pulm high yield Flashcards
1
Q
pnemothorax is result of
A
loss of vaccuum between pleura layers
2
Q
innervation pulmonary
A
CN10; vagus
PNS: CN10/vagus - constrict bronchioles
Sensory - CN10
SNS (sympathetic chain ganglia): dilate bronchioles
Phrenic N - (C3,4,5 - keep the diaphragm alive)
Bronchi - B2 autonomic nerve fibers
3
Q
parts of mediastinum
A
ant: thymus
middle: heart + pericardium
post: esophagus, desc aorta, azygos veins, thoracic duct, sympathetic trunk
sup: aortic arch, brachiocephalic veins
4
Q
location of lung and pleura at MCL
A
L: 6th rib
P: 8th rib
5
Q
location of lung and pleura at axillary line
A
L: 8
P: 10
6
Q
location of lung and pleura at costal angle (dorsal):
A
L: 10
P: 12
7
Q
location of apex of lung
A
4cm above rib
8
Q
laryngeal innvervation
A
CN10 vocalization
9
Q
nose innervation
A
CN 1 olfaction
CN 5 sensation
10
Q
how does mucus drain out of the head
A
sphenoid > ethmoid (bridge of nose) > maxillary (under eyes)
frontal > maxillary
———maxillary > nasal cavity
11
Q
tidal volume TV
A
normal breathing
12
Q
inspiratory reserve volume IRV
A
deep inspiration
13
Q
ERV
A
deep expiration
14
Q
residual volume RV
A
volume in lungs after max expiration
cant be measured by spirometry
Prevents lung collapse
15
Q
anatomic dead space
A
vol of conducting airways
16
Q
physiologic dead space
A
vol of lungs that doesn’t participate in gas exchange
diff size ppl have diff size dead space
17
Q
FEV1
A
forced expiratory volume
vol of air expired in 1 sec after max inspiration
usually 80%
18
Q
FRC (functional residual capacity)
A
ERV + RV
Vol of gas in lungs after NORMAL expiration
Can’t measure with spirometry since it includes RV
19
Q
VC (vital capacity)
A
TV + IRV + ERV
MAX vol of gas that can be exhaled after MAX inspiration
20
Q
TLC (total lung capacity)
A
volume of gas present in lungs after MAX inspiration (SUM OF ALL THINGS)
21
Q
medulla central control of breathing
A
in reticular formation:
dorsal respiratory group (inspiration, rhythym) input CN9+10, output to diaphragm - phrenic n
ventral resp group (active expiration)
22
Q
pons central control of breathing
A
apneustic center (lower pons): inspiration (gasp)
pnemotaxic center (upper pons): inhibits inspiration (reg rate + vol)
23
Q
cortex central control of breathing
A
hyper and hypo ventilation
24
Q
inc/dec CO2 effect on environment
A
inc: acidic
dec: base
25
respiratory acid base problems
CO2
26
metabolic acid base problems
bicarb/HCO3-
27
causes of respiratory acidosis
sedation, sleep apnea, chest wall injuries, COPD
28
causes of respiratory alkalosis
anxiety, thyrotoxins, mountain climbing
29
causes of metabolic acidosis
ketoacidosis, lactoacidosis (shock), chronic diarrhea
30
causes of metabolic alkalosis
loop diuretics (K loss), insulin (K movement), vomiting (K loss)
31
where is normal physiologic life on the hemoglobin/oxygen dissociation curve
between mixed venous blood (lower) and arterial blood
anywhere else = hypoxemia
32
causes of hypoxemia
dec alveolar PO2 (high altitude)
hypoventilation (sedatives, COPD, neuromuscualr dz)
V/Q mismatch (fibrosis, PE, pulm edema)
venous admixture (R>L shunt)
dec O2 carrying capacity (anemia, CO poison (MOST COMMON))
33
States of CO2 transport/most common state of CO2
Most common - HCO3- (via bicarb chloride transport on RBC membrane)
Carbaminonemoglobin HBCO2 - bound to HB at N terminus of non heme globin
Dissolved
34
allergic rhinitis is a ___ mediated rxn
IgE
35
chronic rhinitis
superimposed bacterial infxn superimposed on infectious/allergic
36
acute sinusitis can become
osteomyelitis if it spreads into orbit or penetrates bone
37
epiglottitis
h influenza, b-hemolytic strep
thumbrint sign xray
ER; lethal
dont open their mouth
38
pressure pulmonary circulation vs systemic
pressure lower in pulmonary circulation (and thus lower resistance)
39
cartilage rings in trachea and bronchi are
C rings (smooth muscle B2 fibers in back connecting relax with sympathetic)
40
pulm edema causes
LHF (“cardiac asthma”, wet)
Pulm capillary membrane damage (pnemonia, toxic gas inhalation, near drowning)
41
adult respiratory distress syndrome/shock lung
injury to type I pneumocytes and capillary endothelial cells in lung
viral infxns, burns, near drowning, dialysis, Lyme
> pulm edema, fibrosis, infxn, dec compliance
42
pulm HTN RF
LHF, mitral stenosis, inc vascular resistance, emboli, scleroderma
43
atelectasis
collapse or incomplete expansion of acini
tumors, FB, mucus bblockage, compressive, deficiency of surfactant, contraction
44
two types of pulm edema and which is worse
intersitial
alveolar (progression) - dec perfusion
45
compliance =
Distensibliity of lungs and chest wall; change in volume for a change in pressure (slope of pressure/vol curve)
Inversely proportional to wall stiffness (inc stiffness = dec compliance)
Inc by surfactant
Inc compliance = lung easier to fill
46
ex of decreased compliance pathologies
fibrosis
lack of surfactant (premature newborn)
high pulm venous pressure (Pulm fibrosis, LHF)
47
ex of increased compliance pathologies
emphysema
48
obstructive vs restrictive (interstitial) lung dz
O: obstructive EXIT of air from lungs
R: inflammation/scarring of parenchyma; fibrosis
49
COPD emphysema vs chronic bronchitis
E: "pink puffers"
normal pCO2 - chronic compensation (low O2 > chronic stim from erythropoietin > inc RBC > reactive polycythemia)
barrel chest, pursed lips, slow forced expiration
cig smokers (most common) or def of serum a1 protease inhibitor
perm dilation of acinus, destruction alveolar walls
CB: "blue bloaters"
inc pCO2
persistent cough w sputum 3+ months of year in 2 consecutive yrs
obese, cor pulmonale, cyanotic
NO hypercapnic drive to breathe
Inc bacterial superimposed infections
50
consolidative pnemonias vs atypical pnemonias
C: broncho/lobular, lobar
A: primary/walking
51
broncho/lobular pneumonia
one segment fills with pus
strep pnemoniae
gram + cocci
kelbseiella p gram - rod in alcoholics
rusty brown/brick dust sputum
52
lobar pnemonia
entire lobe fills with pus
patchy opportunistic infection, aspiration pnemonia usu RUL
53
lung abscess
infx teeth, gums, tonsils > aspiration of bacteria > septic pulmonary emboli
54
TB
mycobacterium TB
delayed hypersensitivity type IV
fever, wt loss, acid fast bacilli
CAN BE IN ANY ORGAN; starts as granulomatous disease in lung
55
asthma
small bronchi reactive airway disease > constriction
type I hypersens, IgE
56
pnemoconiosis
dust inhalation, aspestos
type I IgE
57
goodpastures
antibodies against basement membrane, type II
hemopytsis, hematuria
58
pleural effusion
wet outside the lung
LHF, infxn
inc pressure around lung
59
pnemothorax
air or gas in pleural cavity
traumatic or spontaneous
tension pneumothorax (pushed pulm sys away)
tympany, dec breath sounds
60
most dangerous primary respiratory cancer
small/oat cell undifferentiated carcinoma
pancoast tumor, hormone secreting, rapid death
61
lung cancer suspected in all ptswith
hemoptysis
62
obstructive lung dz
asthma, COPD, cystic fibrosis
63
Stages of pulmonary embryonic development
Every Pulmonologist Can See Alveoli
Wk 4 - lung bud comes from distal respiratory diverticulum
Embryologic (wk 4-7)
Pseudoglandular (wk5-17)
Canalicular (wk 16-25)
Saccular (wk 26-birth)
Alveolar (wk 36-8 years)
64
Embryologic stage of embryonic development
Weeks 4-7
Lung buds > trachea > bronchial buds > main stem bronchi > secondary (lobar) bronchi, tertiary (segmental) bronchi
Errors at this stage = tracheoesophageal fistula
65
Pseudoglandular stage of embryonic development
Weeks 5-17
Endodermal tubules > terminal bronchioles; surrounded by modest capillary network
Larynx formed by week 12
Respiration impossible, incompatible with life
66
Canalicular stage of embryonic development
Weeks 16-25
Terminal bronchioles > respiratory bronchioles > alveolar ducts; prominent capillary network
Airways inc in diameter
Pneumocystis at 20 weeks
Respiration at 25 weeks
67
Saccular stage of embryonic development
Weeks 26-birth
Alveolar ducts > terminal sacs separated by 1” septae
68
Alveolar stage of embryonic development
Weeks 36-8 years
Terminal sacs > adult alveoli
In utero, respiration is aspiration and expulsion of amniotic fluid
69
Microscopic anatomy of nasopharynx
Respiratory (stratified squamous) epithelium
Striated muscle
Lymphatics
70
Microscopic anatomy of Trachea + extrapulmonary bronchi
Respiratory epithelium
9 C shaped cartilage with smooth muscle
71
Microscopic anatomy of Intrapulmonary bronchi, large and small bronchioles
Transition to no cartilage
Transition from respiratory > ciliated columnar epithelium
Prominent smooth muscle
Clara/club cells (brochiolar surfactant)
Cuboidal bronchioles
Basal cells in large airways
72
Microscopic anatomy of Terminal bronchioles
Cuboidal epithelium
No cartilage
Patches of cilia
Some Clara cells
73
Microscopic anatomy of respiratory bronchioles
Cuboidal, transitioning to squamous
Clara cells
Surfactant
74
Microscopic anatomy of Alveolar ducts
Porous squamous
Surfactant
75
Microscopic anatomy of Alveolar sacs, alveoli
Porous squamous
Type I pneumocytes (thin, squamous, 95%) - gas exchange
Smooth muscle at orifices
76
Microscopic anatomy of Interalveolar septum
Capillary I in Zona diffusa
Alveolar macrophages (dust cells)
Type II pneumocystis (septal cells) - granular, cuboidal, 5%, secrete surfactant/stem cells
77
Rib types/how many
7 true
8-10 false
11 + 12 floating
78
Layers of pleura
Visceral - lungs
Serous fluid
Parietal - thoracic cage
79
Flow of blood to and from lungs
Pulm arteries: RV > lung (DEOX)
Pulm veins: lung > LA (OX)
Bronchial artery: aorta > lung tissues (OX)
Bronchial vein: lung tissues > azygos veins (DEOX)
80
Flow of air through respiratory system
Trachea > primary bronchi > secondary (lobar) bronchi > tertiary (segmental) bronchi > bronchioles > terminal bronchioles > respiratory bronchioles > alveoli
81
Chemoreceptor stimuli breathing
Central (medulla): acidic pH, inc pCO2
Peripheral:
-carotid(CN9) - acidic, inc pCO2
-aortic (CN10O - dec pCO2
82
Muscles for respiration during exercise
Diaphragm + external intercostals - inspiration
Internal and abdominal - expiration
83
Hypoxemia, def + MOA
CO poisoning, caps hemoglobin saturation at 50% (death)
84
Gas diffusion rate is proportional to
Sum of partial pressure of gas mix
85
Why is venous blood slightly more acidic than arterial blood?
Because of CO2
86
Oxygen dissociates more easily from hemoglobin when pH is _____
Lower
87
Pulmonary arterial pressure vs systemic
Pulm - 15mmHg
Systemic - 100mmHg
88
surfactant biochem, cell type, production time
Phospho lipoprotein, 20% = protein
Made by type II alveolar cells in Saccular and alveolar phases of lung development
89
Functions and biochem nitric oxide pulmonary
Regulates vascular and bronchial tone (stimulates dilation)
Formed from amino acid arginine by enzyme nitric oxide synthase (requires H4 biopterin as cofactor)
90
under normal conditions are inspiration and expiration active or passive
Inspiration - active, muscles contract
Expiration - passive, muscles relax
91
Inspiratory capacity (IC)
IRV + TV
ALL air inhaled after normal exhalation
92
Minute ventilation (Ve)
Total volume of gas entering the lungs per minute
Ve = Vt x RR
93
Normal tidal volume
500mL
94
Alveolar ventilation (Va)
Volume of gas that reaches the alveoli each minute
Va = (Vt-Vd) x RR
Vd=physiologic dead space
95
Elastic recoil
Lungs intrinsic nature to deflate with expiration
Tendency for lungs to collapse inward and chest wall to spring outward at baseline - opposite motions balance and prevent lung collapse (unbalanced = pneumothorax)
96
At FRC, what are pressurez
Airway and alveolar presssures = atmospheric pressure
Intrapleural pressure is neg (neutral/pos = lung collapse)
97
CO2 transport / gas exchange
Oxygenation of hemoglobin promotes dissociation of H from hemoglobin
Equilibrium shifts toward CO2 formation
CO2 released from RBCs (haldane effect)
98
Pulmonary circulation is a ___ resistance, ___ compliance system
Low resistance
High compliance
99
In pulmonary circulation oxygen diffuses ____ and CO2 diffuses ____ across alveolar membrane
Oxygen slowly
CO2 rapidly
100
Pulmonary diffusion increases with
Increased area
Larger difference between partial pressures
101
Pulmonary diffusion decreases with
Decreased area
Less difference between partial pressures
Thicker alveolar wall
102
Pulmonary vascular resistance decreases with
Inc CO
Dec arterial resistance
Dec blood viscosity
Dec vessel length
Inc vessel radius (vasodilation)
Alkalosis
Hypocarbia
103
Pulmonary vascular resistance Increased by
Hypoxia
Hypercarbia
Acidosis
Sympathetic stimulation
Hypervolemia
104
V/Q perfusion ratios
V/Q = 1
Zone 1 (apex) V/Q inc (ven dec, per dec more)
Zone 2 (middle) - V/Q = 1
Zone 3 (base) - V/Q dec (ven inc, per inc more)
105
Highest amount of PO2 in ___ air, lowest in ____
Tracheal air > alveolar air > systemic arterial blood > mixed venous blood
106
Bronchial adenoma
Benign or malignant
Prolonged course
Both sexes
Sx or asx
Metastasis infrequent
107
SCC
Malignant
In bronchi or near hilium
Produce parathyroid like hormone
Elevated serum Ca
108
Adenocarcinoma
Women
Beneath pleura
In scars in lung
