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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 happens to diffusing capacity in interstiial lung diseases
Exposed collagen fibers provides impetus for clotting cascade
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Lowered
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals

2. Susceptibility to what infection is increased in silicosis and why
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
In between perfusion limited and diffusion limited
TB - silica disrupt phagolysosomes and impair MACS
Dec - no change

3. What is used to treat methemoglobin
Long bone fractures and liposuction
Methylene blue
Airway obstruction (shunt) 100% O2 does not improve PO2
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

4. If you aspirate a peanut while upright - where will it go
Shunting
Lower portion of right inferior lobe
Carcinoid - carcinoid
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue

5. Which pts are at risk for apriation PNA
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Inc EPO leading to erythrocytosis
Alchoholics or epileptics

6. Lung cancer not linked to smoking - peripheral - grows along airywas - can present like a PNA - cancer and complication
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
FRC - inward pull of lung balanced by outward pull of chest wall

7. What changes in pH occur during strenuous exercise and why
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
CT angio
Dec - due to lactic acidosis
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

8. What is compliance and When is it decrease
Dorsiflexion of food leads to tender calf muscle
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Bicarb (90%) - bound to globin (5%) and dissolved (5%)

9. What organisms cause interstitial PNA and What are the characteristics
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Productive cough for greater than 3 months in at least 2 years
Tissue hypoxia from dec O2 sat and dec O2 content
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

10. At what lung volume is system pressure atmospheric and why
FRC - inward pull of lung balanced by outward pull of chest wall
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
Air that can still be breathed out after nl expiration
CO x O2 content of blood

11. What is the defect in panacinar emphysema - and what else do you see
Alpha1- antitrypsin def - also cirrhosis
Small airways
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

12. What layers must CO2 and O2 traverse to complete gas exchange
PAO2 - PaO2 = 10-15 mmHg
N- terminus - carbaminohemoglobin
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

13. Where are ventilation and perfusion highest in the lung - respectively
Airway obstruction (shunt) 100% O2 does not improve PO2
Positive cooperativity and negative allostery - unlike myoglobin
Both highest in the base
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

14. What cellular changes occur at high altitude
Lungs collapse inwards and chest wall spring out
Gland depth/total thickness of broncial wall - >50%
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Inc mitochondria

15. In which zone of the lung is Pa > Pv >PA
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
N- terminus - carbaminohemoglobin
Zone 3
Right shift - favors taut - low affinity for O2 - O2 unloading

16. Hilar mass arising from the bronchus; cavitation - hx of smoking - PTHRP - cancer and histo
Squamous cell carcinoma - keratin pearls and intracellular bridges
Exposed collagen fibers provides impetus for clotting cascade
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning

17. What cells in the lung produce surfactant and What does it do
Coal miner's - silicosis - abestosis
CO2 - acid/altitude - DPG - Exercise - Temperature
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Viral - URIs - allergens and stress

18. What causes secondary pulm HTN
Respiratory effort against airway obstruction
CO - 200x
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
C3 - 4 - 6 - phrenic nerve - referred to shoulder

19. What is early onset hypoxemia from in chronic bronchitis
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Shunting
20.1 mL O2 /dL
Diffuse alveolar damage leads to ince alveolar capillary perm and protein rich leakage into alveoli resulting in formation of intra - alveolar hyaline membrane

20. What are the risk factors for neonatal RDS
20.1 mL O2 /dL
Prematurity - maternal RDS - cesarean delivery
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
CO2 is absorbed into the RBC - carbonic anydrase catalyzes the rxn of CO2 + H2O to yield H2CO3 - which readily dissociateds into H+ and HCO3-

21. What TX is the mother given before delivery - and what TXs are given to the infant
Low resistance and high compliance
CO x O2 content of blood
Steroids to mom - artificial surfactant and thyroxine to neonate
Inc

22. What is the TX for small cell lung cancer
Inoperable - responsive to chemotherapy
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Dec - due to lactic acidosis
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)

23. What is the tendency of the lungs vs the chest wall
Lungs collapse inwards and chest wall spring out
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Lung cancer

24. What is the leading cause of cancer death
Lung cancer
Carcinoid - carcinoid
Dec - because physiologic shunt dec O2 extraction from ratio
Airway obstruction (shunt) 100% O2 does not improve PO2

25. How happens to the proton from the rxn the created bicarb
It binds to Hb -
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Air that moves into lung with each quiet respiration
Stasis - hypercoagulability - endothelial damage

26. If you aspirate a peanut while supine - where will it go
S. aureus or anaerobes
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Superior portion of right inferior lobe
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

27. Other than surfactant - what other important substances are produced by the lungs
20.1 mL O2 /dL
Dec - due to lactic acidosis
Prostaglandins - histamine - ACE - kallikrein
Retinopathy of maturity

28. What is the course of of pulm HTN
Clara cells - type II pneumocytes; multiple densitites on CXR
Methacholine challenge
S. aureus or anaerobes
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale

29. What lung abnl is characterized with dec breath sounds - hyperresonance - absent fremitus - towards which side does the trachea deviate
Inc production
Tension pneumo - away from lesion
PA02 = 150 - PACO2/0.8
IRV + TV + ERV + RV

30. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Opposites
IRV + TV + ERV + RV

31. What are the causes of hypoxemia
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Inc mitochondria
Lobar PNA
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

32. What is the presentation of lung cancer

33. What happens in perfusion limited circulatioin and which gases does this apply to...
Air that can still be breathed out after nl expiration
Both highest in the base
L/S < 1.5
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

34. How does recurrent thromboemboli cause pulm HTN
Dec cross sectional area of pulm vasc bed
Deep leg veins
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis

35. Where does lung cancer met to...
Deep leg veins
Apex of healthy lung
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

36. What lung abnl is associated with bronchial breath sounds over lesion - dullness and increased fremitus
Lobar PNA
CT angio
Drainage
<60

37. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Everything but RV - TV + IRV + ERV
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Person stops breathing for at least 10 seconds repeatedly during sleep
Inc resistance leading to inc pressure

38. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Right shift - favors taut - low affinity for O2 - O2 unloading
Respiratory effort against airway obstruction
High alveolar pressure compresses capillaries
Prematurity - maternal RDS - cesarean delivery

39. What is the pathology of emphysema
Inspiration by diaphragm - expiration is passive
Shunting
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
Lowered

40. What is Homan's sign
PA02 = 150 - PACO2/0.8
Dorsiflexion of food leads to tender calf muscle
Anatomic dead space and smooth muscle
CO x O2 content of blood

41. What is the formula for oxygen delivery to tissues
CO x O2 content of blood
RALS - righ anterior - left superior
Prematurity - maternal RDS - cesarean delivery
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

42. What kind of connection exists between endothelial cells in the capilaries
Metastasis - breast - colon - prostate - bladder -
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
Tight jxns
Bronchial obstruction - toward side of lesion

43. What does kallikrein do
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents
Hypertrophy of mucus secreting glands in the bronchioles
Activates bradykinin
Bleomycin - busulfan - anmiodorone

44. What does a V/Q ratio of infinity indicate
Dorsiflexion of food leads to tender calf muscle
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

45. What organisms cause a bronchoPNA and What are the characteristics
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
TB - silica disrupt phagolysosomes and impair MACS
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
IRV + TV + ERV + RV

46. In COPD - what happens to airways at high lung volumes
Airways close prematurely resulting in inc RV and dec FVC
Surfactant
Milky fluid with inc TGs
S. aureus or anaerobes

47. What is the alveolar gas equation approximation
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Chest pain - tachypnea and dyspnea
IRV + TV + ERV + RV
PA02 = 150 - PACO2/0.8

48. What do type II cells do - What is their morphology - when do they proliferate
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Lowered
Shed epithelium from mucus plugs

49. How does autoimmune dz cause thromboemboli
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
High alveolar pressure compresses capillaries
Tension pneumo - away from lesion
Mismatch

50. What is central sleep apnea
Surfactant
Right
No respiratory effort
P = 2ST/radius