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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 a particular cause of eosinophilic granulomas - and what cells infiltrate
Hyaline membrane disease
Right
Histiocytosis X - Langerhans cells
Inc excretion of bicarb to compensate for respiratory alkalosis

2. Define vital capacity (VC)
N- terminus - carbaminohemoglobin
Everything but RV - TV + IRV + ERV
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

3. What are the subtypes of pneumoconioses

4. What happens to O2 content and O2 sat as Hb falls
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Dec - no change
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Centriacinar

5. What doe FAT BAT stand for
Upper lobes - cor pulmonale - caplan's syndrome
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Apex of healthy lung
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types

6. What happens to FEV1 and FVC in both obstructive and restrictive lung disease and What is the difference
In between perfusion limited and diffusion limited
Wheezing - crackles - cyansosis - late - onset dyspnea - blue bloater
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death

7. Which muscles are involved in quiet breathing and What part of respiration do the control
Inspiration by diaphragm - expiration is passive
Acute/chronic inc in vent
Mismatch
Elastic properties

8. What are fat emboli associated with
TB - apex
Heart
O2 binding x O2 sat + dissolved O2
Long bone fractures and liposuction

9. Eggshell calcificant of hilar lymph nodes - associtated with foundries - sandblasting and mines - pneumoconioses and path
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Acute/chronic inc in vent

10. What happens to diffusing capacity in interstiial lung diseases
Lowered
Positive cooperativity and negative allostery - unlike myoglobin
Steroids to mom - artificial surfactant and thyroxine to neonate
Dec in lung volumes - FVC - TLC

11. What does a V/Q ratio of 0 indicate
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Airway obstruction (shunt) 100% O2 does not improve PO2
Hypoxic vasocxn
Respiratory bronchioles - alveolar ducts - alveoli - participates in gas exchange

12. How do you prevent DVT
Inc production
Heparin
SVC syndrome - pancoast tumor - horners - endocrine - recurrrent laryngeal symptoms - effusions (pleural or pericardial)
More indolent

13. What TX is the mother given before delivery - and what TXs are given to the infant
L/S < 1.5
Steroids to mom - artificial surfactant and thyroxine to neonate
Dec
Upper lobes

14. What are the lab/study findings in adenocarcinoma of the lung
Centriacinar
Zone 1
Drainage
Clara cells - type II pneumocytes; multiple densitites on CXR

15. Where do you find type I cells - What is their morphology - and What do they do
Inc resistance leading to inc pressure
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Carcinoid - carcinoid

16. Where do 95% of PE arise from
Dec - due to lactic acidosis
Deep leg veins
Dec release of fetal glucocorticoids
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

17. What is the Reid index and what perfectange is characteristic of chronic bronchitis
COPD and destruction of lung parenchyma - mitral stenosis - recurrent thromboemboli - autoimmune dz - left to right shunt - sleep apnea - or living at high altitude
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
Gland depth/total thickness of broncial wall - >50%

18. How much O2 can 1 g of Hb bind - What is nl Hb in the blood and When does cyanosis happen
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
Chroniclly tired
Elastase
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

19. What is the leading cause of cancer death
Lung cancer
Viral - URIs - allergens and stress
High alveolar pressure compresses capillaries
Incr - right - dec - left

20. What spinal nerves innvervate the diaphragm and where can pain from the diaphragm be referred
Surfactant def leading to inc surfact tension and alveolar collapse
C3 - 4 - 6 - phrenic nerve - referred to shoulder
20.1 mL O2 /dL
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration

21. What can amniotic fluid emboli lead to...
DIC - especially postpartum
L/S > 2 = lecithin/sphingomyelin
Lost with alveolar walls
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

22. What increases the risk of PDA in neonatal RDS
Drainage
Inc EPO leading to erythrocytosis
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Persistently low O2 tension

23. What are the causes of ischemia
Lungs collapse inwards and chest wall spring out
Air that can still be breathed out after nl expiration
Tight jxns
Loss of blood flow - impeded arterial flow - reduced venous drainage

24. What are the potential causes of poor breathing mechanics leading to restrictive lung disease - and What are examples in each
Shunting
RALS - righ anterior - left superior
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity
Bronchial obstruction - toward side of lesion

25. 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
Type II pneumocytes - after week 35
Trauma - sepsis - shock - gastric aspiration - uremia - acute pancreatitis - amniotic fluid embolism
PA02 = 150 - PACO2/0.8

26. What is methemoglobin
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Dec - because physiologic shunt dec O2 extraction from ratio
Air in excess of tidal volume that moves into lung on maximal inspiration
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy

27. What does the law of Laplace state about tendency of alveoli to collapse
Alchoholics or epileptics
In between perfusion limited and diffusion limited
On expiration as radius dec
Right shift - favors taut - low affinity for O2 - O2 unloading

28. What changes in V/Q throughout the lung during exercise
Dec
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Ratio from apex to base becomes more uniform

29. What is a consequence of pulm HTN
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Inspiration by diaphragm - expiration is passive
Viral - URIs - allergens and stress

30. What happens to lung volumes in restrictive lung disease
Dec
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
Bronchial obstruction - toward side of lesion

31. What changes in CO2 occur during exercise
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
CO2 - acid/altitude - DPG - Exercise - Temperature
O2 binding x O2 sat + dissolved O2
Inc production

32. What do PFTs show in restrictive lung disease
Squamous cell carcinoma - keratin pearls and intracellular bridges
FEV1/FVC > 80%
CO2 - acid/altitude - DPG - Exercise - Temperature
Poor muscular effort - polio - myasthenia gravis; poor structural apparatus - scoliosis - morbid obesity

33. Define inspiratory reserve volume (IRV)
Air in excess of tidal volume that moves into lung on maximal inspiration
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
O2 (emphysema - fibrosis) - CO - gas does not equilibrate by the time blood reaches the end of the capillary
Inc EPO leading to erythrocytosis

34. What are the potential TX for sleep apnea
Methacholine challenge
IRV + TV
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Weight loss - CPAP - surgery

35. What lab ration indicates fetal lung maturity
CT angio
Mismatch
Anatomic dead space and smooth muscle
L/S > 2 = lecithin/sphingomyelin

36. What changes in O2 consumption change during exercise
Inc O2 consumption
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Hypoxemia because of shunting - V/Q mistmatch - fibrosis

37. What causes neonatal RDS
Surfactant def leading to inc surfact tension and alveolar collapse
Everything but RV - TV + IRV + ERV
Alchoholics or epileptics
Chroniclly tired

38. What causes primary pulm HTN
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Chronic hypoxic vasocxn
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc

39. In which zone of the lung is PA > Pa > Pv
Centriacinar
Zone 1
Air that can still be breathed out after nl expiration
Inc 2 -3- DPG - righward shift

40. What is occupied in the space that would have been the left middle lobe
Centriacinar
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Heart

41. What changes in lung volunes occur as a result of restrictive lung disease
Type II cells
Dec in lung volumes - FVC - TLC
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

42. How is pulmonary circulation characterized in terms of resistance and compliance
Mesothelioma - pleura - psammoma bodies
Low resistance and high compliance
Shunting
Inc O2 consumption

43. If you aspirate a peanut while supine - where will it go
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Air in lung after maxmimal expiration - cannot be measured on spirometry
Superior portion of right inferior lobe
CO x O2 content of blood

44. How does sleep apnea or high altitude cause pulm HTN
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Hypoxic vasocxn
Carcinoid - carcinoid
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

45. What is sleep apnea associated with
Dec in the FEV1/FVC
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Upper lobes - cor pulmonale - caplan's syndrome

46. What is the equation for physiologic dead space
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]
Acute/chronic inc in vent
Dec
Hypoxic vasocxn

47. What does decreased PAO2 do
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Shunting
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG

48. What is obstructive sleep apnea
Fe 2+
Respiratory effort against airway obstruction
Tissue hypoxia from dec O2 sat and dec O2 content
Methylene blue

49. What is positive cooperativity of hemoglobin refer to...
Productive cough for greater than 3 months in at least 2 years
N- terminus - carbaminohemoglobin
On expiration as radius dec
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

50. What are the causes of hypoxia
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Both highest in the base
Dorsiflexion of food leads to tender calf muscle