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105 Cards in this Set
- Front
- Back
- 3rd side (hint)
from which embryological origin does the respiratory system arise?
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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 |
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by when is surfactant production complete?
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32-34 wks
how do you know it's complete? |
L:S ratio = 2:1
OR see phophatidylglycerol |
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which steroids can we give a mother in premature labor if the baby's lungs are not completely mature?
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IM dexamethasone (works fastest)
betamethasone beclamehtasone |
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consequence of free radical damage in babies
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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
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MCC of premature hemorrhage in newborn?
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intraventricular hemorrhage due to free radical damage
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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 |
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from what do ppl w/ restrictive lung dz die?
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cor pulmonale (R sided HF due to pulm HTN)
what about obstructive? |
bronchiectasis
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what kind of ventilation do we need to put ppl w/ restrictive lung dzs on?
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small tidal volume w/ high frequency - allows O2 to diffuse across
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MCC of ARDS
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sepsis
how? |
leaky bld vessels will wash away surfactant and lead to collapse of alveolil
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kussmauls sign + hammans sign
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pneumothorax
what will be seen w/ bp? |
drop of >10mm
can also see drop in pulse rate of >10 |
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tall lanky guy w/ long digits has sudden chest pain - what are you thinkin?
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spontaneous pneumothorax
who is this more common in and why? |
women b/c of estrogen making fibers weak
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what happens to the airway as you get more and more free radicals?
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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
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which lung dz has a problem w/ ventilation? which has poor diffusion?
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ventilation = obstructive
poor diffusion = restrictive which one is susceptible to bacteria? nonbacteria? |
bacteria = obstructive
nonbacteria = restrictive (likes interstitium) |
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who's responsible for amniotic fluid production?
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mom (80%) and baby (20%)
how does fetus contribute? |
swallows and pees
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fxn of amniotic fluid?
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shock absorption and creates vacuum around baby to allow alveoli to inflate
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3 causes of polyhydramnios
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autonomic dysfxn (MCC?)
neuromuscular dz (MCC?) Esophageal or duodenal atresia |
MCC autonomic = Riley Day syndrome
MCC neuromuscular = Werdnig-Hoffman syndrome |
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cause of oligohydramnios?
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renal agenesis or obstruction
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decr amniotic fluid can lead to what other issue?
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pulmonary aplasia or hypoplasia
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oligohydramnios due to absent abdominal muscles - what failed to happen?
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mesenchyme never infiltrated the wall
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MC diaphragmatic hernia
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Bochtalek in the back
what's the other one? |
morgagni in the midline
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what's considered the extrathoracic airway?
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tip of lip to the glottis
when does it narrow and expand? |
narrows on inspiration
expands on expiration |
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what's considered the intrathoracic airway?
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glottis to the alveoli
when does it narrow and expand? |
narrows on expiration
expands on inspiration |
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3 narrowings of the trachea
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glottis
midway b/c of compression of aorta carina at T4 |
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MC location for coin to be stuck?
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carina
what about larger objects? |
glottis
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where in the lung do small objects fall?
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right lower lobe
where if the pt is standing? lying down? |
standing = posterior segment
lying down = superior segment |
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MCC of RLL pneumonia?
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aspiration of foreign body
3 MC aspirated objects? |
peanuts
popcorn hot dogs |
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clearing mechanism if >20 mm?
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mucus
2-20? <2? |
2-20 = cilia
<2 = mps |
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when do tracheal cartilage C-rings become fully encircled?
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when main stem bronchus enters parenchyma
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histology of trachea
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upper 1/3 = stratified squamous
lower 1/3 = short columnar mid 1/3 = mix main epithelium? |
pseudostratified tall columnar ciliated epithelium
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man comes in w/ PMI on the right side and recurrent pneumonia - what is the defect?
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dynein arm is defective
what other problem might he have? |
infertility
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asthma in kid <2 y/o
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bronchiolitis
cause? |
parainfluenza if mild
RSV if severe |
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MCC of airway pneumonia
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bacteria
MC bacteria? |
s. pneumonia
h. influenza n. catarrhalis |
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MCC of interstitial pneumonia
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non-bacteria
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tracheal infection of person right after had surgery - cuase?
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s. aureus
what if it's a child? |
diphtheria
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child comes in w/ high fever, muffled voice and drooling - cuase?
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h. influenza b
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pneumonia caused by:
rusty colored sputum |
s. pneumonia
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pneumonia caused by:
curant jelly sputum |
klebsiella
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pneumonia caused by:
sulfur granules |
actinomyces israelii
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pneumonia caused by:
malodorous or gas formation |
anaerobes
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pneumonia caused by:
after the flu |
s. aureus
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MCC of atypical pneumonia from 0 to 2mo
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chlamydia
from 10-30? >40? |
10-30 = mycoplasma
>40 = legionella |
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newborn w/ ground glass appearance on x-ray - eosinophils in culture - last wk had conjunctivitis according to mom - cause?
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chlamydia
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20 y//o w/ ground glass appearance on x-ray - cold agglutinin positive - cause?
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mycoplasma
type of Ab for the cold agglutinin? |
IgM
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45 y/o w/ silver stain in lungs - has diarrhea and cold - was in a hotel for 1 wk - cause?
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legionella
what else does it cause? |
heart block
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pneumonia in spelunker in the caves in Ohio - cause?
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histoplasmosis
on microscopy? |
see things in mps
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pneumonia in pigeon breeder from NY - see nodules on skin - cause?
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blastomycosis
on microscopy? |
broad-based budding
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pneumonia in someone who just came from brazil - cause?
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paracoccidiomycosis
on microscopy? |
ship wheel appearance
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pneumonia in gardener - cause?
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sporothrix
treatment? |
KI
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pneumonia in someone working in the barn - see infiltrate w/ eosinophils - cause?
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aspergillus
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shipyard worker w/ breathing difficulties - cause?
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asbestosis
MC cancer caused by this? |
bronchogenic carcinoma
then mesothelioma |
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sandblaster w/ breathing difficulties
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silicosis
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cotton factory worker w/ breathing difficulties
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bissinosis
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Repairman at a TV station who does a lot of welding
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berrylliosis
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only Gram positive organism that is partially acid fast
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nocardia
treatment? |
TMP/SMX
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noncaseating granuloma w/ nodule at the hilum
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sarcoidosis
what else can be high? |
ACE and Ca
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MC mass in lungs of kids
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hamartoma
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MC mass in lungs of adults
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granuloma
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MC tumor of the lungs
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adenoma
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2 central lung cancers
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Squamous Cell
Small cell |
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lung cancer that causes incr Ca, decr P, and can see PTHrP
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Squamous
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paraneoplastic syndromes associated w/ small cell carcinoma of lung
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cushing's dz (inc ACTH)
SIADH (inc ADH) inc PTH inc TSH |
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MCC of SIADH
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pain
others? |
inc ICP
hypoxic lung problems drugs cancer |
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drugs that can cause SIADH
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amphotericin B
chloropropamide carbamazepine |
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lung cancer NOT related to smoking
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bronchioalveolar adenocarcinoma
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pt comes in flushed, w/ wheezing and diarrhea - what will you see in urine?
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5-HIAA
has carcinoid syndrome |
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4 risk factors for lung cancer
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smoking
radon 2nd hand smoke pneumoconioses |
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which type of lung issue has FEV1/FVC ratio >0.80?
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restrictive - can blow out whatever took in
what about obstructive ratio? |
FEV1 decr more than FVC so ratio is <0.80
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when is there max compliance of the lung?
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middle of inspiration and expiration
who loses compliance first - restrictive or obstructive? |
restrictive b/c has 0 compliance at beginning of dz
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during what point of breathing in is intrathoracic pressure MOST negative?
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TLC
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MCC of +ve intrathoracic pressure
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pericardial tamponade or pneumothorax
what 2 signs will you see? |
kussmaul's - inc JVD w/ inspiration
pulsus paradoxicus |
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MCC pericardial tamponade
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trauma or cancer
what will you see on chest x-ray? |
enlarged cardiac shadow
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where in the lungs is bld flow greatest?
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bottom of hte lungs
why? (3 reasons) |
gravity
less resistance inc O2 to the bottom (causes vasodilation) |
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where in the lungs is oxygenatoin the greatest?
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at the top of the lungs
why? what about w/ inspiration? |
always oxygenated
w/ inspiration, it's the bottom b/c of more compliance |
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where is V/Q ratio the greatest?
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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
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where is ventilation the greatest?
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top of lungs b/c always open
what about w/ inspiration? |
bottom of lungs b/c of compliance
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receptor in lung responsible for inc respiratory rate?
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j-receptors
where in lungs is it? what does it sense? |
interstitium
senses particles in interstitium |
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receptor in lung responsible for exhalation
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slow adapting receptor
where in lungs is it? what does it sense? |
slow adapting receptors
senses stretch |
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which receptor is responsible for restrictive lung dz problems?
obstructive? |
restrictive = J
obstructive = slow adapting |
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2 sinuses present at birth
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maxillary and ethmoid
which appear by age 2? age 4? |
2 = sphenoidal
4 = frontal |
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only sinus that drains up
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maxillary
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sinus problem w/ pain to the teeth?
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maxillary
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sinus problem w/ pain behind eyes
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ethmoid
sphenoidal |
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sinus problem w/ pain in head
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frontal
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sensor of CO2, pH, and H+ ions
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aortic body
where found? |
arch of aorta
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sensor of O2, CO2, pH and H+ ions
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carotid body
where found? |
bifurcation of internal and external
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which type of tissue is most responsive to pCO2? to O2?
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CO2 = brain
O2 = periphery |
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MC form of pCO2 in body?
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bicarb
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which parts of the brain control breathing?
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pons (pneumotactic center and apneustic center)
medulla what about when sleeping? |
medulla
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which part of the pons responds to CO2? to O2?
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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) |
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which part of breathing control is most sensitive to osmotic shifts?
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pons
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what is kussmaul's breathing
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rapid deep breathing
what does it cause? |
metabolic acidosis
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what is apneustic breathing?
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pneumotactic center is desensitized b/c CO2 is high all the time
where's the lesion? |
below the pneumotactic center
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what is central apnea?
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no inspiratory effort in 20 seconds or more
Rx? |
caffeine, theophylline
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what is obstructive apnea?
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occluding airway during sleep
MCC? |
obesity
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where's the lesion w/ apnea?
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below the apneustic center
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what is cheyne stokes breathing?
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stutter breaths until last breath before death
where's the lesion? |
at the medulla
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causes of lesions to the medulla?
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hypoglycemia
ischemia |
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mom brings child in b/c every time child turns head, he passes out - dx?
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thoracic outlet syndrome - extra rib is cutting off bld supply to brain
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family brings grandma in b/c as they went to leave, grandma went to wave goodbye and passed out - dx?
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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
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pancreatitis, hepatitis, emphysema - problem?
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antitrypsin deficiency
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emphysema caused by smoking
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central
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emphysema caused by aging
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distoacinar
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top 3 environmental causes of asthma attacks if extrinsic
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dust mites, roach poop, pet dander
what about if you're from the hood? |
roach poop first
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only restrictive dz to behave obstructively
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emphysema
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causes of bullous emphysema
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s. aureus
pseudomonas |
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