeatedly during sleep
Inc 2 -3- DPG - righward shift

28. What is methemoglobin
O2 binding x O2 sat + dissolved O2
Air in lung after maxmimal expiration - cannot be measured on spirometry
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Carcinoid - carcinoid

29. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Histiocytosis X - Langerhans cells
Carcinoid - carcinoid
Dec in lung volumes - FVC - TLC
Retinopathy of maturity

30. Why is there eventual loss of capillary beds in emphysema
Lost with alveolar walls
Type II cells
<60
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

31. What happens to lung volumes in obstructive lung disease
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Inc
Productive cough for greater than 3 months in at least 2 years
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

32. At what PaO2 does cyanosis begin
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
<60
Inoperable - responsive to chemotherapy
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

33. What is another name for neonatal RDS
CO - 200x
Inoperable - responsive to chemotherapy
Hyaline membrane disease
On expiration as radius dec

34. Where is cartilage present in the respiratory tree
Upper lobes - cor pulmonale - caplan's syndrome
Air that can still be breathed out after nl expiration
Everything but RV - TV + IRV + ERV
Trachea and bronchi

35. What is compliance and When is it decrease
Bronchial obstruction - toward side of lesion
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Methylene blue
Shunting

36. What changes in O2 consumption change during exercise
RALS - righ anterior - left superior
Inc O2 consumption
Dec - due to lactic acidosis
Persistently low O2 tension

37. What is the order of decreasing pressures among the alveola - capillaries and veins in zone 2 of the lungs
Inc O2 consumption
Pa > PA > Pv
Inc shear stress leading to endothelial injury
Respiratory bronchioles - clear debris in alveoli - bronchi

38. What are the findings of chronic bronchitis
Inc mitochondria
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
P = 2ST/radius
Surfactant def leading to inc surfact tension and alveolar collapse

39. What is the pathology of chronic bronchitis
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Hypertrophy of mucus secreting glands in the bronchioles
Low resistance and high compliance

40. What kind of course does interstitial PNA follow in comparison to bronchoPNA
More indolent
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Dec - no change
Incr - right - dec - left

41. How do you prevent DVT
Heparin
Bronchial obstruction - toward side of lesion
Incr - right - dec - left
RALS - righ anterior - left superior

42. What changes in CO2 occur during exercise
Methylene blue
Zone 3
Inc production
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

43. What are curschmann's spirals
CO - 200x
Shed epithelium from mucus plugs
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
O2 binding x O2 sat + dissolved O2

44. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Incr - right - dec - left
TB - apex
Airways close prematurely resulting in inc RV and dec FVC
Lost with alveolar walls

45. What lab ration indicates fetal lung maturity
N- terminus - carbaminohemoglobin
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
L/S > 2 = lecithin/sphingomyelin

46. At what PaO2 does hypoxemia begin
IRV + TV + ERV + RV
<60
More indolent
<75

47. What findings are associated with emphysema
Everything but RV - TV + IRV + ERV
Inc resistance leading to inc pressure
Shed epithelium from mucus plugs
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

48. What is the defect in panacinar emphysema - and what else do you see
Deoxygenated blood - elastic walls
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Alpha1- antitrypsin def - also cirrhosis
Lung cancer

49. What changes in ventilation rate occur during exercise
Loss of elastic fibers
Inc to meet O2 demand
Methacholine challenge
Matched - =1 adequate gas exchange

50. What is obstructive sleep apnea
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Respiratory effort against airway obstruction
FRC - inward pull of lung balanced by outward pull of chest wall
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy