Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
151 Cards in this Set
- Front
- Back
|
What are the four primary physical signs used to evaluate respiratory distress in the newborn?
|
Cyanosis, Grunting, Retraction, Tachypnea
|
|
|
What scoring method is used to evaluate respiratory distress in the newborn?
|
ACoRN (Acute care of at-risk newborns)
|
|
|
What are the three most common causes of respiratory distress in the newborn?
|
Idiopathic/Infant respiratory distress syndrome (IRDS); Transient tachypnea of the newborn (TTN); Aspiration syndromes
|
|
|
What are the five embryological phases of lung development?
|
Embryonic; Pseudoglandular; Canalicular; Terminal Sac; Alveolar phase
|
|
|
During what embryological phase in bronchial branching completed? Is respiration possible during this phase?
|
Pseudoglandular phase (7-16 weeks); Respiration is not possible due to lack of alveoli and respiratory bronchioles
|
|
|
During which embryological phase is respiration possible?
|
Canalicular phase (16-25 weeks)
|
|
|
What cells are responsible for surfactant production?
|
Type 2 cells
|
|
|
When does surfactant production start?
|
Terminal sac phase (25-40 weeks)
|
|
|
What is the most common neonatal respiratory problem in newborns delivered via cesarean section?
|
Transient tachypnea of the newborn
|
|
|
What is the pathophysiology of transient tachypnea of the newborn?
|
Delay in clearance of residual lung fluid after birth
|
|
|
Is meconium aspiration syndrome more common in pre-term or post-term babies?
|
Post-term, as a term or pre-term baby will typically not have a bowel movement before birth
|
|
|
What is the primary deficiency in infant respiratory distress syndrome?
|
Surfactant production is insufficient
|
|
|
Why does peripheral edema occur in infant respiratory distress syndrome?
|
IRDS babies are holding onto fluid, they don't pee much in the first 24 hours
|
|
|
What drug can be used antenatally to increase lung maturity in a preterm fetus?
|
Maternal betamethasone (steroid)
|
|
|
What is required for a clinical diagnosis of bronchopulmonary dysplasia?
|
Continuing requirement for oxygen at 28 days of age, or 36 weeks gestation (corrected)
|
|
|
What is the pathophysiology of bronchopulmonary dysplasia?
|
Abnormal/arrested lung development; Abnormal surfactant production or turnover; Inflammation; Barotrauma; Volutrauma; Oxygen toxicity
|
|
|
A term baby is delivered without complications, is pink, screaming and crying as normal. However, when crying stops the baby turns blue. What might be the cause?
|
Choanal atresia - Babies are obligate nose breathers and these C.A. babies have an obstruction in the nose
|
|
|
Aspiration pneumonia, choking and cyanosis with feeding and an inability to insert a catheter into the stomach may be indicative of what congenital condition?
|
Tracheo-esophageal fistula
|
|
|
A lack of lung fluid during lung development can cause what condition?
|
Pulmonary hypoplasia
|
|
|
Where is efferent motor information sent from the inspiratory center?
|
The phrenic nerve, which innervates the diaphragm
|
|
|
Peripheral chemoreceptors which provide information to the inspiratory center are responsive to concentrations of which three substances?
|
O2; CO2; H+ (pH)
|
|
|
What are the four primary sources of afferent information to the inspiratory center in the brainstem?
|
Peripheral chemoreceptors; Central chemoreceptors; Lung stretch receptors; Muscle and joint receptors
|
|
|
How does responsiveness to changes in O2 and CO2 change during sleep?
|
Respiratory centers in the brain are less responsive to changes in these substances
|
|
|
What are the two general ways which we can manipulate pressure differentials to treat a pneumothorax?
|
Increase air pressure inside lungs/alveoli (eg CPAP); Decrease pressure inside pleural space (eg thoracentesis)
|
|
|
What is the primary action of surfactant?
|
Reduces surface tension to prevent airway collapse
|
|
|
Is lung compliance higher during inspiration or expiration?
|
Expiration (i.e. it takes more energy to inspire than to expire)
|
|
|
Total lung capacity - Vital capacity = ?
|
Residual volume
|
|
|
What is the difference between inspiratory reserve volume and inspiratory capacity?
|
IC includes tidal volume, IRV does not
|
|
|
What is a normal FEV1:FVC ratio?
|
75-85%
|
|
|
In obstructive lung disease, what happens to the FEV1:FVC ratio?
|
It decreases (takes longer to exhale all the air)
|
|
|
In restrictive lung disease, what happens to the FEV1:FVC ratio?
|
Typically, the ratio is normal (though FVC is decreased)
|
|
|
What are the two main zones of the lungs?
|
Conducting zone & Respiratory zone
|
|
|
What is the difference between anatomical and physiological dead space?
|
Anatomical dead space is only the conducting zone; Physiological dead space also includes diseased areas in lungs which are not functioning properly in gas exchange
|
|
|
What two components comprise tidal volume?
|
Alveolar volume + Dead space volume
|
|
|
What is the formula for alveolar ventilation?
|
Respiratory rate * (Tidal volume - Dead space volume)
Also: (Tidal volume - Dead space volume) = Alveolar volume |
|
|
What are the 6 steps to allow use of oxygen by tissues?
|
Control (brain); Ventilation; Diffusion (alveolar); Circulation; Diffusion (tissue); Metabolism
|
|
|
How does volume of a gas change with an increase in pressure? With an increase in temperature?
|
Increased pressure: Volume decreases; Increased temperature: Volume increases
|
|
|
What is the fraction of oxygen in room air?
|
21%
|
|
|
What is the formula for Fick's law of diffusion across a cell membrane?
|
Vgas = (DA/t) * (P1-P2)
A (surface area) = 85 m2 per lung t (thickness) = 0.5 microns D (constant) = Solubility/MW P1, P2 = pressure of gas on each side of the membrane |
|
|
Is diffusion-limited alveolar gas exchange considered normal or abnormal?
|
It is considered abnormal, as the rate of diffusion, rather than the rate of perfusion (i.e. resp/heart rate) is the limiting factor in diseased states
|
|
|
What is the active carrier of oxygen in the blood?
|
Hemoglobin
|
|
|
1 gram of hemoglobin can hold how much O2?
|
1.39 mL O2
|
|
|
What is the formula for A-a gradient? What is a normal A-a gradient?
|
A-a = PAO2 - PaO2
PA = alveolar pressure Pa = arterial pressure A normal A-a gradient should be less than 10 mm Hg for a healthy young adult, with age correction at A-a/4 + 4 |
|
|
How do you calculate the alveolar oxygen pressure?
|
PAO2 = FIO2*(PB - 47) - PaCO2/R
FIO2 = Fraction of inspired O2 (0.21) PB = Barometric pressure (760 mm Hg) 47 = Vapour pressure of water PaCO2 should be ~ 40 R (respiratory quotient) = VCO2/VO2 (0.8) Subbing the numbers in: Normal air sea level, PAO2 = 100 mm Hg |
|
|
What three roles does airway surface liquid have?
|
Airway hydration; Innate immunity; Antimicrobial defense
|
|
|
Submucosal glands of the conducting zone secrete what?
|
Airway surface liquid
|
|
|
What is the primary active transport channel responsible for chloride content in airway mucus?
|
CFTR
|
|
|
What effect do pro-inflammatory signalling molecules released in an allergic reaction have on airway diameter?
|
These molecules (histamine, cytokines, leukotrienes, etc) have a bronchoconstrictory effect
|
|
|
What is the first step following IgE binding to an allergen and pro-inflammatory mediator release from mast cells?
|
Mucus hypersecretion
|
|
|
What two types of chronic inflammatory cells are found in patients with COPD?
|
CD8+ lymphocytes; Neutrophils
|
|
|
How do epithelial cells change in COPD?
|
Replacement of epithelial cells by squamous cells
|
|
|
What is the mechanism of action of inhaled corticosteroids?
|
They diffuse into the cells to directly modulate gene expression and suppress inflammatory responses
|
|
|
Put the following structures in order from proximal to distal: Alveolus, Bronchus, Respiratory bronchiole, Terminal bronchiole, Trachea
|
Trachea; Bronchus; Terminal Bronchiole; Respiratory Bronchiole; Alveolus
|
|
|
What two "old fashioned" terms were used to describe what is now known as COPD?
|
Emphysema; Chronic bronchitis
|
|
|
What are some examples of chest exam physical signs in COPD?
|
Barrel chest; Hyperresonance to percussion; Diffusely diminished breath sounds; Scattered expiratory wheezes
|
|
|
Is COPD preventable? Treatable? Reversible?
|
COPD is preventable and treatable, but not fully reversible (though it is partially reversible)
|
|
|
What is the most common cause of COPD in the Western world?
|
Cigarette smoking
|
|
|
What deficiency has been associated with COPD?
|
Alpha 1-antritrypsin deficiency
|
|
|
What are the three main components of expiratory flow limitation in COPD?
|
Increased resistance; Extrinsic airway factors; Reduced driving pressure
|
|
|
How does increased airway resistance occur in COPD?
|
Mucosal inflammation and edema; Airway remodelling and fibrosis; Mucus secretions
|
|
|
How much sputum production is required for a diagnosis of chronic bronchitis?
|
4 days/week; 3 months/year; 2 years in a row
|
|
|
What 3 factors contribute to increased sputum production in chronic bronchitis/COPD?
|
Increased number of mucous glands; Increased number of goblet cells; Reduced mucous clearance by damaged cilia
|
|
|
What should PaCO2 and PaO2 arterial blood gases be relative to normal in COPD?
|
PaCO2 increased (hypercapnea); PaO2 decreased (hypoxia)
|
|
|
How can hematocrit change in COPD?
|
It can increase in order to compensate for low oxygen (i.e. polycythemia)
|
|
|
Is emphysema a clinical, radiological or pathological diagnosis?
|
Pathological
|
|
|
How do neutrophils worsen emphysema/COPD?
|
Neutrophils release elastase which destroys the alveolar tissue and stimulates mucous production (Elastase damages elastin in lungs)
|
|
|
What does alpha-1 antitrypsin do?
|
It inhibits neutrophil elastase to prevent damage to healthy tissue
|
|
|
The parenchyma distal to the terminal bronchiole is know as what region?
|
Acinar region (Acinus) - Also, respiratory zone
|
|
|
Is alpha 1-antitrypsin deficiency more associated with upper or lower-lobe emphysema?
|
Lower lobe (i.e. distal instead of proximal)
|
|
|
In which direction do cilia in the bronchus move?
|
Distal to proximal (towards the mouth)
|
|
|
Is cartilage present in bronchioles?
|
No, only in the bronchus and trachea
|
|
|
What is the smallest distinct functional unit in the lung visible on pathology specimens?
|
Lobule (each containing ~30 acini, which cannot be definitively distinguished)
|
|
|
What should you suspect if you see clubbing in a patient with COPD who smokes?
|
Suspect another cause, such as lung cancer - COPD does not cause clubbing
|
|
|
What test can be used to diagnose asthma?
|
Methacholine challenge
|
|
|
Unlike in chronic bronchitis, which type of leukocyte is typically prevalent in asthma?
|
Eosinophils
|
|
|
What is Sempter's triad?
|
ASA sensitivity, Nasal polyps, Asthma
|
|
|
In general, how is a wheeze formed?
|
Narrowing of the airways causing a vibration when air passes through
|
|
|
What are the three main categories of defense against pathogens in the upper conducting zone?
|
Physical processes (Coughing, cilia, air flow); Chemical defense (Mucus, NO); Cellular mechanisms (phagocytosis by macrophages)
|
|
|
What is the approximate flow rate of mucus?
|
3 mm/min
|
|
|
What are two examples of bactericidal molecules in the airway?
|
Reactive oxygen species; Lysozyme
|
|
|
What are four factors that may defeat mucosal defenses?
|
Too many bacteria/viruses; Pathogenic evasion of defenses; Exposures which may incapacitate defenses; Host factors (genetic predisposition, systemic disease)
|
|
|
What are three components to making a diagnosis of asthma in a preschooler?
|
Typical pattern of symptoms; Response to therapy; Absence of any red flags. PFT's are not reliable in this age group.
|
|
|
Is persistent wheezing in early childhood more or less indicative of allergic/atopic triggers than transient wheezing?
|
More. Transient wheezing is typically related to viral triggers
|
|
|
According to the modified asthma predictive index, what is considered a major risk factor for the development of asthma (there are 3)?
|
Parental history of asthma; Physician-diagnosed atopic dermatitis; Allergic sensitization to at least one aeroallergen
|
|
|
What are the two classes of "controller" medications for asthma?
|
Inhaled corticosteroids; Leukotriene receptor antagonists
|
|
|
What are the three classes of "reliever" medications for asthma?
|
Fast-acting beta-2 agonists; Long-acting beta-2 agonists; Anticholinergic agents
|
|
|
Ipratropium bromide and Tiotropium bromide are examples of what class of medication?
|
Inhaled anticholinergic agents (for COPD & asthma)
|
|
|
How long do inhaled corticosteroids need to be used before they achieve a maximal effect?
|
2 to 4 weeks
|
|
|
What is acceptable asthma control in relation to frequency of daytime symptoms? Nighttime symptoms?
|
< 4 daytime symptoms/week; < 1 nighttime symptom/week
|
|
|
What is the most common reason for poor asthma control? What are three other?
|
Compliance issues are most common; Technique, Environment, Comorbidities (GERD, URTI)
|
|
|
A severe exacerbation of asthma despite inhaled corticosteroid use may warrant a short course of what type of drug?
|
Oral corticosteroids
|
|
|
Are leukotriene receptor antagonists more useful in children older or younger than 5 years of age?
|
LTRAs are typically used in children under 5 in combination with an ICS
|
|
|
What are five ways which a virus-infected airway epithelium can stimulate compensatory changes?
|
Mucus hypersecretion; Plasma leakage; Inflammatory cell recruitment; Airway hyperresponsiveness; Neural activation
|
|
|
What is the strongest predictor of a patient receiving an antibiotic for a respiratory illness?
|
If the doctor thinks that the patient is expecting an antibiotic
|
|
|
What are the three ways in which bacteria can reach the lungs?
|
Inhalation, aspriation, hematogenous spread
|
|
|
Are larger bacteria typically seen in inhalation or aspiration routes of pneumonia?
|
Typically aspiration - large inhaled bacteria cannot pass through the innate defenses of the lungs.
|
|
|
What 4 clinical features (signs/symptoms) are typically required for the diagnosis of community acquired pneumonia?
|
Cough, fever, sputum production, pleuritic chest pain
|
|
|
What is the average mortality for hospitalized patients with community-acquired pneumonia?
|
14%
|
|
|
What is the most common bacterial cause of community-acquired pneumonia?
|
Strep pneumoniae
|
|
|
What is the most common "atypical" pathogen causing community-acquired pneumonia?
|
Mycoplasma pneumoniae (23% of all cases)
|
|
|
What is the most common viral cause of pneumonia?
|
Influenza (A & B)
|
|
|
What are some indicators that a pneumonia may have a viral instead of bacterial cause?
|
Older, more frail patients with more cardiac disease; More likely normal white cell count; October - May
|
|
|
What are three issues facing treatment of community-acquired pneumonia?
|
Empiric therapy may be ineffective; Increases in antimicrobial resistance; Host factors
|
|
|
What is a 4-step approach to patients with pneumonia in the ER?
|
Severity of illness upon clinical presentation; Presence or absence of comorbid illness; Acquired in community or nursing home; Where will treatment be given?
|
|
|
What are some example of diagnostic testing for pneumonia?
|
CXR; Sputum aerobic culture; Blood culture; Pleural fluid culture
|
|
|
What are two examples of nosocomial pneumonia?
|
Hospital-acquired pneumonia & Ventilator-associated pneumonia (Also: Healthcare-associated pneumonia - nursing home; dialysis patient)
|
|
|
Acid-fast bacillus staining is useful to identify which genus of organism?
|
Mycobacterium (eg: tuberculosis, bovis)
|
|
|
What is the gold standard for diagnosis of TB?
|
Mycobacterial culture
|
|
|
What is the most common human infection known?
|
Tuberculosis
|
|
|
What infection has been associated with a 100-fold increase in risk of progression from tubercle to active TB?
|
HIV infection (immunosuppression; AIDS is 170x)
|
|
|
What are the two cornerstone drugs for first-line treatment of TB?
|
Isoniazid & Rifampin
|
|
|
What is the most common cause of death in HIV infected individuals worldwide?
|
Tuberculosis
|
|
|
How have incidence rates of lung cancer changed in women in the last 30 years? In men?
|
Women: Increased incidence; Men: Decreased incidence
|
|
|
What percentage of lung cancer is attributable to smoking?
|
85%
|
|
|
When do peripheral nodules become symptomatic?
|
Not until they touch the chest wall
|
|
|
What are two common sites of metastases for lung cancer? What are two less common sites?
|
Bone & Brain; Adrenal glands & Liver
|
|
|
How are peripheral lung nodules most often diagnosed?
|
Usually as an incidental finding on CXR or CT for some other reason
|
|
|
What percentage of lung cancers are associated with a paraneoplastic syndrome?
|
2%
|
|
|
A tumour in the apex of the lung is known as what?
|
Pancoast tumour
|
|
|
What are the two primary classifications of lung cancer on histology?
|
Small cell and non-small cell
|
|
|
What percentage of lung cancers are small-cell?
|
20%
|
|
|
What is the typical treatment for early stage non-small cell lung cancer?
|
Surgery
|
|
|
What is the typical treatment for early stage small cell lung cancer?
|
Combined chemotherapy and radiation (due to high likelihood of hematogenous spread)
|
|
|
Are squamous cell tumours typically found peripherally or in the central airway? What about adenocarcinomas?
|
SC: Central; AC: Peripheral
|
|
|
Enlargement of what lymph node is likely indicative of lung cancer?
|
Supraclavicular lymph node
|
|
|
What information might you want when investigating a solitary pulmonary nodule?
|
Smoking history; Old X-rays; TB history; Characteristics of nodule; Hx of pneumonia; Hx of cancer
|
|
|
What are four X-ray characteristics of lung cancer?
|
Growing nodule (sequential CXR); Rough edges; Solid; Solitary
|
|
|
What is the approximate cure rate for all forms of lung cancer in Stage 1? Stage 3?
|
1: 60-80%; 3: 10-15%
|
|
|
What 5 facts are necessary to describe a cancer?
|
1: Primary or secondary - cell type
2: Stage 3: Date of diagnosis 4: What treatment was given 5: Age of patient |
|
|
Is there greater resistance to airflow in the bronchus or in the alveoli?
|
Bronchus
|
|
|
How does the diffusion coefficient of CO2 compare with that of O2?
|
The diffusion coefficient, D, or CO2 is about 20 times higher than that of O2
|
|
|
Which three parameters of gas diffusion change with breathing?
|
Surface area, thickness, alveolar pressure
|
|
|
At the end of inspiration, what is alveolar surface area and wall thickness in relation to that at the end of expiration?
|
At the end of inspiration, surface area is largest and thickness is smallest to allow for easier O2 diffusion across the membrane
|
|
|
What are some indications for doing a surgical airway?
|
Edema of glottis; Fracture of larynx; Severe oropharyngeal hemorrhage
|
|
|
What are the three (four) classifications of pneumothorax?
|
Simple; tension; open; (major airway injury)
|
|
|
Pneumothorax resulting from pressure rising in the chest is what type?
|
Tension
|
|
|
Why does decreased venous return occur in tension pneumothorax?
|
The IVC is kinked in a tension pneumothorax due to increased pressure on the mediastinum pushing it to one side
|
|
|
What is the best way to evaluate/visualize a major airway injury causing a pneumothorax?
|
Bronchoscopy
|
|
|
What are three sources of blood from a hemothorax?
|
Bleeding chest wall vessels (intercostals, mammary); Torn lung; Major vascular injury (pulmonary, aorta)
|
|
|
Is the presence of a meniscus on CXR more suggestive of a pnemothorax or hemothorax?
|
Hemothorax (meniscus is top of fluid - could also be a pleural effusion)
|
|
|
What is the most common chest wall injury?
|
Rib fracture
|
|
|
Why is a rib fracture in a kid more serious than in an adult?
|
Pediatric ribs are more flexible, and thus much greater blunt force trauma is required to break them
|
|
|
3 or more ribs fractured in 2 places, frequently associated with lung contusions is known as what?
|
Flail chest
|
|
|
Why do we always admit someone with flail chest?
|
High risk of going into respiratory failure
|
|
|
A patient comes into the ER following an MVC with a number of rib fractures including the first and second rib. Mediastinal structures are displaced and the AP window is reduced. What should you be worried about?
|
Aortic injury
|
|
|
What are four possible tests used to diagnose an injury to the aorta?
|
CXR; CT Chest; Transesophageal echogram; Angiography
|
|
|
A patient presents with a ruptured spleen and an injury to the aorta. What should you fix first?
|
Fix the spleen first - the aortic injury will be contained for some time
|
|
|
At sea level and at rest, what is the approximate distance along the pulmonary capillary that O2 is fully diffused and saturated? How might this change with fibrosis?
|
About 1/3 of the way. With fibrosis, it takes longer to reach the equilibrium between air and blood, possibly never reaching equilibrium
|
|
|
At higher altitudes, how does the speed of O2 diffusion from airway to bloodstream change?
|
Due to reduced driving pressure (lower airway pressure), it takes longer for equilibrium to be reached
|
|
|
What five factors contribute to lung diffusing capacity?
|
Diffusion coefficient of the gase; Surface area of the membrane; Thickness of the membrane; Time required for the gas to combine with proteins in the lungs; Capillary blood (binding of hemoglobin to O2)
|
|
|
The amount of O2 delivered to tissues is determined by which two factors?
|
Cardiac output (blood flow); Oxygen content of blood (dissolved and bound to Hb)
|
