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 happens to O2 content and O2 sat as Hb falls
L/S < 1.5
CO x O2 content of blood
Dec - no change
Productive cough for greater than 3 months in at least 2 years

2. What is another name for neonatal RDS
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Pa > PA > Pv
Hyaline membrane disease
Inc resistance leading to inc pressure

3. What happens to lung volumes in obstructive lung disease
Inc
O2 binding x O2 sat + dissolved O2
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Tissue hypoxia from dec O2 sat and dec O2 content

4. What lobes are affected in silicosis
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Bleomycin - busulfan - anmiodorone
L/S < 1.5
Upper lobes

5. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Prostaglandins - histamine - ACE - kallikrein
Chronic hypoxic vasocxn
Tension pneumo - away from lesion
CO2 - acid/altitude - DPG - Exercise - Temperature

6. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Dec release of fetal glucocorticoids
Lobar PNA

7. What is the TX for small cell lung cancer
Inoperable - responsive to chemotherapy
Trachea and bronchi
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
FRC - inward pull of lung balanced by outward pull of chest wall

8. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Weight loss - CPAP - surgery
Inc mitochondria
Pleural effusion
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

9. What is the leading cause of cancer death
Lung cancer
Inc production
Air in excess of tidal volume that moves into lung on maximal inspiration
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium

10. If you aspirate a peanut while supine - where will it go
Superior portion of right inferior lobe
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
Prematurity - maternal RDS - cesarean delivery

11. Why is cesarean delivery a risk factor for neonatal RDS
Centriacinar
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Stasis - hypercoagulability - endothelial damage
Dec release of fetal glucocorticoids

12. What doe FAT BAT stand for
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Dec dec in FEV1 - dec in FVC
Tissue hypoxia from dec O2 sat and dec O2 content
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways

13. What does the respiratory zone consist of and What is its fxn
Inc airway pressure to prevent airway collapse during exhalation
Inc EPO leading to erythrocytosis
Inspiration by diaphragm - expiration is passive
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

14. What can amniotic fluid emboli lead to...
Bleomycin - busulfan - anmiodorone
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Right lung - right main stem bronhus is wider and more vertical
DIC - especially postpartum

15. What cells make surfactant and At what week is produced most abundantly
Bleomycin - busulfan - anmiodorone
Type II pneumocytes - after week 35
4 polypeptide subunits - 2 alpha and 2 beta
Viral - URIs - allergens and stress

16. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
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
Lower portion of right inferior lobe
Inc 2 -3- DPG - righward shift
Lowered

17. What is an association and potential complication of paraseptal emphysema
L/S < 1.5
Ivory white calcified pleural plaques
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males

18. What does pulm HTN result in
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Lower portion of right inferior lobe
Mesothelioma - pleura - psammoma bodies
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries

19. What is the main complication of therapeutic supplemental O2?
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
CO2 - acid/altitude - DPG - Exercise - Temperature
Histiocytosis X - Langerhans cells
Retinopathy of maturity

20. What cells in the lung produce surfactant and What does it do
Coal miner's - silicosis - abestosis
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

21. What is a lung abscess and What does usually result from
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%

22. What are the findings associated with sarcoidosis
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Bronchial obstruction - toward side of lesion
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

23. What is central sleep apnea
No respiratory effort
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Hyaline membrane disease

24. At what PaO2 does hypoxemia begin
Elastic properties
Lung cancer
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
<75

25. Define expiratory reserve volume (ERV)
Carcinoid - carcinoid
Both highest in the base
Productive cough for greater than 3 months in at least 2 years
Air that can still be breathed out after nl expiration

26. What is the presentation of lung cancer

27. How do you prevent DVT
Heparin
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

28. In which zone of the lung is Pa > Pv >PA
TB - apex
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Zone 3
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

29. What changes in lung volunes occur as a result of restrictive lung disease
Air that can still be breathed out after nl expiration
Ratio from apex to base becomes more uniform
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
Dec in lung volumes - FVC - TLC

30. Lung absecss often reults From what organisms
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
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Chest pain - tachypnea and dyspnea
S. aureus or anaerobes

31. What are curschmann's spirals
Inc excretion of bicarb to compensate for respiratory alkalosis
CT angio
Shed epithelium from mucus plugs
Air in excess of tidal volume that moves into lung on maximal inspiration

32. What is sleep apnea associated with
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Everything but RV - TV + IRV + ERV
O2 binding x O2 sat + dissolved O2

33. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Histiocytosis X - Langerhans cells
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Bleomycin - busulfan - anmiodorone
Viral - URIs - allergens and stress

34. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Pa > PA > Pv
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Airway obstruction (shunt) 100% O2 does not improve PO2
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung

35. What reaction and enzyme create bicarb and Where does it happen
Dec in the FEV1/FVC
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Air that moves into lung with each quiet respiration
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

36. How does mitral stenosis cause pulm HTN
Inc resistance leading to inc pressure
TB - apex
Ciliated cells
Dec - due to lactic acidosis

37. What properties determine the combined volumes of the chest wall and lungs
Elastic properties
Pa > PA > Pv
Drainage
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

38. How does left to right shunt cause pulm HTN
Heart
Inc shear stress leading to endothelial injury
Bleomycin - busulfan - anmiodorone
TB - apex

39. What is a chronic complication of sleep apnea
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
Upper lobes - cor pulmonale - caplan's syndrome
Chroniclly tired
Upper lobes

40. Which lung is the more common site for an inhaled foreign body and why
Milky fluid with inc TGs
Right lung - right main stem bronhus is wider and more vertical
Inc to meet O2 demand
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

41. What is the course of of pulm HTN
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Type II pneumocytes - after week 35
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

42. What are the causes of ischemia
Loss of blood flow - impeded arterial flow - reduced venous drainage
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Both highest in the base
Metastasis - breast - colon - prostate - bladder -

43. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Air that can still be breathed out after nl expiration
Squamous cell carcinoma - keratin pearls and intracellular bridges
Tissue hypoxia from dec O2 sat and dec O2 content

44. A carcinoma in the apex of the lung can cause what syndrome and What is the tumor called

45. What is the formula for O2 content
O2 binding x O2 sat + dissolved O2
Ratio from apex to base becomes more uniform
Activates bradykinin
Dec dec in FEV1 - dec in FVC

46. Where does exercise sit on the graph of PaO2 vs length along the pulm capillary
Upper lobes - cor pulmonale - caplan's syndrome
Type II pneumocytes - after week 35
In between perfusion limited and diffusion limited
Inc airway pressure to prevent airway collapse during exhalation

47. What are the associations with bronchiectasis

48. Define physilogic dead space
Apex of healthy lung
Lower portion of right inferior lobe
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

49. What happens to lung volumes in restrictive lung disease
TB - apex
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Dec
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

50. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes