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 changes in 2 -3 - DPG occur at high altitude
Chroniclly tired
Apex of healthy lung
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2

2. In which zone of the lung is PA > Pa > Pv
Zone 1
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Dipalmatoyl phosphatidylcholine
Viral - URIs - allergens and stress

3. What do hemoglobin modifacations lead to...
Tissue hypoxia from dec O2 sat and dec O2 content
Chest pain - tachypnea and dyspnea
0 - negative - prevents pneumothorax
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary

4. What is the V/Q ratio at the apex and base of the lung
Deoxygenated blood - elastic walls
Hyaline membrane disease
Inspiration by diaphragm - expiration is passive
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)

5. What is early onset hypoxemia from in chronic bronchitis
0 - negative - prevents pneumothorax
Dipalmatoyl phosphatidylcholine
Shunting
Right lung - right main stem bronhus is wider and more vertical

6. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Ivory white calcified pleural plaques
Right lung - right main stem bronhus is wider and more vertical
Incr - right - dec - left

7. What muscles are involved in breathing during exercise and What do they control
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Zone 1
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Viral - URIs - allergens and stress

8. How does recurrent thromboemboli cause pulm HTN
Pa > PA > Pv
Fe 2+
Mismatch
Dec cross sectional area of pulm vasc bed

9. What are clara cells What is their morphology and What do they do
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells
Opposites
Bullae - rupture leading to spontaneous pneumothorax often in young - otherwise healthy males
20.1 mL O2 /dL

10. What does the law of Laplace state about tendency of alveoli to collapse
IRV + TV + ERV + RV
Defect in coagulative cascace proteins
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
On expiration as radius dec

11. What are the associations with bronchiectasis

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

12. What are the subtypes of pneumoconioses

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

13. What is the imaging test of choice for PE
CT angio
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
N- terminus - carbaminohemoglobin
It binds to Hb -

14. What is occupied in the space that would have been the left middle lobe
L/S > 2 = lecithin/sphingomyelin
Heart
Prematurity - maternal RDS - cesarean delivery
Lungs collapse inwards and chest wall spring out

15. What is nl pulmonary artery pressure and At what point is it considered pulm HTN
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Everything but RV - TV + IRV + ERV
Dec in lung volumes - FVC - TLC

16. What is the defect in panacinar emphysema - and what else do you see
Dec in lung volumes - FVC - TLC
Deoxygenated blood - elastic walls
Alpha1- antitrypsin def - also cirrhosis
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

17. What lung product is deficient in neonatal RDS
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Surfactant
Airways close prematurely resulting in inc RV and dec FVC
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

18. What organisms cause a bronchoPNA and What are the characteristics
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Dec release of fetal glucocorticoids

19. Why is endothelial damage a risk factor for DVT
Right shift - favors taut - low affinity for O2 - O2 unloading
Exposed collagen fibers provides impetus for clotting cascade
Inc shear stress leading to endothelial injury
Stasis - hypercoagulability - endothelial damage

20. What are the causes of ischemia
Dec - due to lactic acidosis
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Loss of blood flow - impeded arterial flow - reduced venous drainage
Dec in the FEV1/FVC

21. What is the TX for small cell lung cancer
Alpha1- antitrypsin def - also cirrhosis
Inoperable - responsive to chemotherapy
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Retinopathy of maturity

22. What is are the symptoms of a pulmonary embolism
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Exposed collagen fibers provides impetus for clotting cascade
Inoperable - responsive to chemotherapy
Chest pain - tachypnea and dyspnea

23. What do type II cells do - What is their morphology - when do they proliferate
Exposed collagen fibers provides impetus for clotting cascade
Bleomycin - busulfan - anmiodorone
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

24. What is used to treat methemoglobin
Methylene blue
Inc excretion of bicarb to compensate for respiratory alkalosis
Both highest in the base
Trachea and bronchi

25. What properties determine the combined volumes of the chest wall and lungs
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Elastic properties
PAO2 - PaO2 = 10-15 mmHg
Inc due to inc CO

26. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Tight jxns
Repeated cycles of lung injury and wound healing with inc collagen
Respiratory bronchioles - clear debris in alveoli - bronchi
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

27. What does CADET face to the right stand for
CO2 - acid/altitude - DPG - Exercise - Temperature
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

28. What layers must CO2 and O2 traverse to complete gas exchange
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Superior portion of right inferior lobe
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange

29. What is the equation for physiologic dead space
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Defect in coagulative cascace proteins
Inc to meet O2 demand

30. Other than surfactant - what other important substances are produced by the lungs
Zone 1
Prostaglandins - histamine - ACE - kallikrein
Ivory white calcified pleural plaques
Chronic necrotizing infection of bronchi leading to permanently dilated airways - purulent sputum - recurrent infections - hemoptysis

31. What kind of space is in the conducting tree and what kind of muscle exists there
Anatomic dead space and smooth muscle
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Inc airway pressure to prevent airway collapse during exhalation

32. Define vital capacity (VC)
Dipalmatoyl phosphatidylcholine
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing
Everything but RV - TV + IRV + ERV
Inc due to inc CO

33. What lobes are affected in silicosis
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
Upper lobes
Right shift - favors taut - low affinity for O2 - O2 unloading
Dec

34. What is the fxn of the conducting zone
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Inc production
Brings air in and out - warms - humidifies - filters
Stasis - hypercoagulability - endothelial damage

35. What are the findings of chronic bronchitis
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Drainage
Inc 2 -3- DPG - righward shift
Upper lobes

36. In COPD - what happens to airways at high lung volumes
Methacholine challenge
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Airways close prematurely resulting in inc RV and dec FVC
Chronic hypoxic vasocxn

37. What does kallikrein do
It binds to Hb -
Right lung - right main stem bronhus is wider and more vertical
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Activates bradykinin

38. What is the alveolar gas equation approximation
Methacholine challenge
Drainage
PA02 = 150 - PACO2/0.8
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater

39. What is virchow's triad
Ivory white calcified pleural plaques
Prostaglandins - histamine - ACE - kallikrein
Stasis - hypercoagulability - endothelial damage
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

40. What changes in lung volunes occur as a result of restrictive lung disease
Inc due to inc CO
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Air in excess of tidal volume that moves into lung on maximal inspiration
Dec in lung volumes - FVC - TLC

41. What are the causes of hypoxemia
On expiration as radius dec
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

42. What are the two forms of hemoglobin
0 - negative - prevents pneumothorax
Both highest in the base
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
IRV + TV

43. How does sleep apnea or high altitude cause pulm HTN
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Hypoxic vasocxn
IRV + TV
Centriacinar

44. What does the respiratory zone consist of and What is its fxn
CO - 200x
Inc shear stress leading to endothelial injury
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

45. What does a V/Q ratio of 0 indicate
Airway obstruction (shunt) 100% O2 does not improve PO2
<60
Dec in lung volumes - FVC - TLC
Loss of elastic fibers

46. What happens to V/Q ratio in COPD
Mismatch
Ciliated cells
CO2 - acid/altitude - DPG - Exercise - Temperature
Incr - right - dec - left

47. What happens to O2 content and O2 sat as Hb falls
Dec - no change
Inc production
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Air that moves into lung with each quiet respiration

48. What is central sleep apnea
Chronic hypoxic vasocxn
P = 2ST/radius
Ciliated cells
No respiratory effort

49. What does the conducting zone consist of...
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Superior portion of right inferior lobe
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

50. What is a typical tidal volume
Bronchial obstruction - toward side of lesion
Opposites
500mL
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen