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24 Cards in this Set
- Front
- Back
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At what vertebral level does the aorta pass through the diaphragm? The IVC? The esophagus?
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T8: IVC
T10: esophagus T12: aorta "I ate ten eggs at twelve" |
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What is the vital capacity defined as?
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Tidal volume + inspiratory reserve volume + expiratory reserve volume
(= total lung capacity minus the residual volume) |
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R (relaxed) form of Hb... high or low affinity for O2?
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High affinity for O2 (think: when you're relaxed, you do your job better--carry O2)
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Pt with excess of oxidized form of hemoglobin (contains Fe3+ instead of Fe2+)... what is it called, what causes it, and how would you treat it?
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Methemoglobinemia
- Results from exposure to drugs (dapsone, nitrites), enzyme deficiencies, or hemoglobinopathies - Treat with methylene blue |
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What happens in cyanide poisoning, and how would you treat it?
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Cyanide binds cytochrome C in mitochondria
Treat by giving: 1. Nitrites: oxidize hemoglobin --> methemoglobin, which will bind cyanide, freeing cytochrome C 2. Thiosulfate: binds cyanide --> renal excretion |
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What is the definition of pulmonary hypertension?
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>= 25 mmHg
> 35 mmHg during exercise |
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What is primary pulmonary HTN caused by?
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Inactivating mutation in the BMPR2 gene (normally inhibits vascular smooth muscle proliferation)
- Pts have poor prognosis |
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What is the most common cause of secondary pulmonary HTN?
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COPD
- Leads to cor pulmonale |
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How would you calculate pulmonary vascular resistance?
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Remember P = IR, or, P = QR
P = change in pressure (difference between left atrial P and pulm arterial P) Q = flow (cardiac output) |
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When can you see cyanosis?
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When deoxygenated Hb >5 g/dL
- Less likely to see cyanosis in pts w/ anemia and left shifts of O2 dissociation curve - More likely to see cyanosis in pts w/ right shift of O2 dissociation curve (acidosis, fever) |
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Where does CO2 bind to Hb?
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At the N terminus of globin
- Binding favors the taut form of Hb (O2 unloaded) - 5% of CO2 is transported this way (90% transported as HCO3) |
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What is the Reid index, and what happens to it in COPD?
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Reid index = gland depth / total thickness of bronchial wall
- In COPD, Reid index is >50% |
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Young, otherwise healthy man who gets a spontaneous pneumothorax... what is the likely underlying cause?
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Paraseptal emphysema: affects distal part of acinus, and localizes to pleura and interlobar septa; associated with bullae, which can rupture --> pneumothorax
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Restrictive lung disease with eggshell calcification of hilar lymph nodes and increased susceptibility to TB... what is it?
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Silicosis
- Affects upper lobes; assoc. with foundries, sandblasting, mines - Silica may disrupt phagolysosomes and impair macrophages |
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Restrictive lung disease with ferruginous bodies inside macrophages... what is it?
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Asbestosis
- Assoc. with shipbuilding, roofing, plumbing - Affects lower lobes |
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How do you asses lung maturity in a fetus?
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Lecithin-to-sphingomyelin ratio of >2 in amniotic fluid indicates lung maturity
- Usually <1.5 in neonatal respiratory distress syndrome |
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What is dipalmitoyl phosphatidylcholine?
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The major component of surfactant
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What are the risk factors for neonatal respiratory distress syndrome?
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- Prematurity
- Maternal diabetes (due to elevated insulin) - Cesarean delivery (due to decreased release of fetal glucocorticoids) |
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How would you treat neonatal respiratory distress syndrome?
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- Maternal steroids before birth
- Artificial surfactant for infant - Thyroxine |
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Lung cancer with hemorrhagic pleural effusions, pleural thickening, and psammoma bodies... what is it?
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Mesothelioma
- Assoc. with asbestosis |
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Pleural effusion that's milky with increased triglycerides... what kind of effusion is it?
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Lymphatic
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Pleural effusion that's cloudy with increased protein content... what kind of effusion is it?
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Exudate
- Seen in states of increased vascular permeability (malignancy, pneumonia, collagen vascular disease, trauma) |
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What is theophylline and what are its major toxicities?
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- Phosphodiesterase inhibitor--leads to increased cAMP --> bronchodilation
- Narrow therapeutic index --> cardiotoxicity, neurotoxicity (seizures) - Lots of DDIs; blocks action of adenosine |
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What is N-acetylcysteine and what is it used for?
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- Mucolytic --> loosens mucous plugs in CF pts
- Antidote for acetaminophen overdose |
