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105 Cards in this Set

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from which embryological origin does the respiratory system arise?
foregut and neural crest

what structures arise from neural crest cells?
MOTEL PASS
Melanocytes
Odotoblasts
Tracheal cartilage
Enterochromaffin cells
Laryngeal cartilage
Pseudounipolar cells / Parafollicular cells
All ganglia / Adrenal medulla
Schwann cells
Spiral membrane
by when is surfactant production complete?
32-34 wks

how do you know it's complete?
L:S ratio = 2:1
OR
see phophatidylglycerol
which steroids can we give a mother in premature labor if the baby's lungs are not completely mature?
IM dexamethasone (works fastest)
betamethasone
beclamehtasone
consequence of free radical damage in babies
since in bld stream can destroy bld vessels in the retina leading to bleeding and scarring = retrolental fibroplasia OR...
can insert in the medial walls of the ventricles leading to intraventricular hemorrhage

how to prevent?
give vit E
MCC of premature hemorrhage in newborn?
intraventricular hemorrhage due to free radical damage
which lung dz has a problem breathing IN?
which one has a problem breathing out?
IN = restrictive
OUT = obstructive

so which is due to interstitial problem? which to airway problem?
interstitial = restrictive
airway = obstructive
from what do ppl w/ restrictive lung dz die?
cor pulmonale (R sided HF due to pulm HTN)

what about obstructive?
bronchiectasis
what kind of ventilation do we need to put ppl w/ restrictive lung dzs on?
small tidal volume w/ high frequency - allows O2 to diffuse across
MCC of ARDS
sepsis

how?
leaky bld vessels will wash away surfactant and lead to collapse of alveolil
kussmauls sign + hammans sign
pneumothorax

what will be seen w/ bp?
drop of >10mm

can also see drop in pulse rate of >10
tall lanky guy w/ long digits has sudden chest pain - what are you thinkin?
spontaneous pneumothorax

who is this more common in and why?
women b/c of estrogen making fibers weak
what happens to the airway as you get more and more free radicals?
goblet cell hyperplasia and narrowing of airway + inc REID index = bronchopulmonary dysplasia

eqn for REID index?
area occupied by goblet cells divided by total thickness of wall
which lung dz has a problem w/ ventilation? which has poor diffusion?
ventilation = obstructive
poor diffusion = restrictive

which one is susceptible to bacteria? nonbacteria?
bacteria = obstructive
nonbacteria = restrictive (likes interstitium)
who's responsible for amniotic fluid production?
mom (80%) and baby (20%)

how does fetus contribute?
swallows and pees
fxn of amniotic fluid?
shock absorption and creates vacuum around baby to allow alveoli to inflate
3 causes of polyhydramnios
autonomic dysfxn (MCC?)
neuromuscular dz (MCC?)
Esophageal or duodenal atresia
MCC autonomic = Riley Day syndrome
MCC neuromuscular = Werdnig-Hoffman syndrome
cause of oligohydramnios?
renal agenesis or obstruction
decr amniotic fluid can lead to what other issue?
pulmonary aplasia or hypoplasia
oligohydramnios due to absent abdominal muscles - what failed to happen?
mesenchyme never infiltrated the wall
MC diaphragmatic hernia
Bochtalek in the back

what's the other one?
morgagni in the midline
what's considered the extrathoracic airway?
tip of lip to the glottis

when does it narrow and expand?
narrows on inspiration

expands on expiration
what's considered the intrathoracic airway?
glottis to the alveoli

when does it narrow and expand?
narrows on expiration

expands on inspiration
3 narrowings of the trachea
glottis
midway b/c of compression of aorta
carina at T4
MC location for coin to be stuck?
carina

what about larger objects?
glottis
where in the lung do small objects fall?
right lower lobe

where if the pt is standing? lying down?
standing = posterior segment

lying down = superior segment
MCC of RLL pneumonia?
aspiration of foreign body

3 MC aspirated objects?
peanuts
popcorn
hot dogs
clearing mechanism if >20 mm?
mucus

2-20?
<2?
2-20 = cilia
<2 = mps
when do tracheal cartilage C-rings become fully encircled?
when main stem bronchus enters parenchyma
histology of trachea
upper 1/3 = stratified squamous
lower 1/3 = short columnar
mid 1/3 = mix

main epithelium?
pseudostratified tall columnar ciliated epithelium
man comes in w/ PMI on the right side and recurrent pneumonia - what is the defect?
dynein arm is defective

what other problem might he have?
infertility
asthma in kid <2 y/o
bronchiolitis

cause?
parainfluenza if mild
RSV if severe
MCC of airway pneumonia
bacteria

MC bacteria?
s. pneumonia
h. influenza
n. catarrhalis
MCC of interstitial pneumonia
non-bacteria
tracheal infection of person right after had surgery - cuase?
s. aureus

what if it's a child?
diphtheria
child comes in w/ high fever, muffled voice and drooling - cuase?
h. influenza b
pneumonia caused by:

rusty colored sputum
s. pneumonia
pneumonia caused by:

curant jelly sputum
klebsiella
pneumonia caused by:

sulfur granules
actinomyces israelii
pneumonia caused by:

malodorous or gas formation
anaerobes
pneumonia caused by:

after the flu
s. aureus

MCC of atypical pneumonia from 0 to 2mo
chlamydia

from 10-30? >40?
10-30 = mycoplasma
>40 = legionella
newborn w/ ground glass appearance on x-ray - eosinophils in culture - last wk had conjunctivitis according to mom - cause?
chlamydia
20 y//o w/ ground glass appearance on x-ray - cold agglutinin positive - cause?
mycoplasma

type of Ab for the cold agglutinin?
IgM
45 y/o w/ silver stain in lungs - has diarrhea and cold - was in a hotel for 1 wk - cause?
legionella

what else does it cause?
heart block
pneumonia in spelunker in the caves in Ohio - cause?
histoplasmosis

on microscopy?
see things in mps
pneumonia in pigeon breeder from NY - see nodules on skin - cause?
blastomycosis

on microscopy?
broad-based budding
pneumonia in someone who just came from brazil - cause?
paracoccidiomycosis

on microscopy?
ship wheel appearance
pneumonia in gardener - cause?
sporothrix

treatment?
KI
pneumonia in someone working in the barn - see infiltrate w/ eosinophils - cause?
aspergillus
shipyard worker w/ breathing difficulties - cause?
asbestosis

MC cancer caused by this?
bronchogenic carcinoma

then mesothelioma
sandblaster w/ breathing difficulties
silicosis
cotton factory worker w/ breathing difficulties
bissinosis
Repairman at a TV station who does a lot of welding
berrylliosis
only Gram positive organism that is partially acid fast
nocardia

treatment?
TMP/SMX
noncaseating granuloma w/ nodule at the hilum
sarcoidosis

what else can be high?
ACE and Ca
MC mass in lungs of kids
hamartoma
MC mass in lungs of adults
granuloma
MC tumor of the lungs
adenoma
2 central lung cancers
Squamous Cell
Small cell
lung cancer that causes incr Ca, decr P, and can see PTHrP
Squamous
paraneoplastic syndromes associated w/ small cell carcinoma of lung
cushing's dz (inc ACTH)
SIADH (inc ADH)
inc PTH
inc TSH
MCC of SIADH
pain

others?
inc ICP
hypoxic lung problems
drugs
cancer
drugs that can cause SIADH
amphotericin B
chloropropamide
carbamazepine
lung cancer NOT related to smoking
bronchioalveolar adenocarcinoma
pt comes in flushed, w/ wheezing and diarrhea - what will you see in urine?
5-HIAA

has carcinoid syndrome
4 risk factors for lung cancer
smoking
radon
2nd hand smoke
pneumoconioses
which type of lung issue has FEV1/FVC ratio >0.80?
restrictive - can blow out whatever took in

what about obstructive ratio?
FEV1 decr more than FVC so ratio is <0.80
when is there max compliance of the lung?
middle of inspiration and expiration

who loses compliance first - restrictive or obstructive?
restrictive b/c has 0 compliance at beginning of dz
during what point of breathing in is intrathoracic pressure MOST negative?
TLC
MCC of +ve intrathoracic pressure
pericardial tamponade or pneumothorax

what 2 signs will you see?
kussmaul's - inc JVD w/ inspiration
pulsus paradoxicus
MCC pericardial tamponade
trauma or cancer

what will you see on chest x-ray?
enlarged cardiac shadow
where in the lungs is bld flow greatest?
bottom of hte lungs

why? (3 reasons)
gravity
less resistance
inc O2 to the bottom (causes vasodilation)
where in the lungs is oxygenatoin the greatest?
at the top of the lungs

why?
what about w/ inspiration?
always oxygenated

w/ inspiration, it's the bottom b/c of more compliance
where is V/Q ratio the greatest?
at the top of the lungs

what about when laying down
anterior of the lungs - point is that it'll go to whatever's on top according to the ground
where is ventilation the greatest?
top of lungs b/c always open

what about w/ inspiration?
bottom of lungs b/c of compliance
receptor in lung responsible for inc respiratory rate?
j-receptors

where in lungs is it? what does it sense?
interstitium

senses particles in interstitium
receptor in lung responsible for exhalation
slow adapting receptor

where in lungs is it? what does it sense?
slow adapting receptors

senses stretch
which receptor is responsible for restrictive lung dz problems?
obstructive?
restrictive = J
obstructive = slow adapting
2 sinuses present at birth
maxillary and ethmoid

which appear by age 2? age 4?
2 = sphenoidal
4 = frontal
only sinus that drains up
maxillary
sinus problem w/ pain to the teeth?
maxillary
sinus problem w/ pain behind eyes
ethmoid
sphenoidal
sinus problem w/ pain in head
frontal
sensor of CO2, pH, and H+ ions
aortic body

where found?
arch of aorta
sensor of O2, CO2, pH and H+ ions
carotid body

where found?
bifurcation of internal and external
which type of tissue is most responsive to pCO2? to O2?
CO2 = brain
O2 = periphery
MC form of pCO2 in body?
bicarb
which parts of the brain control breathing?
pons (pneumotactic center and apneustic center)
medulla

what about when sleeping?
medulla
which part of the pons responds to CO2? to O2?
CO2 = pneumotactic - exhale
O2 = apneustic - inhale

so which lung dz breathing is controlled by which center?
apneustic controls restrictive (takes longer breathing in)
pneumotactic controls obstructive (takes longer to breathe out)
which part of breathing control is most sensitive to osmotic shifts?
pons

what is kussmaul's breathing
rapid deep breathing

what does it cause?
metabolic acidosis
what is apneustic breathing?
pneumotactic center is desensitized b/c CO2 is high all the time

where's the lesion?
below the pneumotactic center
what is central apnea?
no inspiratory effort in 20 seconds or more

Rx?
caffeine, theophylline
what is obstructive apnea?
occluding airway during sleep

MCC?
obesity
where's the lesion w/ apnea?
below the apneustic center
what is cheyne stokes breathing?
stutter breaths until last breath before death

where's the lesion?
at the medulla
causes of lesions to the medulla?
hypoglycemia
ischemia
mom brings child in b/c every time child turns head, he passes out - dx?
thoracic outlet syndrome - extra rib is cutting off bld supply to brain
family brings grandma in b/c as they went to leave, grandma went to wave goodbye and passed out - dx?
subclavian steal syndrome

cause?
atherosclerosis to early subclavian artery - when kinked off, get vacuum of the 2 vertebral arteries and they drain from the head
pancreatitis, hepatitis, emphysema - problem?
antitrypsin deficiency
emphysema caused by smoking
central
emphysema caused by aging
distoacinar
top 3 environmental causes of asthma attacks if extrinsic
dust mites, roach poop, pet dander

what about if you're from the hood?
roach poop first
only restrictive dz to behave obstructively
emphysema
causes of bullous emphysema
s. aureus
pseudomonas