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117 Cards in this Set
- Front
- Back
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tx: cromolyn
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asthma prophylaxis (not attack)
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mech: cromolyn
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blocks histamine release
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mech: nonspecific beta agonist
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isoproterenol (bronchodilates, vasoconstricts)
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mech: specific beta-2 agonists
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albuterol, salmeterol
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mech: theophylline
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inhibits cAMP PPDesterase -> bronchodilation
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mech: Ach muscarinic antagonist
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ipratropium (prevent bronchoconstriction via vagus nerve)
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tx: 1st line for chronic asthma
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prednisone
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mech: 5-LOX inhibitor
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zileuton
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mech: block LT receptors
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-lukast
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mech: cAMP causes this in the lung
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bronchodilation
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mech: adenosine and Ach cause
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bronchoconstriction
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mech: loratadine
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H1 blocker
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thoracentesis levels for these lines: midclavicular, midaxillary, paravertebral
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5-7, 7-9, 9-11
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what ratio of lecithin/sphingomyelin in amnionic fluid suggests mature lungs?
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2:1, usually by week 35
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major site of airway resistance
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medium sized bronchi ("large")
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which sympathetic receptors bronchodilate?
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beta-2
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sx: decreased FVC, FEV1, FEV1/FVC; increased FRC
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COPD
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sx: decreased FVC, FEV1; increased FEV1/FVC and FRC
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restrictive lung disease
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PO2 humidified tracheal air
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150mmHg (0.21 * 713)
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PO2 alveolar air
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100mmHg; equal to systemic arterial blood
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PCO2 alveolar air
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40mmHg; equal to systemic arterial blood
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PO2 mixed venous blood
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40mmHg
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PCO2 mixed venous blood
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46mmHg
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3 perfusion limited gases
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O2, CO2, N2O
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2 diffusion limited gases
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CO, O2 (sometimes - fibrosis, exercise)
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at 100mmHg alveolar PO2, how much O2 is bound to Hb?
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100%
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at 40mmHg alveolar PO2, how much O2 is bound to Hb?
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75%
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things that shift Hb/PO2 curve to the right
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increased (PCO2, temp, 2,3DPG), decreased (pH)
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things that shift Hb/PO2 curve to the left
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decreased (PCO2, temp, 2,3DPG), increased (pH), HbF
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fetal hemoglobin has a higher affinity for O2 because ____ binds less avidly
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2,3-diphosphoglycerate
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CO, at least initially, shifts the curve which way?
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left - improves O2 binding
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def: decrease in arterial PO2 is called
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hypoxemia (use A-a gradient)
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2 causes of hypoxemia w/ normal A-a gradient
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high altitude, hypoventilation
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3 causes of hypoxemia w/ increased A-a gradient
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diffusion defect; V/Q defect (shunt/deadspace); right-to-left shunt
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def: decreased O2 delivery to tissues is called
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hypoxia (use CO, O2sat)
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def: chloride shift
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bicarb leaves RBC, Cl enters
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this molecule buffers H+ created by carbonic anhydrase in the RBC
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deoxyhemoglobin
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what happens to pulmonary blood flow during hypoxia?
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vasoconstriction - redirects blood away from poorly oxygenated areas
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V/Q ratio is highest at ___ and lowest at ____ of lung
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apex, base; Q changes more than V for the different lung zones
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more gas exchange happens at the ___, less happens at the ___ of the lung
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apex, base
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def: shunt
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V/Q = 0; ventilation blocked; arterial PO2/PCO2 -> mixed venous blood levels
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def: dead space
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V/Q = infinite; perfusion blocked; alveolar PO2/PCO2 -> atmospheric levels
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which part of medullary respiratory center is responsible for inspiration, rhythm
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dorsal group; passive/active breathing
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which part of medullary respiratory center is responsible for expiration
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ventral group; active breathing only
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where is the location of apneustic center?
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lower pons
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where is the pneumotaxic center?
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upper pons, inhibits inspiration
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carotid, aortic arch bodies sense mostly
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O2 below 60mmHg (less effect from sensing CO2/H+)
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central respiratory chemoreceptors are located in the ___ and sense changes in ___
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medulla, H+
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def: hering-breuer reflex
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stretch receptors in smooth muscle of airways decrease breathing frequency
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def: J receptor response
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alveolar receptors stimulate rapid, shallow breathing when pulmonary capillars engorge (LHF)
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in high altitude, 2,3-DPG increases or decreases?
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increases, causing right shift
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acid/base change in high altitude?
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hypoxemia, hyperventilation -> respiratory alkalosis
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which virus is nasopharyngeal CA associated w/?
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EBV
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where do smoking-associated polyps and laryngeal papillomas usually appear?
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true vocal cord
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where does laryngeal SCC have best prognosis?
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glottic
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sx: COPD w/ dyspnea, wheezing expiration
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asthma
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sx: COPD w/ mucus production for a time
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chronic bronchitis
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sx: COPD w/ barrel chest, hypoxia, cyanosis, respiratory acidosis
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emphysema
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sx: diffuse alveolar damage with intra-alveolar hyaline membrane composed of fibrin and cellular debris
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ARDS
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sx: meconium ileus
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cystic fibrosis
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carotid body sends signals through the
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GP nerve
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aortic arch sends signals through the
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vAAgus nerve
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tox: theophylline
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seizures, arrhythmias, GI (severe caffeine)
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exposure: lung infiltrate w/ birefringent particles, calcified nodes, hilar adenopathy
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silica
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exposure: widespread lung infiltrate with beaded rods, clear center, that stain for iron; w/o lymphadenopathy
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asbestosis
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exposure: infiltrate w/ ill-defined opacities and noncaseating granulomas
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beryllosis
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tx: induce asthma reaction, "challenge"
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methacholine
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which lab value is the best measure of alveolar ventilation?
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PaCO2; inversely related
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what are some causes of alveolar hypoventilation?
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restrictive lung disease, reduced respiratory drive
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which zone comprises the anatomic dead space?
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conducting zone, stops at end of terminal bronchioles
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histo: ciliated cells are this type of cell
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pseudostratified columnar
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histo: type 1 pneumocytes are this type
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squamous
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histo: type 2 pneumocytes are this type
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cuboidal, clustered
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2,3-DPG ___ O2 delivery to tissues
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increases
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sx: pneumonia in alcoholic patient, besides s.pneumo, can be caused by these
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gram negative anaerobes from oral/GI (clindamycin)
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mech: N-acetylcysteine
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cleaves disulfide bridges of mucus proteins
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sx: respiratory distress, neuro impairment, upper body petechial rash within days of a long bone fracture
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fat embolism syndrome (stain w/ osmium tetroxide)
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lab findings: pulmonary embolism
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hypoxemia, then respiratory alkalosis. PaO2 and PaCO2 are both down
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sx: lung cancer that stains for enolase, chromogranin, synaptophysin
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small cell carcinoma
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most common site of spread for lung cancer
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adrenal glands, then liver, bone, brain
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sx: stinky sputum in AMS pt
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aspiration pneumonia (oral/GI anaerobes)
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sx: going to high altitude for a couple days leads to
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hypoxemia, hyperventilation, respiratory alkalosis; some compensation
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what happens to PaO2 in high altitude?
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drops to 60mmHg-ish
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during exercise, which blood gas value increases?
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mixed venous blood PCO2 (use more O2 -> O2 decreases)
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CFTR channel is ___-gated
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ATP
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sx: pleural thickening w/ columnar cells joined by desmosomes, abundant tonofilaments, long microvilli
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mesothelioma
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granulomatous diseases may cause increase in this vitamin
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vitamin D -> hypercalcemia
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sx: secondary MTB is mediated by this type of hypersensitivity
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type 4 -> granuloma formation
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sx: bronchiolitis obliterans
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chronic rejection of lung transplant
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def: reid index
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(submucosal gland layer / total bronchial wall); >50% in chronic bronchitis
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sx: dyspnea, tan-colored sputum, CXR infiltrates, with proliferation of columnar mucin-secreting cells in alveoli; no invasion
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bronchioloalveolar carcinoma
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sx: dry cough, hilar adenopathy, pulmonary infiltrates, noncaseating granulomas w/ giant epithelial cells
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sarcoidosis
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exposure: lower lung/pleural interstitual fibrosis w/ ferruginous bodies
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asbestos
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exposure: like sarcoidosis
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beryllosis
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exposure: discrete nodules in upper lung zones
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coal dust
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exposure: CXR shows diffuse nodular infiltrates, possible noncaseating granulomas
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various organic dusts (hypersensitivity pneumonitis)
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sx: superior vena cava syndrome
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mediastinal mass
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most common benign lung tumor
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hamartoma (hyaline cartilage)
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sx: curschmann spirals, charcot-leyden crystals
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asthma
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sx: necrotizing enterocolitis in newborn
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neonatal respiratory distress syndrome
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3 complications of NRDS?
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dysplasia, brain hemorrhage, necrotizing enterocolitis
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sx: sarcoidosis
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lungs, lymphs, eyes, skin, joints
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lab findings: sarcoidosis
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calcium, gammaglobulins, ACE
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most common cause of secondary pulmonary HTN?
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COPD
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sx: lung cancer w/ elevated PTHrP
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squamous cell carcinoma
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sx: lung cancer w/ elevated ADH or ACTH
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small cell carcinoma
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sx: common lung cancer not associated w/ smoking
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adenocarcinoma
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histo: pulmonary cells that degrade toxins
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clara cells
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what level does the vena cava penetrate diaphragm?
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T8
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what level do the esophagus, vagus penetrate diaphragm?
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T10
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what level do the aortic hiatus, thoracic duct, azygous penetrate diaphragm?
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T12
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bradykinin does this to blood vessels
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vasodilates (angioedema)
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sx: hypertrophic pulmonary osteoarthropathy
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adenocarcinoma (clubbing of fingers, increased bone)
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lung cancer marker in smokers
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K-RAS
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lung cancer marker in nonsmokers
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EGFR
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tox: secondary pulmonary HTN
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phen-fen
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rebound rhinorrhea: tachyphylaxis
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run out of NE after chronic a-agonist stimulation
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