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94 Cards in this Set
- Front
- Back
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What obstructive lung dz has hypertrophy of mucus glands in bronchioles?
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Chronic Bronchitis "blue bloaters"--reid index >50%
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What obstructive lung dz has enlargement of airspaces and less recoil?
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Emphysema--pink puffers
destruction of alveolar walls |
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What enzyme has increased activity in emphysema?
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elastase
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Centriacinar Emphysema is caused by?
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smoking
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Panacinar Emphysema is caused by?
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A1 antitrypsin deficiency
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What obstructive lung dz has bronchial hyperesponsiveness and smooth muscle hypertrophy and Curshmans Spirals?
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Asthma--can be triggered by URI, smoking, allergens, stress
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What obstructive lung dz has chronic necrotizing infx of bronchi leading to permanently dilated airways?
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Bronchiectasis--associated c/ bronchial obstruction, poor ciliary motility--CF, kartagener's
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Chronic bronchitis has what type of cough?and lung sounds?
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productive cough for >3 months in 2 or more years
wheezing, crackles, cyanosis |
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Emphysema has increased breath sounds T/F?
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False
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Name two types of restrictive lung dz related to mechanics?
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Obesity, muscular effort (polio, MG)
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What are the 8 types of interstitial lung dz that are restrictive?
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WEAN PIGS
Wegeners granulomatosis, Eosinophilic granulomatosis, ARDS, NRDS, Pneumoconioses (asbestos, coal miners) Idiopathic, Goodpastures, Sarcoidosis |
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What is the nl lecithin/ sphingomyelin ratio? what about in NRDS
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>2.0
usually less than 1.5 |
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What cells make surfactant?
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Pneumocytes Type 2
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How do you tx NRDS?
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steroids before birth, artificial surfactant after
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What is the FEV1/FVC ratio in obstructive lung dz?
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drastically decreased (due to low FEV1)
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What is the pathogenesis of ARDS?
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diffuse alveolar damage--> increased capillary permeability--> protein rich leakage into alveoli--> hyaline membrane forms on alveoli
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What is the FEV1/FVC ratio in restrictive lung dz?
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usually > 80% because FVC is drastically decreased
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What is sleep apnea?
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person stops breathing for at least 10 seconds durind sleep
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What is the difference between central and obstructive sleep apnea?
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Central--no effort to breath
Obs--effort but against obstruction |
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What are complications of sleep apnea?
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Pulmonary HTN, arrythmia, death
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What part of the lung does asbestosis affect?
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lower lobes (vs. upper in coal miner's lung)
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What histological findings are present in asbestosis?
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Ferruginous bodies and ivory white pleural plaques
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Asbestosis and smoking additively increase the risk of_________
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bronchogenic cancer (they both increase the risk of mesothelioma but not additively)
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Breath sounds found in bronchial obstruction are_______
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absent BS over area, decreased resonance and fremitis, tracheal deviation toward lesion
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Breath sounds found in pleural effusion are_______
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absent BS over area, dullness, decreased fremitis
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Breath sounds found in Pneumonia are_______
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may have bronchial BS over area, dullness, increased fremitis,
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Breath sounds found in Ptx are________
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decreased BS, hyperresonant, absent fremitis, tracheal deviation away from lesion
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Lung cancer with hilar mass arising from bronchus with cavitation is _____________
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Squamous cell carcinoma--linked to smoking
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Where are squamous cell carcinoma located usually?
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Centrally
Squamous Sentral Smoking |
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Histology of Sqamous cell carcinoma is ___________
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keratin pearls and intracellular bridges
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Match the following endocrine dz to a lunf tumor: PTH, ACTH, ADH, Serotonin
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PTH--Squamous cell carcinoma (PTHrP)
ACTH, ADH--Small cell (oat)carcinoma 5-HT--carcinoid tumor (can cause flushing, diarrhea, wheezing, etc) |
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Adenocarcinoma of the lung are usually located where?
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Peripheral
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What type of lung cancer is the most common in non-smokers?
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Bronchial adenocarcinoma
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What is the histology of Bronchial and Bronchoalveolar carcinomas?
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Clara cells--type 2 pneumocyts c/ multiple densities on CXR
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What is the location of small cell carcinoma?
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Central
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What is the histology of small cell carcinoma?
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undifferentiated neoplasm of neuroendocrine cells
Kulchitsky cells--small, dark, blue |
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What is the location and prognosis of large cell carcinoma?
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Peripheral and poor
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What is the histology of large cell carcinoma?
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pleomorphic giant cells with leukocyte fragments
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Pancoast't tumor is located where and causes what syndrome?
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apex of lung
Horner's--ptosis, miosis, anhidrosis |
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What is the proteins content and cause(s) of transudate in pleural effusions?
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low
CHF, nephrotic syndrome, hepatic cirrhosis |
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What is the proteins content and cause(s) of exudate in pleural effusions?
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high, cloudy
malignancy, Pna, trauma, collagen vascular dz |
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What organsim(s) usually causes lobar Pna?
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Pneumococcus
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What organsim(s) usually causes broncho Pna?
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S. aureus, H. flu, Kleibsiella, S. pyogenes
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What organsim(s) usually causes interstitial (Atypical) Pna?
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Viruses (RSV, adeno), Mycoplasma, legionella, Chlamydia (that must be some crazy sex)
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Match the following to a type of Pna:
Intra-alveolar exudate-->consolidation (maybe of whole lung) |
Lobar
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Match the following to a Pna: Acute inflammatory infiltrate, patchy, involving more than or equal to 1 lobe
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Bronchopna
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Match the following to a Pna:
Diffuse patchy inflammation localized to interstitial areas ar alveolar walls, involving 1 or more lobes |
Interstitial
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Name the uses of 1st generation H1 blockers.
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Allergy, motion sickness, sleep aid
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What is the main difference in 1st and second generation H1 blockers?
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2nd (--adines) have far less sedation
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Lung abscesses can result from what 2 factors?
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bronchial obstruction or aspiration of gastric contents (especially in drunks)
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Theophylline cause bronchodilation by _____
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inhibiting phosphodiesterase leading to more cAMP (cardio and neurotoxic with narrow TI)
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Ipratropium blocks which receptors?
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Muscarinic--prevents bronchocontriction
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What drug stabilizes mast cells?
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Cromolyn--good for asthma prophylaxis not tx
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What is 1st line therapy for chronic asthma?
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Corticosteroids--Beclomathasone, prednisone which inhibit the synthesis of most cytokines
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Zileutin inhibits which pathway?
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5-lipoxygenase--blocks formation of leukotrienes
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What drugs are especially good for ASA induced asthma?
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Zafirlukast, montelukast (types of anti-LTNs)
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What drug can loosen mucus plugs in CF pts?
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N-acetyl cysteine
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Which of the following are B2 agonists only: Isoproterenol, Albuterol, Salmeterol?
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Albuterol, Salmeterol
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How far down the respiratory tract do pseudocolumanar cilated cells extend?
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To the respiratory bronchioles
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How far down the respiratory tract do goblet cells extend?
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terminal bronchioles
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What are the majority of pneumocytes?
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Type I
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What are the functions do type 2 pneumocytes?
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secrete surfactant and precursors to type 1
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Do arteries or veins runs with the bronchi?
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arteries run with airways in the center of the bronchopumonary segment
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Where do most inhaled foreign bodies end up?
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Right bronchus--it's less steep and longer
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What is the relationship of the pulmonary arteries to the bronchus?
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RALS-- right artery is anterior to bronchi and left is superior
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What structures perforate the diaphragm at T8?
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IVC
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What structures perforate the diaphragm at T10?
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Esophagus, Vagus
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What structures perforate the diaphragm at 12?
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Aorta, azygous, thoracic duct
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Diaphragm is innervated by _______
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C3,4,5 keep the diaphragm alive
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What 5 products are made in the lung?
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Surfactant, prostaglandin, histamine, ACE, Kallikrein (activates bradykinin)
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What is the average tidal volume?
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500 mL
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Residual volume is __________
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air in lung after maximum experation
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End reserve volume is _____________
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air that can still be breathed out after normal expiration
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Functional Reserve Capacity is ____________
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RV + ERV
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What is the equation for determining physiologic dead space?
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Vd= Vt x (PaCO2-PeCO2)/PaCO2
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What factors shift the O2-HGb curve to the right?
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high PCO2, high temp, high acid, high altitude, high 2,3 DPG, low pH (exercise)
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What gases are perfusion limited?
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O2 (in healthy people), CO2, N2O
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What gases are diffusion limited?
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CO O2 in exercise or fibrosis
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What pulmonary artery pressure defines pulmonary HTN?
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>25 mmHg (10-14 is nL)
>35 during exercise |
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What are two common etiologies of secondary pulmonary HTN?
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COPD, L to R shunt
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1 gr Hgb can bind how much O2?
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1.34 mL O2, nl Hgb in blood is 15 g/mL so nL binding capacity is 20.1 mL O2/dL
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O2 content in blood = ?
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(O2 binding capacity X saturation) + dissolved O2
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T/F arterial PO2 of blood falls with low HGB?
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F--O2 content falls but not saturation or PO2
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T/F arterial PO2 falls with chronic lung dz?
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T
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What is the alveolar gas equation?
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PAO2 = PIO2 - PACO2/ R
R= respiratory quotient can usually approximate PAO2=150 - Part CO2/ .8 |
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What part of the lung does TB flourish in?
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apex
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What is the V/Q in the apex?
in the base |
3 (wasted ventilation)
.6 (wasted perfusion) |
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T/F ventilation and perfusion are greater at the base of the lung than the apex
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TRue
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What happens to apical capillaries during exercise?
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dilation, leading to V/Q ratio of close to 1
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V/Q = O is _________
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airway obstruction (shunt)
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V/Q = infinity is ___________
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blood flow obstruction (dead space)
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T/F anatomic dead space = physiologic dead space in healthy people.
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True
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What is the main form in which CO2 is transported?
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Bicarb (90%)
5% bound to Hgb 5% dissolved |
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What are the seven responses to high altitude?
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acute increase in ventilation, chronic increase in ventilation, increased EPO, increased 2,3 DPG, increased mitochondria, increased renal excretion of bicarb to compensate for the respiratory alkalosis (acetazolamide can augment),
Chronic hypoxic pulmonary vasoconstriction results in RVH |
