Quiz 3 Flashcards
1
Q
The foregut is which embryologic layer and surrounded by what?
A
- in the dorsal body wall
- endoderm surrounded by (splanchnic) mesoderm
2
Q
Respiratory system development
- derived from
- endoderm forms?
- mesoderm forms?
A
- sprouts from foregut
- endoderm -> inner epithelium and glandular epithelium
- mesoderm -> conn tissue, smooth muscle and cartilage
3
Q
Esophageal atresia
- definition
- associated with
- can cause
- sxs after birth
A
def -> blind-ending esophagus
assoc -> esophagotracheal fistula = esophagus connected to trachea
causes polyhydramnios -> too much amniotic fluid
Sxs
- aspiration upon feeding
- frothing at the mouth -> can’t swallow saliva
4
Q
Pulmonary agenesis
A
lung buds fail to develop
5
Q
Pulmonary hypoplasia
A
deficiency of later branching of lung bud
6
Q
list 3 late events in lung development
A
- inc alveolar surface area
- activation of alveolar defense systems
- surfactant production
7
Q
Neonatal respiratory distress syndrome is often seen in?
A
premature infants
8
Q
Hereditary surfactant deficiency
- gene for?
- chronic or acute?
A
surfactant B protein gene
long term issue
9
Q
Describe the movement of diaphragm during development
A
cranially -> inferiorly -> dorsally -> dividing intraembryonic coelom in thoracic duct and abdominal cavities
10
Q
The gaps b/w pleural cavity and peritoneal cavity are called?
Are filled in by?
A
- pericardioperitoneal canals
- filled in by pleuroperitoneal membranes
11
Q
Embryological derivatives
- central tendon
- muscular diaphragm? (innervation)
- outer diaphragm (innervation)
- right and left crura
A
septum transversum -> central tendon
myoblasts -> migrate from septum transversum to pleuroperitoneal membrane -> muscular diaphragm
-phrenic nerve
body wall mesenchyme -> outer diaphragm
- segmental
- T7-T12 intercostal nerves
gut mesenchyme -> Right and left crura
12
Q
visceral vs parietal pleura derivation
A
visceral -> outer layer of bronchial buds
parietal pleura -> inner layer of thoracic wall
13
Q
what divides thoracic cavity into pericardial, right and left pleural cavities?
A
fusion of pleuropericardial folds w/ foregut
14
Q
Congenital diaphragmatic hernia is due to
- which side more common?
- complications?
- management?
A
failure of one of the pericardioperitoneal canals to close
USUALLY LEFT
pulmonary hypoplasia -> life threatening
can get pneumothorax in opposite lung
tx w/ surgery before week 16
15
Q
Which cells give rise to small cell lung carcinoma
A
Kulchitsky cells -> neuroendocrine
- secretory granules on basal aspect
- derived from neural crest cells
16
Q
Cystic fibrosis
- inheritance
- defective channel/gene
A
AR
defective ATP-gated Cl- channel
- protein stuck in RER
- CFTR gene
dec Cl- secretion -> inc Na+/H2O reabsorption into cells -> thick mucous
17
Q
Oxymetazoline (Afrin)
- MoA
- indications
A
- for nasal congestion
- stimulates alpha-1 receptors -> vasoconstriction -> reduced edema
18
Q
Vocal vs vestibular fold histology
- glands
- epithelium
A
VESTIBULAR
- has glands
- respiratory epithelium
VOCAL
- no glands!!!
- stratified squamous non-keratinized epithelium
- lacks blood vessels
19
Q
Epiglottis histology
-epithelim
A
Anterior and posterior tip -> in contact with food
-stratified squamous epithelium
Posterior
-respiratory epithelium
20
Q
CC16
- what is it?
- which cells produce it?
- where are these cells found?
- disease implications
A
CC16 -> clara cell secretory protein
-proteinaceous surfactant called surface-active agent
Made by clara cells which are most abundant in terminal bronchioles
CC16 levels in lung disease
- decreased in bronchiolar lavage
- increased in blood
21
Q
What forms the air-blood barrier?
A
Type I pneumocyte, fused basal laminal, endothelial cell
22
Q
Type II pneumocytes
- morphology
- produce (from which specific part)
A
- cuboidal
- surfactant produced in lamellar bodies
23
Q
Emphysema vs pneumonia on histology
A
Emphysema
-destruction of alveolar walls
Pneumonia
-exudate infiltrate w/ WBCs in alveoli and enlarged capillaries
24
Q
Positive likelihood ratio
- equation
- significant value
A
PLR = Sn/(1-Sp) = true positive rate/false positive rate
> 10
25
Negative likelihood ratio
- equation
- significant value
NLR = false neg rate/TN rate = (1-Sn)/Sp
<0.1
26
Which lung capacity allows the lung to stay inflated?
FRC
27
Describe how FRC is affected in restricted vs obstructive lung diseases
RV changes
Obstructive -> inc RV
Restrictive -> dec RV
28
Minute ventilation vs alveolar vent
Subtract out dead space for alveolar vent
Va = (Vt - Vd) x RR
29
Given constant rate of CO2 production, what determines PACO2?
ALVEOLAR VENTILATION
PACO2 = (VCO2 x K)/VA
30
What is located in the pre-Botzinger complex
respiratory pacemaker neurons which generate the respiratory rhythm
31
Compare dorsal and ventral respiratory groups
Both in medullary respiratory center
1. DRG
- dorsomedial part of medulla
- inspiratory neurons
2. VRG
- ventral part of medulla
- inspiratory AND expiratory neurons
32
Location and fx of pneumotaxic center
- located in upper pons
- turns OFF inspiration
- limits TV and regulates RR
- normal breathing persists in its absence
- has an inhibitory effect on the apneustic center
33
Apneustic center
| -location and fx
- lower pons
- apneustic breathing -> prolonged inspiratory gasps followed by brief expiratory movements
concurrent removal of input from the vagus nerve and the pneumotaxic center causes this pattern of breathing -> POOR PROGNOSIS
34
Orthopnea vs. playpnea
orthopnea -> dyspnea lying down
platypnea -> dyspnea relieved when lying down 
35
Compare central vs peripheral chemoreceptors
CENTRAL
- respond to H+ (from CO2 diffusing into CNS)
- ventral surface of medulla
PERIPHERAL
- carotid body
- respond mainly to O2 (< 60mmHg)
- somewhat to CO2 and H+
- CN IX
- type I cells are the sensors of pO2
note: do NOT respond to dec in O2 bound to Hb; only to changes in O2 TENSION
- anemia
- CO poisoning
36
Effect of chronic exposure to low pO2 on carotid body
HYPERTROPHY
37
List 3 effects of acute exposure to high altitude
-effect on the brain?
Acclimatization after several hours - weeks
ACUTE
hypoxemia -> hyperventilation
- hypoxia
- hypocapnia
- respiratory alkalosis -> inhibits central chemoreceptors (low H+) -> cerebral vasoconstriction -> cerebral hypoperfusion -> CNS impairment
-one of the hallmarks of severe altitude sickness is loss of balance and coordination
Mechanism of cerebral vasoconstriction
* direct effect of high pH -> constriction of blood vessels
* low H+ -> more binding of Ca+ to albumin -> hypocalcemia -> cell membrane instability -> vasoconstriction + parasthesia)
ACCLIMATIZATION
- renal comp of resp alk (w/in a day)
- erythropoiesis (3-5 days)
- reduction of bicarb in CSF
- stabilization of CV parameters
38
Long term high altitude exposure on pulmonary blood flow
| -consequences?
Inc pulm resistance -> inc pulm artery pressure -> RVH
-inc in pulmonary resistance due to hypoxia induced vasoconstriction
39
High altitude pulmonary edema through to be due to
high altitude pulm HTN + idiopathic non-inflammatory inc in permeability of vascular endothelium
-genetic predisposition
40
Describe the mech by which HIFs work
- degradation
- maintenance
HIFs are constantly being produced but immediately broken down under normal pO2
1. Under normal O2 levels
- O2 dependent degradation domain (ODDD) is hydroxylated at the proline (using proline hydroxylase)
- ODDD + VHL polyubiquinate HIFs -> targeted for degradation by proteasomes
-backup mech to block HIF action -> asparagine hydroxylation (using FIH) -> prevent HIF from interacting at its domain
Hypoxemia
- none of the above occur and HIFs can act at their target sites to reverse hypoxic conditions
- PHD and FIH activity will be LOW
41
Diving physiology
- Pressure inc by 1 atm for how many feet deep
- what effects does this have on gasses and breathing?
- nitrogen
```
1 atm (760 mmHg) pressure inc for every 33 ft
-makes sure to add this to sea level atm = 1 atm
```
Effects
- partial pressure of each gas inc
- density and viscosity inc as well
- inc pressure -> diminished volume of lungs -> inc resistance of airways -> harder to breathe
Nitrogen
1. dissolves mainly in fat tissue -> compression sickness upon rapid ascent
2. narcosis -> at depth of > 100 ft
- CNS problems -> euphoria, memory loss, irrational behavior
42
Heliox
- 21% O2 and 78% He
- causes more laminar flow -> reduced resistance -> easier to breath
- does not dissolve in tissue as much as N2
CNS
-HPNS -> tremor, nausea, vomiting, dizziness
43
Elastic recoil properties of lung are due to?
elastin and collagen in lung tissue
44
Compare accessory muscles for inspiration vs expiration
Inspiration
- external intercostals
- SCM
- scalenes
Expiration
- abdominal
- internal intercostal
45
Transmural pressure in the lung defined as
Difference b/w intralveolar and intrapleural pressures
46
# Define compliance
- measures
- inversely related to
- is the slope of the
- compare compliance at apex vs base
- compare compliance in emphysema vs fibrosis and how this related to functional residual capacity
C = V/P
- P is the TRANSMURAL PRESSURE
- measures the distensibility of the lungs and chest wall
- inversely related to elastance (elastic tissue)
- slope of pressure-volume curve
- apex this is why ventilation is better at the base (slinky analogy)
- Emphysema -> INC compliance -> collapsing tendency of lung is less than expanding tendency of chest wall at FRC -> compensatory inc in FRC to balance forces -> barrel chest
- Fibrosis -> DEC compliance -> collapsing tendency of lung is greater than expanding tendency of chest wall at FRC -> compensatory DECREASE in FRC to balance forces
47
Lymphangioleiomyomatosis (LAM)
- population
- associated with?
- can cause?
- tx?
- rare
- women of childbearing age
- sporadic or w/ tuberosclerosis complex
- 50% w/ LAM -> pneumothorax
- multiple lung cysts
- tx -> lung transplant
48
Birt-Hogg Dube syndrome
- mutation
- inheritance
- causes what?
- mutation in folliculin gene (FLCN)
- autosomal dominant
- folliculomas on cheeks, chest and back
- lung cysts and spontaneous pneumothorax
- kidney tumors
49
Why do COPD patients expire through pursed lips?
COPD -> loss of elastic fibers -> decreased elastic recoil of lung -> intraalveolar pressure can become lower than intrapleural pressure -> negative transmural pressure -> lung collapse
-pursing the lips -> slow expiration -> inc airway pressure to counteract negative transmural pressure -> less resistance to expiration
50
Compare compliance of lung during expiration vs inspiration
what explains this phenomenon
Remember C=V/P
For a given pressure, lung volume is greater during expiration
- concept of hysteresis
- due to presence of surface forces at the air-liquid interface in the alveolus
51
Law of LaPlace states that?
P = 2T/R
p = collapsing pressure of alveolus (or pressure required to keep it open)
t = surface tension
52
Surfactant production
- which cells
- when
- most important component
- which ratio is checked for adequate surfactant production
- effect on compliance
- effect on transudation of fluid into alveoli
- type II cells
- 24-35 gestational week
- dipalmitoyl phosphatidylcholine (DPCC) -> amphipathic -> hydrophobic components repel each other
- lecithin:sphingomyelin > 2:1
- INCREASES compliance
- PREVENTS transudation of fluid into the alveoli
53
Tx for neonatal respiratory distress syndrome?
| effect on V/Q?
- artificial surfactant
- air enriched in O2
- maternal steroids before birth
-DECREASED V/Q
54
Where in the respiratory tract is laminar air flow MOST likely to occur? why?
TERMINAL BRONCHIOLES
- low flow of air
- large cross sectional area (parallel arrangement -> dec resistance)
55
The major site of airway resistance is at the?
MEDIUM-SIZED SEGMENTAL BRONCHI
56
ANS effect on bronchial smooth muscle
Sympathetic b2 adrenergic agonists -> bronchodilation
PNS -> acetylcholine -> bronchoconstriction
57
Lung volume and airway resistance relationship
| -apply this to asthma
Inverse relationship
asthma -> airway constriction -> compensatory inc lung volume (similar to emphysema) -> helps keep airways open
58
Diffusion vs perfusion limited
- separate by gases
- compare maintenance of gradient of partial pressure
Diffusion limited
- CO -> immediately binds to Hb and very little is dissolved in blood
- O2 (only in fibrosis and emphysema)
- CO2 (disease states)
- gas does NOT equilibrate by the time blood reaches end of capillary -> gradient is maintained
Perfusion limited
- N2O = ideal example
- O2 (normal health) -> equilibrates at about 1/3 length of capillary
- CO2 -> also equilibrates at 1/3 length
- gradient NOT maintained and equilibrium is reached
- diffusion can be increased by increasing blood flow (perfusion)
59
Compare O2 and CO2 in terms of solubility and diffusion
| -implications with regards to pathology?
CO2 24x more soluble in water and diffuses 20x faster
- pressure difference also smaller for CO2
- CO2 also undergoes chemical modification
implication -> Pathological conditions will have much bigger impact on O2 than CO2 diffusion
60
Which lung volume is most representative of alveolar air after diffusion is complete?
ERV - end of forced expiration
61
List 3 categories of conditions that dec diffusing capacity of lung
1. Thickening of barrier
- edema
- fibrosis
- sarcoidosis
- scleroderma
2. Dec surface area
- emphysema
- tumor
- low CO
- low pulm capillary blood volume
3. Dec uptake of O2 by blood
- anemia
- low pulm blood flow
62
Diffusion equation
Vgas = (Area/thickness) x Dk(P1 - P2)
Area dec in emphysema
thickness inc in fibrosis
Dk(P1 - P2) -> difference in partial pressures
63
Effect of exercise on diffusing capacity
INCREASES IT -> opening of dormant pulmonary capillaries
better V/Q match
64
Diffusing capacity of CO, O2 and CO2 under normal conditions
CO - 25 ml/min/mm Hg
O2 - 21 ml/min/mm Hg
CO2 - 420 ml/min/mm Hg (20x higher diffusing capacity than O2)
65
Primary cause of pulmonary edema
INCREASED CAPILLARY HYDROSTATIC PRESSURE
| -fluid can get in interstitium or alveoli
66
Normal O2 binding capacity (show calculation)
20.1 ml O2/100 ml blood
| 15g Hb/100ml) x (1.34 ml O2/g Hb
67
How much O2 is dissolved in the blood (show calculation)?
0. 3 ml O2/100 ml
0. 003 ml O2/100 ml blood/1 mmHg
100 mmHg = pO2 of arterial blood
68
Define P50 for Hb
P50 = pO2 at which Hb is 50% saturated
25mmHg under normal conditions
69
Factors affecting oxygen-Hb dissociation curve
Increasing all the following cause a right shift (dec affinity) -> p50 is INCREASED
C - CO2
A - acid (H+)
D - 2,3-DPG (inc production at high altitude)
-binds to beta chain in Hb dec affinity for O2
-HbF lacks binding site for 2,3-DPG (no beta chain)
E - exercise
T - temperature
70
Describe the haldane effect
deoxy form of Hb is better H+ acceptor than oxy Hb
in lungs -> oxygenation of Hb -> dissociation of H+ from Hb -> CO2 released for expiration
71
3 ways in which CO2 is transported
1. HCO3 - (90%)
2. Carbamino-Hb (5%)
- bound to N terminus of GLOBIN (not heme)
3. dissolved CO2 (5%)
72
What 2 effects does CO have on O2 binding to Hb
1. Dec O2 binding capacity of Hb (dec % O2 sat of Hb)
| 2. Shifts dissociation curve to the left
73
Hyperbaric O2 works by increasing which aspect of O2 content?
Dissolved O2
74
Equation for pulmonary vascular resistance
[P(pulm artery) - P(left atrium)]/Cardiac output
Left atrial pressure = PWP
75
Natural shunting is due to
-venous blood from bronchial and cardiac veins delivering blood to left heart
Around 2%
76
Ruler to assess readiness, confidence and importance of behavior change
1-2: Pre-contemplation
3-4: Contemplation
5-6: Preparation
>7: Action - IMPORTANT
77
READS skill of MI
| -useful for?
```
R: Roll with Resistance
E: Express Empathy
A: Avoid Argumentation
D: Develop Dissonance
S: Support self-efficacy
```
Useful to navigate AMBIVALENCE
78
OARS skill of MI
O: Open-ended questions
A: Affirmations -> "I'm glad you're here today"
R: Reflective Listening
S: Summarizations
79
List 5 types of reflective statements
Content: direct restatement of what the person said
Meaning: Making a guess about the meaning behind the statement
Feeling: Making a guess about the feeling behind the statement
Amplification: Overstates what the person says
Double sided reflection: Captures both sides- dissonance
80
SMART goals
```
Specific
Measurable
Achievable
Related directly to the goal
Time Specific
```
81
How can you tell an interstitial lung disease from a neuromuscular disease?
ILD
- low TLD (restrictive)
- low DLCO
NM disease
- low TLC
- NORMAL DLCO
82
Isolated DLCO w/ no other PFT abnormality may signal
pulmonary vascular disease (e.g. pulmonary HTN)
83
Describe the flow-volume loops for the following
- normal
- mild to moderate obstruction
- mild restriction
NORMAL
-straight even slope
OBSTRUCTION
-concave scooping
RESTRICTION
- high peak
- steep slope
84
Downside of lung dilution technique and plethysmography
Lung dilution
- underestimates FRC inpatients with severe airway disease (ventilation distribution is poor)
- N2 uNderestimates lung volume
Plethysmography
-measures all intrathoracic gas regardless of whether it is communicated w/ airways
85
List 5 things that decrease DLCO
1. Loss of surface area
2. Dec blood vol
3. inc diffusion distance
4. dec Hb
86
Ballpark values for assessing severity of lung defects
```
High: 120%+
Normal: 80 - 120
Mild: 65 - 80
Moderate: 50 - 65
Severe: <50
```
87
FEV1/FVC ratio to use when LLN not give?
| when it is give?
0.7
> 75% LLN
88
What's the cutoff for a good bronchodilator response?
12% and 200ml inc in either FEV1 or FVC
89
Low FVC w/ normal FEV1/FVC indicates? must confirm with?
Restrictive disease
confirm with lung volume
90
Define pseudorestriction
Dec FEV1 and FVC due to increase in RV
- can confirm this by checking TLC
- seen in obstructive pathologies
91
Flattening of both inspiratory and expiratory limbs of FVL indicates?
fixed upper airways obstruction
| e.g. tracheal stenosis due to long term tracheostomy tube
92
Criteria for giving Oxygen
O2 sat 88% or below
OR
PaO2 on ABG of 55 or lower
93
With normal CXR, 90% of cough is 1 of the following:
| -list 3
Asthma
GERD
Allergic rhinitis (hay fever)
94
Most common cause of hemoptysis
acute bronchitis
| -often streaked sputum
95
Ideal position of an endotracheal tube tip
- relative to carina?
- if carina not visualized?
in the trachea 5cm +/- 2 cm above the carina
If carina not seen -> T3 or T4 vertebral body
Carina at T5, T6, or T7 level in > 90% of patients
96
What shape should the aortic pulmonic window be?
CONCAVE
97
Compare pulmonary artery to main bronchus on right and left side
LEFT
-PA arches up over the left main bronchus
RIGHT
-PA course in front of and below the right main bronchus
98
List 3 signs of air space consolidation
1. Air space opacity is poorly marginated except where is abuts the pleura (e.g. fissure)
2. Air Bronchograms: A pattern of air-filled (low-attenuation) bronchi on a background of opaque (soft tissue attenuation) airless lung
- normally can't separate out bronchi from aerated lung farther out from hila b/c bronchi are too thin
3. It obscures adjacent vessels
99
Silhouette sign is useful for?
localizing disease w/in chest
| which lobe?
100
Blunting of costophrenic angle is classic sign of?
pleural effusion
101
Which views of CXR is MOST sensitive for picking up a pleural effusion?
LATERAL DECUBITUS VIEW
-only 10 ml of fluid needed for blunting of CP angles
LATERAL VIEW is next best
FRONTAL VIEW is the worst
102
Which type of pleural fluid can appear like a tumor (pseudotumor)
-how to tell apart?
Loculated interlobar pleural fluid
| -lenticular tapering shape is clue that it's not a tumah
103
Presence of deep sulcus in supine patient indicates?
pneumothorax
104
Tension pneumothorax
- trachea
- diaphragm
trachea shifts to opposite side
diaphragm pushed down
105
3 most common origins of pulmonary thromboembolism
1. deep veins of legs > 95%
2. pelvic veins
3. upper extremities w/ IV access <10%
106
Virchow's triad
1. hypercoagulability
2. Endothelial damage
3. venous stasis
107
Most common sign and sx of pulmonary thromboembolism
Sx - dyspnea
Sign - tachypnea
108
1. When should thrombolysis be used to tx pulmonary thromboembolism?
2. When should IVC filter be used?
1. only for hemodynamically unstable patients
- massive/life threatening PE
- huge risk of severe bleeding
2. IVC filter only when anticoag is contraindicated or failed
109
Chronic PE
- risk of development following acute PE?
- optimal management?
- end result if not tx?
- marker for poor prognosis?
- gold standard for dx? other imaging?
1% - clot doesn't dissolve
-fibrin not being deposited properly
surgery!!!
-medications don't work
pulmonary HTN and right ventricular failure
-vascular changes in small peripheral resistance vessels throughout the lung
mPAP greater than or to 30mmHg -> poor prognosis
-5 year survival only 10% with mPAP >50mmHg
V/Q scan = gold standard
- multiple segmental defects
- pulmonary angiogram also need to be done
110
Basic morphology for Wegener's
| Classic triad
Morphology
- vasculitis -> lymphocytes
- parenchymal necrosis
- granulomatous inflammation -> large macrophages and lymphocytes surround necrotic area
Classic triad
- lungs (lower respiratory tract)
- upper respiratory tract
- kidney (glomerulonephritis)
111
Tx for Wegener's?
Cyclophosphamide/azithoprine or corticosteroids
112
What's done to make a diagnosis of alveolar hemorrhage
Sequential bronchoalveolar lavage
| -increasingly bloody lavage is diagnostic
113
Idiopathic pulmonary hemosiderosis
- population
- associated with
- bx will show
–Primarily a pediatric disease (>80%)
–Associated with celiac disease and elevated IgA in 50% of patients
–Biopsy with bland hemorrhage; no immune complexes
114
Initial tx for Goodpasture syndrome, vasculitis, capillaritis and connective tissue disease
pulses w/ high dose steroids
-can use plasma exchange afterwards for goodpasture's
115
Dx for pulmonary HTN requires mPAP of
Greater than or equal to 25
116
How is PH dxed?
Right heart cath showing elevated pulmonary pressures
117
What histological characteristic is present in all of the following:
IPAH
HPAH
unrepaired congential heart disease
drug and HIV associated PH
PLEXOGENIC PULMONARY ARTERIOPATHY
- looks like a glomerulus
- vessel trying to recanalize itself
```
• Intraluminal
capillary networks
• Dilated vessels
• Thrombosis
• Recanalization
```
118
Heritable PAH mutation
70% have BMPR2 mutation - TFG-beta receptor family
119
List 2 major classes of associated PAH
1. Conn tissue diseases
- scleroderma -> MUST SCREEN
- RA
- SLE
2. Congenital systemic pulmonary shunts
- sheer stress due to left to right shunt
- eventually reversed to right to left shunt
120
WHO classification for pulmonary HTN
I - PAH
II - left heart disease
III - lung disease and/or hypoxia
IV - chronic thromboembolic pulmonary HTN
V - unclear multifactorial mechanisms
121
Tx for PH includes (list 4)
- oral anticoagulant tx
- diuretics
- oxygen -> Keep sat >90%
- inotropic agents (digoxin)
122
3 endogenous pathways that can be altered for vasodilator tx in patients w/ NEGATIVE vasoreactivity trials
1. Endothelin
- powerful vasoconstrictor
- can block it
2. NO - vasodilator
- give extra
- block breakdown of cGMP (viagra = PDE inhibitor)
- turn on adenylate cyclase
3. Prostacyclin
- inc
123
Which class of drugs are associated with PAH?
STIMULANTS (meth, cocaine, fat burners etc.)
124
What's another term for hypoxic respiratory?
What's another term for hypercarbic resp failure?
1. Oxygenation failure
| 2. Ventilatory failure
125
Equation for oxygen delivery
DO2 = CO x oxygen content
= CO x 1.34Hb x O2sat + (PaO2 x 0.003)
126
What causes elevated DLCO
alveolar hemorrhage
127
ARDS presentation and imaging
RAPID ONSET
-dyspnea and tachypnea
SEVERE HYPOXEMIA
-refractory to O2 tx
DIFFUSE PULMONARY INFILTRATES
-seen on CXR
HIGH MORTALITY
128
Which cells undergo hyperplasia in the proliferative/organization phase of diffuse alveolar damage?
TII pneumocytes
129
Cryptogenic organizing pneumonia is responsive to?
| -how does it present?
STEROIDS
-acute onset of cough, dyspnea, fever and malaise
130
Describe histology of organizing pneumonia
| -acute or subacute?
fibroblastic plugs w/in bronchioles, alveolar ducts and alveoli
patch distribution
SUBACUTE
131
minute ventilation (VA) is proporiton to?
VCO2/PaCO2
132
List 5 causes of hypoxic resp failure
VDASH
```
V/Q mismatch
Diffusion limitation
Altitude/low PbO2
Shunt
Hypoventilation
```
133
List 4 causes of hypercapnic resp failure
asthma
COPD
Neuromuscular disease
Narcotic/drug overdose
134
Most useful method for measuring adherence in clinical setting?
Patient questionnaires; self-report
135
Most efficacious interventions for promoting adherence have what to components?
Behavioral AND Educational
136
Calculation for serum osmolality
2Na(mEq/L) + urea(mg/dL)/2.8 + glucose(mg/dL)/18
137
Vaptan
- mech
- indication
- interferes with action at the vasopressin receptors
- used in the treatment of hyponatremia, especially in patients with congestive heart failure, liver cirrhosis or SIADH
CAUSE AQUARESIS
138
Normal total body Na and K
Na - 1960mEq (14L)
K - 3820mEq (28L)
Total = 5880mEq
139
luke compensation mech
met acid
met alk
resp acid
resp alk
10->12
10->6
10->4
10->4
140
Milk-alkali syndrome is due to?
Too much vit D and Ca supplementation
