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Pulm Flashcards

1
Q

Respiratory Distress, Neuro impairment (confusion), upper body petechial rash (thrombocytopenia)

A

Fat Emboli (long bone fracture)…microvascular occlusion

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2
Q

Acute Onset Resp failure, bilateral lung opacities, decreased Pa02/Fi02

A

Acute Respiratory Distress Syndrome

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3
Q

Causes of Acute Respiratory Distress Syndrome

A

Trauma, Sepsis, Shock, Gastric Aspiration, Acute Pancreatitis, Uremia

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4
Q

Intra-alveolar hyaline membranes

A

Acute Respiratory Distress Syndrome. Initial damage from Neutrophils, coag cascade, and free radicals

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5
Q

Normal value in Acute Respiratory Distress Syndrome

A

PCWP!!!
due to protein exudate into alveoli due to increased alveolar capillary permeability (so you basically have protein fluid build up in alveoli and so 02 doesnt go through. so its an example of a shunt)

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6
Q

Non cardiogenic pulmonary edema vs cardiogenic

A

noncardio: normal PCWP
cardiogenic: increased PCWP

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7
Q

Lung compliance in ARDS

A

decreased

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8
Q

Sudden onset dyspnea, chest pain, tachypnea with leg swelling

A

Pulmonary Embolism

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9
Q

FATBAT = Types of PE’s

A

Fat, Air, Thrombus, Bacteria, Amniotic Fluid, Tumor

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10
Q

V/Q mismatch: Hypoxemia and Respiratory Alkalosis

A

PE (my impulse is Respiratory Acidosis because CO2 doesnt get it out. this is wrong)

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11
Q

Respiratory Alkalosis in PE

A

PE causes hypoperfusion of affected pulm parenchyma -> redist. of pulm blood flow and V/Q mismatch -> intrapulmonary R-L shunting -> Hypoxemia

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12
Q

Normal A-a gradient hypoxemia

A

High Altitude, Hypoventilation (opiods/narcotics)

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13
Q

V/Q mismatch causes

A

COPD, Pulmonary Fibrosis, Pulmonary Embolism, Pneumonia, Pulmonary Hyptertension, Asthma

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14
Q

Increased A-a gradient

A

V/Q mismatch, Diffusion Limitation (fibrosis), R-L shunt.
Note: Diffusion limitation i.e. fibrosis DOES RESPOND to 100% 02.
Shunt does NOT respond to 100% 02

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15
Q

CF (sweat glands)

A

Decreased NaCl absorption = hypertonic sweat

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16
Q

CF (respiratory and gastric glands)

A

Decreased Cl secretion =
increased Na and H20 absorption =>
Dehydrated (thick) mucus and negative transepithelial potential (i.e. nasal mucosal surface)

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17
Q

CF path

A

Auto Rec.
Decreased H20 in epithelial secretions = thick viscous mucus =
1. chronic airway obstruction, impaired respiratory bacteria clearance (CHRONIC PRODUCTIVE COUGH)
2. GI maldigestion/absorption (STEATORHHEA)

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18
Q

CF clinical features

A

Chronic Productive Cough
Steatorrhea and FTT
Recurrent Sinopulmonary Infections/Sinusitis (Pseudomonas and Staph Aureus)
Male Infertility (BILAT ABSENCE OF VAS DEFERENS)

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19
Q

Normal CFTR f(x) - Sweat glands

A

Sweat Glands: CFTR (CL- channel) absorbs Cl-, and also activates ENaC (Na channel) to increase Na reabsorption

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20
Q

Normal CFTR f(x) - Respiratory and Gastric Glands

A

Resp/Gastric Glands: CFTR (CL- channel) secretes Cl-, and limit ENaC (Na channel) from absorbing Na

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21
Q

CFTR Mneumonic

A

ClENaC Sap GRsi

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22
Q

Pneumothorax clinical signs

A
  • Unilat chest pain and dyspnea
  • unilat chest expansion
  • Hyperresonance
  • decreased Tactile Fremitus
  • decreased breath sounds
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23
Q

Rupture of apical (subpleural) blebs. Tall, thin young male

A

Primary Spontaneous Pneumothorax

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24
Q

ATP-Gated Cl- Channel

A

CFTR

In CF, the misfolded PROTEIN retained in RER. Misfolded so abnormal post-translational modification.

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25
Last two features to disappear (conducting/respiratory zone)
Cilia and Smooth muscle --> Respiratory Bronchioles
26
Cartilage and goblet cells extend to end of ____
bronchi
27
Type 1 pneumocytes are _____ cells
squamous
28
Type 2 pneumocytes are ______ cells
cuboidal
29
F(x) of Lamellar bodies?
Store and transport Surfactant
30
Conducting zone
Pseudostrat ciliated columnar Warm, Humidify, and Filter air End of Terminal Bronchiole
31
Respiratory Zone
Respiratory bronchioles = Cuboidal | Alveoli = Squamous
32
R or L Left has fewer lobes?
Left has Less Lobes
33
Aspirate to which lobe?
AspiRate to R Lobe (angle is less oblique) Standing: lower Inferior R Lobe Supine: superior Inferior R Lobe
34
Diaphragm structures (which level)
T8: IVC T10: Esophagus, Vagus T12: Aorta, Thoracic Duct, Azygous Vein I Ate - 10 Egg Vites - ATA 12
35
Vital Capacity
TLC - RV Tidal Volume + IRV + ERV Max V that can be expired after a max inspiration
36
Volume of gas present in lungs after a maximal inspiration
Total Lung Capacity
37
Physiologic Dead Space
Anatomic Dead Space (Respiratory Zone) + Alveolar Dead Space Apex of lung = biggest contributor of alveolar dead space (poor perfusion) V of inspired air that doesn't participate in gas exchange
38
Minute Ventilation vs Alveolar Ventilation equation
``` Minute = Tidal Volume x Resp Rate Alveolar = (Tidal V - Dead space) x Resp Rate ```
39
Pressures at FRC
Airway and alveolar P = 0 | Intrapleural = -5
40
Explain Fetal Hb higher 02 affinity
lower affinity for 2,3-BPG (stabilizes Taut)
41
Drugs that Cause this: | Fe2+ ---> Fe3+ (methemoglobin)
Nitrites and benzocaine
42
Methemoglobin
Has increased affinity for Cyanide. Induced methemoglobinemia using nitrites + thiosulfate to treat Cyanide Poisoning
43
Chocolate-colored blood + Cyanosis
Methemoglobinemia
44
Carboxyhemoglobin
Left shift in O2-Hb curve = decrease O2 unloading in tissues CO decreased O2 carrying capacity and O2 content of blood but NOT O2 in plasma (PaO2)
45
Normal value in CO poisoning
PaO2 (doesnt change plasma content)
46
Decreased O2 content of blood with no change in O2 saturation or PaO2 (arterial PO2)
Decreased Hemoglobin
47
Dissolved O2 aka PaO2 changes in CO poisoning, Anemia, Polycythemia?
No change....stays normal in all 3
48
Normal O2 levels
Inspired air: 160 Trachea: 150 Alveolar (-47): 104 Venous: 40
49
(P-pulmartery - P-leftatrium)/CO
Pulmonary Vascular Resistance Pleftatrium aka pulm wedge pressure
50
Response to Exercise
Arterial system stays in homeostasis, Venous fluctuates: No change in PaO2 or PaCO2. Increased venous CO2, decreased venous O2 V/Q ratio from base to apex becomes more uniform
51
DVT Prophylaxis/Acute treatment
HEPARIN DOG (unfractionated) or LMW Heparin (enoxaparin)
52
DVT Treatment/Long-term prevention
Oral anticoagulants = Warfarin, Rivaroxaban
53
V/Q mismatch Hypoxemia Respiratory Alkalosis
Pulmonary Embolism In order to decrease hypoxemia, ventilation increases With Hyperventilation you get resp alk
54
Sudden onset dyspnea, chest pain, tachypnea, tachycardia
Pulmonary Embolism
55
Fat Emboli Triad
``` Hypoxemia Neuro sx (confusion/seizures/lethargy) Petechial Rash (head, neck, thorax, axilla, etc) ``` Associated with long bone fracture and liposuction
56
Imaging test of choice for PE
CT Pulmonary Angiography
57
Does PE cause hemorrhagic or ischemic infarct?
Hemorrhagic (wedge shaped)--> lung has dual blood supply
58
Decreased FEV1/FVC
Obstructive
59
Hyperplasia of mucus-secreting cells (increased Reid Index)
Chronic Bronchitis
60
MQs and neutrophils release proteases (i.e. elastase)
Emphysema
61
Barrel-shaped Chest
Emphysema
62
Enlargement/dilation of air spaces
Emphysema
63
Obstructive lung disease that causes Pulsus Paradoxus
Asthma
64
Shed epithelium that forms whorled mucus plugs, leading to occlusion of bronchi/bronchioles and small airway destruction
Asthma
65
Reversible bronchoconstriction caused by bronchial hyperresponsiveness
Asthma
66
Bronchiectasis associations
Bronchial obstruction Poor ciliary motility (smoking, Kartagener) Cystic Fibrosis Allergic Bronchopulmonary Aspergillosis
67
Allergic Triad
Allergic Rhinitis Atopic Dermatitis Asthma
68
Chronic necrotizing infection of the bornchi
Bronchiectasis
69
Hemoptysis, Recurrent infections, permanently dilated airways
Bronchiectasis
70
Most frequent cause of Pulsus Paradoxus in absence of pericardial disease
Asthma/COPD
71
Increased ACE and Ca2+, noncaseating granuloma, bilateral hilar lymphadenopathy
Sarcoidosis
72
Drugs causing Restrictive lung disease
Bleomycin, Busulfan, Amiodarone, methotrexate
73
FEV1/FVC > 80%
Restrictive
74
Rheamatoid Arthritis + Pneumoconioses with intrapulmonary nodules
Caplan syndrome
75
Ivory white, calcified PLEURAL and SUPRDIAPHRAGMATIC PLAQUES
Asbestosis --> PARIETAL PLEURA
76
Lower lobe pneumoconiosis
Asbestosis
77
Upper lobe pnemoconiosis
Berylliosis, Coal workers pneumoconiosis, Silicosis
78
Iron in alveolar septum
Ferruginous body = asbestosis
79
macrophages with carbon
Coal workers pneumoconiosis (black lung disease)
80
pneumoconiosis with increased suceptibility to TB
Silicosis | Silica disrupts phagolysosomes and imparis macrophages
81
Eggshell calcification(around the rim) of hilar lymph node
Silicosis
82
birefringent particles surrounded by collagen (pneumoconiosis)
Silicosis
83
Alveolar collapse/ground-glass appearance of lung fields
NRDS
84
Cardiac anomaly risk in NRDS
Persistently low O2 --> risk of PDA
85
toxicity of supplemental 02 for NRDS patient
RIB | Retinopathy, Intraventricular hemorrhage, Bronchopulmonary dysplasia
86
Risk factors for NRDS
Prematury Maternal diabetes (causes increased fetal insulin, which decreases surfactant levels) C-section
87
Tx for NRDS
articifical surfactant, maternal steroids before birth
88
2 risks increased in Pneumoconiosis
Cor Pulmonale and Caplan
89
noncaseating granuloma (thus responsive to steroid) + industrial exposure
Berryliosis
90
Normal Pa02 during day, hypoxia at night
Sleep Apnea
91
Increased PaCO2 during waking hours and sleep, decreased PaO2 during sleep
Obesity Hypoventilation Syndrome
92
Nerve relevant to OSA
Hypoglossal
93
Daytime somnolence, morning headaches, RHF
OSA
94
Lungs hyperresonant to percussion
Pneumothorax (simple or tension)
95
Increased tactile fremitus, egophony
Consolidation (Lobar pneumonia, pulmonary edema)
96
Tracheal Deviation toward side of lesion
Atelectasis --> Bronchial obstruction
97
Tracheal Deviation away from lesion
Tension pneumothorax (hyperresonant percussion) or Pleural effusion (dull percussion)
98
Fluid in pleural layers
Pleural effusion. Tx with thoracentesis
99
Air in pleural layers
Pneumothorax
100
unilateral chest pain, dyspnea, expansion. Hyperresonance
Pneumothorax
101
dyspnea in tall, thin, young male (esp a smoker)
Primary spontanous pneumothorax --> rupture of SUBPLEURAL APICAL BLEBS
102
air fluid levels on CXR (almost looks like a fungus ball)
Abscess
103
Tx for lung abscess
Clindamycin
104
Carcinoma in apex of the lung
Pancoast tumer (aka superior sulcus tumor)
105
Sx of Pancoast tumor
Invades cervical sympathetic chain (autonomic ganglia) = Horner's. SVC syndrome, hoarseness, sensorimotor deficits. Shoulder/upper extremity pain from compression of brachial plexus
106
Causes of SVC syndrome
malignancy (Pancoast tumor) and thrombosis from indwelling cathethers
107
keratin pearls and intercellular bridge
Squamous cell carcinoma
108
Inactivating mutation of bmpr2 = ____________. Pathology = _____________ (because bmpr2 usually inihibits it)
Pulmonary Arterial Hypertension Vascular smooth muscle proliferation -->Ultimately get intimal fibrosis and thickening
109
What effect does pulmonary artery hypertension have on cardiac heart sounds?
Accentuated (louder) pulmonary component of second heart sound (P2)..."Loud second heart sound at the upper sternal border" (all Patients take meds)

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