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225 Cards in this Set
- Front
- Back
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respiratory zone of lung consists of
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respiratory bronchile, alveolar duct, alvelo
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where does cartilage end in lung
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bronchi
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where is resistance highest in lung
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medium airways (i.e. segmental bronchi)
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what is needed for coordinated beating of cilia
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gap jcn
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where do goblet cells end in lung
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bronchi
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L/S ratio of what in amniotic fluid indicates maturity
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2
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shape of pneumocytes (1,2, clara)
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sqam, cub, col
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which pneumocytes degrade toxins
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clara cells
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what are lamellar bodies
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contain curfactant
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what innervates juxacapillary receptors
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cnx
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what do j receptors respond to
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vessel dilation
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where are the inferior borders of the pleural membrane located
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2,4,6,8,10,12th rib
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location of arteries vs veins in bronchopulmonary segment
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arteries (both pulmonary and bronchial!) and airway in center, veins & lymphatics on periphery
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relation of pulmonary artery to bronchus on right vs left
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right side, is anterior. Left side, is superior
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if you aspirate a peanut while lying down, where is going to end up
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sup right inf lobe
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if you aspirate a peanut while standing, where is going to end up
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inf right inf lobe
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where is the oblique fissure located in the posterior view
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t2
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at what levels do the following perforate the diaphragm: thoracic duct, azygos, vagus, ivc, esopagus, aorta
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12, 12, 10, 8, 10, 12
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what muscles play a role in inspiration during exercise
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EXTERNAL intercostal, scalene, sternomastoid
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what muscles play a role in expiration during exercise
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abdominal muscles, internal intercostals
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what increases surfactant production
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cortisol, thyroxine
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what decreases surfactant production
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insulin
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what organ produces kallikrein, what does it activate
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lung, bradykinin
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effect of surfactant on work of inspiration
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decreases
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draw out the lung volumes chart
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p504
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when is pulmonary vascular resistance the lowest
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after tidal volume (i.e. at frc)
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physiologic dead space
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tidal volume * fractional co2 excreted ~150mL = anatomic dead space + functional dead space from nonexchanging areas (eg apex)
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what is intrapleural pressure at frc
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negative
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compliance change w/ insufficient surfactant
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decreased
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compliance change w/ pulmonary edema
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decreased
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which form of hg has high affinity
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relaxed
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affinity of 2,3-bpg in fetal hemoglobin
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decreased
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factors which left shift curve:
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decreased c02, temp, acid, 2,3dpg
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effect of co on curve
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reduces max sat and also left shift (decrease p50)
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what things can right shift curve
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increased co2, temp, acid, 2,3 dpg, methemoglobinemia
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methemoglobin's affinity for CN
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increased
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how to tx cyanide poising
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give nitriate, which converts to methemoglobin, which then allows binding to cyanide, then give thiosulfate to bind it from hemoglobin
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drugs that cause methemoglobin
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malarial, dapsone, sulfonamide, local anesthetic, metoclopramide, nitrite
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what hemoglobin change is mountain water likely to produce
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increased nitrates, so methemoglobinemia
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cherry red pigment and headache in elderly
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CO poison
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consequences of PH on blood vessel
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atherosclerosis, medial hypertrophy, intimal fibrosis of pulm art
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why does co left shift curve
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cuz it makes hemoglobin have greater affinity for o2
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why does COPD cause PH
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destruction of lung parenchyma increases resistance
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why does mitral stenosis cause PH
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increased backup to lung
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why does recurrent emboli cause PH
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results in fewer parallel pathways, increases resistance
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why does autoimmune dz cause PH
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inflammation causes intimal fibrosis and medial hypertrophy
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why do cardiac defects cause PH
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L->R shunts increase flow and thus shear stress, which causes endothelial injury
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why does sleep apnea cause PH
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hypoxic vasoconstriction
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why does chronic high altitude cause PH
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hypoxic vasoconstriction
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does co disrupt etc
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binds complex iv
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how to distinguish acute respoiratory acidosis from CO, CN poisoning from o2 stats
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RA will have decreased pO2
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when does pulmonary circulation because diffusion limited
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emphysema (less surface area), fibrosis (increased thickness), CO poison
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gene defect in 1* pulm hypertension. what does it do?
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bmpr2 (inhibits vascular smooth muscle proliferation)
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normal pulmonary a pressure
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10 to 14
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pulmonary a pressure in htn
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>25
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what infections is 1* pulm htn assoc w
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hiv, hhv8
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cxr finding of pulm htn
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tapering of pulmonary a, rv enlargement
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equation of resistance
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nl/r^4
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oxygen content of blood
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binding cap * sat + po2
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how to calculate PAO2
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pAo2 = pIo2 - pAco2/R ~ 150 - alveolar co2/.8
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explain normal A-a gradient w/ hypoxemia
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extrapulmonary cause (e.g. respoiratory center depression, airway obstruction, paraplysis)
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another way to assess alveolar oxygenation
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Pao2/Fio2 (300-500 = normal, <300 = gas exchange issue, <200 = ards)
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hypoxemia vs hypoxia
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hypoxemia is lowered arterial oxygen pressure. Hypoxia is lowered oxygen to tissues
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causes of hypoxemia
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high altitude, hypoventilation, v/q, diffusion, r-l shunt
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v/q at apex vs base
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3 vs .6
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where will TB survive
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apex of lung
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vq = 0 vs infinity. Does oxygen help?
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vq = 0 is shunt (oxygen can't improve po2), vq=infinity is dead space (oxygen helps)
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how much oxygen can 1g hemoglobin bind
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1.34mL
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what is the o2 binding capacity normally
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20.1 mL O2/ dL
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how to quantify how much oxygen delivered to tissues
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CO * o2 content of blood
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haldane effect
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increased o2 at alveoli displaces h+, which causes to combine with bicarb and form co2
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response to high altitude
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increased ventilation, increased epo, increased 2,3dpg, increased mito, increased bicarb excretion, rvh
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response to exercise
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increased co2 production, o2 consumption, ventilation rate, v/q matching, increased pulmonary flow, increased lactic acid, no change in pao2 or paco2, but increased venous co2
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what is imaging test of choice for PE
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ct angiography
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how does peripheral a dz present differently than dvt
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weak pulse, pallor, poor capillary refill (problem is in getting blood in)
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virchows' triad
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hypercoag, stasis, endothelial dmg
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prevention for dvt
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heparin
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pft in obstructive lung dz
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increased frc, decreased fvc and fev1, and decrease in ratio. but tlc is up
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definition of chronic bronchitis
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productive cough >3 mo in 2 yrs
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what type of airways does chronic bronchitis affect
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small airways
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which obstructive lung disease is likely to have early onset hypoxemia
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chronic bronchitis
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which obstructive lung disease is likely to have early onset dyspnea
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emphyseam
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which obstructive lung disease is likely to have eosinophils
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asthma
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panacinar vs centriacinar emphysa: which lobes
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panacinar = lower, centriacinar = upper
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which emphysema is primary in respiratyr bronchioles
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centriacinar
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which obstructive dz likely to see curschmann's spirals
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asthma
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why likely to see pulsus paradoxus in obstructive lung dz, and what is it most assoc w/
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exaggerated inspiration produces longer period of pulmonary resistance. most assoc w asthma?
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associations for bronchiectasis
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bronchial obstruction, cf, kartageners
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intrinsic asthma - what is triggered by
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aspirin, nsaid
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where is infarct of lung likely to be located
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periphery, in widge shaped config
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nasal polyps: children vs adults
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children usually cf, adults usually long standing allergies and rhinitis
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causes of restrictive lung dzz
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poor chest expansions (neuromuscular, structural), interstitial - ards, neonatal, sarcoid, idiopathic pulm fib, goodpasture, wegener, eosinophilic granuloma, drug tox
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what causes eosinophilic granuloma
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histiocytosis x
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which pneumoconioses accoc/ w/ cancer
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silicosis, asbestos
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which pneumoconioses assoc/ w/ increased risk of tb
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silicosis
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what is caplan's syndrome
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pneomuconiosis + cavitating rheumatoid nodules
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which pneumoconiosis affects the upper lobes
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coal miners, silicosis
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eggshell calcification on hilar lymph nodes
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silicosis
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ferruginous bodies
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asbestosis
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calfied pleural plaques
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asbestosis
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when is cutoff point (time) for neonatal surfactant worrying
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34 weeks
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risk factors for neonatal rds
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prematurity (immature lung), maternal diabetes (insulin inhibits surfactant), cesarean delivery (no stress means no cortisol)
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risk of supplemental o2 in neonatal rds
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retinopathy of prematurity
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what pneumoconiosis may disrupt phagolysososmes and impair macrophages
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silicosis
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causes of ards
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trauma, sepesis, shock, gastric aspiration, uremia, pancreatitis, amniotic fluid emboism
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course of dmg from ards
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release of neutrophlic substances, actrivation of coag cascade, ros
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central vs obstructive sleep apnea
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both stop breathing for at least 10s. Central has no respiratory effort
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blood changes in sleep apnea
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epo
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breath sounds, resonance, fremitus, trachealdeviation for: bronchial obstruction, pleural effusion, pneumonia, tension pneumo, spont pneumo
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p512
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solitary coin lesion in periphery of lung
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bronchial hamartoma (bening)
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complications of lung cancer
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svc syndrome, pancoast, paraneoplastic, hoarseness, effusion, esophageal
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radon toxicty
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lung cancer
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location of : scc, adenocarcion, small cell, large cell, carcinoud, mesotheliuim
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scc and small = central
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which cancer has psomma body
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mesothelima
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which cancer can result in hypertrophic osteoarthropathy
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bronchioalveolar carcionma
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which is neoplasm of kulchitsky cells
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small cell
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which cancer is chromogramin, synaptophysin, enolase +
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small cell
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whch cancer is inoperable
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small cell
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which cancer can lead to muscle weakness
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small cell
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what can cause pain radiating to axilla and scapula
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pancoast
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normal cyanosis vs differential cyanosis
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eisenmenger & tetrology vs adult coarc and pda
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mcc of lobar pneumonia
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pneumococcus, kleb
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what is bronchopneumonia? mcc?
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acute inflammatory infiltrate spanning bronchioles to alveoli -- patchy distribution may involve more than 1 lobe... s aureus, hflu, klebs, spyogenes
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which type of pneumonia involves more than 1 lobe
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bronchopneumonia
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causes of pleural transudate
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chf, nephrotic, cirrhosis, pulmonary embolism
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causes of pleural exudate
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malig, pneumonia, collagen vasuclar dz, trauma
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why is 1g histamine block a suboptimal sleep aid
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decrease rem sleep
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what is the most sedating 2g antihistamine
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cetirizine
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adverse effect of salmeterol
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termore and arrythmia
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what drugs inactivate nfkappab
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corticosteroid
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best tx of aspirin asthma
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zafirlukast, montelukast
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which antileukotriene is best for age >1? Age>5
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montelukast, zafirlukast
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mechanism of guaifenesin
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stimulate vagus to generate low visc secretion
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what drugs can supress cough reflex
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opoids
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mechansm of bonsetan
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ag of endothelin-1 receptor
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minute ventilation vs alveolar ventilation
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minute = tidal * breaths/min. alveolar = (tidal - dead space) * breaths
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what is physiologic shunt
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2% of cardiac output bypasses pulm circulation
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where is medullar respiratory center located
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reticular formation
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input to medullary resporatory center
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ix (peripheral chemo), x (peripheral chemo & mechano)
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dorsal group vs ventral group medullary resp center (
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dorsal = inspiration. Ventral = expiration, not active during quiet breathing
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apneustic center - locaton and function
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lower pons. Stimulates deep and prolonged gasp
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pneumotaxis center
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upper pons - inhibs inspiration
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chemoreceptor status in ppl with chronic lung dz
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central chemorceptors lose ability and peripheral ones take over
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sx of choanal atresia
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cyanosis while feeding
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infectious causes of sinusitis
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rhino, s pneumo, anaerobes, fungi
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sinusitis aduts vs childre
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maxillary in adults, ethmoid in children
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where are laryngeal carcinoma usually located
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true vocal cord
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resportion vs compression atelectasis
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resportion - mucus after surg, carcionma -> obstruction -> no fibraiton, dullness on persussion, potential deviation of trachea. Compression - mass effect forcilby compressing lung and collapsing it
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bronchopulmonary dysplasia complication of
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o2 therapy w/ rds
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how to tell b/w ards and cardiogeneic pe
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pcwp higher than 18 in cardiogenic shock
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presentation of typical pneumonia
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sudden onset of high fever w/ productive cough
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mcc of nosocomial pneumonia
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if on respirator, pseudomonas. Also see e coli and gm+
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causes of pneumonia in ic
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cmv, pcp, aspergillus
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virulence factor of TB
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cord factor
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tb resistance mechanisms
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mycolic acid, catalase peroxidase
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most common site of spread for miliary tb
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kidney
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cuase and organisms of lung abscess
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bronchial obstruction or aspiration - s aureus, aerobic and anaerobic strep, kleb
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sx of lung abscess
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spiking fever w/ productive fould smelling cough
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do you see eosinophilia or ige in hypersensitivity pneumoninits
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no
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allergic subsatance in farmers lung
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thermophilic actinomyces (s reticuvirgula), moldy hay
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allergic substance in silo fillers dz
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gas
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allergic substance in byssinossi
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cotton linen, hemp, "Monday morning blue"
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cxr finding (heart) of emphysema vs chronic bronchitis
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vertical vs horizontal heart (cuz bronchitis isually obese)
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factors involved in extrinsic astham
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induction of th2 leads to il4 (ige) and il5 (eosinophil)
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where does bronchietcasis usually occur
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lower lobes
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where are neurogenic tumors usally located. what are they in adult and child
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post mediastinum, neuroblastoma (malig) in child, ganglioblastoma in adult(bening)
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what is the most common mediastinal mass
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neruogenic tumor
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what neuromuscular disease may produce a neoplasm that may affect breathing function by compression
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myasthenia -> thymoma
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what lymphoma is likely to occur in ant mediastiunum
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nodular sclerosing hodgenik
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locations for teratoma
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genital, ant mediastinum, sella?
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when do you see pseudochylous pleural effusion
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milky inflammation w/ necrotic debris from RA
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pleural fluid: transudate vs exudate
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exudate: higher protein, ldh, and lower ph
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sx of pleural effusion on cxr
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blunting of costophrenic angle and obscure diapram
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stages of lobar pneumonia
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congestion (first 24h, red boggy lobe, exudate) -> red hepatization (day 2-3, red firm, pmn exudate) -> gray hep (d4-6, gray, degraded rbc, exudate of neutrophil and fibrin) ->resulotion
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what antineoplastic drug can cuase hypersensitivity pneumonitis
|
mtx lugn
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uses of n acetyl cysteine
|
expectorant, acetominophen tox, tx of iv contrast induced nepropathy
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describe how the physiologic chloride shift works
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co2 from venous blood enters RBC, which contains CA. h+ is bound to Hg, and hco3 gets ejected in exchange for cl
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where will things aspirate if lying on left side
|
lingula of left lung
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where will things aspirate if lying on right side
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middle of right lung or post upper right lung
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3 things that can decrease lung compliance
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1. pulmonary fibrosis 2. less surfactant 3. pulmonary edema
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diverticula that have attenuated muscularis externa
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false diverticula
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diverticula that span all layers of intenstial wall
|
true diverticula
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mechanism of bosentan
|
endothelin-1 antagonist (tx 1* PH)
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who is predisposed to get aspiration abscesses
|
1. bronchial obstruction 2. ppl predisposed to loss of (eg alcoholic epileptic)
|
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columnar mucin secreting cells that span alveoli
|
bronchialveolar carcinoma
|
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what part of respiratory tree is affected by chronic bronchitis
|
small airways (bronchioles)
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what type of cells present in infiltrate seen w chronic bronchitis
|
cd8, NO EOSINOPHILS UNLIKE ASTHMA
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what fungal infection is likely to occur in bronchiectasis pt
|
aspergillosis
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what type of lung dz will eosinophilic granuloma cause
|
restrictive lung dz
|
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best way to dx pulmonary embolism
|
ct angiography
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why is there no wheezing or crackles in emphysema
|
there is no forced opening of small airways
|
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what kind of lung dz can cause pulsus paradoxicus
|
obstructive lung dz
|
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why can emphysema result in hypoventilation
|
resetting of central chemoreceptor set point
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what obstructive lung dz can cause hemoptysis
|
bronchiectasis
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what obstructive lung dz is characterized by necrotizing infections
|
bronchiectasis
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what airways are affected in bronchiectasis
|
bronchi
|
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what are curshmanns spirals
|
shed epithelium forming spirals around mucus plugs in asthma
|
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what pneumoconiosis can cause a noncaseating granuloma
|
beryllosis
|
|
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why does silicosis have increased susceptibility of tb and cancer
|
disruption of phagolysosomes and impairing macrophages
|
|
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what pneumoconiosis can result in calcification
|
eggshell calcifaction of hilar lymph in silicosis, calcified pleural plaques in asbestosis
|
|
|
exposure to flourescent light bulbs may cause
|
beryllosis
|
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|
uremia can cause what lung dz
|
ards
|
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pancreatitis can cause what lung dz
|
ards
|
|
|
3 mechanisms of dmg in ards
|
1. neutrophil toxicity to alveolar wall 2. activation of coagulation cascade 3. ros
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|
|
pattern of breathing w/ deeper and faster breathing followed by apnea
|
cheyne stokes breathing
|
|
|
what is source of dmg in cheyne stokes
|
respiratory centers, chf, high altitude
|
|
|
horner + shoulder pain + potential hand weakness
|
pancoast tumor (i.e. superior sulcus tumor)
|
|
|
facial swelling and headache from tumor
|
svc syndrome from mediastinal mass
|
|
|
do you see calcifications in lung cancer
|
no
|
|
|
where does adenocarcinoma usually occur
|
site of prior pulmonary injury or inflammation
|
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what type of lung cancer has increased conversion of clara cells to type 2 pneumocytes? how is this assessed?
|
adenocarcinoma. will see multiple densities on cxr
|
|
|
wat can cause differential blood pressure
|
adult coarctation (which has no cyanosis), and PDA w/ eisenmenger (which DOES have cyanosis)
|
|
|
is strep pneumo a nosocomia infection
|
no
|
|
|
what allergy medicine can cause overflow incontinence
|
anything that has antimuscarinic properties -- including 1g antihistamine, ipratropium (if not inhaled)
|
|
|
how to tell apart infarct vs lung abscess on cxr
|
infarct is on periphery, wedge shaped. abscess is pale colored, round, in parenchyma
|
|
|
usual causes of abscess
|
1. bronchial obstruction 2. aspiration
|
|
|
sinusitis in adults vs children
|
maxillary sinus vs ethmoid sinus
|
|
|
causes of sinusitis
|
URI (rhinovirus, s pneumo), nasal anatomy problems, allergic rhinits
|
|
|
foul smelling cough
|
aspiration - pneumonia, abscess, bronchiectasis
|
|
|
stages of lobar pneumonia
|
congestion -> red hepatization (neutrophils; red; d2-3) -> gray hepatization (gray; rbcs degrade; d4-6) -> resolution
|
|
|
what can cause a milky pleural effusion with increased necrotic debris
|
pseudochylous = RA
|
|
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why does exercise improve the v/q ratio
|
vasodilation of apex
|
|
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among the bronchogenic carcinomas, which is most likely to cause svc syndrome
|
small cell
|
|
|
what respiratory drug has risk of cardiotoxicity and neurotoxicity
|
theophylline
|
|
|
what drug can theophylline competitively block
|
adenosine
|
