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189 Cards in this Set

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Conducting zone

Consists of
nose, pharynx, trachea, bronchi, bronchioles, and terminal bronchioles.
Respiratory zone

Consists of
respiratory bronchioles, alveolar ducts, and alveoli.
Pneumocytes

Pseudocolumnar ciliated cells extend to the
respiratory bronchioles;
Pneumocytes

extend to the respiratory bronchioles
Pseudocolumnar ciliated cells
Pneumocytes

goblet cells extend to the
terminal bronchioles.
Pneumocytes

extend to the terminal bronchioles.
goblet cells
Pneumocytes

%'s
Type I cells (97% of alveolar surfaces)

Type II cells (3%)
role of

Type I cells
line the alveoli.
role of

Type II cells
-secrete pulmonary surfactant.
-serve as precursors to type I cells and other type II cells. Type II cells
role of

clara cells
secrete a component of surfactant - degrade toxins - act as reserve cells
ratio of in amniotic
fluid is indicative of fetal
lung maturity.
A lecithin-to-sphingomyelin
ratio of > 2.0
bronchopulmonary segment

structure
3°(segmental) bronchus
- 2 arteries (bronchial
and pulmonary) in the center - veins and lymphatics drain along the borders.
what is described by RALS––
the heart. The relation of the
pulmonary artery to the
bronchus at each lung hilus
is described by RALS––
Right Anterior; Left
Superior.
Structures perforating diaphragm

what and levels
-T8: IVC.

-T10: esophagus, vagus (2 trunks).

-At T12: aorta (red), thoracic duct (white), azygous vein (blue).
Pain from the diaphragm can be referred to
the shoulder.
Muscles of respiration

in exercise
Inspiration––external intercostals, scalene muscles, sternomastoids.

Expiration––rectus abdominis, internal and external obliques, transversus abdominis,internal intercostals.
5 Important lung products
-Surfactant
-ACE
-Prostaglandins
-histamine
-Kallikrein
Surfactant

aka
dipalmitoyl phosphatidylcholine

or

lecithin
Collapsing pressure =
2T/R

T=tension
R= radius
what activates bradykinin
Kallikrein
role of Kallikrein
activates bradykinin
role of ACE in lung
angiotensin I → angiotensin II; inactivates bradykinin
lung effects of ACE inhibitors and other effect
ACE inhibitors ↑ bradykinin and
cause cough, angioedema)
role of surfactant/mech
↓ alveolar surface tension

↑ compliance
TLC =
IRV + TV + ERV + RV
VC =
TV + IRV + ERV
TV + IRV + ERV
VC
IRV + TV + ERV + RV
TLC
what causes a shift of the curve
to the right.
An ↑ in all factors (except pH)
what causes a shift of the curve to the left.
A ↓ in all factors (except pH)
Pulmonary circulation


normal resistnace and compliance
Normally a low-resistance, high-compliance system.
Pulmonary circulation


A ↓ in PaO2 causes
a hypoxic vasoconstriction that shifts blood away from
poorly ventilated regions of lung to well-ventilated regions of lung.
Pulmonary circulation


Perfusion limited
what molecules / when / describe / how to change
O2 (normal health),
-CO2,
-N2O.
Gas equilibrates early along the length of the capillary. Diffusion can be ↑ only if blood flow ↑.
Pulmonary circulation


Diffusion limited
what molecules / when / describe
–O2 (exercise, emphysema,
fibrosis),
-CO.
-Gas does not equilibrate by the time blood reaches the end of the capillary.
Normal pulmonary artery pressure =

and when is it changes
Normal pulmonary artery pressure = 10–14 mm Hg; or >35 mm Hg during exercise.

-pulmonary HTN ≥25 mm Hg
Pulmonary hypertension

primary vs secondary
Primary––unknown etiology, poor prognosis.


Secondary––usually caused by COPD, also can be caused by L → R shunt.
O2 content =
(O2 binding capacity × % saturation) + dissolved O2.
O2 changes as Hb falls
O2 content of arterial blood ↓ as [Hgb] falls,

but O2 saturation and arterial PO2 do not.
Arterial PO2 ↓ with
chronic lung disease; physiologic shunt ↓ O2 extraction ratio

not decrease in Hb
-Normally 1 g Hgb can bind

-normal Hgb amount in blood

-Normal O2 binding capacity
-1 g Hgb can bind 1.34 mL O2;

-Hgb amount in blood is 15 g/dL.

-O2 binding capacity ≈ 20.1 mL O2 / dL.
↑ A-a gradient may occur in
-hypoxemia; causes include
shunting, high V/Q mismatch, fibrosis (diffusion block)
CO2 transport forms
1. Bicarbonate (90%)
2. Bound to hemoglobin as carbaminohemoglobin (5%)
3. Dissolved CO2 (5%)
Haldane effect
In lungs, oxygenation of hemoglobin promotes dissociation of CO2 from hemoglobin
Bohr effect
In peripheral tissue, ↑ H+ shifts curve to right, unloading O2
7 Response to high altitude
1. Acute ↑ in ventilation
2. Chronic ↑ in ventilation
3. ↑ erythropoietin
4. ↑ 2,3-DPG
5. Cellular changes (↑ mitochondria)
6. ↑ renal excretion of bicarbonate to
compensate for the respiratory alkalosis
7. Chronic hypoxic pulmonary vasoconstriction results in RVH
Emphysema

types with causes
Centriacinar: caused by smoking.

Panacinar: α1-antitrypsin deficiency
α1-antitrypsin deficiency leads to
Panacinar Emphysema and liver cirrhosis
Paraseptal emphysema: what and who
associated with bullae →can rupture →pneumothorax;
often in young, otherwise healthy males.
associated with bullae →can rupture →pneumothorax;
often in young, otherwise healthy males.
Paraseptal emphysema
Emphysema

pathology
↑ elastase activity.

Enlargement of air spaces and ↓ recoil resulting from destruction of alveolar
walls.
Chronic Bronchitis

pathology
Hypertrophy of mucus glands in the bronchioles →Reid index = gland depth / total thickness of bronchial wall; in COPD, Reid index > 50%.
Reid index
gland depth / total thickness of bronchial wall; in COPD, Reid index > 50%.
Bronchiectasis

pathology
Chronic necrotizing infection of
bronchi →permanently dilated airways,
Bronchiectasis

complications
purulent sputum, recurrent infections, hemoptysis.
causes of Bronchiectasis
Associated with bronchial obstruction, CF, poor ciliary motility, Kartagener’s
syndrome.
Asthma triggers
Can be triggered by viral URIs, allergens, and stress.
Restrictive lung
disease causes

Poor breathing mechanics (extrapulmonary):
a. Poor muscular effort––polio, myasthenia gravis
b. Poor structural apparatus––scoliosis, morbid obesity
Restrictive lung
disease 8 types

Interstitial lung diseases (pulmonary):
1. (ARDS) 2. Neonatal RDS
3. Pneumoconioses
4. Sarcoidosis
5. Idiopathic pulmonary fibrosis
6. Goodpasture’s syndrome
7. Wegener’s granulomatosis
8. Eosinophilic granuloma
Pneumoconioses

name some
coal miner’s silicosis, asbestosis
Neonatal respiratory distress
syndrome

Tx
maternal steroids before birth;

artificial surfactant for infant.
Adult acute respiratory distress syndrome (ARDS)

pathophys
Diffuse alveolar damage →↑ alveolar capillary permeability →protein-rich leakage into alveoli. Results in formation of intra-alveolar hyaline membrane.
Adult acute respiratory distress syndrome (ARDS)

initial damage due to
-neutrophilic substances toxic to alveolar wall,
-activation of coagulation cascade,
-oxygen-derived free radicals.
Sleep apnea

types
Central sleep apnea––no respiratory effort.

Obstructive sleep apnea––respiratory effort
against airway obstruction.
Sleep apnea

define
Person stops breathing for at least 10 seconds
repeatedly during sleep.
Sleep apnea

complications
- systemic/pulmonary hypertension,
-arrhythmias,
-possibly sudden death.
-chronic fatigue
Asbestosis

mech
Diffuse pulmonary interstitial fibrosis caused by inhaled asbestos fibers.
asbestos

wrt malignancy
↑ risk of:

pleural mesothelioma

bronchogenic carcinoma.
pneumoconioses

where in lungs
Asbestosis Mainly affects lower lobes. Other pneumoconioses
affect upper lobes (e.g., coal worker's lung).
Asbestos and smoking
Asbestosis and smoking greatly
↑ risk of bronchogenic cancer (smoking not additive with mesothelioma).
Asbestosis

histo
Ferruginous bodies in lung (asbestos fibers coated with hemosiderin). Ivory-white pleural plaques
Bronchial obstruction

-Breath Sounds
-Resonance
-Fremitus
-Tracheal Deviation
-Absent/↓ over affected area

-↓

-↓

-Toward side of lesion
Pleural effusion

-Breath Sounds
-Resonance
-Fremitus
-Tracheal Deviation
-↓ over effusion

-Dullness

-↓

- NC
Pneumonia (lobar)

-Breath Sounds
-Resonance
-Fremitus
-Tracheal Deviation
-May have bronchial
breath sounds over lesion

-Dullness

-↑

-NC
Pneumothorax

-Breath Sounds
-Resonance
-Fremitus
-Tracheal Deviation
-↓

-Hyperresonant

-Absent

-Away from side of lesion
Breath Sounds, Resonance, Fremitus, Tracheal Deviation

-Absent/↓ over affected area
-↓
-↓
-Toward side of lesion
Bronchial obstruction
Breath Sounds, Resonance, Fremitus, Tracheal Deviation

-↓ over effusion
-Dullness
-↓
- NC
Pleural effusion
Breath Sounds, Resonance, Fremitus, Tracheal Deviation

-May have bronchial
breath sounds over lesion
-Dullness
-↑
-NC
Pneumonia (lobar)
Breath Sounds, Resonance, Fremitus, Tracheal Deviation

-↓
-Hyperresonant
-Absent
-Away from side of lesion
Pneumothorax
Lung cancer

complications
SPHERE of complications:
-Superior vena cava syndrome
-Pancoast’s tumor
-Horner’s syndrome
-Endocrine (paraneoplastic)
-Recurrent laryngeal symptoms
(hoarseness)
-Effusions (pleural or
pericardial)
Lung cancer

which types are central
-Squamous cell carcinoma

-Small-cell
Lung cancer

which types are peripheral
Adenocarcinoma:
Bronchial
Bronchoalveolar

Large cell carcinoma
Lung cancer

describe Squamous cell
carcinoma (gross)
Hilar mass arising from bronchus; Cavitation;
Lung cancer

which have strong smoking association
-Squamous cell carcinoma

-Small-cell
Lung cancer

Undifferentiated → very aggressive
Small-cell (oat-cell) carcinoma
Lung cancer

ectopic production of ACTH or ADH
Small-cell (oat-cell) carcinoma
Lung cancer

Lambert-Eaton syndrome.
Small-cell (oat-cell) carcinoma
Lung cancer histology

Small-cell (oat-cell) carcinoma
Neoplasm of neuroendocrine
Kulchitsky cells → small dark
blue cells.
Lung cancer histology

Squamous cell carcinoma
Keratin pearls and intercellular
bridges.
Lung cancer histology

Neoplasm of neuroendocrine
Kulchitsky cells → small dark
blue cells
Small-cell (oat-cell) carcinoma
Lung cancer histology

Keratin pearls and intercellular bridges
Squamous cell carcinoma
Lung cancer histology

Clara cells → type II pneumocytes multiple densities on x-ray of chest.
both types of Adenocarcinoma:
Bronchial
and
Bronchoalveolar
Lung cancer histology

Pleomorphic giant cells with
leukocyte fragments in
cytoplasm.
Large cell carcinoma
Lung cancer histology

Adenocarcinoma
Both Types: Clara cells → type II pneumocytes multiple densities on x-ray of chest.
Lung cancer histology

Large cell carcinoma
Pleomorphic giant cells with
leukocyte fragments in
cytoplasm.
Lung cancer characteristics

Adenocarcinoma: Bronchial
Develops in site of prior pulmonary inflammation or injury
Lung cancer characteristics

most common lung CA in non-smokers
Adenocarcinoma: Bronchial
Lung cancer characteristics

Develops in site of prior pulmonary inflammation or injury
Adenocarcinoma: Bronchial
Lung cancer characteristics

Not linked to smoking.
Adenocarcinoma: Bronchoalveolar
Lung cancer characteristics

parathyroid-like activity → PTHrP
Squamous cell carcinoma
Lung cancer characteristics

Hilar mass arising from bronchus; Cavitation
Squamous cell carcinoma
Lung cancer characteristics

Highly anaplastic undifferentiated tumor; poor prognosis.
Large cell carcinoma
Lung cancer characteristics

Large cell carcinoma
Highly anaplastic undifferentiated tumor; poor prognosis.
Lung cancer characteristics

Carcinoid tumor
Secretes serotonin, can cause carcinoid
syndrome (flushing, diarrhea, wheezing,
salivation).
Lung cancer characteristics

flushing, diarrhea, wheezing,
salivation
Carcinoid tumor
Lung cancer characteristics

most common. Brain (epilepsy), bone (pathologic fracture), and liver (jaundice,
hepatomegaly).
Metastases
Lung cancer common presentation features
cough, hemoptysis, bronchial
obstruction, wheezing, pneumonic “coin” lesion on x-ray film.
cough, hemoptysis, bronchial
obstruction, wheezing, pneumonic “coin” lesion on x-ray film.
Lung cancer
Pancoast’s tumor

where and findings
Carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus, causing
Horner’s syndrome.
Carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus, causing
Horner’s syndrome.
Pancoast’s tumor
Kulchitsky cells
Enterochromaffin (EC) cells (Kulchitsky cells) are a type of enteroendocrine cell[1] occurring in the epithelia lining the lumen of the gastrointestinal tract. also implicated in the origin of small cell lung cancer.
Lambert-Eaton syndrome

findings
progressive weakness that does not usually involve the respiratory muscles and the muscles of face. In patients with affected ocular and respiratory muscles, the involvement is not as severe as myasthenia gravis. The proximal parts of the legs and arms are predominantly affected.
Lambert-Eaton syndrome

causes
small-cell lung cancer, lymphoma, non-Hodgkin's lymphoma
progressive weakness that does not usually involve the respiratory muscles and the muscles of face. In patients with affected ocular and respiratory muscles, the involvement is not as severe as myasthenia gravis. The proximal parts of the legs and arms are predominantly affected.
Lambert-Eaton syndrome
Small-cell carcinoma
aka
oat-cell carcinoma
oat-cell carcinoma
aka
Small-cell carcinoma
Pneumonia types with different organism causes
Lobar - Pneumococcus usually

Bronchopneumonia - S. aureus, H. flu, Klebsiella, S. pyogenes

Interstitial (atypical) pneumonia - viruses (RSV, adenoviruses), Mycoplasma,
Legionella, Chlamydia
Lobar pneumonia Characteristics
Intra-alveolar exudate → consolidation; may involve entire lung
Bronchopneumonia Characteristics
Acute inflammatory infiltrates
from bronchioles into
adjacent alveoli; patchy
distribution involving ≥ 1
lobes
Interstitial (atypical)
pneumonia Characteristics
Diffuse patchy inflammation
localized to interstitial areas
at alveolar walls; distribution involving ≥ 1 lobes
Which type of pneumona

Intra-alveolar exudate → consolidation; may involve entire lung
Lobar
Which type of pneumona

Acute inflammatory infiltrates
from bronchioles into
adjacent alveoli; patchy
distribution involving ≥ 1
lobes
Bronchopneumonia
Which type of pneumona

Diffuse patchy inflammation
localized to interstitial areas at alveolar walls; distribution involving ≥ 1 lobes
Interstitial (atypical)
pneumonia
Which type of pneumona

Pneumococcus most frequently
Lobar
Which type of pneumona

S. aureus
Bronchopneumonia
Which type of pneumona

Viruses (RSV, adenoviruses)
Interstitial (atypical)
pneumonia
Which type of pneumona

Mycoplasma, Chlamydia
Interstitial (atypical)
pneumonia
Which type of pneumona

Legionella
Interstitial (atypical)
pneumonia
Interstitial pneumonia
aka
atypical pneumonia
atypical pneumonia
aka
Interstitial
pneumonia
Which type of pneumona

S. aureus
Bronchopneumonia
Which type of pneumona

H. flu
Bronchopneumonia
Which type of pneumona

Klebsiella
Bronchopneumonia
Which type of pneumona

S. pyogenes
Bronchopneumonia
what are Lung abscess and who gets them
Localized collection of pus within parenchyma, usually resulting from bronchial
obstruction (e.g., cancer) or aspiration of gastric contents (especially in patients
predisposed to loss of consciousness, e.g., alcoholics or epileptics).
Pleural effusions what and causes of

Transudate
↓ protein content.

Due to CHF, nephrotic syndrome, or hepatic cirrhosis.
Pleural effusions what and causes of

Exudate
↑ protein content, cloudy. Due to malignancy, pneumonia, collagen vascular disease,
trauma.
Which type of Pleural effusion

↓ protein content
Transudate
Which type of Pleural effusion

CHF
Transudate
Which type of Pleural effusion

nephrotic syndrome
Transudate
Which type of Pleural effusion

hepatic cirrhosis
Transudate
Which type of Pleural effusion

↑ protein content, cloudy
Exudate
Which type of Pleural effusion

malignancy
Exudate
Which type of Pleural effusion

pneumonia,
Exudate
Which type of Pleural effusion

collagen vascular disease
Exudate
Which type of Pleural effusion

↑ protein content
Exudate
Which type of Pleural effusion

cloudy
Exudate
Which type of Pleural effusion

trauma
Exudate
1st generation H1 blockers

names
Diphenhydramine, dimenhydrinate, chlorpheniramine.
1st generation H1 blockers

Clinical uses
Allergy, motion sickness, sleep aid.
1st generation H1 blockers

Toxicity
Sedation, antimuscarinic, anti-α-adrenergic.
1st generation H1 blockers

mech
Reversible inhibitors of H1 histamine receptors.
2nd generation H1 blockers

mech
Reversible inhibitors of H1 histamine receptors.
2nd generation H1 blockers

names
Loratadine, fexofenadine, desloratadine.
2nd generation H1 blockers

names
Allergy.
2nd generation H1 blockers

names
Far less sedating than 1st generation.
Asthma drugs

name the Nonspecific β-agonists
Isoproterenol
Asthma drugs
Isoproterenol

mech and uses
Nonspecific β-agonists relaxes bronchial smooth muscle (β2).
Asthma drugs
Isoproterenol

toxicity
Nonspecific β-agonists Adverse effect is tachycardia (β1).
Asthma drugs

name the β2 agonists
Albuterol and Salmeterol
Asthma drugs
Albuterol

mech and uses
β2 agonist relaxes bronchial smooth muscle (β2). Use during acute exacerbation.
Asthma drugs
Salmeterol

mech and uses
β2 agonist long-acting agent for prophylaxis.
Asthma drugs
Salmeterol

toxicity
Adverse effects are tremor and arrhythmia.
asthma drug

Adverse effects are tremor and arrhythmia.
Salmeterol
Asthma drugs


name the Methylxanthines
Theophylline
Asthma drugs
Theophylline

mech and uses
Methylxanthine - likely causes bronchodilation by inhibiting phosphodiesterase, thereby ↓
cAMP hydrolysis.
Asthma drugs
Theophylline

tioxicity
Usage is limited because
of narrow therapeutic index (cardiotoxicity,
neurotoxicity).
Asthma drugs

Usage is limited because
of narrow therapeutic index (cardio and neuro toxicity).
Methylxanthines: Theophylline
Asthma drugs

name the muscarinic antagonists
Ipratropium
Asthma drugs
Ipratropium

mech and uses
competitive block of muscarinic
receptors, preventing bronchoconstriction.
Cromolyn

mech and uses
Prevents release of mediators from mast cells. Effective
only for the prophylaxis of asthma. Not effective
during an acute asthmatic attack.
Asthma drugs

7 different Tx drug classes
1. Nonspecific β-agonists
2.β2 agonists
3. Methylxanthines
4. Muscarinic antagonists
5. Cromolyn
6. Corticosteroids
7. Antileukotrienes
Cromolyn

toxicity
Toxicity is rare.
Asthma drugs

name the corticosteroids
Beclomethasone, prednisone
Asthma drugs
Beclomethasone, prednisone

mech
inhibit the synthesis
of virtually all cytokines. Inactivate NF-κB, the
transcription factor that induces the production of
TNF-α, among other inflammatory agents.
1st-line therapy for chronic asthma.
Beclomethasone, prednisone
name the Antileukotrienes
Zileuton

Zafirlukast, montelukast
Zileuton

mech and uses
A 5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes.

asthma
A 5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes.
Zileuton
Zafirlukast, montelukast

mech and uses
Zafirlukast, montelukast––block leukotriene receptors.

Especially good for aspirin induced asthma.
block leukotriene receptors.
Zafirlukast, montelukast
Especially good for aspirin induced asthma.
Zafirlukast, montelukast
Expectorants

names
-Guaifenesin (Robitussin)


-N-acetylcystine
Guaifenesin
aka
Robitussin
Robitussin
aka
Guaifenesin
Guaifenesin

mech and uses
Removes excess sputum but large doses necessary; does not suppress cough reflex.

Expectorants
Removes excess sputum but large doses necessary
Guaifenesin
Mucolytic → can loosen mucus plugs in CF patients.
N-acetylcystine
N-acetylcystine

mech and uses
Mucolytic → can loosen mucus plugs in CF patients.

also used as an antidote for acetaminophen overdose
antidote for acetaminophen overdose
N-acetylcystine