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Respiratory

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Answer 50 questions in 15 minutes.
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1. What doe FAT BAT stand for
RV + ERV - volume in lungs after nl expiration
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
Mesothelioma - pleura - psammoma bodies
Ciliated cells

2. What happens in perfusion limited circulatioin and which gases does this apply to...
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Long bone fractures and liposuction
Elastase
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

3. What is the V/Q ratio at the apex and base of the lung
4 polypeptide subunits - 2 alpha and 2 beta
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Positive cooperativity and negative allostery - unlike myoglobin

4. Define functional residual capacity (FRC)
PVR = (PpulmA - PleftA)/CO
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
High alveolar pressure compresses capillaries
RV + ERV - volume in lungs after nl expiration

5. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
Tissue hypoxia from dec O2 sat and dec O2 content
N- terminus - carbaminohemoglobin
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Hyaline membrane disease

6. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
Inc 2 -3- DPG - righward shift
Type II cells
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
P = 2ST/radius

7. What is the response for ventilation of high altitude
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
Acute/chronic inc in vent
Elastic properties
Hypoxic vasocxn

8. What is used to treat methemoglobin
500mL
Methylene blue
Inc excretion of bicarb to compensate for respiratory alkalosis
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

9. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Surfactant
Incr - right - dec - left
0 - negative - prevents pneumothorax

10. What does kallikrein do
CT angio
Form of hemoglobin bound to CO in place of O2 - causes dec O2 binding capacituy with a left shift in the O2 hemoglobin dissociation curve - dec unloading in tissues
Activates bradykinin
C3 - 4 - 6 - phrenic nerve - referred to shoulder

11. What accounts for the sigmoid shaped O2 dissociation curve with hemoglobin
Dec
Dec in lung volumes - FVC - TLC
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Positive cooperativity and negative allostery - unlike myoglobin

12. What changes in O2 consumption change during exercise
Inc O2 consumption
Respiratory bronchioles - clear debris in alveoli - bronchi
Right shift - favors taut - low affinity for O2 - O2 unloading
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities

13. What is used to treat CN poisoning and why
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
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
Deoxygenated blood - elastic walls

14. What ratio is used to measure lung maturity and What is the value is neonatal RDS
S. aureus or anaerobes
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
L/S < 1.5

15. What is an example of hypercoagulability
Inc airway pressure to prevent airway collapse during exhalation
Inc EPO leading to erythrocytosis
Defect in coagulative cascace proteins
Inc shear stress leading to endothelial injury

16. Define vital capacity (VC)
Superior portion of right inferior lobe
4 polypeptide subunits - 2 alpha and 2 beta
Everything but RV - TV + IRV + ERV
Airway obstruction (shunt) 100% O2 does not improve PO2

17. What is surfactant made of...
Shunting
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Dipalmatoyl phosphatidylcholine
Dorsiflexion of food leads to tender calf muscle

18. Lung absecss often reults From what organisms
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Exposed collagen fibers provides impetus for clotting cascade
Squamous cell carcinoma - keratin pearls and intracellular bridges
S. aureus or anaerobes

19. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
On expiration as radius dec
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Chest pain - tachypnea and dyspnea
Defect in coagulative cascace proteins

20. Why is cesarean delivery a risk factor for neonatal RDS
Dec release of fetal glucocorticoids
Pa > PA > Pv
Loss of elastic fibers
Deoxygenated blood - elastic walls

21. What does the law of Laplace state about tendency of alveoli to collapse
Inc EPO causing inc hemotocrit and hemoglobin - chronic hypoxia
On expiration as radius dec
Inc excretion of bicarb to compensate for respiratory alkalosis
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

22. What properties determine the combined volumes of the chest wall and lungs
More indolent
Elastic properties
Deoxygenated blood - elastic walls
Loss of blood flow - impeded arterial flow - reduced venous drainage

23. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Opposites
Centriacinar
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right

24. What is occupied in the space that would have been the left middle lobe
Inc O2 consumption
DIC - especially postpartum
Heart
Repeated cycles of lung injury and wound healing with inc collagen

25. In which zone of the lung is Pa > Pv >PA
Weight loss - CPAP - surgery
Zone 3
TB - silica disrupt phagolysosomes and impair MACS
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

26. Which structures perforate the diaphragm and where
Inc airway pressure to prevent airway collapse during exhalation
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Coal miner's - silicosis - abestosis
Tissue hypoxia from dec O2 sat and dec O2 content

27. What must occur with a exudate pleural effusion
Drainage
20.1 mL O2 /dL
Chronic hypoxic vasocxn
Gland depth/total thickness of broncial wall - >50%

28. What are the histological findings in asbestosis and what occupations are associated
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Air that can still be breathed out after nl expiration
Centriacinar
Dec in the FEV1/FVC

29. What is Homan's sign
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Lungs collapse inwards and chest wall spring out
Dorsiflexion of food leads to tender calf muscle
Incr - right - dec - left

30. What is are the symptoms of a pulmonary embolism
Brings air in and out - warms - humidifies - filters
PVR = (PpulmA - PleftA)/CO
Chest pain - tachypnea and dyspnea
Prematurity - maternal RDS - cesarean delivery

31. Define inspiratory reserve volume (IRV)
Air in excess of tidal volume that moves into lung on maximal inspiration
Bleomycin - busulfan - anmiodorone
Ratio from apex to base becomes more uniform
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

32. At what PaO2 does hypoxemia begin
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
<75
Dipalmatoyl phosphatidylcholine - decreases surface tension
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

33. What do pulmonary arteries carry - and how are pulm arterial pressures maintained during the cardiac cycle
Defect in coagulative cascace proteins
Deoxygenated blood - elastic walls
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Dec in the FEV1/FVC

34. What is the diffustion formula and what happens to the variables in emphysema and pulmonary fibrosis
Person stops breathing for at least 10 seconds repeatedly during sleep
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Shed epithelium from mucus plugs
Mesothelioma - pleura - psammoma bodies

35. What happens to lung volumes in restrictive lung disease
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Shed epithelium from mucus plugs
Loss of blood flow - impeded arterial flow - reduced venous drainage
Dec

36. What are the 9 interstitial lung diseases

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37. Which muscles are involved in quiet breathing and What part of respiration do the control
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Loss of elastic fibers
Inspiration by diaphragm - expiration is passive
Hyaline membrane disease

38. What does PFTs show in COPD
<75
Dec dec in FEV1 - dec in FVC
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Hypertrophy of mucus secreting glands in the bronchioles

39. Lung cancer in central region - undifferentiated beoming very aggressive - associated with ectopic production of ACTH - ADH and Lambert Eaton syndrome - cancer and histo
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Dipalmatoyl phosphatidylcholine
Everything but RV - TV + IRV + ERV

40. What are fat emboli associated with
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Lung cancer
Long bone fractures and liposuction
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

41. What is the pathology of chronic bronchitis
Ciliated cells
PAO2 - PaO2 = 10-15 mmHg
Zone 3
Hypertrophy of mucus secreting glands in the bronchioles

42. What are potential triggers for asthma
Alchoholics or epileptics
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Right shift - favors taut - low affinity for O2 - O2 unloading
Viral - URIs - allergens and stress

43. Which pts are at risk for apriation PNA
Inc resistance leading to inc pressure
Alchoholics or epileptics
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
Shed epithelium from mucus plugs

44. What is the main complication of therapeutic supplemental O2?
Positive cooperativity and negative allostery - unlike myoglobin
Retinopathy of maturity
Hypoxic vasocxn
CO - 200x

45. What organism causes a lobar PNA and What are the characteristics
Retinopathy of maturity
Repeated cycles of lung injury and wound healing with inc collagen
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
RV + ERV - volume in lungs after nl expiration

46. What is the appoximate O2 binding capacity
Lungs collapse inwards and chest wall spring out
20.1 mL O2 /dL
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Right

47. What happens to lung volumes in obstructive lung disease
Type II pneumocytes - after week 35
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Inc
Chronic hypoxic vasocxn

48. What does ACE do
Shed epithelium from mucus plugs
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Angio I to angio II - inactivates bradykinin (ACEi inc bradykinin and cause cough - angioedema)
Heparin

49. What lobes are affected in silicosis
IRV + TV + ERV + RV
RALS - righ anterior - left superior
Inc to meet O2 demand
Upper lobes

50. What causes neonatal RDS
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane
Superior portion of right inferior lobe
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Surfactant def leading to inc surfact tension and alveolar collapse

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