Pulmo Flashcards
(120 cards)
1
Q
Areas of gas exchange in the respiratory tract
A
- respiratoty bronchiole
- alveolar ducts
- alveoli
2
Q
4 basic lung volumes
A
- Inspiratory Reserve volume (IRV)
- Tidal volume (TV)
- expiratory reserve volume (ERV)
- residual volume (RV)
3
Q
Amount of air inhaled/exhaled w/ each normal breath
A
TV (=0.5 L)
4
Q
Amount of air remaining in the lungs after full exhalation
A
RV (maintains oxygenation between breaths)
5
Q
Max amount of air that one can inhale/exhale
A
Vital capacity (IRV + TV + ERV)
6
Q
Anatomic dead space volume
A
Area w/ no gas exchange from nose to terminal bronchiole (= 150ml)
7
Q
Physiologic dead space volume
A
anatomic dead space volume + alveolar dead space volume
8
Q
Alveolar ventilation per minute
A
Respiratory rate x (TV - physiologic dead space volume)
9
Q
Minute respiratory volume
A
TV x RR
10
Q
Stimulates central chemoreceptors in the medulla
A
carbon dioxide (as CSF H+)
11
Q
lung zones
A
- zone 1 ( no blood flow)
- zone 2 ( internittent bloof flow)
- zone 3 ( continous blood flow)
12
Q
Increase in the ff factors would cause shift to the right of 02 -Hgb dissociation curve ( unloading of 02 from Hgb)
A
- C02
- Acidosis
- 2-3 DPG
- exercise
- temperature
> CADET face right
13
Q
IIncrease in the ff factors would cause shift to the left of 02 -Hgb dissociation curve ( increased binding of 02 to Hgb)
A
- carbon monoxide
- fetal hemoglobin
14
Q
percentage of blood that gives up 02 as it passes through the tissue capillaries
A
Utilization coefficient (25% at rest, 75-85% during exercise)
15
Q
Central control of inspiration; sends inspiratory ramp signals
A
Dorsal respiratory group (DRG) of the medulla
16
Q
Central control of both inspiration and expiration; sends overdrive mechanism in exercise
A
Ventral respiratory group (VRG) of the medulla
17
Q
Limits inspiration and increases respiratory rate
A
Pneumotaxic center of the pons
18
Q
Stimulates inspiration and decreases respiratory rate
A
Apneustic center of the pons
19
Q
Receptors in ventral medulla; stimulated by CSF H+ from blood C02; adapts within 1-2 days
A
Central chemoreceptors ( made up of DRG and VRG)
20
Q
Receptors in carotid bodies (CN IX) and aortic bodies ( CN X); activated when PO2 < 70 mmHg and to a lesser extent, C02
A
Peripheral chemoreceptors
21
Q
Reversibility in asthma(spirometry) is demonstrated by
A
> 12% and 200 ml increase in FEV1:15 mins after an inhaled SABA; or
after a 2-4 week trial of oral corticosteroids ( prednisone or prednisolone 30-40 mg daily)
22
Q
Physiologic abnormality of asthma
A
Airway hyperresponsiveness
23
Q
Pathogenesis behind asthma
A
Imbalance favoring TH2 production over TH1 -> increases IL-1, IL-5 -> increased eosinophils
24
Q
Putative mediators of asthma
A
SRS-A (made up of leukotrienes C4, D4, E4)
25
Whorls of shed epithelium in mucus plugs in asthma
Curschmann's Spirals
26
Crystalloid made up of eosinophil membrane protein seen in both asthma & amoebiasis
Charcot-Leyden crystals
27
Predominant key cell involved in asthma
none
28
Characteristic feature of asthmatic airways
Eosinophil infiltration
29
Most common allergens that trigger asthma
Dermatophagoides ( house dust mites)
30
Most common triggers of acute severe asthma exacerbations
URTI: rhinovirus, respiratory syncytial virus (RSV), coronavirus
31
Mechanism of exercise-induced asthma (EIA)
Hyperventilation
32
EIA is best prevented by regular treatment with
Inhaled corticosteroids
33
Confirms airflow limitation w/ a reduced FEV1, FEV1/FVS ratio, and PEF
Spirometry
34
Primary action of B2 agonists
relax smooth muscle cells of all airways, where they act as functional antagonists
35
Most common side effects of B2 agonist
Muscle tremor and palpitations
36
Most common side effect of anticholinergics
Dry mouth
37
Most common side effects of theophylline
nausea, vomiting, headaches
38
Most effective controllers for asthma
ICS
39
Indicates the need for regular controller therapy
use of reliever medication > 3x a week
40
Most common reason for poor control of asthma
Noncompliance w/ medications, usually ICS
41
Drugs that are safe for asthma in pregnancy
- SABA
- ICS
- Theophylline
42
Asthma and COPD are variatons of the same basic disease
Dutch hypothesis
43
Asthma (allergic phenomenon) and COPD (smoking- related inflammation and damage) are fundamentally different diseases
British hypothesis
44
Pathogenesis behind emphysema
imbalance between protease (elastase) and anti-protease (alpha 1- antitrypsin)
45
First symptom of emphysema
progressive dyspnea
46
Ratio of mucus gland layer thickness to the thickness of the wall between the epithelium and the cartilage of the trachea and bronchi
Reid's index (>0.4 in Chronic Bronchitis)
47
Most highly significant predictor of FEV1
pack years of cigarette smoking
48
Most common form of severe alpha 1 AT deficiency
PiZ: two Z alleles or one Z and one null allele
49
Accounts for essentially all of the redcution in Pa02 that occurs in COPD
ventilation-perfusion mismatching
50
Major site of increased resistance in COPD
small airways < 2 mm diameter
51
Type of emphysema frequently assoc w/ cigarette smoking, characterized by enlarged air spaces found (initially) in association w/ respiratory bronchioles
Centriacinar emphysema
- prominent in the upper lobes and superior segments of lower lobes and often focal
- involves respiratory bronchiole
(SENTROacinar, smoking)
52
Type of emphysema usually observed in patients w/ alpha1 -AT deficiency characterized by abnormally large air spaces evenly distributed w/in and across acinar units
Panacinar emphysema
| - predilection for lower lobes and involves the entire respiratory unit (respirtory bronchiole, alveolar duct, alveoli)
53
Type of emphysema assoc w/ spontaneous pneumothorax
Distal acinar emphysema
| - predilection for upper lobes and involves alveoli
54
Most common type of emphysema w/ irregular involvement and often asymptomatic
Irregular emphysema
55
Major physiologic change in COPD
airflow limitation
56
Newly-developed clubbing of the digits ( not a sign of COPD) should alert an investigation for
Lung cancer
57
The only pharmacologic therapy demonstrated to unequivocally decrease mortality rates
Supplemental O2
58
Strong predictor of future COPD exacerbations
Hx of prior exacerbations
59
Bacteria frequently implicated in COPD exacerbations
- Strep pneumonia
- H. influenza
M. catarrhalis
60
The only 3 interventions shown to influence the natural history of COPD
- smoking cessation
- O2 therapy
- Lung volume reduction surgery
61
Most common pathogenesis of penumonia
aspiration
62
Most common etiology of CAP
Streptococcus pneumoniae
63
Most common etilogy of atypical pneumonia
Mycoplasma pneumonia
64
Most common cause of nosocomial pneumonia and bronchiolitis in children
RSV
65
Main purpose of the sputum gram stain
ensure suitability of sample for culture
66
To be adequate for culture, a sputum sample must have
>25 neutrophils
| <10 squamous cells per lpf
67
Most frequently isolated pathogen in blood cultures of CAP
Streptococcus pneumoniae
68
Irreversible airway dilation that involves the lung in either a focal or a diffuse manner
Bronchiectasis
69
Most common form of bronchiectasis
Cylindrical or tubular
70
Most widely cited mechanism of infectious bronchiectasis
Vicious cycle of hypothesis
71
Most common clinical presentation of bronchiectasis
Persistent cough w/ production of thick sputum
72
Imaging modality of choice for confirming bronchiectasis
Chest CT
73
1st step in the diagnostic approach to pleural effusion
Determine whether effusion is a transudate or exudate
74
Leading cause of transudative pleural effusion
- LV failure
| - cirrhosis
75
Leading causes of exudative pleural effusion
- Bacterial pnuemonia
- malignancy
- viral infection
- pulmonary embolism
76
Most common cause of chylous pleural effusion
Malignancy
77
3 tumors that cause 75% of all mlignant pleural effusions
- Lung CA
- Breast CA
- Lymphoma
78
Benign ovarian tumors producing ascites and pleural effusion
Meig's syndrome
79
The only symptom that can be attributed to the malignant effusion itself
Dyspnea
80
Condition most commonly overlooked in the differential diagnosis of a patient w/ an undiagnosed effusion
Pulmonary embolism
81
Most common cause of chylothorax
Trauma ( most frequently thoracic surgery)
82
Treatment of choice for most cases of chylothorax
Insertion of a chest tube plus administration of Octreotide
83
Population at risk for spontaneous pneumothorax
Tall thin men 20-40 y/o, smoker
84
Tracheal deviation in spontaneous pneumothorax
Ipsilateral tracheal deviation
85
Tracheal deviation in tension pneumothorax
contralateral tracheal deviation
86
Co existence of unexplained excessive daytime sleepiness w/ at least 5 obstructed breathing events (apnea or hypopnea) per hour of sleep
Obstructive Sleep Apnea
87
Breathing pause lasting >10 seconds
Apnea
88
>10 seconds events where ventilation is reduced by at least 50% from the previous baseline
Hypopnea
89
1st step in evaluating a mediastianal mass
Place it in one of the 3 mediastinal compartments
90
Most common lesions in anterior mediastinum
- Thymomas
- Teratomatous neoplasms
- thyroid masses
- terrible lymphomas
> terrible T's
91
Most common masses in the posterior mediastinum
- neurogenic tumors
- meningocoeles
- meningomyelocoeles
- gastroenteric cysts
- esophageal diverticula
92
One of the 3 major cardiovascular causes of death, along w/ MI and stroke
Venous Thromboembolism
93
Causes of pulmonary embolism
- fat
- foreign body
- air
- DVT
- Bone marrow
- amniotic fluid
- tumor
94
Population at risk for pulmonary infarcts
Patients w/ pre existing heart/lung diseases (occurs in the lower lobes)
95
Usual cause of death from pulmonary embolism
Progressive right HF
96
Most frequent history in DVT
Cramp in the lower calf that persists and worsend for several days
97
Most frequent history in PE
unexplained breathlesness
98
Classic signs of PE
- tachycardia
- low grade fever
- neck vein distention
99
Most frequent symptom of PE
Dyspnea
100
Most frequent sign of PE
Tachypnea
101
Useful rule out test: > 95% of patients w/ normal levels (< 500ng/ml) don not have PE
Quantitative plasma D-dimer ELISA
102
Most frequently cited ECG abnormality in PE (in addition to sinus tachycardia)
S1 Q3 T3 sign ( specific but insensitive)
103
Most common ECG abnormality in PE
T wave inversion in lead V1 to V4
104
Prinicipal imaging test for the diagnosis of PE
Chest CT scan w/ IV contrast
105
Second line diagnostic test for PE, used mostly for patients who cannot tolerate IV contrast
Lung scanning
106
Best known indirect sign of PE on transthoracic echo
McConnell's sign
| - Hypokinesis of the RV free wall w/ normal motion of the RV apex
107
Definite diagnostic test for PE w/c visualized an intraluminal filling defect in more than one projection
Pulmonary Angiography
108
Foundation for successful treatment of DVT and PE
anticoagulation
109
Systemic arterial hypotension w/ usually anatomically widespread thromboembolism
Massive pulmonary embolism
110
RV hypokinesis w/ normal systemic arterial pressure
Moderate to large pulmonary embolism
111
Norma RV function and normal systemic arterial pressure (excellent prognosis w/ adequate anticoagulation)
Small to moderate pulmonary embolism
112
Acute onset (<24 hours)
Bilateral patchy airspace disease
Absence of left atrial hypertension (PCWP < 18 mmHg)
Profound shunt physiology ( PA02/Fi02 < 200)
ARDS
113
Top 3 caused of ARDS
- Gram negative sepsis
- gastric aspiration
- Severe trauma
114
Short term morphology of ARDS
Waxy hyaline membranes
115
Long term morphology of ARDS
Intra alveolar fibrosis
116
Histologic manifestation of ARDS
Diffuse alveolar damage
117
- Hypoxic respiratory failure
- pulmonary edema
- Pneumonia
- Alveolar hemorrhage
- ARDS
(type 1,2,3 or 4)
TYPE 1 ARF
118
- Hypercarbic respiratory failure
- central hyperventilation
- Neuromuscular asthenia
- Increased respiratory load
(type 1,2,3 or 4)
TYPE 2 ARF
119
Respiratory failure d/t atelectasis (aka Post Operative RF)
| type 1,2,3 or 4
TYPE 3 ARF
120
Hypoperfusion of respiratory muscles usually secondary to shock
(type 1,2,3 or 4)
TYPE 4 ARF
