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142 Cards in this Set

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Alveolar O2 calculation
%O2 breathing (713) - PCO2/0.8
Increased A-a gradient
primary lung disease; left to right shunts in heart
Forced vital capacity
total amount of air expelled after a maximal inspiration
Forced expiratory volume in 1 second
amount of air expelled in 1 second after maximal inspiration
Choanal atresia
cyanotic when breast feeding; turns pink when crying
Nasal polyps
allergic (MC; adults only), aspirin, cystic fibrosis
Nasal polyp in a child
requires sweat test to exclude cystic fibrosis
Triad asthma
patient on aspirin (pain syndrome) with nasal polyps, asthma
Obstructive sleep apnea (OSA)
snoring with intervals of apnea (respiratory acidosis with hypoxemia)
Obstructive sleep apnea (OSA) S/S:
danger cor pulmonale; requires sleep test; Rx- O2 with continuous positive airway pressure
Sinusitis
maxillary sinusitis MC in adults; ethmoiditis MC in children; S. pneumoniae MC
Nasopharyngeal carcinoma
association with EBV; metastasize to cervical nodes
Laryngeal carcinoma
smoking MCC; hoarseness; squamous cell carcinoma
Resorption atelectasis
MCC of fever 24-36 hrs after surgery
S/S of Resorption atelectasis
dec percussion; absent fremitus, breath sounds; inspiratory lag; elevated diaphragm
Respiratory distress syndrome
decreased production surfactant; airway collapse; hyaline membranes
Type II pneumocytes
synthesize surfactant (lecithin, phosphatidylcholine); stored in lamellar bodies
Surfactant
reduces surface tension in airways; inc synthesis cortisol, thyroxine; dec synthesis insulin
Causes of respiratory distress syndrome
prematurity, maternal diabetes, C-section
Maternal diabetes
maternal hyperglycemia --> fetal hyperglycemia -> inc fetal insulin which dec surfactant
Complications of Respiratory distress syndrome
O2 FR injury (blindness, bronchopulmonary dysplasia); necrotizing enterocolitis
Typical community acquired pneumonia
Streptococcus pneumoniae MCC
Typical pneumonia
bronchopneumonia, lobar pneumonia
S/S of typical pneumonia
productive cough; consolidation - dec percussion, inc tactile fremitus
Atypical community acquired pneumonia
interstitial pneumonia; Mycoplasmapneumoniae MCC
Atypical community acquired pneumonia S/S
low grade fever, non-productive cough, no signs consolidation
Nosocomial pneumonia
Pseudomonas aeruginosa MCC (respirators); others- S. aureus, E. coli
Rhinovirus
MCC common cold; hand to mouth transmission
Respiratory syncytial virus
MCC pneumonia and bronchiolitis in child
Parainfluenza virus
MCC croup in child; trachea area of obstruction
Cytomegalovirus
basophilic intranuclear inclusion surrounded by halo
Influenza
superimposed pneumonia with S. aureus increases mortality
Rubeola
Warthin-Finkeldey multinucleated giant cells
Chlamydia pneumoniae
atypical pneumonia; association with coronary artery disease
Chlamydia trachomatis
pneumonia in newborns; staccato cough; wheezing
Coxiella burnetii
only rickettsia without a vector
Mycoplasma pneumoniae pneumonia
crowded condition; cold agglutinins; azithromycin
Streptococcus pneumoniae pneumonia
Streptococcus pneumoniae pneumonia
Staphylococcus aureus pneumonia
tension pneumatocysts in children with cystic fibrosis
Corynebacterium diphtheriae
toxin produces ADP ribosylation of elongation factor 2
Haemophilus influenzae
exacerbation chronic bronchitis; acute epiglottis in children
Inspiratory stridor child
croup, epiglottitis
Pseudomonas aeruginosa
MCC of pneumonia and death in cystic fibrosis; green sputum
Klebsiella pneumoniae
mucoid sputum in alcoholic
Legionella pneumophila
silver stain; water coolers/mist (grocery produce, restaurants, zoo rain forest
Mycobacterium tuberculosis
strict aerobe; MC COD due to infectious disease worldwide
Candida albicans
vessel invader; yeasts and pseudohyphae
Cryptococcus immitis
pigeon excreta; narrow-based bud
Aspergillus fumigatus
septate hyphae with fruiting body; fungus ball, extrinsic asthma, vessel invader
Mucor species
non-septate; vessel invader; frontal lobe abscess in DKA
Coccidioides immitis
Southwest deserts; inhalation arthrospores in dust; spherule with endospores
S/S of Coccidioides immitis
erythema nodosum (painful nodules lower legs)
Histoplasma capsulatum
Ohio/central Mississippi river valley; excreta bats (spelunker), chickens
H. capsulatum:
simulates TB; yeasts phagocytosed by macrophages
Blastomyces dermatitidis
overlaps histoplasmosis; broad-based buds; skin lesion simulates cancer
Pneumocystis carinii
cysts and trophozoites; pneumonia in HIV; Rx- trimethoprim/sulfamethoxazole
Primary TB
upper portion lower lobe, lower portion upper lobe
Primary TB
Ghon focus (subpleural caseation); Ghon complex (spread to hilar nodes)
Reactivation TB
cavitating lesion in upper lobe; kidney MC extrapulmonary site
Mycobacterium Aviam Intracellulare
atypical TB; MC TB in AIDS
Cystic Fibrosis
AR; 3 nucleotide deletion chromosome 7; defective CFTR (degraded in Golgi apparatus)
S/S of Cystic Fibrosis
pneumonia, malabsorption, males sterile; + sweat test; P. aeruginosa pneumonia MC COD
Lung abscess
MCC aspiration oropharyngeal material (mixed aerobe/anaerobe); x-ray- air/fluid level
Aspiration sitting
posterobasal segment right lower lobe
Aspiration supine
superior segment right lower lobe
Aspiration while laying on right side
right middle lobe, posterior segment right upper lobe
Pulmonary thromboembolism
most derive from femoral vein
Bronchial artery
branch of aorta/intercostal artery; protects against developing pulmonary infarction
Saddle embolus
sudden death due to acute right heart strain
S/S of saddle embolus
pulmonary infarction: dyspnea and tachypnea; pleuritic chest pain; pleural effusion
Dx of Saddle Embolus
ventilation/perfusion scan; respiratory alkalosis; hypoxemia
Pain on inspiration
pleuritic inflammation; pulmonary embolus, pneumonia, pneumothorax
Pathogenesis pulmonary hypertension (PH):
hypoxemia and respiratory acidosis
Hypoxemia + respiratory acidosis
vasoconstriction pulmonary vessels; vasodilation cerebral vessels
Causes of pulmonary hypertension
1° lung disease (COPD, restrictive), recurrent emboli, mitral stenosis, OSA, left-right shunts
Cor pulmonale
PH + RVH
S/S of Cor pulmonale
dyspnea; accentuated P2 (PH); parasternal heave (RVH)
Restrictive lung disease
dec compliance, inc elasticity; interstitial fibrosis/edema
Restrictive lung disease (RLD):
dec all volumes and capacities; inc FEVIsec/FVC ratio
ARDS
Restrictive lung disease; non-cardiogenic pulmonary edema due to alveolar injury
ARDS
neutrophil destruction type I and II pneumocytes; hyaline membranes
Causes of ARDS
septic shock (MC), aspiration gastric contents, severe trauma
Pneumoconiosis
inhalation mineral dust causing interstitial fibrosis; particles < 0.5 p.m reach alveoli
Caplan syndrome
pneumoconiosis + rheumatoid nodules in lungs
Coal worker's lung
"black lung" disease; progressive massive fibrosis; no increased incidence cancer or TB
Silicosis
quartz; nodular opacities; foundry workers; inc incidence cancer and TB
Sources of asbestos
roofing material, old buildings (9/11), pipe-fitter shipyard
Ferruginous bodies
asbestos fiber coated by iron
Asbestosis:
benign pleural plaques (MC); bronchogenic carcinoma (MC cancer); mesothelioma
Mesothelioma
malignancy of serosa; no smoking association
Sarcoidosis
RLD; MC non-infectious lung and liver granulomatous disease
S/S of sarcoidosis
dyspnea, hilar adenopathy (non-caseating granulomas), uveitis, nodular skin lesions
Lab findings in sarcoidosis
inc ACE, hypercalcemia (macrophages synthesize 1-a-hydroxylase)
Kveim test
intradermal injection sarcoid antigens causes skin reaction
Farmer's lung
RLD; lung reaction against thermophilic bacteria in moldy hay
Silo filler's disease
RLD; reaction against nitrogen dioxide in fermenting corn
Byssinosis
RLD; reaction against cotton, linen, hemp products in textile industry
Goodpasture's syndrome
RLD; anti-BM antibodies; begins in lungs and ends in renal failure
Collagen vascular RLD
SLE, rheumatoid arthritis, systemic sclerosis
Drugs causing RLD
amiodarone, bleomycin. busulfan, cyclophosphamide, methotrexate, nitrofurantoin
Obstructive lung disease
inc compliance, dec elasticity
Obstructive lung disease
inc RV, TLC; dec TV, VC; dec FEV1sec, and FVC; dec FEV1sec/FVC ratio
Examples of Obstructive lung disease
asthma, emphysema, chronic bronchitis, bronchiectasis
Asthma
extrinsic (type I hypersensitivity) and intrinsic types
S/S of Asthma
expiratory wheezing (inflamed terminal bronchioles); LTC4,-D4,-E4 bronchoconstrictors
Charcot Leyden crystals
derive from crystalline material in eosinophil granules
Lab findings in severe asthma
initial respiratory alkalosis; respiratory acidosis requires intubation
Emphysema
destruction elastic tissue respiratory unit; lung hyperinflation; smoking MCC; pink puffer
Respiratory unit
respiratory bronchiole, alveolar duct, alveoli
Radiograph of emphysema
inc AP diameter, depressed diaphragms; vertical heart
Pathogenesis of emphysema
dec AAT, inc neutrophil destruction elastic tissue
Centriacinar emphysema
destruction/distention respiratory bronchioles upper lobe in smokers
Panacinar emphysema
destruction/distention entire respiratory unit lower lobes; AAT deficiency
Paraseptal emphysema
upper lobe destruction/distention alveolar ducts, alveoli; pneumothorax
Lab findings in emphysema
normal to decreased PCO2 (respiratory alkalosis)
Chronic bronchitis
productive cough 3 months/2 consecutive years; blue bloater (cyanosis)
Site of obstruction in chronic bronchitis
terminal bronchioles (proximal to respiratory unit)
Lab findings in bronchitis
respiratory acidosis/hypoxemia
Bronchiectasis
obstruction/infection key causes; dilated bronchi/bronchioles extend to periphery
Causes of Bronchiectasis
CF MCC, TB, immotile cilia syndrome
Immotile cilia syndrome
absent dynein arm in cilia; sinusitis, infertility, bronchiectasis, situs inversus
Central lung cancers
squamous cancer and small cell cancer; men > women
Peripheral lung cancers
adenocarcinoma; women > men
Squamous lung cancer
cavitate; secrete PTH-related protein
Small cell carcinoma
neuroendocrine tumor; secrete ACTH and ADH
Bronchioloalveolar carcinoma
no smoking relationship; lung consolidation resembling pneumonia
Scar carcinoma
usually adenocarcinoma developing in old TB scar
Bronchial carcinoid
low grade malignant; hemoptysis; rare cause carcinoid syndrome
Metastatic lung cancer
more common than primary cancer; breast cancer M
Pancoast tumor
squamous carcinoma posterior mediastinum; destruction superior cervical ganglion
S/S of Pancoast tumor
Homer's syndrome- lid lag, miosis, anhydrosis; lower brachial plexus injury
Solitary coin lesion
granuloma MCC
Superior vena caval syndrome
primary lung cancer obstructs vessel; venous congestion
Anterior mediastinal masses
thymoma; nodular sclerosing Hodgkin's; teratomas
Posterior mediastinal masses
usually neurogenic tumors of ganglia
Myasthenia gravis
B cell hyperplasia of thymus MC abnormality; association with thymoma
Thymoma
association with hypogammaglobulinemia, autoimmune disease, pure RBC aplasia
Pleural effusions
transudates or exudates; CHF MCC
Spontaneous pneumothorax
rupture subpleural or intrapleural bleb; air/pleural cavity pressure same
S/S of sontaneous pneumothorax
pleuritic chest pain, dyspnea, tracheal shift ipsilateral side, absent breath sounds
Tension pneumothorax
flap-like pleural tear; increased pleural cavity pressure; compression atelectasis
S/S of Tension pneumothorax
tracheal shift to opposite side; pleuritic chest pain, dyspnea, absent breath sounds