Resp II

Question 1

V/Q

Answer 1

apex zone 1 - high V/Q
zone 2 - Pa greater than PA greater than Pv
base zone 3 - low V/Q

both ventilation and perfusion greater at base of lung than apex

Question 2

exercise and V/Q

Answer 2

apical vasodilation - decreased V/Q

Question 3

ideal V/Q

Answer 3

1

apex = 3
base = 0.6

Question 4

TB infection

Answer 4

thrive high O2

apex of lung

Question 5

V/Q = 0

Answer 5

shunt - airway obstruction

Question 6

V/Q = infinite

Answer 6

blood flow obstruction

Question 7

CO2 transport in blood

Answer 7

HCO3 - 90%
carbamino Hb - HbCO2 - 5%
-bound to Hb at N terminus of globin - favor taut
dissolved CO2 - 5%

Question 8

CO2 bound to Hb

Answer 8

to N terminus of globin

favor taut
-O2 unloading

Question 9

lung CO2 and O2

Answer 9

in lung

• O2 of Hb - prevent dissociation H+ from Hb
• equilbrium shift to CO2 formation
• CO2 released in lungs

haldane effect

Question 10

bohr effect

Answer 10

peripheral tissue

-elevated H+ - shift curve right - unload O2

Question 11

chloride shift

Answer 11

into RBC

exchange for HCO3

high Cl in RBC in venous blood

Question 12

high altitude

Answer 12

low PaO2 - ventilation - low PaCO2
-resp alkalosis

increased EPO production
increased 2,3 BPG production - Hb release more O2

acetazolamide - augment bicarb excretion from kidney

chronic hypoxic pulmonary vasoconstriction - right ventricle hypertrophy

Question 13

rhinosinusitis

Answer 13

MCC - viral URI

may lead to secondary bacterial infection
-strep pneumo, h. flu, m. catarrhalis

Question 14

epistaxis

Answer 14

nose vleed

anterior nostril - kiesselbach plexus

life-threatening - posterior segment - sphenopalatine a - branch of maxillary artery

Question 15

DVT

Answer 15

virchow triad

• stasis
• hypercoag
• endo injury

Question 16

homan sign

Answer 16

pain dorsiflex calf - DVT

Question 17

lines of zahn

Answer 17

interdigitating area pink and red - in thrombi formed before death

with pulmonary embolus

distinguish pre-post mortem clots

Question 18

hypoxemia, neuro abnormal, petechial rash

Answer 18

triad - fat emboli

Question 19

air emboli

Answer 19

nitrogen bubble - precipitate ascending diver

tx - high pressure O2

Question 20

obstructive lung disease

Answer 20

air trap in lung
-elevated RV and decreased FVC

very low FEV1
low FVC
low FEV1/FVC ratio**

V/Q mismatch

chronic - cor pulmonale

chronic bronchitis
emphysema
asthma
bronchiectasis

Question 21

blue bloater

Answer 21

chronic bronchitis

hyperplasia mucus gland
-reid index more than 50% thickness

productive cough more than 3 months for more than 2 years

hypoxemia - shunting

CO2 retention - hypercapnia

secondary polycythemia

Question 22

pink puffer

Answer 22

emphysema

enlarge air space, less recoil, more compliance

destruction of alveoli wall
-more elastase activity

barrel chested
-exhale through pursed lips

Question 23

centriacinar

Answer 23

smoking

Question 24

panacinar

Answer 24

a1 antitrypsin

Question 25

curschmann spiral

Answer 25

shed epithelium - form whorled mucus plug | -with asthma

Question 26

charcot leyden crystals

Answer 26

eosinophilic, hexagonal, double point, needle like crystals from breakdown of eosinophils in sputum with asthma

Question 27

bronchiectasis

Answer 27

chronic necrotizing infection of bronchi dilated airways and hemoptysis association - kartagener, smoking, CF, allergic aspergillosis

Question 28

restrictive lung disease

Answer 28

decreased lung volume decreased FVC and TLC FEV1/FVC ratio greater than 80% lots of causes: - ARDS, NRDS - poor breathing - pneumoconiosis - sarcoidosis - idiopathic pulmonary fibrosis - goodpasture - wegener - langerhans cell histiocytosis - hypersens pneumonitis - drug toxicity - bleo, busulfan, amiodarone, methotrexate

Question 29

obstructive vs. restrictive lung disease

Answer 29

obstructive - higher lung volume - FEV1 - larger decrease - result in decreased FEV1/FVC ratio restrictive - lower lung volume -FEV1/FVC ratio - increased both - FEV1 and FVC decreased - but obstructive has larger decrease FEV1 normal FEV1/FVC ratio = 80%

Question 30

hypersensitivity pneumonitis

Answer 30

mixed type 3 and 4 HS | -to env antigen

Question 31

pneumoconiosis

Answer 31

coal workers, silicosis, asbestosis risk cor pulmonale caplan syndrome - RA and pneumoconiosis with intrapulmonary nodules

Question 32

asbestosis

Answer 32

pleural plaques - pathognomonic risk of cancer - bronchogenic cancer greatest -also mesothelioma affect lower lobe

Question 33

berylliosis

Answer 33

aerospace and manufacturing industry granulomas form - respond to steroid affect upper lobes

Question 34

coal workers pneumoconiosis

Answer 34

coal dust -macro with carbon black lung disease -anthracosis affect upper lobe

Question 35

silicosis

Answer 35

sand blasting, foundries, mines macro - release fibrogenic factor - fibrosis occurs silica - disrupt phagolysosome - impair macros more susceptible to TB risk for bronchogenic carcinoma eggshell calcifications