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147 Cards in this Set
- Front
- Back
The systolic/diastolic blood pressure of the pulmonary circulation |
25/8 mmHg |
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The pulmonary circulatory system has ______ pressure and resistance than the systemic circulation |
lower |
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The property of pulmonary blood vessels that allows vessels to expand and dilate, allowing for large volume increases without increasing pressure |
compliance |
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The pressure across the capillary walls in the lungs |
transmural pressure = (intravascular pressure - alveoli pressure) |
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Increases in lung volume ____________ resistance in alveolar vessels and _____________ resistance in extra-alveolar vessels |
increase, decrease |
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The point at which total pulmonary circulation resistance is lowest |
end of expiration |
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The mechanism used by the lungs to shift circulation to better ventilated alveoli |
hypoxic vasoconstriction |
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The levels that define pulmonary hypertension (arteriole pressure) |
25mmHg at rest, 35mmHg when exercising |
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Simplified Poiseuille's equation |
pressure change = resistance x flow |
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Point at which pulmonary edema occurs |
When pulmonary capillary pressure exceeds 25 mmHg |
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A condition that occurs due to damage to the lung tissue (via toxins, bacteria, or inflammation) that reduces the pressure threshold for pulmonary edema (by increasing capillary permeability) |
adults respiratory distress syndrome (ARDS) |
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Formula for inspired O2 |
PO2(tracheal) = (Ptotal - PH2O) x 0.21 (Note that normally PH20 = 47 mmHg) |
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The alveolar PO2 |
105 mmHg |
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The alveolar PCO2 |
40 mmHg |
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The typical tissue PO2 |
40 mmHg |
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The typical tissue PCO2 |
46 mmHg |
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The type of alveolar dead space caused by disruptions to blood flow / gas exchange |
respiratory dead space |
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Increasing alveolar ventilation (hyperventilation) ___________ the partial pressure of CO2 |
decreases |
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The three components of lung vital capacity |
1. tidal volume 2. inspiratory reserve volume 3. expiratory reserve volume |
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The air that cannot be moved out of the lungs physiologically |
residual volume |
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The procedure used to directly measure pulmonary artery pressures |
pulmonary artery catherization (Swan Ganz) |
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ventilation formula |
total minute ventilation = tidal volume x respiratory rate |
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normal total minute ventilation |
5-6 liters/min |
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The cells of the lung that secrete surfactant |
type II alveolar epithelial cells |
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The major muscles of inspiration |
scalenes and external intercostals |
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The major muscles of expiration |
internal intercostals and abdominal muscles |
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The formula/test used to assess airway resistance |
FEV1/FVC (should be above 70%) |
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In restrictive lung disease, the FVC is ________ and the FEV1 is __________ |
low, normal |
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The major component of surfactant |
DPPC |
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compliance forumla |
compliance = (delta volume) / (delta pressure) |
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Boyle's law formula |
P1V1=P2V2 |
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Any disease that increases airway resistance |
obstructive lung disease |
|
low pitched wheezing noises on physical exam |
rhonchi |
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A decrease in CO2 partial pressure ________ smooth muscle tone of the airways |
increases |
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An obstructive respiratory disease where alveoli (and thus elastic recoil) are destroyed |
emphysema |
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The major factor that causes the inability to exhale normally in emphysema |
loss of elastic recoil |
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Pulmonary diseases that are characterized by decreased distensibility of lungs, pleura, or chest wall |
restrictive lung disease |
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The mechanism of measuring lung volume that is not accurate for patients with obstructive lung disease |
helium dilution test |
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gas diffusion formula |
~ [area x diffusion coefficient x (pressure difference)] / thickness of membrane |
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The test used to test gas diffusion of lung |
CO diffusion test |
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The formula for dissolved gas amount |
amount that dissolves = solubility coefficient x partial pressure |
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oxygen diffusion is normally ______________ limited |
perfusion (diffusion limitation is abnormal) |
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Increases in temperature shift the Hb binding curve to the ____________ |
right |
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Increasing pH shifts the Hb binding curve to the ________ |
left |
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Increasing PCO2 shifts the Hb binding curve to the __________ |
right |
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2,3DPG (indicates increased glycolysis) shifts the Hb binding curve to the __________ |
right |
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The fetal hemoglobin curve is shifted to the ______ |
left |
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Formula that relates ventilation and arteriole CO2 partial pressure |
Va = K(VCO2/PaCO2) |
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Normal value range for alveolar-arterial oxygen gradient |
0-10 mmHg |
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oxygen content formula |
CaO2 = 1.34(Hgb)(oxygen saturation) + 0.003(PaO2) |
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Key sign of hypoventilation |
increased PaCO2 with normal A-a gradient |
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Key sign of a shunt |
High A-a gradient that does not respond to oxygen |
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Normal PaCO2 value range |
35-45 mmHg |
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PaCO2 formula |
VCO2/VA (CO2 production / alveolar ventilation) |
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The part of the brainstem that is largely responsible for rhythmic, autonomic breathing |
medulla |
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The term for normal, quiet breathing |
eupnea |
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The term for dyspnea at rest while supine |
orthopnea |
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The classic pattern of breathing seen in someone with metabolic acidosis |
Kussmaul breathing (rapid and deep pattern) |
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The respiratory neuron group in the medulla responsible for inspiration |
dorsal respiratory group (DRG) |
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The part of the VRG (medulla) that acts as a respiratory rhythm generator |
Botzinger complex |
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Part of the pons that results in deeper and more frequent breaths |
apneustic center |
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Part of the pons that inhibits the DRG and halts inspiration |
pnemotaxic center |
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Receptors in alveoli and small airways that respond to interstitial edema |
J receptors |
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Hormone that suppresses appetite and stimulates ventilation |
leptin |
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Sleep pattern of extreme responses to hyper and hypoventilation |
Cheynes-Stokes respiration |
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Bronchodilator that increases calcium efflux to induce bronchial smooth muscle relaxation |
Beta-2 agonist |
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The mechanism of beta agnoist action |
receptor --> increase cAMP --> PKA --> calcium efflux |
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Three most common beta-2 agnoists |
1. albuterol 2. salmeterol 3. fomoterol |
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The short action "rescue inhaler" beta 2 agonist |
albuterol |
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The two long-acting beta 2 agonist bronchodilators |
salmeterol & formoterol |
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The major short acting anti-cholinergic bronchodilator |
ipratropium |
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The 2 major long acting anti-cholingeric bronchodilators |
tiotropium & umeclidinium |
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The mechanism of action of anticholinergic bronchodilators |
block muscarinic receptors to block |
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The type of bronchodilator indicated for COPD |
anticholinergic |
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The mechanism of action of montelukast |
inhibits LTF4 formation |
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the mechanism of action of zileuton |
blocks formation of all leukotrienes |
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anti-tussive that draws free water into airway |
guaifenesin |
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non-opiate anti-tussive that is not particularly effective |
dextromethorphan |
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genetic disorder that causes emphysema (without smoking / environmental risk factors) |
alpha-1-antitrypsin deficiency |
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The cells responsible for early bronchospasm |
mast cells & macrophages |
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Mechanism of late phase bronchospasm |
Cytokine and chemokine mediated inflammation |
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endogenous bronchodilators |
catecholines |
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The mechanism of exercise induced bronchoconstriction |
reduced water content --> increased tonicity --> irritation and bronchospasm |
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antibody therapeutic that blocks mast cell degranulation (used for intractable asthma) |
omalizumab |
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A condition characterized by dilation and destruction of bronchial walls, retention of mucus, and increased incidence of infections |
bronchiectasis |
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The chloride channel protein affected in cystic fibrosis |
CFTR |
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The primary physiological characteristics of bronchiestasis |
1. mucus hypersecretion 2. epithelial hyperplasia 3. airway hyperreactivity & bronchoconstriction 4. loss of elastic recoil |
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The main pathogen of concern in CF patients |
Pseudomonas aeruginosa |
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The bronchodilator sometimes used in CF patients |
beta 2 agonists |
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The CFTR potentiator drug that works in patients with a specific gene mutation |
Ivacaftor |
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PAO2 formula |
(FiO2)(Pb - PH20) - PaCO2/0.8 |
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The typical fraction of inspired oxygen at sea level |
0.21 |
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The barometric pressure at sea level |
760 mmHg |
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The vapor pressure of water at sea level |
47 mmHg |
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The A-a (Alveolar-arterial) oxygen gradient formula |
(FiO2)(Pb-PH20) - [(PaO2 + PaCO2)/0.8] Note: (FiO2)(Pb-PH20) usually equals 150 |
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Normal A-a gradient value |
0 |
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When determining whether V/Q mismatch or a shunt is responsible, what do you look at? |
Response to oxygen. If PaO2 is <500mmHg after 100% oxygen, then a shunt is responsible. |
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The pH change seen in chronic hypercapnia |
0.03 units pH per 10mmHg rise in PaCO2 |
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The two major sources of innervation for the parietal pleura |
intercostal nerves and phrenic nerve |
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The collapse of a segment of lung |
atelectasis |
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The general mechanism of pleural transudate formation |
changes in pressure (hydrostatic or osmotic) in pleural space or pleural blood vessels |
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Effusion that leaks into the pleural space |
transudate |
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Pleural effusion caused by disruption to pleural membranes |
exudate |
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The sterile exudate form of pneumonia-caused pleural effusion |
parapneumonic effusion |
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The infected exudate form of pneumonia-caused pleural effusion |
empyema |
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A type of pleural effusion caused by disruption of the thoracic duct |
chylothorax |
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Interstitial diseases caused by inhaling inorganic dust |
pneumoconioses |
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Interstitial disease caused by immune reaction to organic molecules |
hypersensitivity pneumonitis |
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The pathogenesis of asbestosis |
macrophages incompletely phagocytose asbestos fibers |
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Cancer of the pleura |
mesothelioma |
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The pneumoconiosis that increases risk for TB, due to effect on alveolar macrophages |
silicosis |
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partially alveolated bronchiole |
respiratory bronchiole |
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bronchiole that does not open in alveoli |
membranous bronchiole |
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defining feature in lung slide of bronchiole |
cartilage |
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The kind of emphysema that is not caused by smoking. Occurs more frequently in lower lobes. |
panlobular emphysema |
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The pathophysiology of ARDS |
Inflammatory response (to infection such as pneumonia or pancreatitis) causes edema of capillary-alveoli interface |
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The kind of WBCs seen in hypersensitivity pneumonia |
CD8+ lymphocytes |
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The major anticholinergic bronchodilator |
ipratropium |
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The kind of pulmonary hypertension that increases the PCWP |
venous pulmonary hypertension |
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The most common gene mutated in hereditary pulmonary hypertension |
BMPR-II |
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The three major medications given to treat pulmonary hypertension (WHO group 1) |
1. NO increase (Ricoiguat) 2. Endothelin antagonist 3. Prostacyclin |
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The types of interstitial lung diseases that lead to a "ground glass" appearance on CT |
infectious or inflammatory |
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The type of interstitial lung disease that leads to honeycombing |
fibrotic |
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Interstitial disease that results in inter-alveolar macrophages. Related to smoking. |
DIP |
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Pulmonary disease characterized by stellate lesions and Birbeck granules. Heavily correlated with smoking. |
PLCH (pulmonary langerhans cell histiocytosis) |
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A fibrotic lung disease with both temporal and spatial heterogeneity. Restricted to interstitia |
UIP (usual interstitial pneumonia) |
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Disease that causes poorly formed granulomas and neutrophil infiltration of interstitia |
hypersensitivity pneumonitis |
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Interstitial lung disease that is not related to smoking |
COP (cryptogenic organizing pneumonia) |
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pulmonary vascular resistance formula |
PVR = (mean pulmonary arterial pressure -PAWP) / cardiac output |
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Major form of inflammation-caused alveolar edema |
ARDS |
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The tend of non-small cell lung cancer that tends to be locally invasive (not metastatic), grow around the hilum, and secrete PTH. (100% of patients have history of smoking.) |
squamous cell |
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The most common form of non-small cell lung cancer that tends to metastasize. Typically located in periphery. |
adenocarcinoma |
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The kind of lung cancer that is more likely to be systemic |
small cell lung cancer |
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Type of lung cancer that causes hypercalcemia |
squamous cell carcinoma |
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Common paraneoplastic syndrome that causes hyponatremia |
SIADH |
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Cancer characterized by keratin pearls and intercellular bridges |
squamous cell carcinoma |
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minute ventilation equation |
VE = (tidal volume) x (respiratory rate) |
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dead space equation |
VD/VT = (PaCO2 - PECO2) / PaCO2 |
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blood oxygen carrying capacity formula |
CaO2 = 1.34 (Hgb) (SaO2) + 0.003(PaO2) |
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Starlings law for pulmonary capillary fluid balance |
= (difference in hydrostatic pressure) - (difference in oncotic pressure) |
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Stretch receptors (of tracheobronchial tree) that prevent hyperinflation |
Hering-Breuer |
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Interstitial lung disease with ground glass opacities & pigmented alveolar macrophages. Only occurs in smokers. |
DIP |
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ILD that has pneumonia like presentation and has alveolar infiltrates. Responds to steroids. |
crypogenic organizing pneumonia (COP) |
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Form of ILD that is an immune response to organic particles |
hypersensitivity pneumonitis |
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The defining PaO2 for hypoxemia |
< 60 mmHg |
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The defining PaCO2 for hypercapnia |
> 45 mmHg |
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The four necessary criteria for ARDS |
1. acute onset 2. abnormal CXT or CT (bilateral opacities) 3. respiratory failure not fully explained by fluid overload or CHF 4. hypoxemia |