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Pulmonology > First Aid Review-Respiratory > Flashcards

First Aid Review-Respiratory Flashcards

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1
Q

Errors in _ stage of lung development can lead to tracheoesophageal fistula

A

Errors in embryonic stage of lung development can lead to tracheoesophageal fistula

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2
Q

Lung bud –> trachea –> bronchial buds –> mainstem bronchi –> secondary bronchi –> tertiary bronchi occurs during _ stage of lung development

A

Lung bud –> trachea –> bronchial buds –> mainstem bronchi –> secondary bronchi –> tertiary bronchi occurs during embryonic stage of lung development

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3
Q

Endodermal tubules –> terminal bronchioles and modest capillary network forms during _ stage of lung development

A

Endodermal tubules –> terminal bronchioles and modest capillary network forms during pseudoglandular stage of lung development

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4
Q

Respiratory bronchioles and alveolar ducts develop in _ stage

A

Respiratory bronchioles and alveolar ducts develop in canalicular stage

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5
Q

Babies are capable of respiration at _ weeks gestation

A

Babies are capable of respiration at 25 weeks gestation

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6
Q

Terminal sacs separated by primary septae develop during _ stage of lung development

A

Terminal sacs separated by primary septae develop during saccular stage of lung development

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7
Q

Secondary septation of the alveolar sacs occurs and we slowly develop towards adult alveoli

A

Secondary septation of the alveolar sacs occurs and we slowly develop towards adult alveoli: alveolar stage

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8
Q

Pulmonary hypoplasia is a congenital lung malformation that involves a poorly developed _

A

Pulmonary hypoplasia is a congenital lung malformation that involves a poorly developed bronchial tree

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9
Q

Club cells are (ciliated/nonciliated) cuboidal cells with secretory granules; they are located in the _ and function to _

A

Club cells are nonciliated cuboidal cells with secretory granules; they are located in the bronchioles and function to degrade toxins, secrete surfactant
* They act as reserve cells

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10
Q

Type I pneumocytes are _ type cells

A

Type I pneumocytes are squamous cells

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11
Q

Type II pneumocytes are _ type cells

A

Type II pneumocytes are cuboidal epithelial cells

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12
Q

What is the purpose of the lamellar bodies?

A

Lamellar bodies hold/secrete surfactant from the type II pneumocytes

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13
Q

Surfactant is composed of multiple lecithins, mainly _

A

Surfactant is composed of multiple lecithins, mainly dipalmitoylphosphatidylcholine (DPPC)

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14
Q

Collapsing pressure of alveoli (P) =

A

Collapsing pressure of alveoli (P) = 2 * Surface tension/ radius

Law of Laplace says that alveoli have an increased tendency to collapse on expiration as the radius decreases

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15
Q

Alveolar macrophages, aka “dust cells” phagocytose foreign bodies in the lungs and release _ and _

A

Alveolar macrophages, aka “dust cells” phagocytose foreign bodies in the lungs and release cytokines and proteases

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16
Q

NRDS will present on chest x-ray with _ appearance

A

NRDS will present on chest x-ray with ground-glass appearance

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17
Q

Risk factors for ARDS

A

ARDS risk factors:
* Prematurity
* Maternal diabetes (increased insulin)
* C-section (fewer fetal glucocorticoids)

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18
Q

Supplemental oxygen of an infant with NRDS can have _ side effects

A

Supplemental oxygen of an infant with NRDS can have RIB side effects
* Retinopathy
* Intravascular hemorrhage
* Bronchopulmonary dysplasia

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19
Q

We screen for fetal lung maturity via the _ ratio

A

We screen for fetal lung maturity via the lecithin/sphingomyelin ratio
* L/S should be > 2

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20
Q

A lecithin/sphingomyelin ratio of < 1.5 is predictive of _

A

A lecithin/sphingomyelin ratio of < 1.5 is predictive of NRDS

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21
Q

Airway resistance is the highest in the _

A

Airway resistance is the highest in the large-medium sized bronchi

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22
Q

Cartilage and goblet cells extend to the _

A

Cartilage and goblet cells extend to the end of the bronchi

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23
Q

Terminal bronchioles have _ epithelium

A

Terminal bronchioles have simple ciliated cuboidal epithelium

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24
Q

Respiratory bronchioles have _ epithelium

A

Respiratory bronchioles have simple cuboidal and squamous epithelium

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25
If you aspirate a peanut while supine it is most likely to end up in the _
If you aspirate a peanut while supine it is most likely to end up in the **superior segment of the right lower lobe**
26
If you aspirate a peanut while lying on the right side it is most likely to end up in the _
If you aspirate a peanut while lying on the right side it is most likely to end up in the **right upper lobe**
27
If you aspirate a peanut while upright it is most likely to end up in the _
If you aspirate a peanut while upright it is most likely to end up in the **right lower lobe**
28
The thoracic duct and the azygos vein travel through the diaphragm at the _ with the _ structure
The thoracic duct and the azygos vein travel through the diaphragm at the **aortic hiatus** with the **aorta** structure
29
Inspiratory capacity =
Inspiratory capacity = **TV + IRV**
30
Physiologic dead space estimation =
Dead space = TV * (PaCO2 - PECO2 / PaCO2) In other words, dead space = taco paco peco paco
31
Minute ventilation equation
Total volume of gas entering the lungs per minute: VE = TV * RR
32
Alveolar ventilation equation
Volume of gas that reaches the alveoli each minute: VA = (TV - dead space volume) * RR
33
Normal RR is _
Normal RR is 12-20
34
What happens to intrapleural pressure as we inspire?
It will get more negative Ex: -5 at FRC --> -10
35
What happens to intrapleural pressure as we expire?
It will go from more negative to less negative Ex: -10 --> -5 (rest)
36
What happens to TLC in the elderly? RV?
As we age, **TLC stays the same** however, we get increased lung compliance due to the loss of elastic recoil --> **RV increases**
37
As we age *lung* compliance _ and *chest wall* compliance _
As we age *lung* compliance **increases** and *chest wall* compliance **decreases**
38
If residual volume is increasing as we age, _ is decreasing
If residual volume is increasing as we age, **functional vital capacity** is decreasing
39
Individuals with anemia have decreased hemoglobin, which will _ oxygen content of the arterial blood, _ O2 saturation and _ PaO2
Individuals with anemia have decreased hemoglobin, which will **decrease** oxygen content of the arterial blood, but maintain the same O2 saturation and PaO2 * Normal O2 binding capacity in the blood = 20 mL O2/dL
40
Polycythemia will cause O2 content of the arterial blood to _
Polycythemia will cause O2 content of the arterial blood to **increase** * More hemoglobin = higher total O2 content
41
Carbon monoxide poisoning will cause: Hemoglobin: Oxygen saturation of Hb: Dissolved O2 (PaO2): Total O2 content:
Carbon monoxide poisoning will cause: Hemoglobin: **normal** Oxygen saturation of Hb: **decreased** (competes with O2) Dissolved O2 (PaO2): **normal** Total O2 content: **decreased**
42
Methemoglobinemia is a condition whereby _ occurs; this presents with _ and _
Methemoglobinemia is a condition whereby **increased oxidized form of hemoglobin (Fe3+)** occurs; this presents with **cyanosis** and **chocolate-colored blood** * Problematic because the oxidized form (Fe3+) does not bind O2 as readily
43
_ are chemicals found in food preservatives that are known to induce methemoglobinemia
**Nitrites** are chemicals found in food preservatives that are known to induce methemoglobinemia * Note that we can treat cyanide poisoning with nitrites because oxidized Hb has increased affinity for cyanide
44
Methemoglobinemia can be treated using _ and _
Methemoglobinemia can be treated using **methylene blue** and **vitamin C**
45
Both cyanide and carbon monoxide poisoning inhibit aerobic metabolism; how?
Both cyanide and carbon monoxide poisoning inhibit aerobic metabolism **by inhibition of complex IV** (cytochrome c oxidase) * This causes hypoxia that does not fully correct with supplemental oxygen
46
Three treatment options for treating cyanide poisoning
Cyanide poisoning: 1. **Hydroxocobalamin** 2. **Nitrites** 3. **Sodium thiosulfate**
47
We treat carbon monoxide poisoning via _
We treat carbon monoxide poisoning via **100% oxygen** or hyperbaric O2
48
Patient presents with cyanosis, bitter almond odor and cardiovascular collapse:
Patient presents with cyanosis, bitter almond odor and cardiovascular collapse: **cyanide**
49
Patient presents with trouble breathing, headache, and dizziness after sitting next to a warm heater in the winter; MRI shows a bilateral globus pallidus lesion
Patient presents with trouble breathing, headache, and dizziness after sitting next to a warm heater in the winter; MRI shows a *bilateral globus pallidus lesion*: **carbon monoxide poisoning**
50
Cyanide will cause the oxygen-hemoglobin to _
Cyanide will cause the oxygen-hemoglobin to **stay the same**
51
What does carbon monoxide do to the oxygen dissociation curve and O2 content?
Carbon monoxide binds competetively to hemoglobin with 200x the affinity that oxygen does * The small amount of oxygen that can bind to carboxyhemoglobin will be held very tightly and won't be offloaded to the tissues * O2 saturation of Hb goes way down
52
Gases like O2 (healthy individuals), CO2, and N2O are (perfusion/diffusion) limited gases
Gases like O2 (healthy individuals), CO2, and N2O are **perfusion-limited** gases * These gases will equilibrate early along the length of the capillary
53
CO is a (perfusion/diffusion) limited gas
CO is a **diffusion** limited gas * It does not equilibrate by the time the blood reaches the end of the capillary * This is because it so strongly binds hemoglobin * DLCO is the extend to which CO passes from air sacs of lungs into blood
54
O2 may become more "diffusion-limited" in states such as _
O2 may become more "diffusion-limited" in states such as **emphysema, fibrosis, exercise** * Gas will not equilibrate by the end of the capillary if there is a diffusion problem
55
Alveolar gas equation
PAO2 = PIO2 - (PaCO2/R)
56
Respiratory quotient
CO2 produced / O2 consumed Normal is 0.8
57
Wasted ventilation tends to occur at the _ region of the lung
Wasted ventilation tends to occur at the **apex**
58
Wasted perfusion tends to occur at the _ region of the lung
Wasted perfusion tends to occur at the **base**
59
What happens to the lung during exercise?
During exercise there will be an increase in cardiac output and a **vasodilation of the apical capillaries** --> V/Q approaches 1
60
100% O2 does not improve _ cause of hypoxemia
100% O2 does not improve **shunts** * Example: foreign body aspiration
61
CO2 binds hemoglobin at _ location
CO2 binds hemoglobin at **N-terminus of the globin** * *It does not bind the heme*
62
Modes of CO2 transport:
Modes of CO2 transport: *70%* in HCO2- *25%* in Carbaminohemoglobin *5%* dissolved CO2
63
The majority of blood CO2 is carried as HCO3- in the _
The majority of blood CO2 is carried as HCO3- in the **plasma** * Leaves the RBC via HCO3/Cl exchanger
64
Asthma is a type _ hypersensitivity reaction that involves smooth muscle hypertrophy and hyperplasia
Asthma is a **Type I** hypersensitivity reaction that involves smooth muscle hypertrophy and hyperplasia
65
Polio, myasthenia gravis, guillain-barre, scoliosis, and obesity are all examples of _
Polio, myasthenia gravis, guillain-barre, scoliosis, and obesity are all examples of **restrictive lung diseases** *that do not affect A-a gradient or DLCO* * Either due to poor muscular effort or poor structural apparatus
66
Patient presents with bilateral hilar lymphadenopathy, noncaseating granulomas and increased ACE and Ca2+
Patient presents with bilateral hilar lymphadenopathy, noncaseating granulomas and increased ACE and Ca2+: **sarcoidosis**
67
Key features of IPF
Idiopathic pulmonary fibrosis presents with **repeated cycles of injury and wound healing via collagen deposition** * Honeycombing * Traction bronchiectasis
68
Granulomatosis with polyangiitis causes _ type lung disease
Granulomatosis with polyangiitis (GPA) causes **restrictive lung disease**
69
4 notorious drugs that cause restrictive lung disease
1. Bleomycin 2. Busulfan 3. Amiodarone 4. Methotrexate
70
Hypersensitivity penumonitis is a type _ hypersensitivity reaction
Hypersensitivity penumonitis is a **Type III/IV** hypersensitivity reaction
71
Describe the granulomas we expect to see in sarcoidosis
Sarcoidosis is associated with noncaseating granulomas that contain **schaumann and asteroid bodies**
72
"Ivory white" supradiaphragmatic and pleural plaques
"Ivory white" supradiaphragmatic and pleural plaques: **asbestosis**
73
Asbestosis affects the _ lobes
Asbestosis affects the **lower lobes**
74
Berylliosis affects the _ lung lobes and is associated with _ granulomas
Berylliosis affects the **upper** lung lobes and is associated with **noncaseating** granulomas
75
_ is a pneumoconiosis that is thought to disrupt phagolysosomes and impair macrophages, increasing TB susceptibility
**Silicosis** is a pneumoconiosis that is thought to disrupt phagolysosomes and impair macrophages, increasing TB susceptibility
76
"Eggshell" calcification of the hilar lymph nodes on chest x-ray
"Eggshell" calcification of the hilar lymph nodes on chest x-ray: **Silicosis**
77
Psammoma bodies
Psammoma bodies: **mesothelioma**
78
ARDS can only be diagnosed via the following criteria:
ARDS can only be diagnosed via the following criteria: 1. **Abnormal chest x-ray showing bilateral opacities** 2. **Respiratory failure within 1 week of alveolar insult** 3. **Decreased PaO2/FiO2** 4. **Symptoms of respiratory failure not due to the heart**
79
Central sleep apnea may be caused by :
Central sleep apnea may be caused by: * **C**ongestive heart failure * **C**NS toxicity * **C**heyne Stokes respirations
80
Hearing bronchial sounds in the lungs themselves (rather than the trachea) may indicate _
Hearing bronchial sounds in the lungs themselves (rather than the trachea) may indicate **consolidation from pneumonia**
81
Tracheal deviation from a pleural effusion or a tension pneumothorax is in _ direction
Tracheal deviation from a pleural effusion or a tension pneumothorax is **away from the side of the lesion**
82
Tracheal deviation from atelectasis is in _ direction
Tracheal deviation from atelectasis is **towards the side of the lesion**
83
Staph aureus and haemophilus influenzae tend to cause _ type pneumonia
Staph aureus and haemophilus influenzae tend to cause **bronchopneumonia**
84
On day two of a pneumonia we expect to see _ in _ stage
On day two of a pneumonia we expect to see **red-purple, partial consolidation of the parenchyma; exudate containing mostly bacteria** * This is the *congestion phase* * Lasts from day 1-2
85
From day 3-4, lobar pneumonia is in _ stage
From day 3-4, lobar pneumonia is in **red hepatization stage** * Red-brown consolidation * Exudate contains fibrin, bacteria, RBCs, WBCs * It is reversible
86
Day 5-7 of lobar pneumonia is marked by the _ stage
Day 5-7 of lobar pneumonia is marked by the **gray hepatization stage** * Lobe is uniformly gray * The exudate is full of WBCs, **lysed RBCs**, and fibrin
87
After 8 days, lobar pneumonia is in the _ stage
After 8 days, lobar pneumonia is in the **resolution stage** * Enzymative digestion of exudate by macrophages
88
Lambert-Eaton myasthenic syndrome is a possible complication of lung cancer; it involves muscle weakness from _
Lambert-Eaton myasthenic syndrome is a possible complication of lung cancer; it involves muscle weakness from **antibodies against presynaptic Ca2+ channels**
89
Squamous cell carcinoma commonly causes _ electrolyte abnormality
Squamous cell carcinoma commonly causes **hypercalcemia** from **PTHrp**
90
Pleomorphic giant cells on histology indicate _ lung cancer
Pleomorphic giant cells on histology indicate **large cell carcinoma**
91
Squamous cell often presents with a _ on CXR
Squamous cell often presents with **hilar mass arising from the bronchus** on CXR

Pulmonology (16 decks)

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