Pulm Flashcards Preview

Step 1 Flash Cards > Pulm > Flashcards

Flashcards in Pulm Deck (48):
1

Structures cross the diaphragm at what levels

I ate 10 eggs at 12
- IVC - T8
- esophagus - T10
- aorta - T12

2

physiologic dead space equation

Vd = Vt x (PaCO2 - PeCO2)/PaCO2
taco, paco peco, paco
= tidal volume (arterial PCO2 - expired air PCO2)/arterial PCO2

3

things that favor the taught form of Hgb

Cl-, H+, CO2, 2,3BPG and temperature
- right shift favored by BAT ACE: BPG, altitude, temp, acid, CO2, exercise

4

methemoblobin

- oxidized Hgb (Fe3+), doesnt bind Hgb as well, seen in newborns and with oxidative stress (cyanosis and chocolate covered blood)
- binds cyanide well, so give nitrites to form methemoglobin in cyanide poisoning, then give thiosulfate to bind cyanide and be renally excreted

5

carboxyhemoglobin

CO binds Hgb, causes a left shift and pts have cherry red skin

6

perfusion limited vs. diffusion limited

- perfusion limited: things that are perfusion limited equilibrate early: O2 in healthy ppl, CO2, N2O
- diffusion limited: things that do not equilibrate by the time the blood reaches the end of the capillary: O2 in emphysema and fibrosis, CO

7

hypoxemia with normal Aa gradient

high alt, hypoventilation

8

hypoxemia with increased Aa gradient

VQ mismatch, diffusion limitation, RL shunt

9

V/Q = 0

shunt
- does not improve with 100% O2

10

V/Q = infinity

blood flow obstruction
- does improve with 100% O2

11

Haldane effect

oxygenation of Hgb promotes dissociation of H+ from Hgb, therefore CO2 is released

12

Bohr effect

increased H+ in the tissue causes a right shift, causing unloading of O2

13

response to high altitude

decreased PaO2 leads to hyperventilation
- increased EPO
- increased 2,3BPG for more O2 unloading
- more renal excretion of bicarb to compensate for respiratory alkalosis

14

response to exercise

increased CO2 production and O2 consumption
- increased ventilation rate, and V/Q becomes more uniform throughout the lung
- no change in PaO2 and PaCO2, but increase in venous CO2 and decrease in venous O2 content

15

rhinosinusitis bugs

S. pneumo, H flu, M catarrhalis

16

virchow triad

- predisposition to DVTs
- stasis, hypercoagulability, endothelial damage

17

different types of emboli and their classic findings

- fat: hypoxemia, neurologic abnormalities and petechial rash
- amniotic fluid: DIC
- gas: divers, treat with hyperbaric O2

18

centriacinar vs. paracinar emphysema

- centri - smokers
- para - alpha 1 antitrypsin

19

asthma path findings

Curschman spirals (shed epithelium forms mucus plugs)
Charcot-Leyden crystals (formed from breakdown of eosinophils in sputum)

20

bronchiectasis

- chronic necrotizing infection of bronchi --> permanently dilated airways, purulent sputum, recurrent infections and hemoptysis
- assoc w/ bronchial obstruction, poor ciliary motility (smoking), Kartagener syndrome, CF, allergic bronchopulmonary aspergillosis

21

asbestosis findings and increased risks

- asbestos (ferrunginous) bodies are golden-brown fusiform rods resembling dumbells
- increased incidence of bronchogenic carcinoma and mesothelioma

22

silicosis findings

- impairs macrophages, leads to fibrosis and increased susceptibility to TB
- "eggshell" calcification of hilar lymph nodes

23

pulm HTN

- primary due to BMPR2 gene, leading to vascular smooth muscle cell proliferation, poor prognosis
- secondary due to COPD, VTE, AI disease, L-R shunt, sleep apnea or high alt

24

most common sites that metastasize TO the lungs

breast, colon, prostate, bladder

25

most common sites that the lungs metastasize to

adrenals, brain, bone, liver

26

lung adenocarcinoma

- most common
- peripheral
- activating mutations include k-ras, EGFR, and ALK
- clubbing

27

squamous cell carcinoma of the lung

- Central, Cavitation, Cigarrettes, hyperCalcemia (PTHrP)
- SCa+++mous
-keratin pearls and intercellular bridges

28

small cell (oat cell) lung cancer

- central, undifferentiated, aggressive
- Acth, Adh, Antibodies (Lambert-Eaton), Amplification of myc
- inoperable, treat with chemo
- neoplasm of the neuroendocrine Kulchitsky cells --> small dark blue cells

29

large cell carcinoma

- peripheral
- highly anaplastic undiff tumor, poor prognosis
- removed surgically
- pleomorphic giant cells

30

bronchial carcinoid tumor

- excellent prognosis
- symptoms due to mass effect, occasionally carcinoid syndrome (flushing, diarrhea, wheezing)
- nests of neuroendocrine cells, Chromagranin A +ve

31

mesothelioma

- malignancy of the pleura with hemorrhagic pleural effusions and pleural thickening
- psammoma bodies

32

pancoast tumor

- Horner, SVC, sensorimotor defects, hoarseness, upper extrem edema

33

transudate pleural effusion

low prot content
- CHF, nephrotic syndrome, hepatic cirrhosis

34

exudate pleura effusion

high prot content
- malignancy, infection, collagen vascular disease, trauma

35

lymphatic pleural effusion

- milky fluid with high TG
- thoracic duct injury

36

1st gen H1 blockers

- diphenhydramine, dimenhydrinate, chlorpheniramine
- used in allergy, motion sickness, sleep aid
- tox - sedation, antimuscarinic, anti-adrenergic

37

2nd gen H1 blockers

- loratidine, fexodenadine, desloratidine, cetirizine
- used in allergy
- tox - less sedating because less CNS penetration

38

guaifenesin

expectorant - thins resp secretions, does not suppress cough reflex

39

NAC

mucolytic - can loosen mucous plugs in CF kids

40

dextromothorphan

- antitussive (NMDA antagonism)
- synthetic codeine analog
- mild opioid effect in excess, mild abuse potential
- naloxone can be given for overdose

41

pseudoephedrine, phenylephrine

- alpha agonist nasal decongestants
- reduce hyperemia, edema and nasal congestion
- tox - HTN, can also cause CNS stimulation/anxiety
- tachyphylaxis - rapidly declining effect after a few days due to decreased production of norepi at nerve terminals

42

b2 agonists

- albuterol (short), salmeterol, formoterol (long-acting)
- relaexes smooth muscle
- SE: tremor and arrhythmia

43

theophylline

- methylxanthine that causes bronchodilation by inhibiting PDE --> inc CAMP because of decreased breakdown
- narrow TI, p450 metabolizes it, blocks adenosine actions

44

beclomethasone, fluticasone

corticosteroids that inactivate NFkB, the transcription factor that induces the production of TNFa and other inflammatory cytokines

45

monteleukast, zafirlukast

leukotriene receptor blocker, good for aspirin-induced asthma

46

zileuton

5-lipoxegenase pathway inhibitor (blocks AA --> leukotriene conversion)

47

omalizumab

monoclonal IgE Ab for allergic asthma

48

bosentan

used to treat pulmonary arterial hypertension, competitively antagonizes endothelin-1 receptors, decreased pulmonary vascular resistance