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121 Cards in this Set

  • Front
  • Back
A patient exhibits an extended expiratory phase; what is the disease process?
obstructive lung disease
Tall, thin teenage male has abrupt-onset dyspnea, left sided chest pain, reduced breath sounds, and hyperresonace. What happened?
Spontaneous pneumothorax
Young women can't conceive, suffers from recurrent URI's, and has dextrocardia. What is her problem?
Kartagener's syndrome (mutated dynein protein)
What is the TLC of a person with these lung volumes: FRC=5, IRV=1.5, IC=2, VC =3.5
Preterm infant has increased lung density on Xray and difficulty breathing. What's wrong, and what could have prevented it?
neonatal respiratory distress syndrome. Give mom steroids before birth to increase fetal surfactant production
25-year old comatose dude on a ventilator dies from fever, had a pus-filled cavity in his lung. What happened?
He aspirated infective material and it led to a lung abscess
52-yr-old woman undergoing menopause is tired. What's the dx and has her O2 sat and O2 content changed?
anemia due to blood loss. O2 sat is unchanged, O2 content is decreased
Patient has hypoxia, but a normal chest X-ray. What's the cause?
Pulmonary embolism
What disease can a pulmonary embolism mimic?
myocardial infarction
Patient has hypoxia, and enlarged heart on chest X-ray. What's the cause of the hypoxia?
Which anatomical structures are part of the conducting zone of the respiratory tree?
everything from the nose/mouth down to the terminal bronchioles. Only moves air, no gas exchange
Cartilage is present only in the ________ and _________ of the respiratory tree
trachea and bronchi
Which anatomical structures are part of the respiratory zone of the respiratory tree?
respiratory bronchioles, alveolar ducts, and alveoli. They all exchange gases.
What is the lecithin/sphingomyelin ration used for?
A value of >2 in the amniotic fluid indicates that the fetus has mature lungs
Which cell type lines the alveolar surface, and is thin to facilitate gas exchange?
Type 1 pneumocyte
Which cells are cuboidal, secrete surfactant, and proliferate when the lung is damaged?
Type II pneumocyte
Which cells secrete components of surfactant, and also degrade toxins in the respiratory tree?
Clara cells
Where are the vessels in any given broncho-pulmonary segment?
Bronchial and pulmonary arteries run with the bronchus, veins and lymphatics run along the margins
If I inhaled a grape, which lung would it end up in and why?
Right lung, because the right mainstem bronchus is wider and more vertical than the left one
Where are the pulmonary arteries in relation to the mainstem bronchi at the hilum?
Right artery is anterior to the bronchus, left artery is superior to the bronchus
The fissure between the superior lobe and the middle lobe of the right lung corresponds to what other structure?
4th rib
At what vertebral level does the IVC penetrate the diaphragm?
At what vertebral level does the esophagus penetrate the diaphragm?
At what vertebral level does the aorta penetrate the diaphragm?
Pain in the diaphragm can feel like pain from....where?
Your shoulder
Which muscles control breathing during quiet respiration?
inspiration - diaphragm
expiration - passive
Which muscles control breathing during exercise?
inspiration - external intercostals, scalenes, sternomastoids
expiration - abdominals, internal intercostals
What 3 things does surfactant do?
decrease alveolar surface tension, increase lung compliance, decrease work of inspiration
Lung volumes: tidal volume (TV)?
air that moves into and out of lungs during a normal, quiet breath
Lung volumes: expiratory reserve volume (ERV)?
air that can be breathed out after a normal exhalation
Lung volumes: Inspiratory reserve volume (IRV)?
air in excess of tidal volume that you can breath in on maximum inspiration
Lung volumes: Residual volume (RV)?
air left in the lung after maximal expiration
Lung volumes: Vital Capacity (VC)?
or, the total amount of usable lung volume
Lung volumes: Functional Residual Capacity (FRC)?
or, total air left in the lung after a normal, quiet expiration
Lung volumes: Inspiratory capacity (IC)?
or, total amount of air you can breath in after a normal, quiet expiration
Lung volumes: Total Lung Capacity (TLC)?
or, total amount of air that your lungs can hold
What is the formula for determining the physiologic dead space?
TV x (PA-PE) / PA
TV=tidal volume
PA=arterial pCO2
PE=expired air pCO2
In plain english, what does it mean when the oxygen-hemoglobin curve is moved to the left?
hemoglobin holds on to oxygen tighter
What can cause the oxygen-hemoglobin curve to move to the left?
lower temperature, lower pCO2, higher pH, lower 2,3DPG, fetal hemoglobin, resting
What can cause the oxygen-hemoglobin curve to move to the right?
higher temperature, higher pCO2, lower pH, higher 2,3DPG, exercising
In plain english, what does it mean when the oxygen-hemoglobin curve moves to the right?
Hemoglobin doesn't hold on to oxygen very tightly; O2 moves into tissues easier
The pulmonary circulation is normally a ______-resistance, _______-compliance system
low resistance, high compliance
Hypoxia (decreased O2) in lung tissue leads to....what?
local vasoconstriction, to shunt blood to other places where there is more oxygen
What does it mean to say that O2 transport is perfusion-limited in pulmonary capillaries?
O2 equilibriates almost instantaneously; to increase diffusion, you must increase blood flow
What does it mean to say that in certain disease states, O2 transport is diffusion-limited in pulmonary capillaries?
O2 does not equilibriate by the time the blood leaves the capillary due to fibrosis or scarring
What are the 2 problems with CO poisining?
CO left-shifts the oxyHgb curve (less tissue offloading) and has 50% more affinity to bind to HgB
How do you treat CO poisining?
100% oxygen
Normal pulmonary artery pressure is.....?
10-14 mmHg
What are the cutoffs for pulmonary hypertension?
at rest: >25mmHg
excercise: >35mmHG
What causes primary pulmonary hypertension?
Nobody knows, and it carries with it a really bad prognosis
What causes secondary pulmonary hypertension?
COPD, usually, but can also be caused by a L->R shunt
How does airway resistance relate to length and radius of the vessel?
resistance increases with increased length, decreases a lot with increased radius
What is the equation for Pulmonary Vascular Resistance (PVR)?
(pulmonary artery pressure - pulmonary wedge pressure) / cardiac output
What is the O2 binding capacity in a normal person?
20.1 mL oxygen per deciliter
What is the equation for total oxygen content of the blood?
(O2 binding capacity x %saturation) + dissolved O2
What is the formula for oxygen delivery to tissues?
cardiac output x blood oxygen content
What is the Alveolar Gas Equation?
pAO2=pIO2-(pACO2 / R)
pAO2=oxygen in the alveolus
pIO2=oxygen in inspired air
pACO2=CO2 in the alveolus
R=respiratory quotient
What can you use as an easier approximation of the Alveolar Gas Equation?
PAO2=150-(PaCO2 / 0.8)
What is a normal Alveolar-arterial (A-a) gradient?
10-15 mmHg
What does it mean if the A-a gradient is elevated?
hypoxemia due to shunting, V/Q mismatch, or fibrosis
How do you calculate the A-a gradient?
What does a very very small V/Q ratio mean?
Shunt. Lots of perfusion, not much ventilation. 100% O2 does NOT improve pO2
What does a very very large V/Q ratio mean?
Dead Space. Not much perfusion, lots of ventilation. 100% O2 improves pO2
Identify the 3 lung zones in terms the V/Q ratio
Zone 1 -> V/Q=3, at the apex
Zone 2-> V/Q=1, in the middle
Zone 3-> V/Q=0.6, at the base
What are the 3 ways carbon dioxide is transported from tissues?
As bicarb (90%)
bound to Hgb (5%)
dissolved in plasma (5%)
What are the body's responses to living at high altitude?
increased ventilation, increased hematocrit, increased Hgb, increased 2,3DPG, increased bicarb excretion
In general, what happens in obstructive lung disease?
increased residual volume, decreased vital capacity. decreased FEV1, decreased FEV1/FVC ratio. V/Q mismatch.
In plain english, what happens in obstructive lung disease?
You breath air in, but the air can't get out. Lung compliance is high, lung elasticity is low
What happens in Chronic Bronchitis?
hypertrophy of mucus-secreting glands, increase in thickness of small airway walls.
what is the timeframe for diagnosing Chronic Bronchitis?
productive cough for longer than 3 consecutive months in more than 2 years
What happens in emphysema?
Destruction of alveolar walls leads to enlarged, floppy airspaces
What are some symptoms of Chronic Bronchitis?
wheezing, crackles, cyanosis
What are some symptoms of emphysema?
dyspnea, decreased breath sounds, tachycardia, pursed lips
What causes centriacinar emphysema?
What causes panacinar emphysema?
alpha1-antitrypsin deficiency
What's special about paraseptal emphysema?
Cause bullae (air bubbles) that can rupture and lead to pneumothorax. Happens in otherwise healthy young males
What happens in asthma?
bronchi constrict at the drop of a hat. Smooth muscle hypertrophy. Triggered by allergies, stress, viruses.
What are some symptoms of asthma?
cough, wheezing, dyspnea, tachypnea, hypoxemia, pulsus paradoxus, mucus plugs
What happens in bronchiectasis?
necrotizing infection that leads to permanently dilated airways.
What are some symptoms of bronchiectasis?
recurrent infections, purulent sputum, hemoptysis
What other syndromes can lead to bronchiectasis?
Cystic fibrosis, Kartagener's syndrome, poor ciliary motility
In general, what happens in Restrictive Lung Diseases?
Lungs can't expand. FEV1/FVC ratio is greater than 80%. reduced total lung volume
What two general categories do restrictive lung disease fall into?
those due to musculoskeletal problems, and those due to inherent problems with the lung
Polio and myasthenia gravis can lead to what kind of lung disease?
restrictive lung disease due to poor muscular support
Scoliosis and morbid obesity can lead to what kind of lung disease?
restrictive lung disease due to structural support issues
Give some examples of inherent restrictive lung diseases
ARDS, chemical inhalation, sarcoid, goodpasture's, Wegener's, pulmonary fibrosis, hyaline membrane disease
What causes neonatal respiratory distress syndrome? (also called hyaline membrane disease, I don't know why)
lack of surfactant. Lung alveoli collapse in on themselves
What happens in ARDS?
injury leads to protein leakage into alveolar space. Neutrophils cause damage, hyaline membranes form
What is the normal value for the FEV1/FVC ratio?
A person has focal absent breath sounds, decreased resonance and fremitus, and his trachea deviates toward the affected side. What's his problem?
obstructed bronchus
A person has decreased focal breath sounds, dull percussion, decreased fremitus, and no tracheal deviation. What's her problem?
pleural effusion
A person has normal breath sounds, dull percussion, increased fremitus, and no tracheal deviation. What's their problem?
Lobar pneumonia
A person has decreased breath sounds, hyperresonant percussion, absent fremitus, and the trachea deviates away from the affected side. What is the problem?
Where does Squamous cell carcinoma occur, and what causes it?
central tumors in the hilum. You'll see cavitations. Caused by smoking.
Where does adenocarcinoma occur, and what kind of cells give rise to it?
peripheral sites of prior injury, arises from both type 2 pneumocytes and clara cells. Not linked to smoking
Where does Small Cell Carcinoma occur, and what's the pathology?
central location, aggressive, undifferentiated. Comes from neuroendocrine cells. Treat with chemo
Where does Large Cell Carcinoma occur, and what's the pathology?
peripheral location, undifferentiated, poor prognosis. Treat with surgery
What kind of tumor can secrete serotonin and cause flushing, diarrhea, wheezing, and salivation?
Carcinoid tumor
What cancers commonly metastatize to the lung?
brain, bone, and liver
What tumor occurs in the apex of the lung, and can cause Horner's syndrome?
Pancoast's Tumor
Which pneumonia presents with intra-alveolar exudate and consolidation on chest X-ray? What organism causes it?
Lobar pneumonia, usually caused by pneumococcus
Which pneumonia presents with inflammation starting in bronchioles and moving in to the alveoli in a patchy distribution?
What organisms commonly cause bronchopneumonia?
S aureus, H flu, Klebsiella, S pyogenes
Which pneumonia causes diffuse patchy inflammation in the interstitium, leaving the alveoli alone?
Interstitial (atypical) pneumonia
What organisms commonly cause interstitial pneumonia?
RSV, adenovirus, mycoplasma, legionella, chlamydia
What organisms are usually found in lung abscesses?
S aureus or anaerobes
What are the 2 most common causes of lung abscess?
bronchial obstruction due to a tumor, or aspirated gastric contents
What's the difference between a transudate and an exudate?
Transudate has low protein content and is mostly clear, exudate has high protein content and is mostly cloudy
What are some common causes of a trandudative pleural effusion?
CHF, nephrotic syndrome, hepatic cirrhosis
What are some common causes of an exudative pleural effusion?
malignancy, pneumonia, collagen vascular disease, trauma
how does isoproterenol work and what is it used for?
treats asthma by relaxing bronchial smooth muscle. It's a beta-agonist
How does albuterol work, and what is it used for?
treats asthma by relaxing bronchial smooth muscle. Very fast acting, you inhale it.
How does salmeterol work, and what is it used for?
treats asthma by relaxing bronchial smooth muscle. Long-acting, used prophylactically
how does theophylline work, and what is it used for?
treats asthma by inhibiting phosphodiesterase -> increasing bronchodilation. Toxic to heart and nerves.
How does ipratropium work, and what is it used for?
treats asthma by blocking muscarinic receptors, preventing bronchoconstriction
How does cromolyn work, and what is it used for
treats asthma by inhibiting mast cell effectors. Prophylaxis only, useless for an acute attack
Why do you give corticosteroids (beclomethasone, prednisoe) to people with asthma?
they prevent the inflammation that causes the long-term thickening and damage to the bronchial wall
how does zileuton work, and what is it used for?
treats asthma by blocking the conversion of arachidonic acid into leukotrienes. Reduces inflammation
How do zafirlukast and montelukast work, and what are they used for?
treats asthma by blocking leukotriene receptors, therefore lessening the inflammatory response
What is guaifenesin used for, and what does it do?
removes excess phlegm, but does NOT suppress the cough reflex
What is N-acetylcysteine, and who is it given to?
It's a mucolytic, and is given to CF patients