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