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96 Cards in this Set
- Front
- Back
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What pneumocytes are precursors to type I pneumocytes?
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Type II, makers of surfactant
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What is a lecithin to sphingomyelin ratio of >2 indicative of in amniotic fluid?
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Fetal lung maturity
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What do Clara cells do?
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Columanr cells that degrade toxins and act as reserve cells.
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Where is the more common site for foreign body inhalation?
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Right lung because the right main stem bronchus is wider and more vertical than the left
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Where will a peanut go
1) aspirated upright 2) while supine |
1) lower portion of right inferior lobe
2) superior portion of right inferior lobe |
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Describe the architectural setup of bronchopulmonary segments, lymphatics, veins, arteries?
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Each segmental bronchus has a tertiary bronchus and two arteries in the center.
Veins and lymphatics run along the borders. |
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How are the pulmonary arteries located relatively to the hila?
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Right anterior
Left Superior |
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What structures perforate the diaphragm and at what level?
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T8: vena cava
T10: esophagus T12: aortic hiatus |
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What are the accessory muscles of inspiration?
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external intercostals, scalene muscles, sternomastoids
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What are the accessory muscles of expiration?
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rectus abdominis, internal and external obliques, transversus abdominis, internal intercostals
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What does histamine do to the lungs?
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bronchoconstriction
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What is vital capacity?
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everything but the residual volumes
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What is functional residual capacity?
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RV + ERV
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What is Inspiratory capacity?
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IRV + TV
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What is the formula for determination of physiologic dead space?
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Vd = Vt x (PaCO2 - PeCO2)/PaCO2
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What factors favor the taut form (O2 unloading) of Hb?
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Increased Cl, CO2, temperature, 2,3 BPG, H+
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What is methemoglobin?
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Oxidized form of Hb that does not bind O2 as readily, but has increased affinity for cyanide.
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How do you treat methemoglobinemia?
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Methylene blue
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What does a decrease in PaO2 cause in the lungs?
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hypoxic vasoconstriction shifting blood away from poorly ventilated regions of lung to well-ventilated regions
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What factors affect diffusion?
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v gas = Area/Thickness x difference in partial pressures
A decreased in emphysema T increased in pulmonary fibrosis |
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What is the normal pulmonary artery pressure?
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10-14 mmgHg.
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What are values of pulmonary hypertension?
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>25mmHg or >35 mmHg during exercise
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What is the cause of primary pulmonary hypertension?
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Inactivating mutation in the BMPR2 gene. This normally functions to inhibit vascular smooth muscle proliferation.
Poor prognosis |
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What are causes for secondary pulm hypertension?
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COPD, recurrent thromboemboli, autoimmune disease, left-to-right shunt, sleep apnea or high altitude
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What is a normal A-A gradient? What makes it increased?
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10-15 mmHg. Increased with shunting, V/Q mismatch, fibrosis
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Differences between hypoxemia and hypoxia?
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Hypoxemia means decreased PaO2. Hypoxia means decreased O2 delivery to the tissues.
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Causes for hypoxemia?
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high altitude, hypoventilation, V/Q mismatch, Diffusion limitation, Right-to-left shunt
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Causes for hypoxia?
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Decreased CO, hypoxemia, anemia, cyanide posioning, CO poisoning
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What is the Haldane effect?
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In lungs, oxygenation of Hb promotes dissociation of H+ from Hb. This shifts equilibrium toward CO2 formation. therefore, CO2 released from RBCs.
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What is the Bohr effect?
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In peripheral tissue, increased H+ from tissue metabolism shifts curve to right, unloading O2.
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Do PaO2 or PaCO2 change in exercise?
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No. But do see an increase in venous CO2 content.
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What are the PFT features of COPD?
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Airways close prematurely at high lung volumes, resulting in increased RV and decreased FVC. PFTs: super decreased FEV1, decreased FVC - decreased FEV1/FVC ratio.
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Pathology of chronic bronchitis?
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Blue Bloater. Hypertrophy of mucus-secreting glands in bronchioles. See productive cough > 3 consecutive months in >2 years.
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Differentiating centriacinar, panacinar, paraseptal emphysema
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Centriacinar = smoking
Panacinar = alpha-antitrypsin deficiency Paraseptal emphysema = associated with bullae --> spontaneous pneumothorax |
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Characteristics of emphysema?
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Increased elastase activity. Exhale through pursed lips to increase airway pressure and prevent airway collapse during exhalation.
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What is Bronchiectases associated with?
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bronchial obstruction, CF, poor ciliary motility, Karagener's syndrome.
At risk for aspergillosis. |
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PFTs in relation to restrictive lung disease?
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Decreased lung volumes- FEV1/FVC still good though >80%.
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Types of poor breathing mechanics leading to restrictive lung disease?
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Poor muscular effort - polio, myasthenia gravis
Poor structural apparatus - scoliosis, morbid obesity |
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Types of interstitial lung diseases that cause restrictive lung disease?
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ARDS, hyaline membrane disease, pneumoconioses, sarcoidosis, IPF, Goodpasture's, Wegener's granulomatosis, Eosinophilic granuloma, Drug toxicity
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Which lobes do coal miner's and silicosis pneumoconioses affect?
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upper
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Risk factors for Neonatal RDS?
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maternal DM, prematurity, C section
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What is sleep apnea associated with?
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obesity, loud snoring, systemic/pulm HTN, arrhythmias, possibly sudden death
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Features of Squamous cell carcinoma?
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Central. LINKED TO SMOKING. Some PTHrP activity. Cavitation.
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What is most common type of lung cancer in nonsmokers and females?
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Bronchial adenocarcinoma. Peripheral.
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Features of bronchioalveolar adenocarcinoma?
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Can grow along airways. Peripheral. Not linked to smoking.
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Features of small cell carcinoma?
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Central. Undifferentiated. AGGRESSIVE. Ectopic production of ACTH or ADH. Neoplasm of neuroendocrine Kulchitsky cells. Chemo not surgery.
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Feautres of large cell carcinoma?
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Peripheral. Surgerically removed.
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What is Pancoast's tumor?
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Apical tumor that can affect sympathetic plexus and lead to Horner's syndrome
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Match organisms with type of pneumonia?
Lobar Bronchopneumonia Interstitial |
Lobar - Pneumococcus, Klebisiella
Bronchopneumonia - S aureus, H flu, Klebsiella, S pyogenes Interstitial - Mycoplasma, Legionella, Chlamydia, Viruses |
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Common cause of lung abscess?
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Aspiration or bronchial obstruction. S. aureus or anaerobes.
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Difference between transudate and exudate for pleural effusions?
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Transudate - low protein content - Cirrhosis, CHF, nephrotic syndrome
Exudative - pneumonia, cancer, trauma |
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What drug can loosen mucus plugs in CF patients?
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N-acetylcysteine. Mucolytic.
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Adverse effect of isoproterenol?
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Tachycardia since it's a nonspecific B agonist.
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Method of action of theophylline?
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Bronchodilation by inhibiting phosphodiesterase, decreases cAMP hydrolysis.
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High levels of cAMP do what to lung?
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Bronchodilation
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Ipratropium and asthma?
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Competitive block of muscarinic receptors, preventing bronchoconstriction.
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What are some antileukotrienes?
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Zileuton - blocks conversion of arachidonic acid
Zafirlukast, montelukast- block leukotriene receptors. Good for aspirin-induced asthma. |
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What type of pt will giving O2 may make them stop breathing? Why?
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Hypercapnic. Central chemoreceptors pushed by CO2 and they grew used to that level. Drive by O2 is done by carotid and aortic bodies.
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Stratified squamous in respiratory tract is found where?
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true vocal cords, oropharynx, laryngopharynx, anterior epiglottis, upper half of posterior epiglottis
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Cromolyn works by?
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Blocking mast cell mediator release
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Most common CF mutation is due to?
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Delta 508. Post-translational processing abnormal. (glycosylation)
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What causes cerebral vasodilation?
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Increased CO2
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What are clues for sarcoid?
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increased Ca, high numbers of CD4+ lymphocytes
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What can silicosis lead to?
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impaired macrophage killing
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Loss of surfactant leads to?
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alveolar atelectasis
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What are the microbial agents responsible for bacterial pneumonia after influenza?
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strep, staph aureus, h flu
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What type of pneumonia is klebsiella related to?
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nosocomial pneumonia, EtOH, IVDU
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What respiratory findings can Left Ventricular Failure (S3) lead to?
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Fluid in lungs --> decreased compliance
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What drug can you challenge asthma patients with to test it out?
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Methacholine
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Where in the respiratory tract does the cilia stop? Goblet cells?
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Cilia are in respiratory bronchioles but not in alveolar ducts. Goblet cells end right before bronchioles.
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Pleural pressure at FRC?
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-5 mmHg
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Places to do thoracentesis?
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Midclavicular - 5-7
Mid axillary - 7-9 Paravertebral - 9-11 |
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Scleroderma can be associated with what pulmonary finding?
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Pulm HTN
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Background of squamous cell carcinoma?
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25-40% of cancers. SMOKING. Central. Look for cavitation. Also increased Ca from PTHrP
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Background of small cell carcinoma?
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20-25%. Central. SIADH, ACTH. Lambert-eaton syndrome = antibodies against Ca channels.
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Background of adenocarcinoma?
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25-40%. Peripheral. Clubbing. Hypertrophic osteoarthropathy. Most common in women and non smokers.
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Background of large cell carcinoma?
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Peripheral. 10-15%. Gynecomastia and galactorrhea.
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Mechanism molecular of bronchodilation?
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Increased cAMP (inhibit myosin-P and decrease IC Calcium)
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Cause for primary pulmonary HTN?
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endothelial dysfunction
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Subpleural bleb is risk factor for?
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Pneumothorax
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What is ARDS mechanism?
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Mediated by type II pneumocytes
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Alveolar wall destruction is seen with what disease?
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Emphysema
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Formula for La Place?
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P = T/R
expect smaller alveoli to collapse first |
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Pulmonary embolism findings!!?!!?
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Respiratory alkalosis with hypoxemia also from the hyperventilation
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Pneumothorax remedy?
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Fixed with chest tube placement
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Risk factor for pneumothorax?
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apical subpleural blebs
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Opacification on X-ray. Trachea toward? Trachea away?
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Toward = atelectasis
Away = pulm effusion |
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Most antiinflammatory relief to asthma?
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Corticosteroids
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Obstructive lung disease presents with what volume changes?
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Increased RV, FRC, Increased TLC
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Asthma test?
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Methacholine (muscarinic agonist) challenge
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Normal alveolar ventilation?
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100 mmHg
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Greatest risk after asbestos?
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Bronchogenic carcinoma
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Bronchiectasis. With eosinophils. IgE high. ?
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ABPA.
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MEdiates chronic rejection with lung?
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Brioncholitis obliterans.Small airways.
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Bronchioloalveolar neoplasm on bx?
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columnar mucin-secreting cells, filling alveolar spaces without invading stroma or vessels. looks like pneumonia.
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Majority of airway resistance is where?
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medium and small-sized bronchi
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