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83 Cards in this Set

  • Front
  • Back
what type of cell lines respiratory tree?
pseudostratified ciliated columnar cells (to respiratory bronchioles)
what type of cells line alveoli?
type I pneumocytes (97% of surface area); squamous
stem cells of pneumocytes?
type II pneumocytes
which cells secrete surfactant?
type II pneumocytes; cuboidal
chemical name of surfactant?
dipalmitoyl phosphatidylcholine
nonciliated columnar cells that degrade toxins in alvioli?
Clara cells
what amniotic finding indicates fetal lung maturity?
lecithin-to-sphingomyelin ratio of >2.0
what is in the center (anatomically) of each bronchopulmonary segment?
tertiary bronchus and two arteries (bronchial and pulmonary)
what vessels are at the border of each bronchopulmonary segment?
veins and lymphatics
how many lobes in each lung?
Right: three lobes
Left: two plus lingula
if you aspirate a small object, where does it go?
while upright: lower portion of right inferior lobe
while supine: superior portion of right inferior lobe
anatomic relation of pulmonary artery to the bronchus at each lung hilus?
RALS:
Right Anterior
Left Superior
at what level do various important structures perforate diaphragm?
T8: IVC
T10: esophagus, vagus
T12: aorta, thoracic duct, azygous vein
what cranial nerves innervate the diaphragm?
C3, 4, 5
what muscles are used in forceful inspiration?
diaphragm + external intercostals, scalenes, sternomastoids
what muscles are used in forceful expiration?
rectus abdominis, internal and external obliques, transversus abdominis, internal intercostals
five compounds secreted by lung?
1. surfactant
2. prostaglandins
3. histamine
4. angiotensis-converting enzyme
5. kallikrein (activates bradykinin)
which form of hemoglobin (taut vs. relaxed) has high affinity for O2?
Relaxed
fetal hemoglobin has higher/lower affinity for oxygen than adult hemoglobin?
HIGHER (due to lower affinity for 2,3-BPG)
how do you treat cyanide poisoning?
1. use nitrates to oxidize hemoglobin to methemoglobin (binds cyanide)
2. use thiosulfate to bind cyanide for renal excretion
normal pulmonary artery pressure?
10-14 mmHg
definition of pulmonary hypertension?
pulmonary artery pressure > 25 mmHg or >35 during exercise
cause of primary pulmonary hypertension?
inactivating mutation in BMPR2 gene
formula for pulmonary vascular resistance (PVR)?
P(PA) - P(LA)
-----------------------
cardiac output
what causes cyanosis?
more than 5 g/dL of deoxygenated Hb
approximation of alveolar gas equation?
PA(O2) = 150 - PA(CO2)/0.8
(150 is PO2 in inspired air, 0.8 is normal respiratory quotient)
normal A-a gradient?
10-15 mmHg
three things that cause increased A-a gradient?
1. V/Q mismatch
2. right-to-left shunting
3. diffusion limitation/fibrosis
where is V/Q normally >1?
at apex of lungs (wasted ventilation)
where is V/Q normally <1?
at base of lungs (wasted perfusion)
why is reactivation TB typically found in apices of lungs?
thrives in high O2 found at apex (due to V/Q > 1)
how is most carbon dioxide transported in the blood?
as bicarbonate (90%); result of carbonic anydrase activity in rbcs
what other condition is seen along with amniotic fluid emboli?
DIC
imaging test of choice for PE?
CT angiography
Virchow's triad?
1. stasis
. Hypercoagulability
3. endothelial damage
Homan's sign?
pain in calf with dorsiflexion of foot (sign of DVT)
cause of centriacinar emphysema?
smoking
cause of panacinar emphysema?
alpha-1-antitrypsin deficiency
what type of emphysema causes spontaneous pneumothorax in young, healthy males?
paraseptal emphysema (associated with bullae)
in what condition do you see a decreased FEV1/FVC ratio?
obstructive lung disease
what pattern of PFTs do you see in restrictive lung disease?
decreased FVC and TLC with FEV1/FVC ratio > 80%
what meds cause restrictive long disease?
bleomycin, busulfan, amiodarone
ivory white calcified pleural plaques?
asbestosis
what causes "eggshell" calcification of hilar lymph nodes?
silicosis
golden-brown dumbbell shaped rods inside macrophages in lungs?
asbestos bodies
what neoplastic conditions are associated with asbestosis?
bronchogenic carcinoma and mesothelioma
at what point in gestation is surfactant produced?
mostly after 35th week
supplemental O2 given in neonatal respiratory distress syndrome can cause what pathology?
retinopathy
what are risk factors for neonatal respiratory distress syndrome?
prematurity, maternal diabetes, cesarean delivery
mechanism of ARDS?
diffuse alveolar damage causes increased capillary permeability and protein-rich leakage into alveoli. Results in formation of intra-laveolar hyaline membrane
normal FEV1/FVC ratio?
80%
"coin" lesion on chest x-ray?
lung cancer
where in lung does squamous cell carcinoma occur?
central (hilar mass)
histology of squamous cell carcinoma (of lung)?
keratin pearls and intracellular bridges
where in lung does adenocarcinoma occur?
peripherally, at site of prior pulmonary inflammation or injury
in what type of lung cancer do Clara cells differentiate into type II pneumocytes?
adenocarcinoma
type of lung cancer most often associated with ectopic ACTH or ADH production?
small cell carcinoma
Lambert-Eaton syndrome?
autoantibodies against neuromuscular junction calcium channels produced by lung small cell carcinoma; results in decreased ACh being released
peripherally located, highly anaplastic undifferentiated lung tumor with poor prognosis?
Large cell carcinoma
lung cancer with histology showing pleomorphic giant cells with leukocyte ragments in cytoplasm?
large cell carcinoma
lung cancer with Psammoma bodies in histology?
mesothelioma
types of lung cancer most likely causing Pancoast's tumor?
squamous cell or small cell carcinomas (peripherally located)
most common cause of lobar pneumonia?
pneumococcus, then klebsiella
most common causes of interstitial (atypical) pneumonias?
Viruses (RSV, adenoviruses), Mycoplasma, Legionella, Chlamydia
Most common organisms causing lung abscesses?
S. aureus, anaerobes
first generation H1 blockers?
diphenhydramine, dimenhydrinate, chlorpheniramine
second generation H1 blockers?
loratadine, fexofenadine, desloratadine, cetirizine
MOA of isoproternol?
non-specific beta-agonist; relaxes bronchial smooth muscle, but also causes tachycardia
clinical use of albuterol vs. salmeterol?
albuterol: short acting B2 agonist, use during acute asthma exacerbation
salmeterol: long-acting agent for prophylaxis
MOA of theophylline?
causes bronchodilation by inhibiting phosphodiesterase (decreases cAMP hydrolysis); metabolized by P450
MOA of ipratropium?
competitive block of muscarinic receptors; prevents bronchoconstriction
MOA of cromolyn
prevents release of mediators from mast cells; used for ppx against asthma
first line therapy for chronic asthma?
inhared corticosteroids
medication especially used for aspirine-induced asthma?
montelukast and other leukotriene inhibitors
bosentan?
medication used ot treat pulmonary hypertension; competitively antagonizes endothelin-1 receptors and decreases pulmonary vascular resistance
mechanism by which smoking causes COPD?
smoking increases neutrophil elastase activity which over time causes destruction to alveolar walls and decreased diffusion of oxygen into alveolar walls
in COPD, what is limiting factor to oxygenation of pulmonary circulation?
diffusion (unlike healthy lungs, which are perfusion limited)
PPX for PCP pneumonia?
TMP-SMX (second line is aerosolized pentamidine in case of sulfa allergy)
what organism causes strep throat?
streptococcus pyogenes
treatment for strep throat?
penicillin
mechanism of infertility associated with cystic fibrosis?
congenital absence of vas deferens
what happens to TLC in COPD?
increased due to lung hyperinflation
vitamin abnormality seen in sarcoidosis?
elevated vitamin D due to increased conversion from inactive form by macrophages