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159 Cards in this Set

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COPD
obstruction of air flow -> air trapping in lungs low FEV1/FVC ratio (hallmark)
chronic bronchitis
"blue bloater" productive cough for >3 months in 2 or more years hypertrophy of mucus-secreating glands in the bronchioles leading cause is smoking
emphysema
"pink puffer" destruction of alveolar walls -> enlargement of airspaces and decreased recoil caused by smoking and alpha1-antitrypsin deficiency -> increased elastase activity
asthma
bronchial hyperresopnsiveness -> reversible bronchoconstriction
bronchiectasis
chronic necrotizing infection of bronchi -> dilated airways, purulent sputum, recurrent infections, hemoptysis
Which COPD disease is associated w/ Curschmann's spirals?
asthma
Which COPD disease is associated w/ Kartagener's syndrome?
bronchiectasis
Which COPD disease is associated w/ alpha1-antitrypsin deficiency?
emphysema
Which COPD disease is associated w/ cystic fibrosis?
bronchiectasis
restrictive lung disease
restricted lung expansion -> decreased lung volumes (VC and TLC) FEV1/FVC > 80%
abestosis
diffuse pulmonary interstitial fibrosis caused by inhaled asbestos fibers feruginous bodies, ivory-white pleural plaques
Abestosis increases the risk of what?
pleural mesothelioma, bronchogenic carcinoma
Asbestosis and smoking greatly increase the risk of what type of cancer?
bronchogenic cancer
Asbestosis is typically seen in what population?
shipbuilders, plumbers
neonatal respiratory distress syndrome
surfactant deficiency -> increased surface tension -> alveolar collapse
What is the lectin:spingomyelin ratio in the amniotic fluid in neonatal respiratory distress syndrome?
<1.5
What is the treatment for neonatal respiratory distress syndrome?
maternal steroids before birth, artificial surfactant for infant
Kartagener's syndrome
dynein arm defect -> immotile cilia
What disease is Kartagener's syndrome associated with?
situs inversus
What types of bronchogenic carcinomas arise centrally?
squamous cell carcinoma small cell carcinoma
What types of bronchogenic carcinomas arise peripherally?
adenocarcinoma bronchioalveolar carcinoma large cell carcinoma
Small cell carcinoma of the lung may lead to what syndrome?
Lambert-Eaton syndrome
What are the complications of lung cancer?
(SPHERE) Superior vena cava syndrome Pancoast's tumor Horner's syndrome Endocrine (paraneoplastic) Recurrent laryngeal symptoms (hoarseness) Effusions (pleural or pericardial)
Pancoast's tumor
carcinoma that occurs in the apex of lungs
What can Pancoast's tumor affect?
cervical sympathetic plexus -> Horner's syndrome
lobar pneumonia
most frequently caused by pneumococcus intra-alveolar exudate -> consoldiation
bronchopneumonia
most frequently S. aureus, H. flu, Klebsiella, S. pyobenes acute inflammatory infiltrates from bronchioles into adjacent alveoli patchy distribution involving >= 1 lobes
interstitial (atypical) pneumonia
most frequently caused by viruses (RSV, adenoviruses), Mycoplasma, Legionella, Chlamydia diffuse patchy inflammation localized to interstitial areas at alveolar walls distribution involving >= 1 lobes
Which type of pneumonia involves intra-alveolar exudate?
lobar
Which type of pneumonia is most frequently caused by viruses?
interstitial
Which type of pneumonia is most frequently caused by Pneumococcus?
lobar
Which type of pneumonia is most frequently caused by S. aureus?
bronchopneumonia
Which type of pneumonia is most frequently caused by mycoplasma?
interstitial
Which type of pneumonia is most frequently caused by S. pyogenes?
bronchopneumonia
Which type of pneumonia is most frequently caused by H. flu?
bronchopneumonia
Which type of pneumonia is most frequently caused by Chlamydia?
interstitial
Which type of pneumonia is most frequently caused by Legionella?
interstitial
Which type of pneumonia is most frequently caused by Klebsiella?
bronchopneumonia
What are the physiological responses to high altitude: 1-, 2-, 3-, 4-, 5-, 6-, 7-
1- acute increase in ventilation, 2- chronic increase in ventilation, 3- increase in EPO leading to an increase in hematocrit and hemaglobin (chronic hypoxia), 4- increase in 2,3-DPG, 5- Cellular changes (increase in mitochondria), 6- increase in excretion of bicarbonates to compensate for respiratory alkalosis, 7- chronic hypoxic pulmonary vasoconstriction results in RVH
What is the action of 2,3-DPG?
binds to hemaglobin so that hemoglobin releases more O2
What does acetazolamide doe?
it increases the renal excretion of bicarbonates.
What are 5 important lung products?
Surfactant, prostaglandins, histamine, ACE, Kallikrein
What does surfactant do? What is Surfactant? What makes Surfactant?
It decreases alveolar surface tension which increases complaince, it is made of dipalmitoyl phosphatidylcholine (lecithin), it is produced by type II pneumocytes
What pathologic process has a deficiency of Surfactant?
Neonatal RDS
What are the funcitons of ACE
converst angiotensin I to Angiotensin II, inactivates bradyykinin (ACE inhibitors yield increase bradykinin and cause cough, angioedema)
What is the colapsing pressure
2(tension)/Radius
What does Kallikrein do?
It activates bradykinin
What is the Residual volume (RV)?
air in lung at max expiration
What is the expiratory reserve volume (ERV)?
air that can still be breathed out after nl expiration
What is the tidal volume (TV)?
air that moves into lung with each quiet inspiration (nl = 500ml)
What is the inspiratory reserve volume (IRV)?
Air in excess of tidal volume that moves into lung on max inspiration
What is the vital capacity (VC)?
TV + IRV + ERV
What is the functional reserve capacity (FRC)?
RV + ERV (volume in lungs after normal espiration)
What is the inspiratory Capacity (IC)?
IRV+ TV
What is the total lung capacity (TLC)?
IRV+TV+ERV+RV
Decreased affinity of hemoglobin for O2 = shift ___
Right
A right shift is caused by an increase or decrase in each of the following factors: P50, metabolic needs, PCO2, temperature, H+, pH, altitude, and 2,3-DPG
Increase in all but pH
Fetal Hb curve is shifted ___
Left (increased affinity for O2)
T/F: Pulmonary circulation is normally a low-resistance, low-compliance system
F - Low-resistance, high-compliance
Cor pulmonale and subsequent RV failure are a consequence of pulmonary ______
Hypertension
Hypoxic vasoconstriction that shifts blood away from poorly ventilated regions is caused by ______
Decrease in PaO2
In normal health, O2 is perfusion or diffusion limited?
Perfusion limited - gas equilibrates along the length of the capillary
Which of the following is diffusion limited: CO2, N2O, or CO?
CO - gas does not equilibrate by the time the blood reaches the end of the capillary
When is O2 diffusion limited? What is the equation for Vd?
Exercise, emphysema, fibrosis (Vt) x (PaCO2 -PeCO2)/PaCO2; Pa = arterial & Pe = expired air
What is the ideal V/Q ratio?
V/Q = 1 (permits adequate oxygenation)
At the base of the lung, there is greater ventilation, perfusion, or both?
Both are greater
What is V/Q at the apex of the lung?
V/Q = 3 (wasted ventilation)
What is V/Q at the base of the lung?
V/Q = 0.6 (wasted perfusion)
V/Q = 0 implies _____
Airway obstruction (shunt)
V/Q = infinity implies ______
Blood flow obstruction (physiological dead space)
Organisms such as TB that thrive in high O2 flourish in the apex or base of the lung?
Apex
During exercise (increased cardiac output), the vessels in the apex of the lung ___-------_______
Vasodilate such that V/Q approaches 1 (versus normal apex V/Q of 3)
CO2 is transported from tissue to lungs in these 3 forms: ______
(1) Bicarbonate (2) Bound to hemoglobin (3) Dissolved CO2
What percentage of CO2 is transported in the form of bicarbonate?
90%
What is the intracellular enzyme that converts CO2 into H2CO3?
Carbonic anhydrase
H2CO3 is broken down into H+ and HCO3. What happens to the H+?
H+ combines with Hb to form HHb (deoxyhemoglobin)
H2CO3 is broken down into H+ and HCO3. What happens to the HCO3?
HCO3 is pumped out of the red blood cell in exchange for Cl-
What is the Haldane effect?
Oxygenation of hemoglobin promotes the dissociation of CO2 from hemoglobin
What does kallikrein do
Activates bradykinin
What affect to ACE inhibitors have on bradykinin
Increase bradykinin, which lead to cough and angioedema
COPD = also known as OLD: obstructive lung disease: why is it called obstructive?
obstruction of AIR FLOW → air traping in lungs
COPD = also known as OLD: obstructive lung disease: what is the major PFT finding?
FEV1 / FVC ration is ↓ (hallmark finding)
COPD = also known as OLD: obstructive lung disease: name the 4 types of COPD
1) Chronic Bronchitis (Blue Bloater) 2) emphysema (pink puffer) 3) asthma 4) bronchietasis
COPD = also known as OLD: obstructive lung disease: what is the definition of Chronic Bronchitis
productive cough for >3 consecutive months in two or more years.
COPD = also known as OLD: obstructive lung disease: what do you expect on lung histology?
hypertrophy of mucus-secreting glands in the bronchioles (Reid index of >50%)
COPD = also known as OLD: obstructive lung disease: leading cause is smoking: what are the physical findings for Chronic Bronchitis? (name 3)
1)cyanosis 2) wheezing 3) crackles
COPD = also known as OLD: obstructive lung disease: what is the pathophysiological mechanism of EMPHYSEMA?
destruction of fibrous septa/alveolar walls → enlargement of air space and ↓ total surface area for gas exchange
COPD = also known as OLD: obstructive lung disease: if the cause is smoking, what kind of emphysema would you see on histo slide?
centri-acinar emphysema
COPD = also known as OLD: obstructive lung disease: what else can cause emphysema: (also may work synergistically with smoking): What kind of findings do you see in lung histo and name another organ affected?
alpha 1-antitrypsin deficiency → panacinar emphysema + liver cirrhosis
COPD = also known as OLD: obstructive lung disease: what causes the emphysema in this disorder?
↑ elastase activity to damage lung tissue.
COPD = also known as OLD: obstructive lung disease: name 4 findings of emphysema (in general)
1) dyspnea; 2) ↓ breath sounds 3) tachycardia 4) ↓ I/E ratio
COPD = also known as OLD: obstructive lung disease: What is mechanism of asthma
BRONCHIAL hypersensitivity/hyperresponsiveness → REVERSIBLE bronchoconstriction
COPD = also known as OLD: obstructive lung disease: name 3 common triggers
1) viral URI 2) allergens 3) stress!!
COPD = also known as OLD: obstructive lung disease: name 7 findings
1) cough 2) wheezing 3) dyspnea 4) hypoxemia 5)↓ I/E ratio 6) tachypnea 7) pulsus paradoxus
COPD = also known as OLD: obstructive lung disease: BRONCHIECTASIS: what is its mechanism??
chronic necrotizing infection of BRONCHI → dilated airways, purulent sputum, recurrent infections, hemoptysis (see Robbins for a good discussion of this)
COPD = also known as OLD: obstructive lung disease: what disorders is bronchietasis commonly associated with?
1) bronchial obstruction 2) cystic fibrosis 3) poor ciliary motility
Restrictive Lung Disease (RLD): What are classic PFT findings for RLD?
↓ VC ↓TLC ; FEV1/FVC ration > 80%
Restrictive Lung Disease (RLD): Name the two MAJOR types of RLD
1) poor breathing mechanics (EXTRA-pulmonary) 2) Interstitial lung diseases
Restrictive Lung Disease (RLD): cover up various parts of the text/table/outline to test yourself on the following: 1) 2 types of poor breathing mechanics 2) 8 types of interstitial disease that give you a restrictive picture.
0
Lung Physical Findings: cover up parts of the very good table to test yourself on various findings.
0
Lung Physical Findings: Obstructive vs. Restrictive findings
0
Lung Physical Findings: Name 3 lung volumes that are increased in COPD
↑TLC, ↑FRC, ↑RV
Lung Physical Findings: What 2 values are BOTH reduced in COPD and RLD?
1) FEV1 and 2) FVC (think FEV1/FVC ratio) NOTE! in COPD, FEV1 is more dramatically reduced and thus the FEV1/FVC ratio is ↓
Asbestosis = long latency = think shipbuilders and plumbers: what is the main pathology resulting from asbestosis?
DIFFUSE, interstitial fibrosis caused by inhaled asbestos Fibers.
Asbestosis = long latency = think shipbuilders and plumbers: What cancers are increased in pts with asbestosis?
1) pleural mesothelioma 2) bronchogenic carcinoma (BC)
Asbestosis = long latency = think shipbuilders and plumbers: Major finding in lung?
Ferruginous bodies: asbestos fibers coated with hemosiderin also 2) ivory white pleural plaques
Neonatal respiratory distress syndrome: What is the main cause
surfactant deficiency --> to increased surface tension --> alveolar collapse
Neonatal respiratory distress syndrome: surfactant is made by which cells? After when?
type 2 pneumocytes after 35th gestational week
Neonatal respiratory distress syndrome: what do you measure? Where do you get this fluid?
lecithin-to-sphingomyelin ratio in the amniotic fluid = measure of lung maturation <1.5 in neonatal distress syndrome
Neonatal respiratory distress syndrome: what is surfactant made of (chemical name)
dipalmitoyl phosph-tidyl-choline (DP-PTC)
Neonatal respiratory distress syndrome: treatment for poor maturation of lungs
1) before birth = maternal steroids 2) after= artificial surfactant
Karta-gener's syndrome: what is this?
immotile cilia due to dynein arm defect
Karta-gener's syndrome: results in what in female and male? (4 things)
1) sterility (in male sperm also immotile) 2)bronchietasis 3)recurrent sinusitis (bacteria & particles not pushed out) 4) associated with situs inversus (e.g. dextro-cardia)
Lung Cancer: name the 3 main classes of cancers that affect parts of the lung
1) bronchogenic carcinoma (with different subtypes) 2) carcinoid tumor 3) metastasis
Lung Cancer: list the 5 types of major bronchogenic carcinomas
CENTRAL 1) squamous cell ca 2)small cell ca PERIPHERAL 3) adenocarcinoma 4) bronchoalveolar ca 5) large cell ca
Lung Cancer: mnemonic: what is meant by SPHERE of symptoms?
S= superior vena cava syndrome; P= pancoast tumor; H= Horner's syndrome; E= Endocrine (paraneoplastic); Recurrent laryngeal / hoarseness; E = Effusions (pleural OR pericardial)
Lung Cancer: What can a CARCINOID tumor cause?
Carcinoid Syndrome = flushing, diarrhea, wheezing, and salivation
Lung Cancer: Metastases to lung is very common, LUNG cancer also prone to metastasize to what other parts?
1) brain (epilepsy) 2) bone (fracture) 3)liver (jaundice + hepatomegaly)
Pancoast tumor: What is it?
it's a carcinoma of the apex of lung
Pancoast tumor: what may it affect?
may affect CSP= cervical sympathetic plexus causing Horner's syndrome
Pancoast tumor: what is Horner's syndrome?
P.A.M. is Horny = Ptosis, Anhydrosis, Miosis
Pneumonia: 1st AID breaks it down into TYPE/ ORGANISM/ CHARACTERISTICS = cover parts of this table and fill in the blanks
0
Pneumonia: Lobar Pneumonia; Organism(s) and characteristics
Pneumococcus; intraalveolar exudate -> consolidation, may involve entire lung
Pneumonia: Bronchopneumonia: Organism and characteristics
S aureus, H flu, Klebsiella, S pyogenes; Acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving >= 1 lobes
Pneumonia: Interstitial pneumonia; Organism(s) and characteristics
Viruses, mycoplasma, legionella; diffuse patchy inflammation localized to interstitial areas at alvolar walls; distribution involving >= 1 lobes
Arachidonic acid products: What enzyme breaks down membrane lipid into arachidonic acid?
Phospholipase A2
Arachidonic acid products: What two enzymes are responsible for the production of Hydroperoxides (HPETEs) and Endoperoxidases, respectively from arachidonate?
Lipoxygenase= HPETE, Cyclooxygenases=endoperoxidases
Arachidonic acid products: What major class of products do HPETEs give rise to?
Leukotrienes
Arachidonic acid products: What are the 3 major products of Endoperoxidases?
Prostacyclin (PGI), Prostaglandins (PGE, PGF), Thromboxane (TXA)
Arachidonic acid products: In general what effect do leukotrienes have on bronchial tone?
Leukotrienes in general increase bronchial tone
Arachidonic acid products: In the arachodonic acid pathway, what two enzymes do corticosteroids block?
Phospholipase A2, COX-2
Arachidonic acid products: NSAIDs, Acetaminophen and COX-2 inhibitors block which arachadonic acid pathway enzymes
NSAIDs-non-selectively block COX-1 and COX-2, acetaminophen doesn't block COX-1 or COX-2, but instead it may block COX-3 in found in the brain, COX-2 inhibitors block COX-2
Arachidonic acid products: What are the 4 major effects of Prostacyclin
decrease platelet aggregation, decrease vascular tone, decrease bronchial tone, decrease uterine tone
Arachidonic acid products: What are the 3 major effects of Prostaglandins
increased uterine tone, decrease vascular tone, decrease bronchial tone
Arachidonic acid products: What are the 3 major effects of Thromboxane
increase platelet aggregation, increase vascular tone, increase bronchial tone
Arachidonic acid products: Zileuton is a ________ pathway inhibitor?
Lipoxygenase
Arachidonic acid products: Zariflukast is associated with what enzymes?
Lekukotrienes
Asthma drugs: Bronchodilation is mediated by what molecule
cAMP
Asthma drugs: Bronchoconstriction is mediated by _________ and ___________
Ach and adenosine
Asthma drugs: How many asthma drug categories are there?
7- (1) nonspecific B-agonists, (2) B2 agonists, (3) Methylxanthines, (4) muscarinic antagonist, (5) cromolyn, (6) corticosteroids, (7) Antileukotrienes
Asthma drugs: What is the only nonspecific B-agonist drug and what are its effects?
Isoprotenerol-relaxes bronchial smooth muscle (B2) and tachycardia (B1) (adverse effect).
Asthma drugs: What are the two B2 selective agonist asthma drugs?
Albuterol- relaxes bronchial smooth muscle (B2), Salmetrol
Asthma drugs: What are the indications for Albuterol and Salmetrol, respectively?
Albuterol- use during acute exarcebation, Salmetrol- long-acting agent for prophylaxis
Asthma drugs: what are the notable adverse effects of B2 agonist?
arythmias and tremor
Asthma drugs: B2-agonists activate this enzyme in bronchial smooth muscle that leads to an increase in ________ = bronchodilation
B2 agonists activate adenylate cyclase and increase conversion of ATP to cAMP
Asthma drugs: What are the likely mechanism of action theophylline?
bronchodialation by inhibition phosphodiesterase (PDE), decreasing cAMP hydrolysis and antagnonizing adenosine action
Asthma drugs: Why is usage of theophylline limited?
limited b/c narrow therapeutic index (cardiotoxicity, neurotxicity)
Asthma drugs: What kind of drug is Ipratropium?
muscarinic antagonist
Asthma drugs: How does mechanism of action of Ipratropium?
competitive block of muscarinic receptors= prevention of bronchoconstriction
Asthma drugs: cromolyn works by inhibiting the release of _______ from ______ cell?
prevents release of medicators from mast cells
Asthma drugs: Cromolyn is mainly used for the ______ of athsma and it is not indicated for _______ treatment of athsma?
Used only for prophylaxis, not effective during acute episode. Also, toxicity rare
Asthma drugs: __________and ________ are two major corticosteroids used for treatment of what kind of asthma?
Beclomethasone and prednisone are 1st line therapy for chronic asthma
Asthma drugs: What is the mechanism of action of corticosteroids?
inhibits the synthesis of virtually of cytokines-->inactivates NF-KB, the transcription factor that induces the production of TNF-a, amonth other inflammatory agents.
Asthma drugs: Zileuton blocks the conversion of _______ to ________.
zileuton is a 5-lipoxygenase pathway inhibitior. Blocks the conversion of arachidonic acti to leukotrienes
Asthma drugs: Zafirlukast works by_______ ________ ________
bloking leukotriene receptors
Asthma drugs: What the most basic asthma treatment strategy?
avoidance of exposure to antingen (dust, pollen, etc)
Asthma drugs: After exposure to antigen crosslinks IgE on mast cells. This is prevented by the following drugs: _________ and ________
cromolyn and steroids
Asthma drugs: Following allergen exposure mediators are released (ex. _______ and _________). This triggers an ______ asthmatic response characterized by ________ and may be treated with the following 3 asthmatic drug categories to treat the symptoms.
examples of mediators are leukotrienes and histamine. Following allergen exposure an early asthmatic response characterized by bronchoconstriction that can be treated with B-agonsists, methylxanthines, and muscarinic antagonists.
Asthma drugs: Also, mediators elicit a ________ response is which leads to bronchial __________ and is treated with __________.
mediators elicit a late response and this leads to bronchial hyperactivity. This is best treated with steroids.