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211 Cards in this Set
- Front
- Back
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What is the foregut derived from?
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endoderm
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What is the foregut comprised of?
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respiratory tract, GI tract from the mouth to the second part of the duodenum
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What is the acronym for the tissues derived from the neural crest?
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MOTEL PAASS
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What does MOTEL PAASS mean?
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M- melanocytes
O- odontoblasts T- tracheal cart. E- enterochromatin L- laryngeal cart. P- parafollicular A- all ganglia A- adrenal meduall S- schwann S- spiral membrane |
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When is surfactant production complete?
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32-34 weeks
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What organ develops first in the embryo?
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brain
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When is the notocord visible by?
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3 weeks
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When is the brain formed by?
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8 weeks
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What is the purpose of surfactant?
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it decreases the atmospheres effect on the alveoli
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What does surfactant prevent?
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atelectasis- collapse
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What does surfactant do to the compliance of the alveoli?
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increases
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What is the compliance equation?
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C = delta volume/delta pressure
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What ratio is used to measure surfactant levels?
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lecitnin/sphyngomyelin levels
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Out of the two compounds in the ratio, which is made first?
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sphyngomyelin
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Using the ratio, how do you know if surfactant production is complete?
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the ratio is 2:1 or greater
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What else can be used to see if surfactant is being made?
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phosphatidylglycerol- it's a breakdown product of surfactant
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If both the lecithin/sphyngo and phosphatidylglycerol levels are negative, what 2 drugs can be given to the mother?
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beclamethasone or betamethasone
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What if the baby is born early, what can be given to prevent atelectasis?
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synthetic surfactant
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What is given to all premies to stop the buildup of free radicals?
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vit E
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What is the treatment for right sided heart failure?
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fluids
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Would you ever give fluids in left sided heart failure?
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never
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Do pts. with restrictive lung disease have trouble breathing in or out?
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in
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What does the A-a gradient look like in restrictive lung disease?
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increased
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What is the pO2, pCO2 and pH in restrictive lung disease?
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decreased, decreased, high (alkaline)
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Is compliance good or bad in restrictive lung diseases?
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poor
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What do all restrictive lung disease pts all die from?
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right sided heart failure called cor pulmonale (rt. sided heart failure do to pulmonary HTN)
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What is the #1 cause of death in the 1st 60 days of life?
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hyaline membrane disease
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What type of ventilator is used for hyaline membrane disease HMD?
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a jet ventilator
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Why a jet ventilator?
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it reduces free radicals caused by more O2 the patient needs due to decreased diffusion from the disease
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The increased pressure needed to breath in HMD can cause what to happen?
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pneumothorax
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What is the Kussmaul sign?
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increased JVD on inspiration
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What is a positive pulsus paradoxicus?
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> 10 mm Hg drop in BP on inhail
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What are the classic signs of HMD?
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+ Kussmaul, + pulsus paradoxicus, loss of BP and pulse, cyanosis, and + Hammans sign
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What is a + Hammans sign?
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you can feel subcutaneous emphysema- can feel rough and air bubbles
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What two bacteria can cause a spontaneous pneumothorax?
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staph and pseudo. pneumo
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Why can they cause a spontaneous pneumo?
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they both have elastase
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Who is a spontaneous pneumo. common in? Why?
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females on birth control- because estrogen is a muscle relaxant
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What is a tramatic pneumothorax from?
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stab wound or rib fractures
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For a symptomatic pneumothorax, what must be done?
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chest tube
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What is a tension pneumothorax?
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the lung is being squashed by air
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What must be done in a tension pneumothorax?
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a needle must be inserted in the 2nd intercostal space, midclavicular line to let the air rush out and a chest tube must be placed in the 3rd space pointing up
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What is the most common cause of a pneumothorax?
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right side stab wound
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What does a left side stab wound cause in order from most common to least?
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tamponade and pneumothorax (tamponade is fluid accumulation around the heart and cause the heart to not fill properly from compression)
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Pts with obstructive lung disease have trouble breathing which way?
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out
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In obstructive disease, what does pO2, pH and pCO2 look like
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pO2 is normal or low and pCO2 is high, pH is low (acidic)
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What is the most common cause of death in obstructive disease?
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bronchiectasis- digestion of the airway
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Where does 80% of the amniotic fluid come from?
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filtrate of mom's plasma
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Where does the other 20% come from?
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directly from the fetus
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What is the main function of amniotic fluid?
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shock absorption
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What is the secondary function of amniotic fluid?
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prevent atmospheric pressure from affecting the fetus
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In general, what causes polyhydramnios?
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the baby is not digesting the amniotic fluid
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In general, what causes oligohydramnios?
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the baby does not add to the fluid
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What are the top 3 causes of UTIs?
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e. coil, proteus, klebsella
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What is the top cause of UTIs if the stem says nitrite (-)?
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enterococcus
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What causes the pruning in prune belly syndrome?
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absence of abdominal wall musculature
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In Prune Belly Syndrome, why is there oligohydramnios?
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the fetus is unable to bear down and urinate
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What is the #1 cause of neuropathy in the U.S.?
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diabetes
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How does the diaphragm form?
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from ventral to dorsal
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What is the most common deformity in the diaphragm?
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Bochtalek defect- rear defect
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What is an anterior or midline diaphragm hernia called?
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Morgagni defect
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What is the extrathoracic space defined as?
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from the lips to the glottis
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What is the intrathoracic space defined as?
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from the glottis to the alveoli
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What does the extrathoracic airway do on inspiration? On expiration?
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narrows, expands
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Is the extrathoracic airway protected by the thoracic cage?
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no
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What does the intrathoracic airway do on inspiration? On expiration?
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expands, narrows
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What is the stimulus of a sigh or a yawn?
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too much CO2 in the dead space
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How many C-shaped cartilage rings does the trachea have?
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16-20
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Where does the opening of the C face?
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posteriorly
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Where are the 3 anatomic narrowings in the trachea?
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glottis, midway (due to compression by the aorta), and carina (T4- level of the nipple- bifurcation)
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After the bifurcation, which side is narrower and straighter?
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right side
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When does the trachea start to have cartilage all the way around it?
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when it goes into the lung because the lung sits on it all the way around
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If a person is choking and is unable to speak, where is an object lodged?
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in the trachea
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Where do large objects tend to lodge in the trachea?
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glottis
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Where do small objects tend to lodge?
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right lower lobe
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If a person is sitting or standing up, where will an aspirated object be found?
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posterior segment
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If a person is lying down, where will a small aspirated object be found?
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superior segment
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What are the 3 top aspirations in the U.S.?
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peanuts, popcorn, hot dogs
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In the lungs, what does the dead space function as?
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act as conducting airways
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What is the total ventilation equation?
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Vt = Vd + V alv
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Where do coins get stuck?
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at the carina
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Where is dead space in the pulmonary system?
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from the lips to the terminal bronchiole
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What size particles does mucous take care of?
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> 20 um
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What size particles does cilia take care of?
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> 2 um to < 20 um
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What size particles does macrophages take care of?
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< 2 um
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Type 1 pneumocytes are what?
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macrophages
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Type 2 pneumocytes do what?
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produce surfactant
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What is the 2 functions of goblet cells?
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produce mucous and trap debris
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How much does mucous mover per 1 cough?
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1 inch
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Where is most smooth muscle found in the pulmonary system?
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medium brionchioles
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What section of the airway does asthma affect?
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medium airway
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What type of cells is the airway lined with?
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type 1
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What type of cells are the alveoli lined with?
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type 2
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What type of cells does the upper 1/3 of the airways have?
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stratified squamous
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What type of cells does the mid 1/3 have?
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combination
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What is the main respiratory epithelium?
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tall columnar ciliated epithelium
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What type of cells does smoking change your respiratory system to?
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squamous cells
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What part of the airway does cilia line?
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the whole airway
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Which way does cilia beat?
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to the mouth
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What is the configuration of cilia?
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9 + 2 - 9 microtubules, 2 actin proteins
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What protein gives cilia flexibility?
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dynein
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In Kartagener's syndrome, what is defective?
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dynein arm
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What are the 3 most common clues pointing at Kartagener's?
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bronchiectasis, infertility, situs inversus
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How many coughs would bronchitis present with?
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about 5- mucous down about 5 inches
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What is the most common cause of the death in Kartagener's?
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bronchiectasis
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What condition in Down's causes macroglossia?
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hypothyroidism
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What does decreased breath sounds indicate?
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space between the alveolus and chest wall is occupied
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What does dullness to percussion mean?
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space between the alveolus and chest wall is occupied
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Increased fremitus means?
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consolidation on the same side to atelectasis on the opposite side
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With atelectasis, which side does the trachea deviate?
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towards the atelectasis and away from pneumothorax
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What are the 4 most common lung viruses?
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parainfluenza (80%), RSV (15%), adenovirus, influenza
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What sings will you see with croup?
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swelling around the glottis, + steeple sign
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In acute bronchitis, how long has there been increased mucous?
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> 1 week, < 2 years
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In chronic bronchitis, how long has there been increased mucous?
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> 2 years for at least 3 consecutive months
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What is the suspect for pneumonia of the airways?
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bacteria
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What is suspect for pneumonia of the interstitum?
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something other than bacteria
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What causes epiglotitis?
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Influenza B
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How does epiglotitis present?
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fever, stritor, muffled voice, drooling
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What causes trachetitis?
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C. diptheria
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What is a clue for C. Diptheria?
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chinese letters
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Pneumonia with rusty colored sputum is caused by what?
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strep pneumonia
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Pneumonia with curant jelly sputum is caused by what?
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klebsiella pneumonia
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Pneumonia with sulphur granules is caused by what?
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actinomyces pneumonia
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Pneumonia after the flu is caused by?
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staph aureus
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Pneumonia with a malodorous smell or gas formation is caused by what type of microbe?
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anaerobe
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In order, what are the 3 most common causes of pneumonia in the US?
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strep pneumo, H. influenza, and n. catharralis
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What are the 3 causes of atypical and their age group they affect?
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chlamydia 0-2 months
mycoplasma 10-30y (walking) legionella > 40y |
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What is a clue for atypical pneumonia caused by chlamydia?
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stecatto coughing, increased eosinophils and conjunctivitis
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What is a clue to pneumonia caused by legionella?
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silver stains
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What fungus is common in the midwest?
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histoplasmosis
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What fungus is common in the northeast?
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blastomycosis
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What fungus is common in the southwest?
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coccidiomycosis
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What fungus is common in South America?
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paracoccidiomycosis
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What fungus is caused by moldy hay or basements?
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aspergillus
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What fungus comes from a rose thorn?
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sporothrix
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What is a clue pointing to asbestosis?
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catch at work, shipyard worker, pipe fitter, insulation tech, brake mechanic
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What is a clue pointing to silicosis?
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sandblaster or glass blower
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What is a clue pointing at bissinosis?
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cotton fibers
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What is a clue pointing at berrylliosis?
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radio and television metal
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What is the only Gram + that is acid fast?
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nocardia
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Who does nocardia effect the most?
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diabetics
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What is diagnostic of sarcoidosis?
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noncaseating granulomas
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What is the most common central cancer of the lung- accounts for 90%?
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squamous cell carcinoma
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What central cancer of the lung accounts for the remaining 10%?
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small cell carcinoma
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What 4 hormones and their percentage does small cell carcinoma produce?
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ACTH- 90%
ADH- 5% PTH- 3% TSH- 2% |
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ACTH secrete by small cell carcinoma can lead to what disease and what side effect?
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cushing's disease and SIADH
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What labs are diagnostic of SIADH?
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normovolemia, decrease serum OSM, increased urine OSM
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In reference to what peripheral lung cancer does 2 larges in a question stem refer?
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large cell carcinoma- everything is huge
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What is the most common risk factor for lung cancer?
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primary smoking
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What is the intrathoracic space comprised of?
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chest wall and pleural space
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What are the 3 physiologic parts of the lung?
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intrathoracic space, pulmonary vasculature, pulmonary airway
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What is the compliance equation?
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C = delta V/ delta P
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What does elasticity provide?
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recoil
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What is RV?
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the amount of air left in the lungs after a forced expiration
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What is ERV?
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the amount of air that can be forced out after a normal exhalation
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What is FRC?
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the combination of RV and ERV
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What is TV?
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the amount of air you take in during a normal inhalation
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What is IRV?
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the amount of air you can force inspire
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What is TLC?
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all the air in your lungs at the end of a deep breath
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What is VC?
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the air you can breath in after forced exhalation (ERV + TV + IRV)
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What 4 muscles allow you to inspire?
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external intercostals, pectoralis minor, sternocleidomastoid, trapezius
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A value below an FEV/FVC ratio of .8 is what kind of lung disease?
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obstructive
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A value above an FEV/FVC of .8 is what tye of lung disease?
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restrictive
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A compliance rises, what happens to airflow?
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it increases
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What two bugs are associated with a pneumothorax?
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staph aureus and pseudomonas
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Intrathoracic pressure should always remain what?
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negative
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What is the Kussmaul sign?
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increased JVD (jugular vein distension) with ispiration
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What is pulsus paradoxicus?
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exaGGERATED DROP IN BP ?(> 10 MM HG) on inspiration
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What does a + Kussmaul or Pulsus Paradoxicus indicate?
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positive intrathoracic pressure
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What is the most common cause of a + Kussmaul or Pulsus paradoxicus?
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pericardial tamponade or pneumothorax
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What is the most common cause of pericardial tamponade?
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trauma or cancer that causes bleeding around the pericardium
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What is the treatment for pericardial tamponade?
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pericardiocentesis
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What is the most common cause of a pneumothorax?
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trauma
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What is a spontaneous pneumothorax associated with?
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estrogen use or collagen disease
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What is the treatment for a pneumothorax?
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chest tube placement
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Why does S2 splitting widen on inspiration?
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because flow (Q) increases
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What is the only disease with a fixed S2 splitting?
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ASD
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What is the most common cause of an ASD?
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defect in the primum secundum
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What is the normal rate of respiration per minute?
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12-16 breaths
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What are the 3 reason flow in greater at the bottom of the lungs than the top?
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gravity, less resistance, more oxygen goes tot he bottom of the lung with each breath
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Where in the lung is more oxygenation accomplished on inspiration?
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at the bottom
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Where in the lung is more oxygenation accomplished on expiration? Why?
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at the top- because it's always open
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So, where is there more ventilation in the lungs on inspiration?
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at the bottom
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Overall, where is there more ventilation in the lungs? Why?
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at the top- the mouth is always open
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Where is the V/Q ratio the greatest in the lung?
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at the top, equal in the middle, and least at the bottom
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What pattern does every V/Q mismatch follow?
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restrictive
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What do J-receptors in the lungs detect? What do they signal?
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interstitial particles, signal increased respiration
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Where are slow adapting receptors found? What is the function?
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in the ribs, especially the sternocostal joints- sense stretch and inflation and causes exhalation
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A respiratory rate above 30 indicates what kind of disease?
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restrictive
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When are the maxillary and ethmoid sinuses present?
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when you are born
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When is the sphenoidal sinus evident?
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age 2
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When is the frontal sinus evident?
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4-6 y
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Where is the aortic body found?
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in the arch of the aorta
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What does the aortic arch measure?
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pCO2, pH and H+ ions
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Where is the carotid body located?
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bifurcation of the internal and external carotids
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What does the carotid body detect?
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PO2, PCO2, pH, and H+ ions
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What blood gas is the brain sensitive too?
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pCO2
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What part of the brain controls breathing in and out?
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pons
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Specifically, what part of the pons controls exhaling?
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pneumotactic
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Specifically, what part of the pons controls inhaling?
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apneustic
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What are the 4 criteria for declaring someone brain dead?
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no response to stimulus, flat EEG, prove brain stem is dead and 2 doctors must agree
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What is the difference between comatose and brain dead?
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comatose can respond to stimulus
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What is the job of the medulla?
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responsible for basic functions
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What is the respiratory rate of the medulla?
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8-10
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What does the pons respond to?
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the environment
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What is locked-in syndrome?
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the pons is damaged, pt is only able to blink
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Na levels should never change more than what in a 24 h period?
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10 m.eq.
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Glucose levels should enver change more than what in a 1 h period?
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100 m.eq.
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What is the normal anion gap?
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10-12
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What is apnea?
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lack of inspiratory effort
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What is central apnea?
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no inspiratory effort with or without bradycardia in 20 seconds or more
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What is obstructive apnea? usually caused by?
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occlusion of the airway during sleep- usually caused by obesity
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