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Pulmonary Flashcards

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1
Q

Conducting vs respiratory zones

A

Conducting zone

  • large and small airways, as get to smaller airways, have more in parallel and thus less resistance
  • anatomic dead space - no gas exchange
  • cartilage, goblet cells, pseudostratified columnar epithelium to beginning of terminal bronchioles
  • airway smooth muscle cells through terminal bronchioles

Respiratory zone

  • respiratory bronchioles, alveolar ducts, and alveoli
  • site of gas exchange
  • cuboidal epithelium in respiratory bronchioles, simple squamous in alveolar ducts
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2
Q

Type I and type II pneumocytes

A

Type 1: Make up 97% of alveolar surfaces, squamous

Type 2: secrete surfactant, serve as precursors to type 1

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3
Q

Club cells

A

nonciliated, cuboidal cells with secretory granules that secrete a component of surfactant

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4
Q

Surfactant

A

secreted by type II pneumocytes and club cells; made up of lecithins including dipalmitoylphophatidylcholine. Synthesis begins at week 26, mature levels at week 35. Lecithin : sphingomyelin ratio over 2 indicates fetal lung maturity

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5
Q

Aspiration locations

A

When upright: lower portion of R inf lobe

When supine: sup portion of R inf lobe

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6
Q

Relationship between pulmonary artery and brochus

A

Righ: pulm artery anterior to main bronchus
Left: pum artery superior to main bronchus

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7
Q

Structures perforating diaphragm

A

T8: IVC
T10: esophagus and vagus n
T12: aorta

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8
Q

Functional residual capacity

A

residual volume plus expiratory reserve volume (volume of gas in lungs after normal expiration

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9
Q

Physiologic dead space

A

=anatomic dead space of conducting airways + alveolar dead space (most is in apex)

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10
Q

Minute ventilation vs alveolar ventilation

A

Minute ventilation=Total volume of gas entering lungs per minute
=Vt x RR

Alveolar ventilation=Volume of gas per unit time reaching alveoli

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11
Q

Intrapleural pressure

A

Negative at FRC to prevent pneumothorax

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12
Q

Compliance

A

Change in lung volume for given change in pressure. Decreased in pulmonary fibrosis, pneumonia, pulmonary edema. Increased in emphysema, aging.

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13
Q

Methemoglobinemia

A

Oxidized form of Hb with increased affinity for cyanide, decreased affinity for O2

Presents with cyanosis and chocolate-colored blood

Treated with methylene blue

Can induce methemoglobinemia with nitrites to treat cyanide poisoning

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14
Q

Perfusion vs diffusion limited

A

Perfusion limited: Gas equilibrates early along length of capillary; diffusion increased only if blood flow increased; case in normal lung

Diffusion limited: Gas does not equilibrate by time blood reaches end of capillary; seen in emphysema and pulmonary fibrosis

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15
Q

Alveolar gas equation

A

PAo2 = PIo2 - PaCO2/R

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16
Q

Causes of hypoxemia

A

Normal A-a gradient: high altituide, hypoventilation

Increased A-a gradient: V/Q mismatch, diffusion limitation, right to left shunt

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17
Q

V/Q mismatch in normal lung

A

V/Q high at apex: wasted ventilation
V/Q low at base: wasted perfusion
both ventilation and perfusion greater at base than apex
V/Q approaches 1 with exercise due to vasodilation of apical capillaries

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18
Q

Pathology of V/Q

A

V/Q=0 airway obstruction (shunt), 100% O2 does not improve

V/Q=infinity blood flow obstruction, 100% O2 improves PaO2

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19
Q

Transport of CO2

A

90% as HCO3-
5% as HbCO2
5% as dissolved CO2

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20
Q

Vichow triad

A

1) stasis
2) hypercoagulability
3) endothelial damage: exposed collagen triggers clotting cascade

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21
Q

Homan sign

A

dorsiflexion of foot causes calf pain; sign of DVT

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22
Q

Lines of Zahn in PE

A

Interdigitated areas of pink and red found in thrombi that occur prior to death

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23
Q

Classic triad of fat emboli

A

Hypoxemia + neurologic abnormalities + petechial rash

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24
Q

Amniotic fluid emboli - complication

A

Can lead to DIC, especially postpartum

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25
Air emboli
Nitrogen bubbles precipitate in ascending divers. Treated with hyperbaric O2
26
PFTs of obstructive lung disease
Decreased FEV1 and decreased FVC with decreased FEV1/FVC ratio (hallmark)
27
Chronic bronchitis
Path: hyperplasia of mucus secreting glands Clinical: productive cough for over 3 mos per year for over 2 years. Wheezes, crackles, cyanosis, hypercapnea, secondary polycythemia
28
Emphysema - two forms
Centriacinar associated with smoking | Panacrinar associated with alpha1 antitrypsin def
29
Emphysema findings
Increased elastase activity leading to loss of elastic fibers and increased compliance/decreased recoil
30
Pathologic findings of asthma
Smooth muscle hypertrophy Curschmann spirals: shed epithelium forms mucus plugs Charcot-Leyden crystals: eosinophilic, hexagonal, double pointed crystals from breakdown of eosinophils in sputum
31
Sarcoidosis findings
Bilateral hilar lymphadenopathy, noncaseating granulomas, increased ACE, increased Ca++
32
Hypersensitivity pneumonitis
Mixed type III/IV hypersensitivity. Dyspnea, cough, chest tightness, headache. Classically in farmers and those exposed to birds
33
Asbestosis
Exposure: shipbuilding, roofing, plumbing Pathology: ivory white calcified supradiaphragmatic and pleural plaques. Golden brown rods in alveolar septum. Presentation: restrictive lung disease. Risk of cor pulmonale. Risk of lung cancer (bronchogenic carcinoma more than mesothelioma)
34
Berylliosis
Exposure: aerospace and manufacturing industries Pathology: granulomas in upper lobes Presentation: restrictive lung disease
35
Coal workers pneumoconiosis
Exposure: prolonged coal dust exposure Pathology: Macrophages laden with carbon, inflammation, fibrosis in upper lobes Presentation: restirctive lung disease
36
Silicosis
Exposure: foundries, sandblasting, mines Pathology: Macrophages release fibrogenic factors in response to silica. Eggshell calcifcation of hilar lymph nodes. Effects upper lobes. Presentation: Restrictive lung disease. Increased risk for bronchogenic carcinoma
37
Neonatal respiratory distress syndrome
Pathophysiology: surfactant deficiency causes increased surface tension and alveolar collapse Imaging: ground glass appearance of lung fields Treatment: Maternal steroids before birth, artificial surfactant for infant Complications: PDA due to persistent low O2. Retinopathy, intraventricular hemorrhage, and bronchopulmonary dysplasia due to supplemental O2
38
ARDS
Presentation: Acute onset resp failure with bilateral lung opacities and decreased PaO2/FiO2 in absence of HF Pathology: Diffuse alveolar damage results in increased alveolar capillary permeability and protein leak into alveoli. Causes noncardiogenic pulmonary edema with normal PCWP. Formation of intra-alveolar hyaline membranes. Treatment: mechanical ventilation with low tidal volume
39
Drugs that cause pulmonary hypertension
Amphetamines, cocaine
40
Pathology of pulmonary hypertension
pulmonary artery pressure greater than 25 mmHg at rest Arteriolosclerosis, medial hypertrophy, intimal fibrosis of pulmonary arteries
41
Tracheal deviation in different respiratory conditions
pleural effusion: none or away from side of lesion atelectasis: toward side of lesion tension pneumo: away from side of lesion simple pneumo: none
42
Types of pleural effusion
Transudate: due to disruption of starling forces (increased hydrostatic pressure, decreased oncotic pressure) due to HF, nephrotic syndrome, hepatic cirrhosis. Low protein Exudate: High protein. Due to malignancy, pneumonia, collagen vascular disease, trauma Lymphatic: High TGs. Due to thoracic duct injury by trauma or malignancy
43
Types of pneumothorax
Primary spontaneous: rupture of apical blebs or cysts in tall thin young male Secondary spontaneous: due to diseased lung or high pressure mechanical vent Traumatic: blunt or penetrating trauma Tension: Air enters pleural space but can't get out. Causes trachea to deviate away from affected lung
44
Lobar pneumonia
Organisms: S pneumo, Legionella, Klebsiella Pathology: consolidation due to exudate, involves entire lobe or lung
45
Bronchopneumonia
Organisms: S pneumo, S aureus, H flu, Klebsiella Pathology: inflammation from bronchioles into adjacent alveoli, patchy distribution
46
Interstitial pneumonia
Organisms: viruses, mycoplasma, legionella, chlamydia Pathology: diffuse patchy involvement involving interstial areas
47
Lung abscesses
Clinical: Classically seen in patients with loss of consciousness and aspiration of oropharyngeal contents or bronchial obstruction Pathology: Local collection of pus in parenchyma. Due to anaerobes Imaging: Air-fluid levels Treatment: Clindamycin
48
Pancoast tumor
Carcinoma in apex of lung. Can invade cervical sympathetic chain and cause Horner syndrome, SVC syndrome, sensorimotor defects, hoarsness
49
SVC syndrome
Obstruction of SVC by malignancy or thrombosis preventing blood drainage from head, neck, and upper extremities. Causes facial plethora, JVD, and edema. Can raise intracranial pressure if obstruction severe.
50
Sites of metastasis for lung cancers
Adrenals, brain, bone, liver
51
Cancers that metastasize to lung
Breast, colon, prostate, bladder
52
Small cell carcinoma of lung
Location: central Pathology: Undifferentiated neuroendocrine cells that appear as small dark blue cells. Chromogranin A+, amplificiation of myc genes Clinical: Very aggressive. Can made ACTH, cause SIADH, cause myasthenic syndrome, cause paraneoplastic encephtalitis
53
Adenocarcinoma of lung
Location: peripheral Clinical: most common lung cancer in nonsmokers, and overall. Clubbing. Pathology: mutations in KRAS, EGFR, ALK. Glandular pattern. Mucin +
54
Squamous cell carcinoma of lung
Location: central Clinical: can cause hypercalcemia through a paraneoplastic syndrome Pathology: Hilar mass, cavitation, keratin pearls
55
Large cell carcinoma of lung
Location: peripheral Clinical: Poor prognosis Pathology: Highly anaplastic and undifferentiated, pleomorphic giant cells, can secrete beta hcG
56
Bronchial carcinoid tumor
Pathology: neuroendocrine cell nests; chromogranin A + Clinical: escellent prognosis, presents with symptoms of mass effect, occasionally cuases carcinoid syndrome
57
meconium ileus
obstruction of distal ileum by dehydrated meconium. Most commonly cuased by cystic fibrosis. Often is the presenting symptom at birth of CF.
58
Influenza vaccine
Inactivated vaccine: Induce antibodies against hemagglutinin antigen which inhiibin bindings ot hemagglutinin to host cell receptors, prevneting virus from entering cells.q
59
Minute ventilation vs alveolar ventilation
Minute ventilation is total volume of new air that enters resp pathways per minute Alveolar ventilation is only volume of new air reaching gas exchange areas per minute - doesn't include dead space
60
piriform recess
Cavities on either side of laryngeal orifice. During swallowing, food diverted into piriform recesses and then into esophagus by epiglottis. Food can get stuck in it and damage the internal laryngeal nerve, which serves as the afferent limb of the cough reflex
61
DHR flow cytometry
Tests for neutrophil superoxide production to diagnose CGD. Preferred to NBT testing.
62
First vs second generation H1 blockers
First gen: end in "ine" or "ate" - diphenhydramine, dimenhydrinate, chlorpheniramine Second gen: end in "adine" - loratadine, fexofenadine, desloratadine, cetirizine
63
N-acetylcysteine
Mucolytic agent used to loosen mucus plugs in CF patients by disrupting disulfide bonds. Also is antidote for acetaminophen OD
64
Dextromethorphan
Synthetic codeine. Antagonizes NMDA glutamate receptors
65
Nasal decongestants
Names: Pseudophedrine, phenylephrine MOA: alpha1 agonists, constrict nasal vessels to reduce edema and congestion ADRs: HTN, CNS stimulation/anxiety
66
Bosentan
MOA: endothelin-1 receptor antagonist - decreases pulmonary vascular resistance Use: pulm htn ADRs: hepatotoxicity
67
Sildenafil
MOA: Inhibits PDE-5 leading to vasodilation Use:pulm HTN, ED
68
Prostacyclin agonists
Names: epoprostenol, iloprost MOA: vasodilatory effect, inhibits platelet aggregation ADRs: flushing, jaw pain Use: pulm htn
69
Ipratropium
MOA: muscarinic antagonist - prevents bronchoconstriction Use: asthma, COPD; tiotropium is long acting form
70
Anti-leukotriene agents
Montelukast and zafirlukast: block leukotriene receptors, good for aspirin-induced asthma Zileuton: 5-lipoxygenase pathway inhibitor, blocks conversion of AA to leukotrienes
71
Omalizumab
monoclonal anti-IgE antibody used in allergic asthma resistant to steroids and B2 agonists
72
theophylline
MOA: inhibits phosphodiesterase, increasing cAMP and causing bronchodilation Use: narrow therapeutic index limits use for asthma
73
Metacholine
MOA: M3 agonist Use: metacholine challenge to diagnose asthma
74
Cryptococcus neoformans
Budding yeast with thick capsule. Opportunistic pathogen. Most commonly causes meningoencephalitis. Lung infection usually occurs first but is usually asymptomatic
75
Normal A-a gradient
Less than 10-15 mmHg
76
Pancoast syndrome
Caused by tumor at lung apex, often in superior sulcus. Presents with shoulder pain, Horner syndrome, spinal cord compression
77
Fat embolism syndrome
Acute onset neurologic abnormalities, hypoxemia, petechial rash

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