First Aid - Respiratory

Front 1

conducting zone

Back 1

large airways + bronchi + terminal bronchioles

Front 2

purpose of conducting zone

Back 2

warm, humidify, filter the air

Front 3

cartilage in respiratory system

Back 3

extends to end of bronchi

Front 4

respiratory zone

Back 4

respiratory bronchioles + alveolar ducts + alveoli, gas exchange

Front 5

collapsing pressure

Back 5

= 2*surface tension/radius

Front 6

surfactant synthesis

Back 6

begins week 26, mature levels reached week 35

Front 7

fetal lung maturity

Back 7

L:S > 2.0

Front 8

T8

Back 8

IVC

Front 9

T10

Back 9

esophagus

Front 10

T12

Back 10

aorta, thoracic duct, azygos vein

Front 11

innervation of diaphragm

Back 11

C3, 4, 5 (phrenic nerve)

Front 12

physiologic dead space

Back 12

Vd = Vt * (PaCO2 - PECO2)/(PaCO2)

Front 13

minute ventilation (Ve)

Back 13

= Vt * respiratory rate

Front 14

alveolar ventilation (VA)

Back 14

= (Vt - Vd) * RR

Front 15

elastic recoil

Back 15

lungs want to collapse in, chest wall wants to spring outward

Front 16

FRC importance

Back 16

inward pull of lungs = outward pull of chest wall; AW and alveolar pressures are 0, intrapleural pressure is negative, PVR at minimum

Front 17

decrease in compliance

Back 17

pulmonary fibrosis, pneumonia, pulm. edema

Front 18

increase in compliance

Back 18

aging, emphysema

Front 19

shift Bohr curve to the right

Back 19

increase H+ (decr. pH), incr. CO2, incr. 2,3-BPG, incr. temperature

Front 20

methemoglobin Hb

Back 20

oxidized form of Hb (Fe3+), doesn't bind O2 as readily, incr affinity for cyanide

Front 21

methemoglobinemia presentation

Back 21

cyanosis, chocolate-colored blood

Front 22

methemoglobinemia Rx

Back 22

methylene blue

Front 23

carboxyhemoglobin

Back 23

bound to CO instead of O2; decr. oxygen-binding capacity, left-shift oxygen-Hb dissociation curve = decr. O2 unloading in tissues

Front 24

carboxyhemoglobin Rx

Back 24

100% O2 + hyperbaric O2

Front 25

fetal Hb dissociation curve

Back 25

shifted left due to higher affinity for O2

Front 26

O2 content of blood

Back 26

(Hb*1.34* % saturation) + dissolved O2

Front 27

decrease in PaO2 + pulmonary circulation

Back 27

hypoxic vasoconstriction

Front 28

Fick's diffusion equation

Back 28

Vgas = A/T X D(P1-P2)

Front 29

pulmonary vascular resistance (PVR)

Back 29

= P(pulm artery) - P(L atrium)/CO

Front 30

alveolar gas equation

Back 30

PAO2 = PIO2 - (PaCO2/R)

Front 31

PIO2

Back 31

(Pb - 47) * FiO2

Front 32

A-a gradient

Back 32

PAO2 - PaO2, normal 10-15 mmHg

Front 33

hypoxemia + incr. A-a gradient

Back 33

right to left shunting, V/Q mismatch, diffusion limitation (fibrosis)

Front 34

Hypoxemia + normal A-a gradient

Back 34

high altitude, hypoventilation (opioid use)

Front 35

V/Q at apex

Back 35

increased (3) = wasted ventilation

Front 36

V/Q at base

Back 36

decreased (0.6) = wasted perfusion

Front 37

base of the lung vs. apex

Back 37

ventilation and perfusion are both greater

Front 38

where do you find TB?

Back 38

apex (b/c thrives in high O2)

Front 39

V/Q = 0

Back 39

oirway obstruction (shunt)

Front 40

V/Q approaches infinity

Back 40

blood flow obstruction

Front 41

Haldane effect

Back 41

at lungs, oxygenation of Hb => dissociate H+ => form CO2 => release CO2 from RBCs

Front 42

Bohr effect

Back 42

at tissues, incr. H+ from tissue metabolism shifts curve to right = unload O2

Front 43

high altitude effects on PaO2 and PaCO2

Back 43

decr. atmospheric oxygen = decr. PaO2 = incr. ventilation = decr. PaCO2

Front 44

other high alt. effects

Back 44

incr. EPO = incr. HCT, incr. 2,3-BPG, incr. mitochondria, RVH (chronic hypoxic VC)

Front 45

high altitude - kidneys

Back 45

compensate for respiratory alkalosis by incr. renal excretion of HCO3-

Front 46

exercise

Back 46

incr. CO2 production, incr. O2 consumption, incr. ventilation rate, V/Q more uniform, incr. pulm. BF, lower pH (lactic acidosis); no change in PaO2 and PaCO2

Front 47

DVT predisposition

Back 47

Virchow triad = stasis + hypercoagulability + endothelial damage

Front 48

prophylaxis + acute management of DVT

Back 48

unfractionated heparin or LMWH (enoxaparin)

Front 49

Rx of DVT

Back 49

oral anticoagulants (warfarin, rivaroxaban)

Front 50

lines of zahn

Back 50

interdigitating areas of pink and red - pulmonary emboli

Front 51

types of emboli

Back 51

FAT BAT = fat, air, thrombus, bacteria, amniotic fluid, tumor

Front 52

imaging test of choice for PE

Back 52

CT pulmonary angiography

Front 53

PE symptoms

Back 53

sudden onset dyspnea, chest pain, tachypnea, tachycardia

Front 54

chronic bronchitis pathology

Back 54

hyperplasia of mucus-secreting glands in bronchi

Front 55

chronic bronchitis Sx

Back 55

productive cough for >3 mo for >2 years, wheezing, crackles, cyanosis, late-onset dyspnea, CO2 retention

Front 56

emphysema pathology

Back 56

incr. air spaces, decr. recoil, incr. compliance, decr. diffusing capacity for CO

Front 57

emphysema sx

Back 57

exhale through pursed lips, barrel-shaped chest

Front 58

asthma pathology

Back 58

smooth muscle hypertrophy, Curschmann spirals, Charcot-Leyden crystals

Front 59

asthma sx

Back 59

cough, wheezing, tachypnea, dyspnea, hypoxemia, decr. insp./exp. ratio, pulsus paradoxus, mucus plugging

Front 60

bronchiectasis findings

Back 60

dilated airways, purulent sputum, recurrent infections, hemoptysis

Front 61

bronchiectasis associations

Back 61

poor ciliary motility (smoking, Kartagener), CF, ABPA, bronchial obstruction

Front 62

ILDs (restrictive lung dz)

Back 62

ARDS, IRDS, pneumoconiosies, sarcoidosis, IPF, goodpasture, Wegener's, eosinophiic granulomatosis, hypersensitivity pneumonitis, drug toxicity

Front 63

hypersensitivity pneumonitis

Back 63

mixed type III/IV reaction to environmental antigen = dyspnea, cough, chest tightness, H/A

farmers, bird exposure

Front 64

asbestosis

Back 64

pleural plaques, incr. risk of lung cancer, lower lobes

Front 65

berylliosis

Back 65

aerospace, manufacturing industries; affects upper lobes, granulomatous on histology

Front 66

coal workers' pneumoconiosis

Back 66

black lung disease - macrophages laden with carbon results in infl. & fibrosis; upper lobes

Front 67

anthracosis

Back 67

asymptomatic, urban dwellers exposed to sooty air

Front 68

silicosis

Back 68

sandblasting, mines; macrophages release fibrogenic factors, incr. TB and bronchogenic carcinoma risk; upper lobes

Front 69

supplemental O2 in IRDS

Back 69

retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia (RIB)

Front 70

ARDS characteristics

Back 70

acute onset respiratory failure, bilateral lung opacities, decr. PaO2/FiO2, no HF

Front 71

ARDS pathogenesis

Back 71

DAD = incr. alveolar cap. permeability = leakage into alveoli + noncardiogenic pulm. edema = intraalveolar hyaline membranes

Front 72

normal mean pulm. a pressure

Back 72

10-14 mmHg

Front 73

pulm. HTN

Back 73

>25 mmHg at rest

Front 74

cause of idiopathic PAH

Back 74

BMPR2 gene inactivating mutation

Front 75

pleural effusion - physical exam

Back 75

decr. breath sounds, dull percussion, decr. fremitus

Front 76

atelectasis - physical exam

Back 76

decr. breath sounds, dull percussion, decr. fremitus, trachea towards side of lesion

Front 77

simple pneumothorax - physical exam

Back 77

decr. breath sounds, hyperresonant, decr. fremitus

Front 78

tension pneumothorax - physical exam

Back 78

decr. breath sounds, hyperresonant, decr. fremitus, trachea away from side of lesion

Front 79

consolidation (lobar pneumonia, pulm. edema) - physical exam

Back 79

bronchial breath sounds, late inspiratory crackles, dull percussion, incr. fremitus

Front 80

transudate

Back 80

low protein; caused by incr. hydrostatic pressure or decr. oncotic pressure (HF, nephrotic syndrome, cirrhosis)

Front 81

exudate

Back 81

high protein; caused by malignancy, pneumonia, CVD, trauma

Front 82

pneumothorax sx

Back 82

unilateral chest pain and dyspnea, unilateral chest expansion

Front 83

primary spontaneous pneumothorax

Back 83

rupture of apical blebs/cysts; tall, thin, young white males

Front 84

secondary spontaneous pneumothorax

Back 84

diseased lung, mechanical ventilation w/ use of high pressures -> barotrauma

Front 85

traumatic pneumothorax

Back 85

blunt or penetrating trauma

Front 86

tension pneumothorax

Back 86

air enters pleural space but can't exit = trachea deviates away from affected lung

Front 87

lobar pneumonia

Back 87

S. pneumoniae >>> Legionella, Klebsiella

Front 88

bronchopneumonia

Back 88

S. pneumoniae, S. aureus, H. influenzae, Klebsiella; acute infl. infiltrates from bronchioles into adjacent alveoli - patchy distribution

Front 89

interstitial (atypical) pneumonia

Back 89

viruses, Mycoplasma, Legionella, Chlamydia; diffuse patchy infl. in interstitial areas at alveolar walls; more indolent course ("walking pneumonia")

Front 90

cause of lung abscess

Back 90

aspirate oropharyngeal contents or bronchial obstruction; anaerobes (Fusobacterium, Peptostreptococcus, Bacteroides), or S. aureus

Front 91

CXR lung abscess

Back 91

see air-fluid levels

Front 92

pancoast tumor causes...

Back 92

horner syndrome (ptosis, miosis, anhidrosis, enopthalmos)

Front 93

SVC syndrome

Back 93

impairs blood drainage from the head, neck, upper extremities; caused by malignancy, thrombosis from indwelling catheters

Front 94

sites of metastases from lung cancer

Back 94

adrenals, brain, bone, liver

Front 95

bronchioloalveolar carcinoma

Back 95

adenocarcinoma in situ; CXR shows hazy infiltrates like pneumonia, excellent prognosis

Front 96

squamous cell carcinoma paraneoplastic syndrome

Back 96

incr. PTHrP = hypercalcemia