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Flashcards in CHAPTER: Resp Deck (46):
1

Another name for phosphatidylcholine

Lecithin
L/sphingomyelin ratio > 2 = healthy

2

Where in the airways is:
1. Highest R
2. End cartilage // goblet cells
3. End SM

Med size airways = ↑est R
End cart + GC @ bronchi
End SM @ terminal bronchioles

3

What goes through at T10 vs 12?

10: esophagus + CN 10
12: red - white - blue
Aorta - thoracic duct - azygous vein

4

Level at which these bifurcate:
Common carotid
Trachea
AA

CC: C4
T: T4
AA: L4

5

What value isn't measured on spirometry and thus messes up a lot of lung vol calcs

RV

6

Where is Hgb taut vs relaxed

Taut @ tissues = low O2 affinity for unloading
Relaxed @ resp to pick up O2
↑O2 affinity b/c ↓BPG affinity

7

4 causes of a R shift in the Hgb binding curve

R shift = ↓affinity
1. Acidosis: (exercise) ↑H+ to bind Hb = HbH
2. ↑BPG
3. ↑Temp
4. ↑Pco2: think will make O2 unload more to correct this
5. Altitude

8

How does CO poisoning change the Hgb binding curve

L shift - ↑affinity for CO

9

Describe how methemoglobin is generated + 2 symptoms + antidote

Hgb (Fe 2+) + nitrates or benzocaine (local anesthetic)
Convert to Hgb (Fe 3+) = mHg
Symptoms:
1. Cyanosis
2. Chocolate blood
Antidote = methylene blue

10

How does the O2 binding curve change with CO?

1. Comes down = ↓O2 bound to Hb
2. Faster slope = ↑affinity for CO > O2

11

Why does myoglobin not show positive cooperativity (aka more linear slope of binding curve)?

B/c monomeric

12

What is hypoxemia vs hypoxia?

Xemia = ↓PaO2 = dissolved O2
Hypoxia = ↓O2 delivery to tissues
Xemia can lead to hypoxia

13

Describe V/Q of the lobes of the lung

Top lobe = ↓V/↓↓Q = ↑ratio = wasted vent b/c preferentially vasocontrict away from a low airflow area
Middle w/e
Bottom lobe = highest V + Q but ↑V/↑↑Q = ↓ratio, aka the perfusion is so much greater than vent

14

Describe change to high altitude:

↓O2 atm = ↓PAO2 = ↓PaO2
↑vent to compensate = ↓PaCO2 = resp alkalosis (time causes comp metabolic acidosis aka excreting HCO3)
↑EPO + BPG to comp
↓PAO2 -> hypoxic vasoconstriction -> pulm HTN + RHF

15

2 BVs you need to know for nose bleeds

Ant = Kiesselbach plexus
Post/potentially life threatening = sphenopalatine art (branch maxillary art)

16

What does a negative D dimer tell you about suspected PE?

Not a PE
+ d dimer rules in it, - rules it out

17

What is Homan sign?

If you dorsiflex pts foot -> calf pain
Sign of PE

18

3 causes of nasal polyps

1. Repeated rhinitis
2. CF (kid)
3. ASA intol asthma (adult)

19

What might you biopsy for suspected nasopharyngeal carcinoma//aka what might present?

Cervical LNs
See keratin + (epi) cells w/ lymphocyte background (makes sense since EBV tumor)

20

Describe etiology of vocal cord nodules that are:
1. Bilateral
2. 1 unilat
3. Multiple unilat

1. Overuse - made of myxoid CT
2 // 3 - adults // kids - laryngeal carcinoma = SCC
Smoking, alc, or HPV 6/11 (weird low grade!!)

21

3 non-lung presentations of TB granulomas

Base meninges
Kidney -> sterile pyuria (pus in urine)
Pott's... duh you know that

22

Shape of TB granuloma + cytokine that maintains it

Horseshoe - necrotic granuolma
IFNg

23

Hemm or ischemic infarct for PE

Unlikely to infarct at all b/c lots co-lat circulation
If anything, hemm

24

What type of gas causes problems with the bends? What is this disease called if it goes chronic and causes bone necrosis?

Nitrogen bubbles precipitating
Caisson disease

25

What are Lines of Zahn

Pink + red interdig of a PE
Tells you pre-mortem PE

26

Describe chronic bronchitis
1. Symptoms
2. FEV1/FVC ratio
3. Measure of severity
4. Pathophys

Productive cough on/off > 2yrs
Hypertrophy of mucous glands: Reid index (B/A+B+C)
Mucous plugs trap CO2
Air trapping = obstructive = ↓FEV1/FVC

27

Histo findings asthma

Mucous plugs w/ Curschmann spirals
Charcot Leyden crystals = eos

28

PE + CXR finding for asthma

Pulsus paradoxus (↓10 on insp) among others
Peribronchial cuffing

29

Dseases that are causes of bronchiectasis

Damage cilia: smoking, Kartagener
CF
ABPA

30

How do misfolded A1AT proteins stain?

PAS + @ ER hepatocytes

31

Describe imaging of pulm fibrosis

TGF beta mediated
1. Subpleural patches "honeycombing"
2. Lower >> upper lobe

32

What is Caplan syndrome?

Pneumoconioses + RA

33

Histo berylliosis

Granulomas

34

Patho + histo + imaging for silicosis

Silica X macrophage phagolysosome (↑risk TB)
Macro are able to cause fibrosis
Histo: birefringent particles
Imaging: eggshell calcification hilar LNs

35

Patho ARDS

Endo damage -> protein rich fluid leaks into alveoli
Pulm edema that isn't due to heart = normal PCWP

36

Describe acute vs chronic lung transplant rejection

Acute = BVs lymph infiltrate
Chronic = bronchiolitis obliterans = X small airways

37

Gene for heritable pulm art HTN

BMPR 2 - excess SM prolig
Think young woman with resp distress and possible RHF

38

Percussion of atelectasis

Dull

39

Breath sounds for consolidation

Pna, pulm edema
Bronchial BS // insp crackles

40

What would milky pleural effusion fluid suggest?

↑TGs = lymphatic
"Chylothorax"

41

4 stages of lobar pna

1. Red + soft = congestion
2. Red + firm = exudate in alveolar space
3. Gray + firm = RBCs in exudate get degrade
4. T2P resolve to normal tissue

42

What cells cause lung abscess (not bugs)

Neutrophils + macro responding to infection kill bugs and surrounding tissue

43

2 histo + markers and features for mesothelioma

Cytokeratin
Calretinin
Long slender microvilli + tonofilaments

44

Histo + paraneo of small cell carcinoma

Poorly diff neuroendocrine - + NCAM (neural cell adhesion molecules)
ACTH (Cushing presentation)
SIADH (hypoNa b/c dilute)
Lambert Eaton

45

Histo + paraneo of squamous cell carcinoma

Keratin pearls w/ intercell bridges
PTHrP

46

Histo + paraneo of large cell carcinoma

Pleomorphic giant cells
BhCG