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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 are the histological findings in asbestosis and what occupations are associated
Prostaglandins - histamine - ACE - kallikrein
Dec cross sectional area of pulm vasc bed
P = 2ST/radius
Asbestos bodies are golden brown fusiform rods resembling dumbells located inside macrophages - shipbuilding - roofing - and plumbing

2. increases In what substances favor the taut form of hemoglobin and which direction does that shift the O2 dissociation curve
Squamous cell carcinoma - keratin pearls and intracellular bridges
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Opposites
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius

3. Which muscles are involved in quiet breathing and What part of respiration do the control
Inspiration by diaphragm - expiration is passive
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
Ciliated cells
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)

4. A carcinoma in the apex of the lung can cause what syndrome and What is the tumor called

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5. Define inspiratory reserve volume (IRV)
No respiratory effort
<60
Air in excess of tidal volume that moves into lung on maximal inspiration
0 - negative - prevents pneumothorax

6. What are potential triggers for asthma
RSV - adenovirus - mycoplasma - legionella - chlamydia; diffuse patchy inflammation localized to interstitial areas at alveolar walls; distrubtion involving 1 or more lobes
Acute/chronic inc in vent
Viral - URIs - allergens and stress
Blood flow obstruction creating physiologic dead space - assuming < 1--% dead - 100% O2 should improve PO2

7. How does mitral stenosis cause pulm HTN
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
Inc resistance leading to inc pressure
Ciliated cells
IRV + TV + ERV + RV

8. 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
Inc mitochondria
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
In between perfusion limited and diffusion limited

9. What is early onset hypoxemia from in chronic bronchitis
Inc airway pressure to prevent airway collapse during exhalation
Bicarb (90%) - bound to globin (5%) and dissolved (5%)
Shunting
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis

10. What changes in V/Q throughout the lung during exercise
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
Ratio from apex to base becomes more uniform
Atherosclerosis - medial hypertrophy - and intimal fibrosis of pulm ateries
Methacholine challenge

11. What is the cycle of idiopathic pulmonary fibrosis
Incr - right - dec - left
TB - silica disrupt phagolysosomes and impair MACS
Dec dec in FEV1 - dec in FVC
Repeated cycles of lung injury and wound healing with inc collagen

12. What does the oxygenation of Hb in the lungs do to the equilibirum of the CA rxn
Viral - URIs - allergens and stress
No change - but inc venous CO2 content
Stasis - hypercoagulability - endothelial damage
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

13. What lab ration indicates fetal lung maturity
It binds to Hb -
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
Inc airway pressure to prevent airway collapse during exhalation
L/S > 2 = lecithin/sphingomyelin

14. What is carboxyhemoglobin and What does it cause
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
Dec release of fetal glucocorticoids
Inspiration by diaphragm - expiration is passive
No respiratory effort

15. What ratio is used to measure lung maturity and What is the value is neonatal RDS
Upper lobes
Surfactant
Chroniclly tired
L/S < 1.5

16. How far to the pseudostratified ciliated columnar epithelium extend - What do MACS do in the alveoli - and how far do the goblet cells extend
Oxidized form of hemoglobin (ferric - Fe 3+) that does not bind O2 as readily - but has high affinity for CN-
Ratio from apex to base becomes more uniform
Neutrophilic substance toxic to alveolar wall - activation fo coagulation cascade or oxygen derived free radicals
Respiratory bronchioles - clear debris in alveoli - bronchi

17. What does a V/Q ratio of 0 indicate
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
Cough - wheezing - dyspnea - tachypnea - hypoxemia - dec I/E ratio - pulsus paradoxus - mucus plugging
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
Airway obstruction (shunt) 100% O2 does not improve PO2

18. How does left to right shunt cause pulm HTN
Inc EPO leading to erythrocytosis
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
FEV1/FVC > 80%
Inc shear stress leading to endothelial injury

19. Why is endothelial damage a risk factor for DVT
Elastase
Exposed collagen fibers provides impetus for clotting cascade
Nose - pharynx - trachea - bronchi - brionchioles - terminal bronchioles
20.1 mL O2 /dL

20. What are the two forms of hemoglobin
Taut form - low affinity for O2; relaxed form has high affinity for O2 (300x)
Air that can still be breathed out after nl expiration
No change - but inc venous CO2 content
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound

21. What is the imaging test of choice for PE
No change - but inc venous CO2 content
CT angio
Long bone fractures and liposuction
Dyspnea - dec breath sounds - tachycardia - late onset hypoxemia due to eventual loss of capillary beds - early onest dyspnea - pink puffer - barrel chest

22. How many lobes does each lung have - and What is the lingula
Right lung = 3 lobes - left lung = 2 lobes; lingula is homologue of right middle lobe in the left lung
Inc resistance leading to inc pressure
Upper lobes - cor pulmonale - caplan's syndrome
Squamous cell carcinoma - keratin pearls and intracellular bridges

23. What is the alveolar gas equation
Lower portion of right inferior lobe
Coal miner's - silicosis - abestosis
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Carcinoid - carcinoid

24. What changes in ventilation rate occur during exercise
CO x O2 content of blood
Ivory white calcified pleural plaques
Horners syndrome from affect of cervical sympathetic plexus - pancoast's tumor
Inc to meet O2 demand

25. Where does lung cancer met to...
Adrenals - brain (epilepsy) - bone (pathologic lesions) - liver (jaundice - hepatomegaly)
Upper lobes
Inoperable - responsive to chemotherapy
Inc EPO leading to erythrocytosis

26. Where do you find type I cells - What is their morphology - and What do they do
97% of alveolar surfaces - line alveoli - squamous - thin and optimal for gas exchange
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Inc 2 -3 DPG - binds to Hb so the Hb releases more O2
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals

27. What is the criteria for chronic bronchitis
Nl = 10-14 - pulm HTN at or above 25 or above 35 during exercise
Bilateral hilar lymphadenopathy - noncaseating granuloma - inc ACE and calcium
Bind 4 O2 molecules and higher affinity for each subsequent O2 molecule bound
Productive cough for greater than 3 months in at least 2 years

28. In COPD - what happens to airways at high lung volumes
Airways close prematurely resulting in inc RV and dec FVC
Apex = 3 (wasted ventilation) Base = 0.6 (wasted perfusion)
Defect in coagulative cascace proteins
Right lung - right main stem bronhus is wider and more vertical

29. What direction does an increase in metabolic need shift the O2 dissociation curve
Right
No respiratory effort
Positive cooperativity and negative allostery - unlike myoglobin
Activates bradykinin

30. At what PaO2 does cyanosis begin
Inspiration by external intercostals - scalenes - sternomastoids; expiration by rectus abdominus - internal/external obliques - transversus abdominus - internal intercostals
Small cell (oat cell) carcinoma - neoplasm of neuroendocrine with Kultchitsky cells (small dark blue cells)
<60
Squamous cell carcinoma - keratin pearls and intracellular bridges

31. What does the combination of increased CO2 and increased proton binding do to the O2 dissociation curve
Incr - right - dec - left
Dec O2 delivery to tissues - dec cardiac output - anemia - CN poisoning - CO poisoning
Chroniclly tired
Right shift - favors taut - low affinity for O2 - O2 unloading

32. What is fetal hemoglobin made of and why does it have a higher affinity for O2
Mismatch
20.1 mL O2 /dL
2alpha and 2 gamma subunits - lower affinity for 2 -3 BPG
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

33. What is the airway and alveolar pressure at FRC - What is the intrapleural pressure - and What does that prevent
Person stops breathing for at least 10 seconds repeatedly during sleep
Trachea and bronchi
Pleural effusion
0 - negative - prevents pneumothorax

34. What happens to lung volumes in restrictive lung disease
Opposites
Lung cancer
Dec
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion

35. What is the definition of sleep apnea
Person stops breathing for at least 10 seconds repeatedly during sleep
Respiratory effort against airway obstruction
Large cell carcinoma - pleomorphic giant cells with leukocyte fragments in cytoplasm - removed surgically and less responsive to chemotherapy
Inc resistance leading to inc pressure

36. What enzyme increases activity in emphysema
Right lung - right main stem bronhus is wider and more vertical
Lower portion of right inferior lobe
Elastase
Exposed collagen fibers provides impetus for clotting cascade

37. What causes primary pulm HTN
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
0 - negative - prevents pneumothorax
Loss of blood flow - impeded arterial flow - reduced venous drainage
Localized collection of pus within parenchyma - usually resulting from bronchial obstruction - apsiration of oropharyngeal contents

38. What does decreased PAO2 do
Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor - embolus types
RALS - righ anterior - left superior
Mesothelioma - pleura - psammoma bodies
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung

39. What do type II cells do - What is their morphology - when do they proliferate
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis
Respiratory bronchioles - clear debris in alveoli - bronchi
Inc protein - cloudy content - malignancy - PNA - collagen vascular dz - trauma
3% - secrete pulm surfactant - cuboidal and clustered - precursor to type I and II - proliferate during lung damage

40. What is the TX for small cell lung cancer
Decrease in both - though in obstructive FEV1 is more dramatically reduced resulting in FEV1/FVC ration < 80%
Inoperable - responsive to chemotherapy
N- terminus - carbaminohemoglobin
Bronchial hyperresponsiveness causes reversible bronchocxn - smooth muscle hypertrophy and curschmann's spirals

41. 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
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
R = 8nl/pir^4 - n=viscosity - l = length - r = vessel radius
Promotes dissociation of H+ from Hb and shifts equilibrium back towards CO2 formation for exhalation

42. What causes neonatal RDS
PAO2 = PIO2 - (PACO2/R) R = respiratory quotient = CO2 produced/O2 consumed
Tension pneumo - away from lesion
Surfactant def leading to inc surfact tension and alveolar collapse
Respiratory effort against airway obstruction

43. Why is cesarean delivery a risk factor for neonatal RDS
Hypoxic vasocxn shifts blood away from poorly ventilated regions of lung to well ventilated regions of lung
Long bone fractures and liposuction
Small airways
Dec release of fetal glucocorticoids

44. In which zone of the lung is PA > Pa > Pv
Dec PaO2 - high altitude - hypoventilation - V/Q mismatch - shunting - diffusion
Zone 1
Clara cells - type II pneumocytes; multiple densitites on CXR
Inc

45. What is the formula for pulm vasc resistance
PVR = (PpulmA - PleftA)/CO
Dec in lung volumes - FVC - TLC
Positive cooperativity and negative allostery - unlike myoglobin
Silicosis - MACS respond to silica and release fibrogenic factors leading to fibrosis

46. At What terminal does CO2 bind the globin molecule
N- terminus - carbaminohemoglobin
Inactivating mutation in the BMPR2 gene which nl fxns to inhibit vasc smooth musc proliferation - poor prognosis
Centriacinar
Bronchial obstruction - toward side of lesion

47. What layers must CO2 and O2 traverse to complete gas exchange
Adenocarcinoma of lung - bronchial - most common cancer in females and non smokers
<75
Alveolar space - type I epithelial cell - BM - endothelial cell capillary lumen
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli

48. What effects do O2 and CO2 have on pulm circulation - in relation to the other
Cl - - H+ - CO2 - 2 -3- BPG - temperature - shifts to the right
Opposites
Person stops breathing for at least 10 seconds repeatedly during sleep
Bicarb/Cl - exchanger - brings a Cl - into the RBC and expels bicarb into the serum

49. What is used to treat methemoglobin
Deep leg veins
Volume of inspired air that does not take part in gas exchange - anatomical dead space of conducting airways plus fxnal dead space in alveoli
Bronchial obstruction - CF - poor ciliary motility - Kartagener's syndrome - and the potential to develop aspergillosis
Methylene blue

50. Other than surfactant - what other important substances are produced by the lungs
Prostaglandins - histamine - ACE - kallikrein
Deep leg veins
Air in lung after maxmimal expiration - cannot be measured on spirometry
Gland depth/total thickness of broncial wall - >50%