Pulm - PFTs; Chronic Obstructive Disease

Question 1

____________ (obstructive/restrictive) lung diseases cause individuals to breathe at high lung volumes.

Answer 1

Obstructive lung diseases cause individuals to breathe at high lung volumes.

Question 2

____________ (obstructive/restrictive) lung diseases cause individuals to breathe at low lung volumes.

Answer 2

Restrictive lung diseases cause individuals to breathe at low lung volumes.

Question 3

Physiological dead space = __________ dead space + __________ dead space

Answer 3

Physiological dead space = anatomical dead space + alveolar dead space

Question 4

Shunt is _______ that flows through the lungs but does not participate in gas exchange.

Answer 4

Shunt is blood that flows through the lungs but does not participate in gas exchange.

Question 5

How are alveolar (V_A) and dead space ventilation (V_D) related to total ventilation (V_E)?

Answer 5

V_E = V_A + V_D

Question 6

There is higher perfusion at which portion of the lung?

There is higher ventilation at which portion of the lung?

Answer 6

Bottom;

bottom

Question 7

Normal alveolar O₂ and CO₂ are ____ mmHg and ____ mmHg, respectively.

Answer 7

Normal alveolar O₂ and CO₂ are 100 mmHg and 40 mmHg, respectively.

Question 8

In cases of increased dead space due to blocked perfusion, alveolar O₂ and CO₂ are ____ mmHg and ____ mmHg, respectively, in the alveoli that aren’t perfused.

Answer 8

In cases of increased dead space due to blocked perfusion, alveolar O₂ and CO₂ are 150 mmHg and 0 mmHg, respectively, in the alveoli that aren’t perfused.

Question 9

In cases of increased shunting due to blocked airways, alveolar O₂ and CO₂ are ____ mmHg and ____ mmHg, respectively, in the alveoli that are blocked.

Answer 9

In cases of increased shunting due to blocked airways, alveolar O₂ and CO₂ are 40 mmHg and 45 mmHg, respectively, in the alveoli that are blocked (same O₂ and CO₂ values found in mixed venous blood).

Question 10

Normal airways show V/Q ________.

Answer 10

Normal airways show V/Q matching.

Question 11

Increased shunting is due to _________ blockage.

Increased dead space is due to _________ blockage.

Answer 11

Increased shunting is due to airway blockage.

Increased dead space is due to vessel blockage.

Question 12

The oxygen-hemoglobin dissociation curve shifts right in response to increases in what factors?

Answer 12

pCO₂

H⁺

2,3-DPG

Temperature

Question 13

Physiological causes of hypoxemia:

1. _______________
2. _______________
3. Shunt (V/Q = 0)
4. V/Q mismatch
5. Diffusion abnormality

Answer 13

Physiological causes of hypoxemia:

1. Reduced fraction of oxygen (e.g. altitude)
2. Hypoventilation
3. Shunt (V/Q = 0)
4. V/Q mismatch
5. Diffusion abnormality

Question 14

Physiological causes of hypoxemia:

1. Reduced fraction of oxygen (e.g. altitude)
2. Hypoventilation
3. ______________
4. ______________
5. Diffusion abnormality (e.g. fibrosis)

Answer 14

Physiological causes of hypoxemia:

1. Reduced fraction of oxygen (e.g. altitude)
2. Hypoventilation
3. Shunt (V/Q = 0)
4. V/Q mismatch
5. Diffusion abnormality (e.g. fibrosis)

Question 15

Physiological causes of hypoxemia:

1. Reduced fraction of oxygen (e.g. altitude)
2. Hypoventilation
3. ______________
4. V/Q mismatch
5. ______________

Answer 15

Physiological causes of hypoxemia:

1. Reduced fraction of oxygen (e.g. altitude)
2. Hypoventilation
3. Shunt (V/Q = 0)
4. V/Q mismatch
5. Diffusion abnormality (e.g. fibrosis)

Question 16

What is the equation for calculating alveolar-arterial gradient?

Answer 16

A-a gradient ≤ age/3

Question 17

What is the alveolar gas equation?

Answer 17

P_AO₂ = (FiO₂ (P_Atmo - P_{H<span>2</span>O})) - (P_aCO₂ / R)

P_AO₂ = (0.21 (760 - 47)) - (P_aCO₂ / 0.8)

(i.e. P_AO₂ = 150 - P_aCO₂ / 0.8)

Question 18

Name three small airway respiratory diseases.

(RBC)

Answer 18

1. Respiratory bronchiolitis (of cigarette smokers)
2. Polypoid bronchiolitis obliterans
3. Constrictive bronchiolitis

Question 19

Emphesyma is associated with what cardiac pathology?

Answer 19

Cor pulmonale

Question 20

Which of the following is most responsible for the emphysematous lung damage seen in alpha₁-antitrypsin deficiency?

Macrophages

Neutrophils

T cells

B cells

Eosinophils

Answer 20

Neutrophils

Question 21

Where is alpha₁-antitrypsin produced?

Answer 21

The liver

Question 22

Alpha₁-antitrypsin deficiency most affects what two organ systems?

Answer 22

Lungs (emphysema);

liver (cirrhosis)

Question 23

Alpha₁-antitrypsin is normally found on chromosome _____ (MM is normal; zz is pathological).

Answer 23

Alpha₁-antitrypsin is normally found on chromosome 14 (MM is normal; zz is pathological).

Question 24

Alpha₁-antitrypsin is normally found on chromosome 14 (_____ is normal; _____ is pathological).

Answer 24

Alpha₁-antitrypsin is normally found on chromosome 14 (MM is normal; zz is pathological).

Question 25

In cases of alpha₁-antitrypsin deficiency, a lysine residue is exchanged for glutamic acid. What is the result in the liver?

Answer 25

Misfolded protein aggregates --\> **cirrhosis**

Question 26

Emphysema associated with smoking is \_\_\_\_\_\_\_lobular. Emphysema associated with alpha₁-antitrypsin deficiency is \_\_\_\_\_\_\_lobular.

Answer 26

Emphysema associated with smoking is **_centri_**lobular. Emphysema associated with alpha₁-antitrypsin deficiency is **_pan_**lobular.

Question 27

How does the diaphragm appear in patients with emphysema?

Answer 27

Flattened

Question 28

Does emphysema affect CO diffusion rates?

Answer 28

**Yes** (decreased due to decreased surface area)

Question 29

Patients with ____________ are known as 'pink puffers.' Patients with ____________ are known as 'blue bloaters.'

Answer 29

Patients with **_emphysema_** are known as 'pink puffers.' Patients with **_chronic bronchitis_** are known as 'blue bloaters.'

Question 30

Describe the difference between centrilobular and panlobular emphysema.

Answer 30

Question 31

A spontaneous pneumothorax is most likely to be seen in what patient population?

Answer 31

Tall, athletic, young men

Question 32

A spontaneous pneumothorax is most likely to arise in what portion of the lung?

Answer 32

The apex

Question 33

What is here described? ## Footnote ***A chronic condition where the walls of the bronchi are thickened irreversibly dilated from inflammation and infection.***

Answer 33

Bronchiectasis

Question 34

How can bronchiectasis lead to life-threatening hemorrhage?

Answer 34

Erosion into bronchial arteries

Question 35

Name some of the S/Sy of bronchiectasis.

Answer 35

Hemoptysis Morning productive cough Clubbing Cor pulmonale Secondary amyloidosis

Question 36

**Upper** **lobe** bronchiectasis is most associated with what disorder?

Answer 36

Cystic fibrosis

Question 37

Which of the following is associated with bronchiectasis? ## Footnote ***Obstruction*** ***Cystic fibrosis*** ***Necrotizing infections*** ***Congenital deficiency of bronchial cartilage*** ***Kartagener's*** ***Immunodeficiencies (especially IgA-related)***

Answer 37

All of them

Question 38

Chronic bronchitis is defined as what?

Answer 38

**Chronic productive cough** (on most days) **for** **≥ 3 months for 2 successive years** (with no other known cause)

Question 39

How does chronic bronchitis present on auscultation?

Answer 39

Coarse ronchi and wheezes

Question 40

How is chronic bronchitis associated with V/Q mismatch?

Answer 40

Secretions block inhaled air from contacting pulmonary blood flow

Question 41

What effects might hypoxia have on an individual with chronic bronchitis?

Answer 41

**Pulmonary** **hypertension**; **cor pulmonale**; increased **hematocrit** (EPO secretion) visible **cyanosis**

Question 42

When FEV₁ falls below 50%, the 5-year survival drops to \_\_\_\_%.

Answer 42

When FEV₁ falls below 50%, the 5-year survival drops to **_50_**%.

Question 43

Chronic bronchitis has a reid index of above \_\_\_\_%.

Answer 43

Chronic bronchitis has a reid index of above **_50_**%.

Question 44

The Reid index is the ratio of the thickness of the _________ to the thickness of the \_\_\_\_\_\_\_\_\_.

Answer 44

The Reid index is the ratio of the thickness of the **mucosal** **_glands_** to the thickness of the **_wall_**.

Question 45

Bronchioles are the airways \< _____ in diameter.

Answer 45

Bronchioles are the airways \< **_2 mm_** in diameter.

Question 46

What percentage of smokers develop COPD?

Answer 46

15 - 20%

Question 47

What is the most common cause of COPD?

Answer 47

Smoking

Question 48

What cells are the main drivers of lung damage in smokers that develop COPD?

Answer 48

CD8+ T cells

Question 49

Name two medications (an adrenergic antagonist and an antidepressant) that can be used in aiding smoking cessation.

Answer 49

Varenicline; bupropion

Question 50

Name a few pharmacological methods of approaching treatment for patients with COPD.

Answer 50

**Smoking cessation tools** (varenicline; bupropion; nicotene patches); **beta agonists**; **immunosuppressants** (stop T cell and neutrophil damage); **protease** **inhibitors**; **mucoregulators**

Question 51

Which type of COPD patient will most resemble a patient with heart failure?

Answer 51

Chronic bronchitis

Question 52

How do emphysematous patients' hearts present on X-ray?

Answer 52

Very small hearts found in the center of the chest

Question 53

**True/False**. Clubbing is often seen in patients with COPD.

Answer 53

**False**. Clubbing is associated with bronchiectasis, cystic fibrosis, bronchogenic carcinoma, intrapulmonary vascular malformations, and congenital heart disease.

Question 54

A COPD patient with clubbing is most likely to have what condition?

Answer 54

Lung cancer

Question 55

What is the gold standard for the diagnosis and assessment of COPD?

Answer 55

Spirometry

Question 56

For diagnoses of COPD, FEV₁/FVC is \_\_\_\_\_\_%. A normal FEV₁/FVC is \_\_\_\_\_\_%.

Answer 56

For diagnoses of COPD, FEV₁/FVC is **\< _70_**%. A normal FEV₁/FVC is **\> _80_**%.

Question 57

Besides spirometry, ______ can be used to differentiate between various obstructive lung diseases.

Answer 57

Besides spirometry, **_DLCO_** can be used to differentiate between various obstructive lung diseases.

Question 58

DLCO is low in which cause of COPD?

Answer 58

Emphysema | (reduced surface area)

Question 59

What will occur if a patient continues to smoke after their FEV₁ has decreased to less than 30%?

Answer 59

Rapid decline in FEV₁

Question 60

What is the only therapy for COPD that has shown improved survival benefit?

Answer 60

Oxygen therapy

Question 61

The major exacerbation of COPD is \_\_\_\_\_\_\_\_\_\_.

Answer 61

The major exacerbation of COPD is **_infection_**.

Question 62

If a patient's FEV₁ increases by \_\_\_\_% after administration of bronchodilators, then a patient likely has asthma rather than COPD.

Answer 62

If a patient's FEV₁ increases by **_12_**% after administration of bronchodilators, then a patient likely has asthma rather than COPD.

Question 63

Patients that are heterozygous for the abnormal alpha₁-antitrypsin gene are most at risk for emphysema under what condition(s)?

Answer 63

If smoking is initiated | (otherwise asymptomatic)

Question 64

**True/False**. Both chronic bronchitis and emphysema increase a patient's risk of cor pulmonale.

Answer 64

True.

Question 65

Besides cor pulmonale, chronic bronchitis also increases a patient's risk of **_i_**\_\_\_\_\_\_\_\_\_\_.

Answer 65

Besides cor pulmonale, chronic bronchitis also increases a patient's risk of **_infection_**.

Question 66

Bronchiectasis is associated with a(n) ____________ in bronchial tone.

Answer 66

Bronchiectasis is associated with a **_decrease_** in bronchial tone.

Question 67

Name two causes of localized bronchiectasis.

Answer 67

1. Tumor or foreign body 2. Necrotizing infection

Question 68

Bronchiectasis is associated with what mycotic infection?

Answer 68

Allergic bronchopulmonary aspergillosis

Question 69

What two congenital disorders are associated with bronchiectasis?

Answer 69

Cystic fibrosis; Kartagener's syndrome

Question 70

What are the clinical features of bronchiectasis?

Answer 70

Cough; dyspnea; foul-smelling sputum

Question 71

How is bronchiectasis diagnosed?

Answer 71

High-resolution CT

Question 72

What is the most common diease leading to bronchiectasis?

Answer 72

Cystic fibrosis

Question 73

**True/False**. Bronchiectasis is irreversible.

Answer 73

True.

Question 74

Which is not a common cause of bronchiectasis? a) Cystic fibrosis b) Hypogammaglobulinemia c) Lung cancer d) Non-tuberculosis mycobacterium

Answer 74

Which is not a common cause of bronchiectasis? a) Cystic fibrosis b) Hypogammaglobulinemia **c) Lung cancer** d) Non-tuberculosis mycobacterium

Question 75

What is the gold standard for diagnosis of cystic fibrosis?

Answer 75

Sweat chloride test

Question 76

Cystic fibrosis is the most common lethal genetic disease affecting what race?

Answer 76

Caucasians

Question 77

What is the inheritance pattern of cystic fibrosis?

Answer 77

Autosomal recessive