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84 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Where in the respiratory tract do goblet cells stop?
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bronchi
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Where does the pseudostratified ciliated columnar cell type end in the respiratory tract? What lines the rest?
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respiratory bronchioles
squamous epi (Type 1 pneumocytes) |
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What does the mnemonic RALS mean?
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Right - Anterior
Left - Superior the relation of the pulmonary artery to the bronchus at each hilum |
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What is the most vulnerable place for aspirate while supine?
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superior portion of right inferior lobe
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What structures perforate the diaphragm at: T8? T10? T12?
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T8 - IVC
T10 - esophagus, vagus T12 - aorta, azygous vein, thoracic duct |
"I ate (8) 10 Eggs At 12"
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Where does referred pain from the diaphragm go?
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the shoulder
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What are the accessory muscles of inspiration?
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external intercostals
scalene sternomastoids |
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What are the accessory muscles of expiration?
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internal and external obliques
transversus abdominis internal intercostals rectus abdominis |
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What is the vital capacity?
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tidal volume + inspiratory reserve + expiratory reserve
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What is the formula for dead space (Vd)?
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Vt x (PaCO2 - PeCO2)/PaCO2
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Why does fetal Hg have higher affinity for O2 than adult?
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because it has lower affinity for 2,3-BPG, which tends to kick off O2
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Which state is iron usually in when loaded in Hg?
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reduced state (Fe2+) = ferrous
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How do you treat Methemoglobinemia?
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with Methylene blue
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Why do nitrites work for treating cyanide poisoning?
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they oxidize Hg to methemoglobin, which binds CN- more readily than O2 so that cytochrome oxidase can continue to function.
*Add thiosulfate to bind the Hb-CN- complex and form thiocyanate which is renally excreted |
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What happens to the P50 during a left vs. right shift of the Hg dissociation curve?
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left = dec. P50
right = inc. P50 |
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What is normal pulmonary artery pressure? What is the cut-off for pulmonary HTN?
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normal = 10-14 mmHg
HTN = >25mmHg |
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What causes primary pulmonary hypertension?
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inactivating mutation in the BMPR2 (a TGF-R) gene which normally functions to inhibit vascular smooth muscle proliferation
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poor prognosis
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What are the causes of secondary pulmonary HTN
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COPD
mitral stenosis left-to-right shunt recurrent thromboemboli autoimmune disease |
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How do you calculate O2 content?
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O2 binding capacity (20.1) x %sat
+dissolve O2 |
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When does PaO2 decrease?
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NOT affected by Hb
only drops if chronic lung disease because physiologic shunt decreases the O2 extraction ratio |
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Which measures are affected by Hb status?
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O2 binding capacity and therefore O2 content
NOT O2 saturation and PaO2 |
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What is the alveolar gas equation?
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PAO2 = PIO2 - (PACO2/R)
approximated by: PAO2 = 150 - (PACO2/0.8) |
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What causes an increased A-a gradient?
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R ==> L shunt
V/Q mismatch fibrosis (diffusion block) |
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What is the difference between hypoxemia and hypoxia?
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Hypoxemia is synonymous with decreased PaO2
Hypoxia is coupld be due to hypoxemia but could also have normal PaO2 but you're not getting that O2 to the tissues for whatever reason |
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What causes hypoxemia?
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Normal A-a gradient: high altitude or hypoventilation
Inc. A-a gradient: V/Q mismatch, diffusion limitation, right-to-left shunt |
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What causes hypoxia?
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anemia
dec. CO CN poisoning CO poisoning (hypoxemia) |
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What does a V/Q mismatch approaching zero indicate?
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Airway obstruction and/or shunt
100%O2 does NOT improve PO2 |
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What does a v/q mismatch approaching infinity mean?
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Blood flow obstruction (physiologic dead space)
100% O2 does help PO2 |
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How do the kidney compensate for high altitude?
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Increase excretion of bicarbonate to compensate for respiratory alkalosis
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What happens to the v/q mismatch during exercise?
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Vasodilation at the apex allows it to become more uniform across the lungs
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What are the findings in COPD?
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Early onset hyoxemia (due to shunting) but late onset dyspnea
Wheezing, crackles, cyanosis |
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What are the findings in emphysema?
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Early onset dyspnea, later onset hyoxemia
Decreased breath sounds, tachy |
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What are the different subtypes of emphysema and what are they associated with?
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Centriacinar - caused by smoking
Panacinar - caused by alpha1-anti trypsin deficiency Paraseptal - bullae, can rupture, spontaneous pneumothorax in young healthy males |
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What drugs can cause restrictive lung disease?
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Bleomycin
Busulfan Amiodarone |
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What do asbestos bodies look like?
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Golden-brown fusiform rods resembling dumbells inside macrophages
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What does asbestosis look like grossly?
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Ivory white calcified pleural plaques
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What are the in utero findings for lung maturity?
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The lecithin-to-sphingomyelin ratio should be >1.5
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Histopathology of ARDS
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Damage to capillaries/alveolar wall from neutrophilic substances, coag cascade or free radical causes Inc. capillary permeability leads to protein rich exudate into alveoli resulting in the formation of an intra-alveolar hyaline membrane
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What are the physical exam findings in pneumonia?
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bronchial breath sounds over lesion
dullness to percussion increased fremitus |
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What are the most common cancer mets to the lung?
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breast
colon prostate bladder |
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What are the most common cancer mets from the lung?
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adrenals
brain bone liver |
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Which paraneoplastic syndrome is associated with squamous cell carcinoma of the lung?
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PTHrP
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What is the histologic finding of squamous cell carcinoma of the lung?
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keratin pearls
intracellular bridges |
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Where is squamous cell carcinoma usually located within the lung?
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hilar mass arising from bronchus
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What is the histo of lung adenocarcinoma?
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clara cells ==> type II pneumocytes
multiple densities on CXR |
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What condition can bronchioalveolar lung cancer result in?
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hypertrophic osteoarthropathy
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Where is small cell lung cancer usually located?
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centrally
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What is the histology of small cell lung cancer?
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neoplasm of neuroendocrine Kulchitsky cells ==> small dark blue cells
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What paraneoplastic syndromes is small cell lung cancer associated with?
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ACTH (cushing)
ADH (SIADH) Lambert-Eaton syndrome |
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Large cell carcinoma histology
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pleomorphic giant cells with leukocyte fragments in cytoplasm
highly anaplastic, undifferentiated |
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Which lung cancers are resectable?
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large cell
carcinoid maybe adeno and squamous cell but NOT small cell |
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Carcinoid tumor of the lungs characteristics
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secretes serotonin - carcinoid syndrome:
flushing wheezing diarrhea salivation fibrous deposits in right heart ==> tricuspid insufficiency, pulmonary stenosis and right heart failure |
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Histology of mesothelioma
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psammoma bodies
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Which types of lung cancer can cause Horner's syndrome?
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non-small cell tumors (peripheral)
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Superior vena cava syndrome findings:
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obstruction of SVC by tumor/thrombis ==> inc. intracranial pressure and risk of aneurysm
JVD facial plethora |
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What is hypersensitivity pneumonitis?
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Mixed type III/IV hypersensitivity rxn to env. antigen usually found in farmers and bird breeders
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What are the findings in hypersensitivity pneuomonitis?
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bibasilar alveolar inflammation
dry rales diffusion coefficient looks like interstitial lung disease or atypical pneumonia on CXR |
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What is Farmer's lung?
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they get granulomas and inc. risk of
actinomyces aspergilla |
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What bugs most commonly cause lobar pneumonia?
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strep pneumo
klebsiella |
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What bugs most commonly cause bronchopneumonia?
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S. aureas (esp. post-flu)
H. flu (esp. in kids) S. pyogenes Klebsiella (diabetics and alcoholics) |
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What bugs most commonly cause interstitial pneumonia?
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viruses (RSV, adenovirus)
Mycoplasma (old kids/young adults) Chlamydia Legionella |
aka "atypical" or "walking" pneumonia
non-productive cough |
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What bugs are most common for lung abscesses?
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S. aureus
anaerobes (bacteroides, peptostrep) |
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What are the 1st generation H1 blockers?
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diphenhydramine (benadryl)
dimenhydrinate chlorpheniramine |
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1st generation H1 blockers clinical use?
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allergic reaction (hives)
motion sickness sleep aid |
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1st generation H1 blockers toxicities?
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sedation
antimuscarinic (urinary retention) anti-alpha-adrenergic (hypotension) |
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What are the 2nd generation antihistamines?
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loratadine
fexofenadine desloratadine cetirizine |
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Why is isoprotenerol helpful in asthma?
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B2 agonist- relaxes bronchial smooth muscle
B1 agonist - adverse effect tachycardia |
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What class of drugs is theophylline?
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methylxanthine
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What is theophylline used for?
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asthma
causes bronchodilation by inhibiting phophodiesterase, thereby dec. cAMP hydrolysis |
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Theophylline toxicity
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narrow therapeutic index so usage is limited
cardiotoxic neurotoxic metabolized by P-450 blocks actions of adenosine |
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Ipatropium MOA
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competitive block of muscarine receptors (M3) preventing bronchoconstriction
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Ipatropium clinical use
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asthma
COPD |
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Zileuton MOA
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blocks conversion of arachidonic acid to leukotrienes
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Zafirlukast, montelukast MOA
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block leukotriene receptors
especially good for aspirin-induced asthma |
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Omalicumab MOA
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monoclonal antibody IgG that binds to IgE so it can't bind to mast cells and prime for allergic rxn
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N-acetylcysteine clinical use
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mucolytic - can loosen mucous plugs in CF patients
antidote for acetaminophen overdose |
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Bosetan MOA
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competitively antagonized enothelin-1 receptors, decreasing pulmonary vascular resistance
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Bosetan clinical use
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pulmonary HTn
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Dextromethorphan MOA
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antagonizes NMDA receptor
synthetic codeine analog |
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Dextromethorphan clinical use
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cough suppressant
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Pseudoephedrine MOA
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alpha-adrenergic agonist so:
dec. hyperemia dec.edema nasal decongestant open EU tubes |
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Pseudoephedrine toxicity
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HTN
CNS stimulation - anxiety |
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Methacholine MOA
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non-selective muscarinic receptor agonist - causes bronchoconstriction
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Methacholine clinical use
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asthma challenge
(sensitive but not specific test) |
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