Cell Biology and Physiology Midterm Review Matthew L. Fowler, Ph.D. Cell Biology and Physiology Block 4 MT: Application only

Areas of Focus Lectures 1 and 2 – NOT MUCH HELP! Background only! (1) Lectures 3 and 4 – 6 Questions Lectures 5 and 6 – ~10-12 questions Lectures 7 and 8 – ~ 10-12 questions Lectures 9 and 10 – ~10-12 questions Lecture 11 – ~5-6 questions Lecture 12 – ~5-6 questions Lecture 13 – ~3-4 Questions Lecture 14 – ~6-7 Questions MEAT!!!!

Exam Focus Clinical Scenarios!!!! Just about everything is in this format!!! No “hard calculations”. Be able to do calculations from spirometry. You MUST know those values and how to calculate volumes, capacities, etc. Which values are theoretical and not measured? Evaluation of a patient’s pulmonary function COPD, Asthma, CB, Emphysema., Bronchiectasis, CF, CHF, Pneumothorax, Cardiac Catheterization, Pre-surgical BW/ABG, PE, Apnea,, Pneumonia, Death – Why did the patient die based on the hard data? (M&M situation) With respect to these: Partial pressures of everything, Atmospheric pressures, other pressures, FEV1, FVC, FRC, RV, Transpulmonary pressure, Trans(whatever) pressure, Transmural pressure, Ideal Alveolar Partial Pressures Evaluation of a diver in the ocean. PO2, CO2, He, N2, etc. Evaluation of a climber on a high mountain. Evaluation of a patient on anesthesia. Neurological control of breathing, central regulation of H+ ions, etc.

Case #1 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature.

Case #1: Question #1 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature. Based on the lab values provided, what changes to biochemically important molecules or systems may be observed in this patient? The partial pressure for oxygen required to saturate hemoglobin at 50% has increased. The partial pressure of oxygen in the air is sufficient to saturate the patient’s blood to 92%. The respiratory exchange ratio is decreased from normal. The respiratory exchange ratio is normal. The rate of unloading of oxygen at tissues has decreased.

Case #1: Question #2 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature. Which of the following figures would be observed in this patient based on the information provided? A B C

Case #1: Question #3 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature. Pulmonary function tests would likely indicate which of the following results? Decreased FEV1 compared to expected Increased FEV1 compared to expected Increased FVC compared to expected Increased FEV1/FVC compared to expected

Case #1: Question #4 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature. The patient is placed on 50% O2 by mask and ABGs were repeated. The patient’s PO2 increased to 88 mm Hg and the PCO2 decreased to 48 mm Hg. Assuming no perfusion/diffusion mismatch, which of the following would be the expected partial pressure of oxygen in the alveoli (rounded to the nearest whole number)? 150 mm Hg 160 mm Hg 210 mm Hg 297 mm Hg 665 mm Hg 760-47-

Case #1: Question #5 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature. Your patient’s total lung capacity was measured to be 5800 mL. Suddenly, the patient becomes extremely hypoxic and lung sounds on the right become absent. You believe that your patient has a collapsed lung. Assuming this is true, which of the following would accurately represent the patient’s new FRC assuming his FRC from the first test was 2400 mL and his current vital capacity is 400 mL. 1000 mL 1200 mL 1400 mL 1800 mL 2000 mL 760-47-

Case #1: Question #6 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature. Based on the information gained from the patient’s arterial blood gases only, all of the following are acceptable differentials diagnoses except… Asthma attack COPD Chronic bronchitis Bronchiectasis Emphysema 760-47-

Case #1: Question #7 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature. Suddenly your patient stops breathing and you are forced to intubate. Which of the following would represent the partial pressure of alveolar oxygen while the patient is paralyzed, supine, and you have a Miller laryngoscope in the patient’s glottis compared to barometric pressure? - 8 cm H2O - 5 cm H2O - 3 cm H2O 0 cm H2O + 5 cm H2O 760-47-

Case #1: Question #8 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature. Your patient deteriorates further and fluid begins entering the endotracheal tube. You are sure that you have a case of pulmonary edema on your hands; more than likely due to the congestive heart failure. Which of the following mechanisms best illustrates a mechanism by which pulmonary edema may arise? Systemic hypotension Pulmonary hypotension Decreased pulmonary vascular resistance Low hydrostatic pressure in pulmonary capillaries Hypoalbuminemia 760-47-

Case #1: Question #9 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature. In a normal healthy individual: In which of the following locations would you expect to find the lowest partial pressure of oxygen prior to diffusion of O2 into tissues? The larynx The trachea The main bronchus The respiratory bronchus The alveoli 760-47-

Case #1: Question #10 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature. Which of the following combinations would result in the greatest exacerbation of pulmonary edema? Oncotic pressure = hydrostatic pressure Oncotic pressure <<< hydrostatic pressure High oncotic pressure and a combination of decreased lymphatic drainage Low hydrostatic pressure and a combination of decreased lymphatic drainage Decreased interstitial pressure in the presence of low hydrostatic pressure 760-47-

Case #1: Question #11 A 67 year-old male presents to the emergency room in respiratory distress. He is obese and is having trouble breathing. He has a history of congestive heart failure, pulmonary hypertension, and asthma. He is mildly cyanotic. He has an productive cough and is able to expel a large quantity of mucus. The sputum is purulent and foul-smelling. Course breath sounds are heard on auscultation. Vitals: HR 120, RR 10, BP 182/91, T 101.1, SaO2 87% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.31, PCO2 53 mm Hg, PO2 58 mm Hg, HCO3- 30 mmol/L CXR: Confirms CHF and pulmonary edema. Diaphragm displays normal curvature. Your patient codes suddenly and does not respond to life-saving measures. On autopsy, it is noted that the patient has a left saddle thrombus in the right pulmonary artery. Which of the following statements is correct with respect what happened in the pulmonary arterial circulation, pulmonary capillaries, and alveoli just prior to cardiac arrest but following the embolization of the saddle thrombus in the pulmonary arteries? Mismatch of the ventilation to perfusion ratio Dilation of the pulmonary capillaries Increase in oncotic pressure in the pulmonary capillaries Increase in the hydrostatic pressure in the pulmonary capillaries Increased cardiac output 760-47-

Case #2 A 88 year-old female presents to the emergency room in respiratory distress. she is emaciated and has a cachectic look about her person. She breathes slowly and intentionally using pursed lips. She has smoked for more than 70 years of her life. She has a history of hyperlipidemia and hypercholesterolemia which is well controlled on medications. Crackling breath sounds are heard on auscultation. Vitals: HR 85, RR 10, BP 113/85, T 98.0, SaO2 92% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.41, PCO2 41 mm Hg, PO2 69 mm Hg, HCO3- 26 mmol/L CXR: Confirms increased air expansion with septal thinning and visualization of otherwise obscured pulmonary vascular structures. Diaphragm is flattened. The use of accessory expiratory muscles is profound.

Case #2: Question #1 A 88 year-old female presents to the emergency room in respiratory distress. she is emaciated and has a cachectic look about her person. She breathes slowly and intentionally using pursed lips. She has smoked for more than 70 years of her life. She has a history of hyperlipidemia and hypercholesterolemia which is well controlled on medications. Crackling breath sounds are heard on auscultation. Vitals: HR 85, RR 10, BP 113/85, T 98.0, SaO2 92% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.41, PCO2 41 mm Hg, PO2 69 mm Hg, HCO3- 26 mmol/L CXR: Confirms increased air expansion with septal thinning and visualization of otherwise obscured pulmonary vascular structures. Diaphragm is flattened. The use of accessory expiratory muscles is profound. Based on the lab values provided, what changes to biochemically important molecules or systems may be observed in this patient? The partial pressure for oxygen required to saturate hemoglobin at 50% has increased. The partial pressure of oxygen in the air is sufficient to saturate the patient’s blood to 92%. The respiratory exchange ratio is decreased from normal. The respiratory exchange ratio is normal. The rate of unloading of oxygen at tissues has decreased.

Case #2: Question #2 A 88 year-old female presents to the emergency room in respiratory distress. she is emaciated and has a cachectic look about her person. She breathes slowly and intentionally using pursed lips. She has smoked for more than 70 years of her life. She has a history of hyperlipidemia and hypercholesterolemia which is well controlled on medications. Crackling breath sounds are heard on auscultation. Vitals: HR 85, RR 10, BP 113/85, T 98.0, SaO2 92% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.41, PCO2 41 mm Hg, PO2 69 mm Hg, HCO3- 26 mmol/L CXR: Confirms increased air expansion with septal thinning and visualization of otherwise obscured pulmonary vascular structures. Diaphragm is flattened. The use of accessory expiratory muscles is profound. Which of the following figures would be observed in this patient based on the information provided? A B C

Case #2: Question #3 A 88 year-old female presents to the emergency room in respiratory distress. she is emaciated and has a cachectic look about her person. She breathes slowly and intentionally using pursed lips. She has smoked for more than 70 years of her life. She has a history of hyperlipidemia and hypercholesterolemia which is well controlled on medications. Crackling breath sounds are heard on auscultation. Vitals: HR 85, RR 10, BP 113/85, T 98.0, SaO2 92% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.41, PCO2 41 mm Hg, PO2 69 mm Hg, HCO3- 26 mmol/L CXR: Confirms increased air expansion with septal thinning and visualization of otherwise obscured pulmonary vascular structures. Diaphragm is flattened. The use of accessory expiratory muscles is profound. Pulmonary function tests would likely indicate which of the following results? Decreased FEV1 compared to expected Increased FEV1 compared to expected Increased FVC compared to expected Increased FEV1/FVC compared to expected

Case #2: Question #4 A 88 year-old female presents to the emergency room in respiratory distress. she is emaciated and has a cachectic look about her person. She breathes slowly and intentionally using pursed lips. She has smoked for more than 70 years of her life. She has a history of hyperlipidemia and hypercholesterolemia which is well controlled on medications. Crackling breath sounds are heard on auscultation. Vitals: HR 85, RR 10, BP 113/85, T 98.0, SaO2 92% on room air. CBC indicates elevated WBCs, HCT, and Hb. ABG: pH 7.41, PCO2 41 mm Hg, PO2 69 mm Hg, HCO3- 26 mmol/L CXR: Confirms increased air expansion with septal thinning and visualization of otherwise obscured pulmonary vascular structures. Diaphragm is flattened. The use of accessory expiratory muscles is profound. Which of the following would be expected with respect to the physiology of this patient The total lung capacity of this patient will increase The residual volume of this patient will decrease This patient has a restrictive lung disease The patient’s lungs will experience increased elastic recoil This patient would be expected to have a thicker basement membrane in the lungs.

Case Question Answers Case #1 Case #2 A C D B E B C A