Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
261 Cards in this Set
- Front
- Back
|
Cause of tracheoesophageal fistula
|
failure of fusion, which normally occurs ventral midline
esophageal atresia and aspiration of gastric contents results |
|
|
lung epithelium is derived from what embryonic layer
|
endoderm
|
|
|
visceral and parietal pleura are derived from what embryonic layer
|
mesoderm
|
|
|
What are the components of the respiratory conducting zone
|
mouth, nose, pharynx, larynx trachea, bronchi, bronchioles, terminal bronchioles
|
|
|
Where is cartilage present in the respiratory tree
|
trachea and bronchi only
|
|
|
What is the respiratory zone
|
Respiratory bronchioles
alveolar ducts alveoli |
|
|
Only segment of conducting respiratory tract what is not pseudostratified ciliated columnar cells
|
larynx
|
|
|
at what segment do goblet cells extend to
|
extend through bronchi, not bronchioles
|
|
|
Type 1 pneumocytes are __% of the cells and __% of the surface area of the alveoli
|
40% of cells
97% of alveolar surfaces |
|
|
Type 2 pneumocytes are __% of the cells and __% of the surface area of the alveoli
|
60% of cells
3% of SA |
|
|
Amniotic fluid indication of fetal lung maturity?
|
Lecithin:Sphingomyelin ratio >2.0
|
|
|
main component of surfactant
|
Dipalmitoyl phosphatidylcholine which decreases surface tension
|
|
|
precursor cell to type 1 and 2 pneumocytes
|
T2 pneumocytes
|
|
|
Clara Cells
|
Nonciliated columnar
80% of bronchiole lining ↑ with pollutants/smoking secrete serous fluid stem cells for ciliated cells and themselves involved with Cl- transport |
|
|
Costodiaphragmic Recess borders
|
Miclavicular 6/8
Midaxillary 8/10 Posteriorly 101/2 |
|
|
What maintains pulmonary arterial pressure at a relatively constant level throughout cardiac cycle
|
elastic walls of Pulmonary Artery
|
|
|
Components of Bronchopulmonary segments
|
Tertiary bronchus
1 pulmonary artery 1 bronchial artery Arteries with Airways |
|
|
Homologue of R middle lobe on left side
|
Lingula
|
|
|
Pulmonary Artery orientation to bronchus on right side
|
Anterior on right
RALS right anterior left superior |
|
|
Pulm A orientation to bronchus on left side
|
Superior on left
RALS Right anterior left superior |
|
|
where does a peanut lodge when aspirated standing up
|
lower portion of right inferior lobe
|
|
|
where does a peanut lodge when aspirated lying down
|
superior portion of right inferior lobe
|
|
|
Tracheal bifuraction
|
T4
|
|
|
Middle R lobe
|
begins at 4th costocartilage →
4th IC → 5th rib → 5th IC |
|
|
Division of superior and inferior lobes left side
|
Superior above 5th
Inferior below 6th |
|
|
Divisions of R lobes
|
Superior ↑ 4th
Middle 4th to 6th Inferior ↓6th important to puncture questions |
|
|
Structures + levels that perforate diaphragm
|
IVC @ T8
Esophagus @ T10 (+vagus) Aorta @ T12 + thoracic duct, azygous vein I(vc) ate(8), 10 Eggs(esophagus), at(aorta) 12 |
|
|
Innervation of diaphragm
|
phrenic 345
|
|
|
Pain referal for diaphragm
|
to shoulder
|
|
|
what does esophagus traverse diaphragm through
|
R crus
|
|
|
Trace the pathway for lymphatic drainage of lungs
|
Bronchopulmonary (hilar) →
Tracheobroncial (bifurcation) → Bronchomediastinal → Mediastinal → on R → R lymphatic duct on L → Thoracic Duct both join venous system at junction of Subclavian and IJ veins |
|
|
What (can) induce surfactant production
what maternal disease predisposes to neonatal respiratory distress |
Corticosteroids
DM |
|
|
Muscle of inspiration during quiet breathing
|
diaphragm
|
|
|
Muscle of expiration during quiet breathing
|
passive, none
|
|
|
Muscles of exercise inspiration
|
Diaphram
External Intercostals scalenes sternomastoids |
|
|
Muscles of exercise expiration
|
Abdominal muscles
Internal intercostals |
|
|
Respiratory center for inspiration
afferent/efferent? |
Dosral Respiratory Center in medulla
vagus/glossopharyngeal afferent phrenic efferent |
|
|
Respiratory center for expiration
|
Ventral
inactive during quiet breathing |
|
|
Central chemoreceptors respond to
|
↓pH, ↑CO2
|
|
|
Peripheral chemoreceptors respond to
|
H+, ↓pH, ↓pO2, ↑pCO2
|
|
|
O2 levels must be below __mm Hg to stimulate respiration
|
60mmHg
|
|
|
Hering-Breuer Reflex
|
smooth muscle stretch in respiratory tract causes decrease frequency of respiration
|
|
|
J cells
|
detect capillary engorgement (CHF)
cause shallow and rapid breathing |
|
|
Surfactant
|
produced by type II pneumocytes
↓ surface tension ↑ compliance ↓ work of inspiration |
|
|
What is deficient in Neonatal RDS
|
dipalmitoyl phosphatidylcholine
|
|
|
Collapsing pressure equation
|
P = 2T/radius
|
|
|
Law of Laplace
|
tendency to collapse on expiration
↓radius ↑pressure |
|
|
Histamine effects in lung
|
Bronchoconstriction
|
|
|
Lung Volumes
RV |
air in lung after maximum expiratory
cannot be measure on spirometry |
|
|
Lung Volumes
ERV |
air that can still be breathed out after normal expiration
|
|
|
Tidal Volume
|
air that moves into lung with each quiet inspiration
500mL |
|
|
IRV
|
air in excess of tidal volume that moves into lung on maximum inspiration
|
|
|
Vital Capacity
|
= IRV + TV + ERV or
= IC + ERV |
|
|
Functional Residual Capacity
|
ERV + RV
volume in lungs following quiet expiration |
|
|
Inspiratory Capacity
|
TV + IRV
|
|
|
TLC
|
IRV + TV + ERV + RV
|
|
|
Minute Volume
|
TV x breaths/minute
|
|
|
Alveolar Volume
|
TV - (Vd x breaths/minutes)
Vd = dead space |
|
|
Vd calculation
|
TV x (PalvCO2 - PexpCO2/PalvCO2)
|
|
|
normal value for anatomic dead space
|
150mL
|
|
|
largest contributor to dead space
|
apex of the lung (V/Q ~ 3)
|
|
|
Tendency of lungs to _____ and chest wall to _____
|
collapse
expand cause of natural negative pressure |
|
|
When is system pressure atmospheric
|
at FRC, when inward pull of lungs is equal to outward pull of chest wall
|
|
|
At FRC, airway and alveolar pressure are __, and intrapleural pressure is ______
|
0
negative negative pressure prevents pneumothorax |
|
|
Compliance
|
Volume/Pressure
↓ with fibrosis, ↓surfactant, pulmonary edema |
|
|
The compliance of the lungs and chest wall individually are _______ than their compliance combined
|
less
individuals slopes (compliance) steeper than combined |
|
|
Hemoglobins _ form has a low affinity for O2
|
Taut (T)
|
|
|
hemoglobins _ form has a high affinity for O2
|
Relaxed (R)
when your Relaxed, you do a better job |
|
|
Name four things which favor the T(taut) form of hgb
|
↑Cl
↑H+ ↑CO2 ↑23BPG shifts curve to right increasing unloading of O2 |
|
|
Why does fetal hemoglobin have a higher affinity to O2
|
has a low affinity for 23BPG
|
|
|
Treatment of Methemoglobinemia
|
METHylene blue
|
|
|
Methemoglobin
|
oxidized (ferric, Fe3+) Iron does not bind o2 readily but ↑ affinity to CN-
|
|
|
treatment of Cyanide poisoning
|
1 Nitrites - oxidizes hemoglobin, which then binds cyanide, allowing cytochrome oxidase to function
2 - add thiosulfate, which will bind this cyanide, forming thiocyanate for renal excretion |
|
|
Carboxyhemoglobin
|
200x O2 for hemoglobin
↓o2 binding capacity, causes a left shift because increases affinity of hemoglobin to oxygen, decreasing oxygen unloading in tissues |
|
|
@ 100mm Hg, hgb is __% saturated
|
100%
|
|
|
@ 40 mm Hg, hgb is __% saturated
|
75%
|
|
|
@ 25 mm Hg, hgb is __% saturated
|
50%
|
|
|
to what value does the oxygen-hemoglobin dissociation curve remain near 100%
|
to 60 mm Hg
humans can tolerate a decrease in atmospheric pressure to 60 mm Hg without effects |
|
|
Why is the dissociation curve sigmoid
|
positive cooperativity (binding of one oxygen molecule increases affinity for next)
|
|
|
Causes of right shift
|
↑CO2
↑acid/altitude ↑DPG ↑Exercise ↑Temperature CADET faces right |
|
|
Causes of left shift
|
↓CO2
fetal hemoglobin ↓Acid/Altitude ↓metabolic demands |
|
|
P50 of left shift
|
decreased p50
|
|
|
P50 of right shift
|
increased P50
|
|
|
Pulmonary Circulation
resistance compliance cardiac output |
low resistance
high compliance (low pressure) same cardiac output |
|
|
effect of low oxygen on pulmonary circulation
|
vasoconstriction
sends blood to oxygenated areas of lung field |
|
|
o2 is normally ______ limited
|
perfusion limited
also CO2, N2O |
|
|
when is o2 diffusion limited
|
during exercise, emphysema, fibrosis
CO always diffusion limited |
|
|
Diffusion equation
|
Vgas = (A/T) x Dk(P1-P2)
A = area T = thickness area decreased in emphysema thickness increased in fibrosis |
|
|
normal pulmonary artery pressure
|
10-14mm Hg
|
|
|
MOA 23DPG
|
binds ß chains of deoxyhemoglobin, ↓ing affinity
|
|
|
values for pulmonary htn
|
25 mm Hg or 35 mm Hg during exercise
|
|
|
Primary Pulmonary HTN
|
due to an INACTIVATING mutation in the BMPR2 gene which normally inhibits vascular smooth muscle proliferation
|
|
|
MOA of Secondary Pulmonary HTN
COPD |
destruction of lung parenchyma
|
|
|
MOA of Secondary Pulmonary HTN
Mitral Stenosis |
↑ resistance → ↑ pressure
|
|
|
MOA of Secondary Pulmonary HTN
recurrent thromboemboli |
↓ cross sectional area of vascular bed
|
|
|
MOA of Secondary Pulmonary HTN
Autoimmune disease |
inflammation → intimal fibrosis → medial hypertrophy
systemic sclerosis |
|
|
MOA of Secondary Pulmonary HTN
Left to Right shunts |
↑ shear stress → endothelial inury
|
|
|
MOA of Secondary Pulmonary HTN
Sleep apnea or high altitudes |
hypoxic vasoconstriction
|
|
|
cause of death in Pulmonary HTN?
|
Decompensated Cor Pulmonale
severe respiratory distress → cyanosis and RVH → cor pulmonale |
|
|
Mechanism behind opening of lung vasculature during first breath?
|
Before first breath lack of oxygen causes vasoconstriction, with introduction of O2 vasodilation occurs
|
|
|
Pulmonary Vascular Resistance equation
|
(Ppa - P pv) / CO
CO = PVR x changeP |
|
|
O2 content equation
|
(O2 binding capacity x % saturation) + O2 dissolved
|
|
|
Cyanosis results when deoxygenated Hb >_g/dL
|
5
|
|
|
O2 delivery to tissues =
|
cardiac output x oxygen content of blood
|
|
|
O2 binding capacity ~
|
20.1 mL O2 / dL
|
|
|
Alveolar gas equation estimation
|
150 - PalvCO2/0.8
|
|
|
average A-a gradient
|
PalvO2-PaO2 = 10-15 mm Hg
|
|
|
causes of ↑A-a
|
shunting
V/Q mismatch fibrosis |
|
|
PaO2 / A-a :
high altitude |
decreased
normal |
|
|
PaO2 / A-a :
hypoventilation |
decreased
normal |
|
|
PaO2 / A-a :
diffusion defects |
decreased
increased |
|
|
PaO2 / A-a :
V/Q defects |
decreased
increased |
|
|
PaO2 / A-a :
R to left shunts |
decreased
increased |
|
|
where in the respiratory tract is resistance greatest
|
medium sized arteries
not capillaries because they are in parallel |
|
|
V/Q at apex of lung
|
3 (wasted ventilation, dead space)
|
|
|
V/Q at base of lung
|
0.6 (wasted perfusion, shunt)
|
|
|
Q, V, V/Q, Po2, Pco2
apex of lung (zone 1) |
Q ↓↓
V ↓ V/Q ↑ pO2 ↑ pCO2 ↓ |
|
|
Q, V, V/Q, pO2, pCO2
base of lung (zone 3) |
Q ↑↑
V ↑ V/Q ↓ pO2 ↓ pCO2 ↑ |
|
|
V/Q → 0 indicates?
|
Shunt, airway obstruction
100% O2 will not improve pO2 |
|
|
V/Q → infiinity
|
Dead space, vascular block (embolus)
if <100% dead space, 100% o2 will improve pO2 |
|
|
__ moves into RBC in exchange for HCO3
|
Cl-
|
|
|
both ventilation and perfusion are greater at the ___ of the lung
|
base of the lung
|
|
|
Palveolar > Pa > Pv, V/Q = 3 characteristic of
|
Zone 1
|
|
|
Pa > Pv > Palveolar, V/Q = 0.6
|
Zone 3
|
|
|
Haldane effect
|
oxygenation of Hb promotes dissociation of H+, shifting towards production of CO2 which is released
|
|
|
Bohr effect
|
↑H+ in peripheral tissue shifts curve to right, unloading O2
|
|
|
majority of CO2 is transported to lungs as
|
dissolved HCO3 (90%)
5% bound at N terminus (NOT heme) as carbaminohemoglobin 5% dissolved CO2 |
|
|
Response to High Altitude
|
↓PalveolarO2
↓PaO2 ↑ventilation rate ↑pH ↑23BPG left shift, ↓ affinity, ↑P50 ↑pulm vasoconstriction ↑RVH ↑cellular mitochondria ↑renal excretion of bicarbonate |
|
|
DOC High Altitudes
|
Acetazolamide
corrects alkalosis loss of fluid relieves pulmonary edema |
|
|
Response to exercise
|
↑CO2 production
↑O2 consumption ↑ventilation rate to meet O2 demand Uniformity of V/Q throughout zones ↑CO↑pulmonary blood flow NO CHANGE in PaO2, PaCO2, but ↑ venous CO2 ↓pH is strenous, secondary to lactic acidosis |
|
|
Postpartum amniotic embolus can lead to
|
DIC
|
|
|
Clinical signs of PE
|
chest pain
tachypnea dyspnea |
|
|
95% of PE arise from
|
DVT
|
|
|
test of choice in PE
|
CT angiography
|
|
|
DOC to prevent PE
|
Heparin
|
|
|
Predispositions to DVT
|
Virchows Triad
1 Stasis 2 Hypercoagulability 3 Endothelial damage |
|
|
Homan's Sign
|
Dorsiflexion of foot causes tender calf muscle
DVT indicator |
|
|
Obstructive Lung Diseases
FEV1, FVC, FEV1/FVC, FRC examples |
↓↓FEV1
↓FVC *↓FEV1/FVC* ↑FRC COPD, Asthma, Bronchiectasis, Bronchitis, Emphysema |
|
|
Restrictive Lung Disease
FEV1, FVC, FEV1/FVC, FRC |
↓FEV1
↓↓FVC **normal/↑FEV1/FVC (>80%)** ↓FVC |
|
|
Definition of Chronic Bronchitis
|
>3 consequetive months in >2 years of productive cough
disease of small airways |
|
|
Pathology of Chronic Bronchitis
|
BLUE BLOATERS
small airway disease hypertrophy of mucus-secreting glands in BRONCHIOLES Reid Index = gland depth / total thickness of bronchial wall = >50% |
|
|
Findings in Chronic Bronchitis
|
Wheezing
Crackles SMOKER Fat Cyanosis (shunting) late onset dyspnea |
|
|
Pink Puffer
|
Emphysema
skinny, pursed lips, early onset dyspnea, ↓breath sounds, tachycardia |
|
|
Why do Pink Puffers breath through pursed lips?
|
Prevent collapse of airways during exhalation
|
|
|
Emphysema pathology
|
enlargement of air spaces and ↓ recoil resulting from destruction of alveolar walls, ↑ compliance
|
|
|
Cause of centriacinar emphysema
|
Smoking, upper lung
|
|
|
Cause of panacinar emphysema
|
α1-antitrypsin deficiency (PiZZ)
also liver cirrhosis |
|
|
Cause of paraseptal emphysema
|
associated with bullae → rupture → spontaneous pneumothorax
often young, otherwise healthy males |
|
|
Pathology of Asthma
|
Bronchial hyperresponsiveness causes reversible bronchoconstricvtion
smooth muscle hypertrophy and Curschmann's spirals (shed epithelium causing mucus plugs) |
|
|
Triggers for asthma
|
viral URIs, allergens, stress
|
|
|
Test for asthma
|
Methacholine challenge
|
|
|
Findings in asthma
|
cough
wheezing dyspnea tachypnea hypoxemia ↓I/E ratio pulsus paradoxus |
|
|
Pathology of Bronchiectasis
|
Chronic necrotizing infection of bronchi → permanently dilated airways, purulent sputum, recurrent infections, hemoptysis
|
|
|
Bronchiectasis associations
|
Bronchial obstruction
CF Kartangener's can develop aspergillosis |
|
|
muscular causes of restictive lung disease
|
polio
myasthenia gravis |
|
|
structural causes of restrictive lung disease
|
scoliosis
morbid obesity |
|
|
Interstitial Lung Diseases causing restrictive lung disease
|
ARDS
Neonatal RDS (hyaline membrane disease) Pneumoconioses (coal miner's, silocosis, asbestosis) Sacroidosis (bilateral hilar lymphadenopathy, noncaseating granulomas, ↑ACE, ↑Calcium) Idiopathic Pulmonary Fibrosis (repeated cycle of injury and healing with ↑ collagen) Good pastures Wegener's Eosinophilic Granuloma (Histiocytosis X) Drug Toxicity (Bleomycin, busulfan, amiodarone) |
|
|
Drug causes of restrictive lung disease
|
Bleomycin
Amiodarone Busulfan AMy BLew the whole BUS |
|
|
Coal Miner's Pneumoconioses
|
restrictive lung disease
Associated with mines Can result in Cor Pulmonale Caplan's Syndrome ( + RA) UPPER LOBES |
|
|
Silicosis
|
Restrictive lung disease
Foundries, Sandblasting, mines Macrophages respons to silica and release fibrogenic factors leading to fibrosis. Silica disrupts phagolysosomes and impairs macrophages increasing susceptibility to TB UPPER lobes *"EGGSHELL" calcification of hilar lymph nodes* |
|
|
Asbestosis
|
Restrictive lung disease
Shipbuilding, roofing, plumbing "IVORY WHITE" calcified PLEURAL plaques. ↑ incidence of bronchogenic carcinoma and mesothelioma LOWER lobes GOLDEN BROWN FUSIFORM RODS ~ DUMBELLS within MACROPHAGES |
|
|
Neonatal respiratory distress syndrome
|
surfactant deficiency, ↑surface tension, alveolar collapse
lecithin:sphingomyelin < 1.5 O2 therapy risks retinopathy |
|
|
Risk factors to neonatal RDS
|
Prematurity
materal DM C-section (decreases fetal GCs) |
|
|
Treatment of neonatal RDS
|
maternal steroids before birth
thyroxine artificial surfactant |
|
|
ARDS possible causes
|
trauma
sepsis shock gastric aspiration uremia acute pancreatitis amniotic fluid embolism |
|
|
Pathology of ARDS
|
DAD → ↑ alveolar capillary permeability → protein leakage → intra-alveolar hyaline membrane
initial damage is due to neutrophilic substances toxic to alveolar wall, activation of coag cascade, oxygen free radicals |
|
|
FEV1/FVC normal
|
80%
|
|
|
FEV1/FVC obstructive
|
<80%
|
|
|
FEV1/FVC Restrictive
|
>80%, ↓TLC
|
|
|
volumes in obstructive
|
↑TLC, FRC, RV
|
|
|
Sleep apnea
obstructive versus central |
Central no respiratory effort
obstructive respiratory effort against airway obstruction |
|
|
associations of sleep apnea
|
obesity, loud snoring, systemic/pulmonary htn, arrhythmia, possible sudden death
|
|
|
treatment of sleep apnea
|
weight loss
CPAP surgergy |
|
|
RBC values in Sleep apnea?
|
Hypoxia ↑EPO erythrocytosis
|
|
|
Bronchial Obstruction
Breath sounds, resonance, fremitus, tracheal deviation |
Absent/↓ sounds over area
↓ Resonance ↓ Fremitus Deviation towards lesion |
|
|
Pleural Effusion
Breath sounds, resonance, fremitus, tracheal deviation |
↓ sounds over effusion
↓ dull resonance ↓ fremitus no tracheal deviation |
|
|
Pneumonia (Lobar)
Breath sounds, resonance, fremitus, tracheal deviation |
Bronchial breath sounds
Dull resonance ↑ fremitus no tracheal deviation |
|
|
Tension Pneumothorax
Breath sounds, resonance, fremitus, tracheal deviation |
↓ breath sounds
Hyperresonant Absent fremitus deviation AWAY from lesion |
|
|
#1 cause of death
|
Lung Cancer
|
|
|
Complications of Lung Cancer
|
SVC Syndrome
Pancoast tumor Horners Endocrine (paraneoplastic) Recurrent Laryngeal Effusions |
|
|
cancers which most commonly metathesize to lung
|
Breast
Colon Prostate Bladder |
|
|
Sites of metathesis FROM lung
|
Liver
Adrenal Bone Brain |
|
|
Squamous Cell Carcinoma
Location |
Central
Squamous Sentral Smoking |
|
|
SqCC
characteristics |
hilar mass arising from BRONCHUS
Cavitation Smoking PTHrP |
|
|
SqCC
Histology |
Keratin Pearls
Intercellular bridges |
|
|
Most common lung cancer in nonsmokes and females
|
Adenocarcinoma (bronchial, bronchioalveolar)
|
|
|
Location of Adenocarcinomas (bronchial, bronchoalveolar)
|
Peripheral, in site of prior pulmonary inflammation or injury
|
|
|
Characteristics of Adenocarcinomas
|
NONsmokers
sites of prior injury grows along airways, can present like pneumonia, can result in hypertrophic osteoarthropathy |
|
|
Lung cancer associated with hypertrophic osteoarthropathy
|
Adenocarcinomas
|
|
|
Histology of Adenocarcinomas
|
Clara cells → type II pneumocytes → multiple densities on CXR
|
|
|
Small Cell (Oat Cell) Carcinoma
Location |
Central
|
|
|
Small Cell Carcinoma
characteristics |
Undifferentiated → very aggressive
Associated with ACTH or ADH Lambert-Eaton syndrome (autoAB against calcium) Response to Chemo Inoperable almost all associated with cigarette smoking |
|
|
Small Cell Carcinoma
Histology |
Neoplasm of neuroendocrine Klutchitsky cells → small dark blue cells
|
|
|
Lung cancer associated with ACTH/ADH
|
Small Cell
|
|
|
Lung Cancer associated with Lambert Eaton
|
Small Cell
|
|
|
Lung Cancer derived from Klutchinsky cells
|
Small Cell
|
|
|
Large Cell Cancer
location |
Peripheral
|
|
|
Large Cell Cancer
characteristics |
Highly anaplastic, undifferentiated tumor
poor prognosis, low response to chemo removed surgically |
|
|
Large Cell Cancer
histology |
Pleomorphic giant cells with leukocyte fragments in cytoplasm
|
|
|
Carcinoid Tumor
characterstics |
secretes serotonin → flushing, diarrhea, wheezing, salivation
fibrous deposits lead to tricuspid insufficiency, pulmonary stenosis, RHF |
|
|
Lung Cancer associated with tricuspid insufficiency, RHF, pulmonary stenosis
|
Carcinoid Tumor
|
|
|
Mesothelioma
location |
Pleura
|
|
|
Mesothelioma
characteristics |
Malignancy of pleura associated with absestos
results in hemorrhagic pleural effusions and pleural thickening |
|
|
Mesothelioma histology
|
Psammoma bodies
|
|
|
Organsms associated with Lobar pneumonia
|
pneumococcus
klebsiella |
|
|
Organisms associated with bronchopneumonia
|
S aureus
H flu Klebsiella S pyogenes |
|
|
Organisms associated with Atypical
|
RSV
Adenovirus Mycoplasma Legionella Chlamydia |
|
|
Characteristics of Lobar Pneumonia
|
Intra-alveolar exudate → consolidation
may involve entire lung |
|
|
Characteristics of Bronchopneumonia
|
Acute inflammatory infiltrates from bronchioles into adjacent alveoli
patchy distribution involving >1 lobe |
|
|
Characterstics of atypical pneumonia
|
DIFFUSE patchy inflammation localized to interstitial areas at alveolar walls
distribution involving >1 lobes generally more indolent course than bronchopneumonia |
|
|
Lung Abscess
|
Localized collection of pus within parenchyma, usually resulting from bronchial obstruction or aspiration of oropharyngeal contents
S aureus most common alcoholics, epileptics predisposed |
|
|
Transudative Pleural effusion
|
↓protein contnet
CHF, nephrotic syndrome, hepatic cirrhosis |
|
|
Exudative Pleural Effusion
|
↑protein content, cloudy
malignancy, pneumonia, collagen vascular disease |
|
|
Lymphatic Pleural Effusion
|
Milky
↑TGs |
|
|
1st generation H1 blockers
|
Diphenhydramine
Dimenhydramine Chlorpheniramine |
|
|
1st generation H1 blockers
Clinical uses |
Allergy
Motion sickness Sleep aid |
|
|
1st generation H1 blockers
toxicity |
Sedation*
antimuscarinic anti α andrenergic |
|
|
2nd generation H1 blockers
|
Loratadine
Fexofenadine Desloratadine Cetirizine |
|
|
2nd Generation H1 blockers
Clinical uses Toxicity |
Allergy
less sedating because of ↓CNS entry |
|
|
Nonspecific ß agonists used in asthma
|
Isoproterenol
relaxes bronchial smooth muscle (ß2), adverse tachycardia (ß1) |
|
|
ß2 agonists used in asthma
|
Albuteral acute
Salmeterol prophylaxis |
|
|
adverse effects of ß2
|
tremor
arrhythmia |
|
|
Theophylline MOA in Asthma
|
bronchodilation
inhibition of phosphodiesterase → ↓cAMP hydrolysis |
|
|
Toxicity of Theophylline
|
narrow therapeutic window
cardiotoxicity, neurotoxicity blocks actions of adenoise |
|
|
antimuscarinic used in asthma
|
Ipratroprium
competitive block of muscarinic receptors, preventing bronchoconstriction also used in COPD |
|
|
Cromolyn
|
prevents release of mediators from mast cells
prophylaxis in asthma, not effective in acute attacks |
|
|
Corticosteroids used in asthma
|
Beclomethasone, Prednisone
1st line therapy in chronic asthma |
|
|
5-lipoxygenase pathway inhibitor, blocking conversion of arachidonic acid to leukotrines
used in asthma |
Zileuton
|
|
|
block leukotriene receptors, especially good in aspirin-induced asthma
|
Zafirlukast, montelukast
|
|
|
drugs used in asthma which inhibit inflammatory activation of leukotrienes
|
corticosteroids (beclemethasone, pred)
Zileuton Zafirlukast, montelukast |
|
|
drugs used in asthma which inhibit bronchoconstriction
|
Bagonists (albuterol, salmeterol, isoprotenerol)
Theophylline Muscarinic antagonists (ipratroprium) |
|
|
site of action of ß agonists in asthma
|
increase production of cAMP, causing bronchial tone to shift towards bronchodilation
|
|
|
site of action of theophylline
|
negative inhibition of PDE, blocking conversion of cAMP to AMP, increasing action of cAMP to allow bronchodilation
|
|
|
chemical mediators that shift bronchial tone towards bronchoconstriction in asthma and drugs which block this
|
acetylcholine, ipratroprium
adenosine, theophylline |
|
|
expectorant which removes excess sputum, no effect on cough
|
Guaifenesin
|
|
|
mucolytic used in CF, also antidote for acetaminophen OD
|
N acetylcysteine
|
|
|
Bosentan
|
used to treat pulmonary HTN
competitively antagonizes endothelin-1 receptors, decreasing pulmonary vascular resistance |
|
|
Guaifenesin
|
expectorant
|
|
|
Arterial pO2 and Arterial O2 saturation at high altitude
hematocrit? |
↓arterial PO2
↓Arterial O2 saturation ↑Hematocrit ↓PalvO2 and ↓ParterialO2, ↑vent, pH, Hgb, 23DPG |
|
|
Location / composition of Primary TB
|
localized to middle lung area and hilar lymph nodes
Ghon Complexes and fibrosis |
|
|
Morphological findings in Pulmonary Hypertension
|
medial hypertrophy
RVH arterial fibrosis luminal narrowing → thrombosis |
|
|
Pathology of Good Pastures
|
necrotizing and hemorrhagic pneumonitis accompanied by RPGN
check hemorrhage and hemosiderin-laden macrophages |
|
|
virulence factor for strep pneumoniae
immune defense? |
Capsule
Antibody formation is essential |
|
|
Drugs involved with hypoventilation of central origin
|
Morphine
Barbiturates |
|
|
common microbes for Lung Abscess
|
S aureus
Anaerobes Oral cavity → Fusobacterium nucleatum →Strep mutans →Bacteroides →Peptococcus |
|
|
Acute response to salicylate poisoning
|
stimulation of respiratory centers and respiratory alkalosis
followed quickly by metabolic acidosis |
|
|
______ ____ is a patchy inflammation of the alveolar wall that eventually leads to the formation of a "honeycomb" lung with marked interstitial fibrosis of walls
|
Interstitial Pneumonitis
|
|
|
most frequent paraneoplastic syndrome associated with squamous cell carcinoma
|
hypercalcemia (PTHr)
|
|
|
carcinogen in tobacco smoke responsible for G:C>T:A mutations in p53 gene common to lung tumors
|
benzo[a]pyrene
initiator, polycyclic aromatic hydrocarbon |
|
|
smokers exposed to absestos have 50 to 90x increased chance of
|
Lung cancer (not mesothelioma)
|
|
|
pathogenic mechanism of radon exposure
|
inhalation and bronchial depostion of radioactive decay products that become attached to environmental aerosols
|
|
|
most common lung cancer
|
adenocarcinoma (37% of male cancer, 47% of female)
|
|
|
markers for adenocarcinoma
|
Thyoid Transcription factor (TTF1)
Mucin |
|
|
KRAS most common in what type of lung cancer
|
adenocarcinoma
also EGFR KRAS mutations worse prognosis |
|
|
azzopardi effect
|
basophilic staining of vascular walls adjacent to small cell carcinoma
due to encrustation by DNA from necrotic tumor cells |
|
|
SVC Syndrome
|
Compression or invasion of SVC causing venous congestion and edema of head and arms
|
|
|
Where can hypertrophic arthropathy be seen (due to adenocarcinomas)
|
Clubbing of fingers
|
|
|
average age for carcinoid tumors
|
<40
|
|
|
Lung Hamartoma
|
solitary peripheral radioopaque 3-4cm "coin lesion" composed of cartilage
|
|
|
major blood supply to nasal mucosa
|
sphenopalatine artery, the terminal branch of the maxillary artery of the external carotid
|
|
|
receptors which are stimulated to cause bronchoconstriction
|
M3
|
