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Respiratory

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What does each bronchopulmonary segment have in the center and along its border
Tert (segmental) bronchus - 2 arteries (bronch/pulm) - veins and lymph drain along the borders - arteries run with airways
Ratio from apex to base becomes more uniform
O2 binding x O2 sat + dissolved O2
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema

2. What is the pathology of emphysema
Enlargement of air spaces and decreased recoil resulting from destrcution of alveolar walls - inc compliance
C3 - 4 - 6 - phrenic nerve - referred to shoulder
High alveolar pressure compresses capillaries
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

3. What is sleep apnea associated with
Air in excess of tidal volume that moves into lung on maximal inspiration
CO x O2 content of blood
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Inc resistance leading to inc pressure

4. What changes in V/Q throughout the lung during exercise
Brings air in and out - warms - humidifies - filters
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Ratio from apex to base becomes more uniform
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

5. What are potential triggers for asthma
Viral - URIs - allergens and stress
Dec - due to lactic acidosis
Mesothelioma - pleura - psammoma bodies
High alveolar pressure compresses capillaries

6. What causes neonatal RDS
Tension pneumo - away from lesion
Surfactant def leading to inc surfact tension and alveolar collapse
L/S < 1.5
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

7. What organisms cause a bronchoPNA and What are the characteristics
L/S < 1.5
Deep leg veins
S. aureus - H flu - Klebsiella - S pyogenis; acute inflmmatory infiltrates from bronchioles into adjacent alveoli; pathy distribution involving 1 or more lobes
Alpha1- antitrypsin def - also cirrhosis

8. What cellular changes occur at high altitude
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Inc mitochondria
Severe respiratory distress - cyanosis and RVH - death from decompensated cor pulmonale
Dipalmatoyl phosphatidylcholine - decreases surface tension

9. What changes in pH occur during strenuous exercise and why
Dec - due to lactic acidosis
20.1 mL O2 /dL
Dec in lung volumes - FVC - TLC
Heparin

10. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
CT angio
Respiratory bronchioles - clear debris in alveoli - bronchi
RV + ERV - volume in lungs after nl expiration
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

11. What is the characteristic lymphatic pleural effusion
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Activates bradykinin
Milky fluid with inc TGs
Small airways

12. What must occur with a exudate pleural effusion
Dec in the FEV1/FVC
Adenocarcinoma of the lung - bronchioalveolar - hypertrophic osteoarthropathy
P = 2ST/radius
Drainage

13. An increase in all things (except pH) causes what shift in the O2 curve - What does a decrease in all things (except pH) cause
Type II pneumocytes - dec alveolar surface tension - inc compliance - dec work of inspiration
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum
Incr - right - dec - left
Inc shear stress leading to endothelial injury

14. What is surfactant made of...
Inc production
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Dipalmatoyl phosphatidylcholine
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis

15. What is a particular cause of eosinophilic granulomas - and what cells infiltrate
Alpha1- antitrypsin def - also cirrhosis
C3 - 4 - 6 - phrenic nerve - referred to shoulder
ARDS - neontatal RDS - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture's - wegeners - eosinophilic granuloma - or drug toxicities
Histiocytosis X - Langerhans cells

16. What happens to lung volumes in obstructive lung disease
Inc
Acetazolamide - inhibits CA and acidifies the blood
Ciliated cells
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise

17. Define total lung capcaity
Carcinoid - carcinoid
Hypertrophy of mucus secreting glands in the bronchioles
Zone 1
IRV + TV + ERV + RV

18. What is the presentation of lung cancer

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19. What organism causes a lobar PNA and What are the characteristics
Strep pneumo most often - or klebsiella - intra - alveolar exudate leading to consolidation; can involve entire lung
Activates bradykinin
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Clara cells - type II pneumocytes; multiple densitites on CXR

20. What is early onset hypoxemia from in chronic bronchitis
Shunting
Change in lung volume for a given change in pressure - decreased in pulmonary fibrosis - insuff surfactant - pulmonary edema
Elastase
Exposed collagen fibers provides impetus for clotting cascade

21. What are mucus secretion swept out by
L/S < 1.5
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Ciliated cells
More indolent

22. What does the law of Laplace state about tendency of alveoli to collapse
On expiration as radius dec
FEV1/FVC > 80%
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Prostaglandins - histamine - ACE - kallikrein

23. What is are the symptoms of a pulmonary embolism
Chest pain - tachypnea and dyspnea
Air in lung after maxmimal expiration - cannot be measured on spirometry
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

24. What is the main complication of therapeutic supplemental O2?
0 - negative - prevents pneumothorax
Mesothelioma - pleura - psammoma bodies
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Retinopathy of maturity

25. What is the defect in panacinar emphysema - and what else do you see
Alpha1- antitrypsin def - also cirrhosis
Lobar PNA
Inc 2 -3- DPG - righward shift
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

26. What are the 3 reasons for an increased A- a gradient
Inc
500mL
Hypoxemia because of shunting - V/Q mistmatch - fibrosis
Carcinoid - carcinoid

27. What does a V/Q ratio of 0 indicate
Inc due to inc CO
Dec affinity of hemoglobin for O2 - facilates unloading of O2 to tissue
Vgas = (A/T) [Dk(P1- P2)] - A = area - T= thickness ; A dec in emphysema and T inc pulmonary fibrosis
Airway obstruction (shunt) 100% O2 does not improve PO2

28. If you aspirate a peanut while upright - where will it go
Histiocytosis X - Langerhans cells
Matched - =1 adequate gas exchange
Lower portion of right inferior lobe
Chest pain - tachypnea and dyspnea

29. At what PaO2 does cyanosis begin
Ciliated cells
Activates bradykinin
Exposed collagen fibers provides impetus for clotting cascade
<60

30. What does the conducting zone consist of...
Productive cough for greater than 3 months in at least 2 years
N- terminus - carbaminohemoglobin
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Nonciliated - columnar with secretory granules - secrete component of surfactant - degrade toxins - ast as resevoir cells

31. Define inspiratory reserve volume (IRV)
Apex of healthy lung
Air in excess of tidal volume that moves into lung on maximal inspiration
More indolent
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

32. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
No change - but inc venous CO2 content
Drainage
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Tissue hypoxia from dec O2 sat and dec O2 content

33. What increases the risk of PDA in neonatal RDS
Lung cancer
Persistently low O2 tension
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12

34. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes

35. What is the formula for oxygen delivery to tissues
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%
Respiratory bronchioles - clear debris in alveoli - bronchi
CO x O2 content of blood

36. What is a consequence of pulm HTN
Cor pulmonale - subsequent RVF - JVD - edema - hepatomegaly
Viral - URIs - allergens and stress
Clara cells - type II pneumocytes; multiple densitites on CXR
Inspiration by diaphragm - expiration is passive

37. What are curschmann's spirals
Ivory white calcified pleural plaques
Shed epithelium from mucus plugs
Brings air in and out - warms - humidifies - filters
N- terminus - carbaminohemoglobin

38. What is methemoglobin
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
Carcinoid - carcinoid
Dec - no change
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-

39. What is the nl form of iron in hemoglobin
Hypoxic vasocxn
Obesity - loud snoring - systemic/pulmonary HTN - arrhythmias and possible sudden death
Methacholine challenge
Fe 2+

40. At what PaO2 does hypoxemia begin
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest
Cough - hemoptysis - bronchial obstruction - wheezing - pneumonic 'coin' lesion on xray or noncalcefied nodule on CT
<75
Lung cancer

41. Synthesis of what substance increases with altitude and What does that do for the O2 sat curve
CO2 - acid/altitude - DPG - Exercise - Temperature
Inc due to inc CO
O2 (nl health) - CO2 - N2O - gas equilibrates early along length of capillary - diffusion can be inc only if blood flow inc
Inc 2 -3- DPG - righward shift

42. Why is endothelial damage a risk factor for DVT
Methylene blue
Trachea and bronchi
Exposed collagen fibers provides impetus for clotting cascade
Inspiration by diaphragm - expiration is passive

43. How does left to right shunt cause pulm HTN
Matched - =1 adequate gas exchange
Inc shear stress leading to endothelial injury
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
4 polypeptide subunits - 2 alpha and 2 beta

44. What is the alveolar gas equation
Retinopathy of maturity
C3 - 4 - 6 - phrenic nerve - referred to shoulder
Lowered
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed

45. What is virchow's triad
Stasis - hypercoagulability - endothelial damage
Zone 3
Upper lobes
Lungs collapse inwards and chest wall spring out

46. How does autoimmune dz cause thromboemboli
Ratio from apex to base becomes more uniform
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
More indolent
Vd = Vt x[(PaCO2 - PeCO2)/PaCO2]

47. What lung abnl is associated with dec breath sounds over lesion - dullness - dec fremitus
Pleural effusion
Ciliated cells
Prematurity - maternal RDS - cesarean delivery
Inc

48. What is the tendency of the lungs vs the chest wall
TB - apex
<60
Lungs collapse inwards and chest wall spring out
FRC - inward pull of lung balanced by outward pull of chest wall

49. Define residual volume (RV)
Inoperable - responsive to chemotherapy
Deep leg veins
Air in lung after maxmimal expiration - cannot be measured on spirometry
Activates bradykinin

50. Peripheral mass develops in site of prior pulmonary inflammation or injury - cancer and epi
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
IVC at T8 - esophagus and vagus at T10 - aorta - thoracic ducts - azygous at T12 - I ate 10 eggs at 12
Systemic sclerosis - inflammation leading to intimal fibrosis and medial hypertrophy
L/S > 2 = lecithin/sphingomyelin