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68 Cards in this Set

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What clue can you get from amniotic fluid if a fetus's lungs are mature yet?
lecithin : sphingomyelin ratio > 2.0 (surfactant made of lecithin)
What is the role of Type II pneumocytes?
- make surfactant
- precursor to Type I and II
- proliferate during lung damage
Do the Lungs have continuous or fenestrated capillaries?
continuous
In a histo section, if you see a blood vessel near a bronchiole, you know the vessel is:
artery (run with airways)
How many lobes does the Right Lung have? The Left Lung?
3; 2 and a lingula
The pulmonary artery is ___ to the right mainstem bronchus and ___ to the left mainstem bronchus.
anterior; superior
The inferior vena cava perforates the diaphragm at the level of:
T8
The esophagus and 2 vagus nerves perforate the diaphragm at the level of:
T10
The aorta, azygous vein, and thoracic duct perforate the diaphragm at the level of:
T12
The diaphragm is innervated by the ___ nerve, which is made of cervical spinal nerves ___, ___, and ___.
phrenic; C3, 4, 5
What muscles do you use during exercise to breathe in?
external intercostals, scalene, sternomastoids
What muscles during exercise do you use to breathe out?
internal intercostals, external & internal obliques, rectus abdominis, transversus abdominis
What is the acute response to high altitude?
acute hyperventilation
What are some body changes that occur after longer exposure to high altitude?
1) chronic hyperventilation
2) inc. mitochondria
3) inc. 2,3-DPG
4) inc. EPO
5) inc. renal excretion bicarb
What are 5 important products of your lungs?
1) surfactant
2) prostaglandins
3) histamine
4) ACE
5) kallikrein (activate brady)
Collapsing pressure =
(2x tension)/radius
What does surfactant do?
lower alveolar surface tension, increase compliance
What is tidal volume?
volume of air you take in with each quiet inspiration, 500 mL
What is residual volume?
the volume of air in Lungs you will never ever be able to exhale
What is functional reserve capacity?
the volume of air you have left in the Lungs after a normal quiet expiration
What is vital capacity?
the volume of air you can exhale to the max after taking a maximum breath in
Under what conditions would the O2-dissociation curve shift to the right?
1) high CO2
2) low pH
3) inc. temperature
4) 2,3-DPG (altitude)
5) inc. metabolic needs (exercise)
When would the O2-dissociation curve be left of normal?
1) fetal Hb
2) low acid, high pH
3) dec. metabolic needs
What does a right-shifted O2-dissociation curve mean?
facilitate O2 unloading to tissues
A drop in arterial PO2 causes what to happen in the lung?
vasoconstriction, to shunt blood away from poorly ventilated areas of Lung to better ventilated regions
What does it mean for a gas to be perfusion limited? What are some examples?
The gas will equilibrate early along the capillary; diffusion increased if perfusion increased; O2 in normal health, CO2, N2O
What does it mean for a gas to be diffusion limited? What are examples?
The gas will not equilibrate by the time the blood reaches end of capillary; O2 when exercising or in emphysema or fibrosis, CO
What does it mean when V/Q = 0?
ventilation is zero, there is an airway obstruction
What does it mean when V/Q approaches infinite?
perfusion is zero, there is blood flow obstruction
Where is ventilation the highest in the lung? Where is PO2 highest?
base; apex, TB likes to grow there
What is the V/Q ratio like in the apex of the lung?
3 (wasted ventilation)
What is the V/Q ratio like at the base of the lung?
0.6 (wasted perfusion)
What is the Haldane effect?
In lungs, when Hb picks up O2 it facilitates CO2 unloading
What is the Bohr effect?
In tissues, increased H+ ions shifts dissociation curve to right for better O2 unloading
What is the hallmark of Obstructive Lung disease?
decreased FEV1/FVC
What do you find in someone with chronic bronchitis?
- productive cough for > 3 consecutive months in 2 or more years
- hypertrophied mucus glands in bronchioles
- wheezing, crackles, CYANOSIS
What is the structural abnormality in emphysema?
alveolar wall destruction --> enlarged air spaces and dec. recoil
What is the main cause of chronic bronchitis?
SMOKING!!!
What kind of emphysema do you see in a smoker vs. someone with a1-antitrypsin deficiency?
smoker - centriacinar
a1-AT - panacinar + liver cirrhosis
In a1-AT deficiency, there is increased activity of which protease enzyme?
elastase
What is the problem in asthma?
bronchial hyperresponsiveness to URI, allergen, stress --> reversible constriction
When do you see Curschmann's spirals?
asthma
Bronchiectasis is associated with what other pathological conditions?
cystic fibrosis, Kartagener's, bronchial obstruction
What are si/sx of bronchiectasis?
hemoptysis, purulent sputum, recurrent infections, dilated airways
What is the FEV1/FVC ratio like in Restrictive Lung disease?
> 80% (all lung volumes are LOW)
What are some causes of Restrictive Lung diseases?
- muscle problem
- structural problem
- interstitial lung disease (ARDS, sarcoidosis, asbestosis, Goodpasture's, Wegener's, IPF...)
A patient comes in and upon examination of his lungs you notice absent breath sounds over part of the right lung, decreased resonance, decreased fremitus, and tracheal deviation toward the right. What is the problem?
bronchial obstruction on the right side
When examining a patient's lungs you notice decreased breath sounds over the base of his left lung, dulled resonance, decreased fremitus. The trachea is in the midline. What is going on?
left pleural effusion
When performing fremitus on a patient's back you notice increased vibrations over a portion of his right lung but decreased resonance in that part. What does he have?
lobar pneumonia in right lung
What would you find on examination of a patient with a right pneumothorax?
on the right side: decreased breath sounds, hyperresonant, absent fremitus; trachea deviate toward left side
LTB4 =
neutrophil chemotactic agent
LTC4, D4, E4 =
bronchoconstriction, vasoconstriction, smooth muscle contraction, inc. vascular permeability
PGI2 =
inhibit PL aggregation, promote vasodilation
What is a normal FEV1/FVC ratio?
80% (out of ~6.5 L lung vol)
A patient with infertility, bronchiectasis, and recurrent sinusitis is also likely to have what other finding?
situs inversus (Kartagener's syndrome)
A patient who had been a plumber for 40 years is found to have ferruginous bodies in his lungs and ivory white plaqes on the pleura. He is at risk for which malignancies?
mesothelioma (psammoma bodies) and bronchogenic cancer - patient has asbestosis which has decades-long latency period
What is the cause of neonatal respiratory distress syndrome?
baby born < 35 weeks does not make adequate surfactant --> alveolar collapse (Tx artificial surfactant)
What are the 5 bronchogenic carcinomas? Which are centrally arising, which are peripherally?
1) central - squamous cell, small cell
2) peripheral - adenocarcinoma, bronchioalveolar, large cell carcinoma
Smoking is linked to which bronchogenic cancers?
- squamous cell CA (make PTH)
- small cell CA (ADH, ACTH, may lead to Lambert Eaton syndrome)
How does lung cancer present?
cough, hemoptysis, bronchial obstruction, wheezing, "coin" lesion on cxr
What is the most common lung carcinoma overall (nonsmokers and women included)?
adenocarcinoma
A patient comes in with dyspnea, cough, facial swelling, ptosis and miosis on one side, and hoarseness. What do you suspect?
lung carcinoma causing "SPHERE" of complications - superior vena cava syndrome, Pancoast's tumor, Horner's, endocrine sxs, recurrent laryngeal problems, effusions
A patient comes in with flushing, diarrhea, wheezing, and salivation. You think:
carcinoid syndrome caused by carcinoid tumor of lung
Where do lung cancers metastasize to?
brain --> epilepsy
bone --> pathologic fractures
liver --> jaundice, hepatomegaly
What is Pancoast's tumor?
apical lung cancer that can impinge on sympathetic plexus causing Horner's syndrome
What is the organism responsible for lobar pneumonia (which has intra-alveolar exudate --> consolidation)?
Streptococcus pneumoniae
What organisms cause bronchopneumonia, infiltrating from bronchioles to adjacent alveoli?
S. aureus, Streptococcus pyogenes, Klebsiella, H. influenzae
What type of pneumonia has diffuse patchy interstitial inflammation involving both lungs, and what organisms cause it?
Atypical/interstitial pneumonia - RSV, adenovirus, Chlamydia, Mycoplasma pneumoniae, Legionella