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84 Cards in this Set
- Front
- Back
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Clara cells
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nonciliated columnar with secretory granules, secrete component of surfactant, degrade toxins, act as reserve cells
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L:S ration
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lecithin to sphingomyelin ration
>2 in amniotic fluid indicated fetal lung maturity |
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Pulmonary surfactant
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dipalmitoyl phosphatidylcholine
dec alveolar surface tension secreted by type II cells- cuboidal and clustered |
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MC site for inhaled foreign body
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Right lung, because right main stem bronchus is wider and more vertical than left
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Relation of pulm artery to bronchus at each lung hilus
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RALS
Right Anterior, Left Superior |
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Where you aspirate
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While upright- lower portion of RLL
While supine- superior portion of RLL |
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Structures perforating diaphragm
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T8- IVC
T10- esophagus, vagus T12- aorta, thoracic duct, azygous vein |
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Inspiration during exercise
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use external intercostals, scalene mm, sternomastoids
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Expiration during exercise
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use rectus abdominis, internal and external obliques, transversus abdominis, internal intercostals
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Law of Laplace
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tendency of lung to collapse on expiration as radius decreases
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Tidal volume
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air that moves into lung with each quiet inspiration, typically 500 mL
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Functional residual capacity
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FRC= RV + ERV
volume in lungs after normal expiration |
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Vital capacity
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IRV+TV+ERV
everything but the residual volume |
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Physiologic dead space
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VD
=anatomical dead space of conducting airways plus functional dead space in alveoli- apex of lung largest contributor to functional dead space |
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Relaxed Hgb
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high affinity for O2
300x more than taut form hgb has positive cooperativity and negative allostery |
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Fetal hgb
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2 alpha and 2 gamma subunits
lower affinity for 2,3-BPG than adult hgb and thus higher affinity for O2 |
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tx CN poisoning
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use nitrites to oxidize hgb to methemoglobin, which binds cyanide, allowing cyt oxidase to function
use thiosulfate to bind this cyanide, forming thiocyanate, which is renally excreted |
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Methemoglobin
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oxidized form of hgb- ferric, Fe3+
does not bind O2 as readily has inc affinity for CN tx with methylene blue |
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Carboxyhemoglobin
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hgb bound to CO, causes dec O2 binding capacity with left shit, dec O2 unloading in tissues
CO has 200x greater affinity for hgb than O2 |
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Right shift of oxygen hgb dissociation curve
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high CO2, high BPG, exercise, high acid/altitude, high temperature
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Primary pulm htn
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due to inactivating mutation in BMPR2 gene- normally inhibits vascular smooth muscle proliferation
poor prognosis |
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Pulm htn
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> 25 mm Hg or > 35 during exercise
nml pulm artery pressure- 10-14 mm Hg 2ndary causes include COPD, MS, recurrent thromboemboli, autoimmune dse, L to R shunt, sleep apnea, living at high altitude |
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Nml Hgb amount in blood
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15 g/dL
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O2 binding capacity
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20.1 mL O2/ dL
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Exercise dec
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venous Po2
inc venous Pco2 |
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Cyanosis
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deoxy Hgb > 5 g/dL
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Normal Aa gradient
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10-15 mm Hg
inc grad may occur in hypoxemia, causes include shunting, V/Q mismatch, fibrosis- impairs diffusion |
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Hypoxemia
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dec PaO2
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Hypoxia
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dec O2 delivery to tissue
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Causes of hypoxemia with nl Aa gradient
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High altitude
Hypoventilation |
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Causes of hypoxemia with inc Aa gradient
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V/Q mismatch, diffusion limitation, R to L shunt
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Ischemia
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loss of blood flow
can be due to impeded arterial flow, reduced venous drainage |
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V/Q at Apex of lung
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3
wasted ventilation |
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V/Q at base of lung
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0.6
wasted perfusion |
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V/Q approaches 0
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airway obstruction- shunt
100% O2 will NOT improve Po2 |
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V/Q approaches infinity
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blood flow obstruction- physiologic dead space
Assuming <100% dead space, 100% O2 will improve Po2 |
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Haldene effect
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In lungs, oxygenation of Hgb promotes dissociation of H+ from Hgb
shifts equilibrium toward CO2 formation, therefore CO2 released from RBCs |
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Bohr effect
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in peripheral tissue, inc H+ from tissue metabolism shifts curve to right, unloading O2
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Response to high altitude
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inc ventilation, inc Epo, inc 2,3 BPG, inc mitochondria, inc renal excretion of bicarb to counter resp alkalosis
chronic hypoxic pulm vasoconstriction results in RVH |
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Fat emboli
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associated with long bone fractures and liposuction
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Amniotic fluid emboli
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can lead to DIC, especially post partum
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Imagine test of choice for PE
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Helical CT
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lines of Zahn
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interdigitating areas of pink and red, represents layers of RBCs, platelets, and fibrin
represents thromboembolus |
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COPD
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air trapping in lungs, inc RV, dec FVC, more dec FEV1, dec FEV1/FVC is hallmark, V/Q mismatch
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Reid index
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gland depth/ total thickness of bronchial wall
>50% in chronic bronchitis |
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Chronic bronchitis
blue bloater |
hypertrophy of mucus secreting glands, dse of small airways
wheezing, crackles, cyanosis- early onset hypoxemia due to shunting, late onset dyspnea |
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Emphysema
pink puffer |
enlargment of air spaces, dec recoil, inc compliance, inc elastase activity, exhalation through pursed lips to inc airway pressure and prevent airway collapse during resp
barrel chested |
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Asthma
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bronchial hyperresponsiveness causes reversible bronchoconstriction
smooth muscle hypertrophy, Curschmann's spirals- shed epithelium from mucous plugs |
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Bronchiectasis
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chronic necrotizing infxn of bronchi leads to permanently dilated airway, purulent sputum, recurr infxns, hemoptysis
ass with bronchial obstruction, smoking, Kartagener's can lead to aspergillosis! |
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Restrictive lung dse
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dec lung voumes, dec FVC and TLC, dec FVC more than FEV1, FEV1/FVC > 80%
due to poor breathing mechanics or interstitial lung diseases |
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Caplan's syndrome
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pneumoconioses + rheumatoid arthritis
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Sarcoidosis
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bilateral hilar lymphadenopathy, noncaseating granuloma, inc ACE and calcium
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Silicosis
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pneumoconiose, ass with sandblasting, foundries and mines
macrophages respond to silica and release fibrogenic factors, leading to fibrosis eggshell calc of hilar LNs inc susceptibility to TB |
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Asbestosis
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ass with shipbuilding, roofing, plumbing
ivory white calcified pleural plaques affects lower lobes ass with inc incidence of bronchogenic carcinoma and mesothelioma asbestos bodies look like dumbbells, located inside macrophages |
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Obstructive sleep apnea
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respiratory effort against airway obstruction
chronically tired |
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Small cell carcinoma of lung
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very aggressive, inoperable, neoplasm of neuroendocrine Kulchitsky cels- small dark blue cells
ass with production of ACTH or ADH, may lead to Lambert Eaton syndrome- autoantibodies against ca channels centrally located |
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Squamous cell ca of lung
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hilar mass arising from bronchus, cavitation, central, linked to smoking, parathyroid like activity- PTHrP
keratin pearls and intracellular bridges |
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Mesothelioma
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located in pleura, ass with asbestosis, results in hemorrhagic pleural effusions and pleural thickening, Psammoma bodies
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SVC syndrome
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obstruction, impairs drainage from head neck and upper extremities
JVD edema inc intracranial pressure |
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Causes of lobar pneumonia
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Strep pneumo, Klebsiella
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Causes of bronchopneumonia
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Staph aureus, H flu, Klebsiella, Strep pyogenes
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Causes of interstitial atypical pneumonia
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RSV, adenovirus, Mycoplasma, Legionella, Chlamydia
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Hypersensitivity pneumonitis
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mixed type III/IV hs rxn to environmental ag
dyspnea, cough, chest tightness, HA seen in farmers and those exposed to birds |
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Air fluid levels seen on CXR
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Lung abscess
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Lymphatic pleural effusion
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chylothorax, milky appearing fluid, inc TG
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Spontaneous pneumothorax
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accumulation of air in pleural space
MC in tall, thin, young males bc of rupture of apical blebs trachea deviates toward affected lung |
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Tension pneumothorax
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trauma or lung infxn, air enters pleural space but cant exit, trachea deviates away from affected lung
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1st gen H1 blockers
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reversible inhibitors of H1 histamine receptors
diphenhydramine, dimenhydrinate, chlorpheniramine tx allergy, motion sickness, sleep aid tox sedation, antimuscarinic, anti alpha adrenergic |
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2nd gen H1 blockers
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loratadine, fexofenadine, desloratadine, ceterizine
tx allergy less sedative than 1st gen bc dec CNS entry |
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beta 2 agonists
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albuterol- used in acute exacerbation of asthma, salmeterol- long actig agent for prophylaxis
relaxes bronchial smooth muscle |
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non selective beta agonist
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isoproterenol
relaxes bronchial smooth muscle adverse effect tachycardia |
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Theophylline
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inhib phosphodiesterase, bronchodilation, narrow TI- cardio and neuro tox
blocks action of adenosine |
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Cromolyn
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prevents release of mediators from mast cells
only effective for prophylaxis of asthma, not during acute attack |
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1st line therapy for chronic asthma
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corticosteroids- beclomethasone, prednisone
inactivate NFkB, transciption factor induces prod of TNF alpha and other inflamm agents |
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Zileuton
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blocks conversion of arachidonic acid to leukotrienes
5-lipoxygenase pathway inhibitor |
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Zafirlukast, montelukast
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block leukotriene receptors
good for aspirin induced asthma!! |
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Ipratropium
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antimuscarinic, prevent bronchocontriciton
tx asthma, COPD |
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Methacholine
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muscarinic receptor agonist
used in asthma challenge testing |
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Guaifenesin
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expectorant- removes excess sputum
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N-acetylcysteine
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mucolytic, loosens mucous plugs in CF pts, antidote for acetaminophen overdose
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Bosentan
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tx pulm htn
competitively antagonizes endothelin 1 receptors, dec pulm vasc resistance |
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Dextromethophan
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antitussive, antagonizes NMDA glutamate receptors, synthetic codeine analog, mild opioid effect
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Psuedoephedrine, phenylephrine
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alpha agonists, nasal decongestants, stimulant
tox htn, CNS stim/anxiety |
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ARDS
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diffuse alveolar damage- inc alveolar capillary permeability- protein rich leakage into alveoli, results in formation of intra alveolar hyaline membrane
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