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79 Cards in this Set
- Front
- Back
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What muscles are responsible for inspiration during exercise?
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external intercostals
scalenes, sternocleidomastoid, |
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What muscles are responsible for expiration during exercise?
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Internal intercostals,
rectus abdominis, transversus abdominis, internal and external obliques |
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What ratio indicates fetal lung maturity?
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lecithin: sphingomyelin > 2.0
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What is deficiency in neonatal respiratory distress syndrome?
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dipalmitoyl phosphatidylcholine (lecithin)
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How do ACE inhibitors cause cough?
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Normally ATII inactivates bradykinin; when blocked, kallikrein is unopposed --> activates bradykinin --> cough and angioedema
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Where are ACE and kallikrein synthesized?
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In the lungs
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What is the formula for collapsing pressure?
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2(tension)/radius
As radius decreases, alveoli are more likely to collapse |
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How is inspiratory capacity calculated?
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tidal volume + inspiratory reserve capacity
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Formula for calculated Vd - physiologic dead space
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tidal volume x (PaCO2-PeCo2)/PaCO2
PaCO2 = arterial PCO2 PeCO2 = expired air CO2 |
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At what point in the breath cycle is the tendency for the lungs to collapse equal to the tendency for the chest wall to spring outward?
What is the system pressure at this point? |
At FRC
System pressure is equal to atmospheric pressure |
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What is the treatment for methemoglobinemia?
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Methylene blue
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What is the treatment for cyanide poisoning?
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Give nitrates to oxidize Hb to metHb --> allows cyt oxidase to fxn
--> thiosulfate to bind cyanide --> thiocyanide is renally excreted |
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What is methemoglobin?
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oxidized form (Fe3+ instead of Fe2+) --> poorer O2 binding
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What is the effect of carboxyhemoglobin on the oxygen dissociation curve?
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Left shift (increased affinity for oxygen, decreased unloading)
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What is the effect of increased metabolic needs on the oxygen dissociation curve?
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Right shift (increased oxygen unloading)
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What is the effect of acidemia on the oxygen dissociation curve?
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Right shift (increased oxygen unloading)
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What is the effect of alkalemia on the oxygen dissociation curve?
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Left shift (increased affinity for oxygen, decreased unloading)
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What is the effect of increased 2,3-DPG on the oxygen dissociation curve?
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Right shift (increased oxygen unloading)
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How does the oxygen dissociation curve of fetal Hb differ from adult Hb?
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Left shift (increased affinity for oxygen, decreased unloading)
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What is the effect of a decrease in PAO2?
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Vasoconstriction that shunts blood towards well-ventilated regions of lung
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How do emphysema and pulmonary fibrosis impact diffusion?
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Both decrease it. Diffusion is proportional to A(rea)/T(hickness).
Emphysema reduces area. Fibrosis increases thickness. |
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What types of gases show perfusion-limited patterns of exchange along pulmonary capillaries?
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O2 (normally), CO2, N2O.
These equilibrate before the end of the capillary. Diffusion can only be increased if blood flow increases. |
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What types of gases show diffusion-limited patterns of exchange along pulmonary capillaries?
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O2 (in emphysema or fibrosis)
CO |
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What is the normal pressure in pulmonary arteries?
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10-14 mmHg
>25 mmHg = HTN >35 mmHg during exercise = HTN |
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What histologic changes are seen as a result of pulmonary HTN?
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medial thickening, intimal fibrosis, atherosclerosis
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What causes primary pulmonary HTN?
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Inactivating mutation in BMPR2 gene (normally inhibits smooth muscle proliferation)
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What causes secondary pulmonary HTN?
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COPD,
mitral stenosis systemic sclerosis left-to-right shunt sleep apnea (hypoxic vasoconstrict) high altitude (hypoxic vasoconstrict) recurrent thromboemboli |
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What is the formula for pulmonary vascular resistance?
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PVR = (Ppulm artery - Pleft atrium)/CO
R = (change in P)/Q R = (8)(viscosity)(length)/(pi)(radius^4) |
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What is the alveolar gas equation?
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PAO2 = 150 - (PACO2)/0.8
150 = PO2 in inspired air 0.8 = respiratory quotient |
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What is the A-a gradient?
When is it increased? |
PAO2 - PaO2 = 10-15
Increased in hypoxemia (V/Q mismatch, fibrosis) |
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Where in the lung are ventilation and perfusion greatest?
Where is V/Q = 3? Where is V/Q = 0.6 Where is V/Q = 1 |
At the bases
At the apices At the bases During exercise |
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In what type of V/Q mismatch should 100% O2 be used?
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Only in physiologic dead space (V>Q) due to blood flow obstruction.
Does not help in physiologic shunt (V<Q) due to airway obstruction. |
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In zone 2 of the lung, how to the partial pressures of oxygen in the alveoli, veins, and arteries compare?
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PA > Pa > Pv
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What are the 3 forms in which carbon dioxide is transferred from the tissues to the lungs?
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1. Bicarbonate, HCO3- (90%)
2. Carbaminohemoglobin, bound to Hb at N terminus (5%) - favors T form --> O2 unloading 3. Dissolved CO2 (5% |
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Pt presents with sudden onset dyspnea, chest pain, and tachycardia. What could be the underlying causes?
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Embolus (95% from deep leg veins):
Fat (bone fractures, liposuction) Air Thrombus Bacteria Amniotic fluid (--> postpartum DIC) Tumor |
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Pt presents with calf tenderness occurring with foot dorsiflexion. What is wrong?
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DVT (positive Homan's sign)
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Pt has productive cough, wheezing, crackles, and cyanosis. What is causing this?
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Chronic bronchitis ("blue bloater") due to hypertrophy of mucus-secreting glands in bronchioles --> early onset hypoxemia, late-onset dyspnea
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Pt has dyspnea, decreased breath sounds, tachycardia. What is causing this?
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Emphysemia ("pink puffer") due to increased elastase activity --> destruction of alveolar walls
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What type of emphysema is caused by smoking?
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Centriacinar
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What type of emphysema is caused by alpha1-antitrypsin deficiency?
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Pancacinar
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What type of emphysema is associated with spontaneous pneumothorax in a young male?
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Paraseptal (cyst/bulla forming)
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Pt has dyspnea, cough, wheezing, tachypnea, hypoxemia, decreased inspiratory/expiratory ratio
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Asthma: bronchial hyperresponsiveness --> bronchoconstriction
Smooth muscle hypertrophy, Curschmann's spirals (shed epithelium from mucus plugs) |
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Pt has dilated airways, purulent sputum, recurrent infections, and hemoptyis.
What is this called? What is it caused by? What infection are they at risk for? |
Bronchiectasis
CF, Kartagener's, poor ciliary motility Aspergillosis |
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What are the mechanical causes of restrictive lung disease?
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Muscle - polio, myasthenia gravis
Structural - scoliosis, obesity |
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What are the causes of restrictive lung disease that are attributable to lowered diffusing capacity?
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ARDS
Neonatal RDS (hyaline membrane dz) Sarcoidosis Pneumoconioses Idiopathic pulmonary fibrosis (collagen) Goodpasture's syndrome Wegener's granulomatosis Eosinophilic granuloma (histiocytosis X) Drug toxicity (bleomycin, amiodarine, busulfan) |
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Pt presents with cough, dyspnea, morning stiffness, and painful joints.
What caused it? What part of lung is affected? |
Coal dust (coal miner's lung) --> Caplan syndrome
Upper lobes |
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Sandblaster presents with cough, dyspnea, and "eggshell" calcification of hilar lymph nodes.
What caused it? What part of lung is affected? |
Silicosis (macrophages respond to silica --> fibrogenesis); may increase susceptibility to TB if macrophages are impaired.
Upper lobes |
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Plumber/roofer presents with bronchogenic carcinoma.
What caused it? What part of lung is affected? What is seen on biopsy? |
Asbestosis
Lower lobes "Ivory white" calcified pleural plaques, dumbbell-shaped bodies in macrophages, "ferruginous bodies" on Prussian blue |
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Baby is born before 35 weeks.
What is his L:S ratio? What did his mom have? How was he delivered? What congenital heart defect? Giving 100% O2 does what? Treatment? |
L:S < 1.5
maternal diabetes Cesarean section low O2 tension --> PDA 100% O2 --> retinopathy Give maternal steroids before birth, artificial surfactant, thyroxine |
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Protein-rich fluid in alveoli, hyaline membranes.
What caused damage? What incited this diffuse alveolar damage? |
Toxic neutrophilic substances OR coagulation cascade OR free radicals
Trauma, sepsis, shock, gastric aspiration, uremia, pancreatits, amniotic fluid embolism |
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Obese pt who snores, has HTN, is always tired...
Has what? Should do what? Could die from what? |
Obstructive sleep apnea (central is no respiratory effort)
Get CPAP, lose weight, surgery Arrythmia |
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Decreased breath sounds in one area, decreased resonance to percussion, decreased fremitus, tracheal deviation.
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Bronchial obstruction (ipsilateral to tracheal deviation), e.g. cancer
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Decreased breath sounds, dullness to percussion, decreased fremitus
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Pleural effusion
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Bronchial sounds in one area, dullness to percussion, increased fremitus
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Lobar pneumonia
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Decreased breath sounds, hyperresonance to percussion, absent fremitus, tracheal deviation
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Tension pneumothorax (on contralateral side to tracheal deviation)
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Pt presents with cough, hemoptysis, decreased breath sounds in one area, wheezing, coin lesions.
Possible complications? |
Lung cancer SPHERE:
- Superior vena cava syndrome - Pancoast's tumor - Horner syndrome - Endocrine (paraneoplastic) - Recurrent laryngeal symptoms - Effusions (pleural or pericardial) |
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Hx of smoking
Hilar mass arising from bronchus, cavitation, PTHrP production What would show up on histology? |
Squamous cell carcinoma
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Keratin pearls and intracellular bridges
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Squamous cell carcinoma
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Clara cells --> type II pneumocytes; multiple densities on chest X-ray
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Bronchial or bronchioloalveolar ADENOcarcinoma
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Peripheral tumor in site of prior pulmonary inflammation or injury
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Bronchial adenocarcinoma
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Peripheral tumor presenting like pneumonia, grows along airways
Can result in hypertrophic osteoarthropathy |
Bronchioloalveolar adenocarcinoma
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Most common lung cancer in nonsmokers and females?
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Bronchial adenocarcinoma
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Central, aggressive tumor. Associated with ectopic ACTH or ADH, Lambert-Eaton Syndrome (anti-Ca channel Igs)
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Small (oat) cell carcinoma
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Poorly differentiated; neuroendocrine Kulchitsky cells (dark blue)
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Small (oat) cell carcinoma
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Inoperable but responsive to chemotherapy
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Small (oat) cell carcinoma
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Pleomorphic giant cells with leukocyte fragments
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Large cell carcinoma
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Peripheral tumor composed of anaplastic cells; unresponsive to chemotherapy; surgically removed
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Large cell carcinoma
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Secretes serotonin, can cause flushing, diarrhea, wheezing, salivation
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Carcinoid tumor
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Malignancy of the pleura resulting in hemorrhagic pleural effusions and pleural thickening
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Mesothelioma
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Psammoma bodies seen on histology
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Mesothelioma
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Common sites of lung metastases
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adrenals
brain (seizures) bone (fractures) liver (jaundice, hepatomegaly) |
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Ptosis, miosis, anyhydrosis can be caused by a lung tumor in what location?
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Apex (Pancoast's) --> compresses cervical sympathetic plexus
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What organisms are usually responsible for lobar pneumonia?
Produce intra-alveolar exudate --> consolidation |
Streptococcus pneumoniae
Klebsiella |
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What organisms are usually responsible for bronchopneumonia?
Inflammatory infiltrates from bronchioles --> alveoli; patchy distribution in >1 lobe |
S. aureus
H. flu Klebsiella S. pyogenes |
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What organisms are usually responsible for interstitial pneumonia?
Diffuse patchy infiltrates localized to interstitial areas at alveolar walls; more indolent |
Viruses (RSV, adenovirus)
Mycoplasma Legionella Chlamydia |
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What situations predispose to lung abscess with S. aureus and anaerobes?
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Bronchial obstruction (e.g. cancer)
Aspiration of oropharyngeal contents (e.g. alcoholics, epileptics) |
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Pleural effusion with low protein content is due to...
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(Transudate):
CHF Nephrotic syndrome Hepatic cirrhosis Anything that causes increased hydrostatic or decreased oncotic P |
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Cloudy pleural effusion with high protein content is due to...
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(Exudate - must drain):
Malignancy Pneumonia Collagen vascular disease Infection Trauma Anything that causes increased vascular permeability |
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Milky fluid with high triglyceride content is composed of...
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lymphatic fluid (lymphatic effusion)
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