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RESP Flashcards

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1
Q

Causes of ↓AIR FLOW

Reversible (3), Irreversible (3)?

A

REVERSIBLE CAUSES:

  • Dynamic hyperinflation during exercise
  • Contraction of smooth muscles surrounding airways
  • Accumulation in bronchi of:
    - Exudate
    - Mucus
    - Infl cells

IRREVERSIBLE CAUSES:

  • Fibrosis -> narrowing of airways
  • Destruction of alveoli (due to their loss of elasticity)
  • Destruction of structures supporting alveoli
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2
Q

“Child with nasal polyp + resp defects”

A

Cystic Fibrosis

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3
Q

General Pres of LOWER Resp Path (9)?

A

PRES:

  • Dysnea
  • Cyanosis
  • Diaphoresis
  • Weight loss
  • Fever
  • Cough
  • Excretions
  • Chest pain
  • Hemoptysis
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4
Q

Pleural Transudate

Def’n, Seen In (3)?

A

Extravascular fluid with↓protein content.

SEEN IN:

  • CHF
  • Hepatic Cirrhosis
  • Nephrotic Sx
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5
Q

Pleural Exudate

Def’n, Appearance, Seen In (General + 4)?

A

Extravascular fluid with↑protein content.

Cloudy.

SEEN IN: states of↑vascular permeability

  • Trauma
  • Malignancy
  • Collagen Vascular Disease
  • Pneumonia

** Must be drained to avoid infection **

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6
Q

Pleural Lymphatic Effusion (Chylothorax)

Def’n, Appearance, Seen In (General + 2)?

A

Presence of lymphatic fluid in pleural space. Due to leakage from thoracic duct or one of its main tributaries.

Milky fluid.

SEEN IN: Thoracic Duct injury

  • Trauma
  • Malignancy
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7
Q

Pneumothorax

Def’n, Pres (6)?

A

Accumulation of air in pleural space.

PRES: (all UNILATERAL + on AFFECTED side)

  • Chest expansion
  • Chest pain
  • Dyspnea
  • ↓breath sounds
  • ↓tactile fremitus
  • Hyperresonance
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8
Q

Spontaneous Pneumothorax

Mech, Pres (2 Epi + 2)?

A

THINK: Trachea + Diaphragm occupy empty space
RUPTURE of subpleural bleb -> HOLE in pleura ->
Collapse of portion of lung.

PRES: MC in young, tall + thin males. Also Scuba-Divers.

  • Trachea deviates TOWARDS collapsed lung
  • Diaphragm UP
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9
Q

Tension Pneumothorax

Mech, Seen In (2), Pres (2), RX?

A

THINK: ↑P / Compression pushing everything over to OPPOSITE side

SEEN IN:

    • Trauma (penetrating chest wall injury)
  • Lung infection

PRES:

  • Trachea deviates AWAY from affected lung
  • Diaphragm DOWN

RX:
- Chest Tube

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10
Q

Pulmonary Embolus (PE)

Etiology, Pres, Appearance on Pulm CTA, Course, DX (2)?

A

ET: 95% arise from deep leg veins / DVT

PRES: Chest pain, dyspnea, tachypnea

PULM CTA: Filling defects

COURSE: Small PEs produce infarcts ONLY if there is underlying lung dz.

DX:

  • Screening: V/P Scan
  • Confirmatory: Pulm CTA
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11
Q

Fat Emboli

Assoc (2), Pres (Triad)?

A

ASSOC:

  • Liposuction
  • Long bone fractures

PRES:

 1. Hypoxemia
 2. Petechial rash
 3. Neuro abnormalities
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12
Q

Amniotic Fluid Emboli

Def’n, Pres (3), Micro Findings?

A

Emboli that enters maternal circ during labor/delivery.

PRES:

  • DIC (due to thrombogenic nature of amniotic fluid)
  • Shortness of breath
  • Neuro symptoms

FINDING = Squamous cells + Keratin debri (from fetal skin) in embolus

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13
Q

Gas Emboli

Def’n, RX?

A

Nitrogen bubbles precipitate in ascending divers.

RX = Hyperbaric Oxygen

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14
Q

CO Poisoning (Carboxyhemoglobinemia)

Mech (3), Causes (3), Pres (2), RX?

A

MECH:

  • CO very diffusable + has higher affinity for Hb than O2 does
    • > ↓O2 Sat = Cyanosis
  • Left shift of O2-Hb Dissociation Curve
  • Blocking Cytochrome Oxidase (O2 unable to accept e-)

CAUSES:

  • Closed space with room heater
  • House Fire
  • Car exhaust

PRES:

  • Headache
  • Red skin tinting (** masks signs of cyanosis **)

RX = 100% O2

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15
Q

Cyanide Poisoning

Mech, Cause, RX?

A

Cyanide (exactly like CO) blocks Cytochrome Oxidase.

CAUSE:
- House Fire (household products made of polyurethane)

RX:
- Nitrites (Thiosulfate):
(Oxidize Hb to MetHb (MetHb has higher affinity for cyanide) ->
MetHb binds cyanide ->
Cyanide no longer blocking cytochrome oxidase)

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16
Q

House Fire

2 things that produce Hypoxia?

A
  • CO Poisoning

- Cyanide Poisoning (household products made of polyurethane)

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17
Q

Uncoupling

Explanation, Uncoupling Agents (3), Assoc?

A

Inner mitochondrial memb synthesizes ATP.
Although this memb is permeable to protons, you only want protons to go through a certain hole / pore in the memb because at the base of this hole / pore is where ATP Synthase is.

Uncoupling is when protons permeate the memb at ALL locations.

  • > Protons draining right through memb -> Rxs producing these protons in the first place (rxs producing FADH + NADH) go into OVERDRIVE!
    • > ↑Rx Rate = ↑Temp (Hyperthermia)
    • > Very low ATP yield

UNCOUPLING AGENTS:

  • Alcohol
  • Dinitrophenol
  • Salicylates

ASSOC:
- Hyperthermia

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18
Q

Methemoglobinemia

Def’n, Mech, Pres / Epi (2), Blood (CLUE), RX (2)?

A

Methemoglobin = Fe3+ (oxidized).

O2 can’t bind to heme groups containing Fe3+ ->↓O2 Sat = Cyanosis.

PRES:
- Cyanotic person coming from Rocky Mountains -> give O2 ->
REMAINS cyanotic
- People on Nitro or Sulfa drugs

BL: CHOCOLATE-COLORED

RX:

  • IV Methylene Blue
  • 2nd line = Vitamin C (reducing agent)
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19
Q

Obstructive Lung Diseases

Mech (4 steps), Comp (3)?

A

Obstruction of air flow -> AIR TRAPPING in lungs ->
Enlargement of air spaces ->
Airways close prematurely at high lung volumes.

COMP:

  • Hypoxemia (due to destruction of alveolar capillaries)
  • Cor Pulmonale (due to chronic hypoxic pulm vasoconstriction)
  • ↑infection risk
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20
Q

Chronic Bronchitis

Chars (4)?

A

CHARS:

  • Thickened bronchial walls
  • Mucous gland enlargement
  • Patchy squamous metaplasia of bronchial mucosa
  • Lymphocytic infiltrate
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21
Q

COPD

Mech (2), Players (3), RF (4), DX?

A

Pulm INFL -> Small Airway dz (due to infl + remodeling)
-> Parenchymal destruction
(due to loss of alveolar connections +↓elasticity)
**↓AIR FLOW **

  • CD8 T cells
  • Macrophages
  • Neutrophils

RF:

  • a1-antitrypsin deficiency
  • Hyper-reactive airways
  • Infections
  • Exposure to tobacco and/or occupational toxins (oxidative stress)

DX:
- Spirometry (gold standard): FEV1/FVC = 25-75% (normal = 80%)

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22
Q

Bronchoconstriction

Mech (2)?

A

MECH:

  • Inflammatory processes
  • ↑Parasympathetic tone (Ach + Adenosine)
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23
Q

Emphysema (“Pink Puffer”)

Mech (2 steps), Etiology, Pres (4)?

A

Destruction of alveolar air sacs / walls (w loss of elastic recoil)
-> Permanent alveolar DILATION + COLLAPSE during EXP.

ET: Protease / Antiprotease imbalance

PRES:

  • “Barrel-shaped chest”
  • Dyspnea + Tachypnea
  • Exhalation thr pursed lips (to↑airway pressure + prevent collapse)
  • Weight loss
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24
Q

Centracinar Emphysema

Etiology, Mech (3 steps)?

A

ET: Smoking (oxidative injury to bronchioles)

Ox injury -> Alv Macrophages + Neutrophils release Proteases
-> Protease-Antiprotease imbalance

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25
Asthma Def'n, Mech / H-S Type, Players (2), Path (Early vs Late-phase rx), Assoc, Micro Findings (3), Pres (6), DX?
Reversible bronchoconstriction -> ***↓AIR FLOW ***. Bronchial HYPERRESPONSIVENESS most often due to allergic stim = Type 1 H-S. - CD4 T cells - Eosinophils Early-Phase = IgE-mediated. Late-Phase = Infl-mediated. ASSOC: - Churg-Strauss Sx (Small-Vessel Vasculitis) FINDINGS: - Smooth muscle hypertrophy - Curschmann's spirals - Charcot-Leyden crystals PRES: *** Episodic clinical features *** - Coughing + Wheezing - Dyspnea + Tachypnea - Hypoxemia - ↓I/E ratio - Mucus plugging - Pulsus Paradoxus DX: Methacholine Challenge
26
"Triad" Asthma Mech (2 steps), Seen In (3)?
S1. Aspirin or NSAIDs block COX -> Arachidonic acid CAN'T form PGs. (Lipoxygenase pathway left open). S2. ... in people who are sensitive to above ... C4, D4, E4 + LT = potent bronchoconstrictors formed. PRES: - Patient on Aspirin or NSAID (chronic pain sx) - Nasal Polyps - Occasional bouts of Asthma
27
Bronchiectasis Mech (3 steps), Causes (5), Pres (3)?
Chronic NECROTIZING INFECTION of bronchi -> Damage to bronchial walls -> Permanent DILATION of bronchi / bronchioles. CAUSES: - Bronchial obstructions - Problems with ciliary motility - Smoking - Kartagener's Sx - Cystic Fibrosis - Allergic Bronchopulmonary Aspergillosis - Common Variable Immunodef PRES: - Recurrent infections - Foul-smelling purulent sputum - Hemoptysis
28
Interstitial Pulmonary Fibrosis Def'n, Appearance on Imaging, RX?
Repeated cycles of lung injury / healing with↑collagen. "Honeycomb" Lung RX = Lung Transplantation
29
Restrictive Lung Diseases Def'n?
Restricted FILLING of lungs -> Restricted lung EXPANSION -> | ↓Lung Volumes.
30
Pneumoconioses Def'n, Mech?
Interstitial fibrosis due to chronic exposure to small fibrogenic particles. MECH: Alveolar Macrophages engulf these particles -> Fibrosis.
31
Asbestos- 3 Dz Categories
- Asbestosis - Benign Asbestos-Related PLEURAL Diseases: - Pleural Effusion - Pleural Thickening - Pleural Plaques - Atelectasis - Malignant Asbestos-Related Diseases: - Mesothelioma - Asbestos-Related Lung Cancer
32
Asbestosis Location, Assoc (3), Micro Finding, Comp (2)?
Affects LOWER lobes. ASSOC: - Roofing - Plumbing - Shipbuilding FINDING = Asbestos bodies COMP: advancement to fibrosis w alteration of pulm architecture - ↑incidence of Bronchogenic Carcinoma - ↑incidence of Mesothelioma
33
Silicosis Location, Mech, Assoc (3), Micro Finding, Comp?
Affects UPPER lobes. MACROPHAGES respond to silica and release fibrogenic factors -> Fibrosis. ASSOC: - Foundries - Mines - Sandblasting FINDING: - "Eggshell" calcification of hilar lymph nodes COMP: - ↑susceptibility to TB (silica disrupts phagolysosomes and impairs macrophages)
34
Sarcoidosis Def'n, Pres (Epi + 4), Micro Finding, Labs (2), Comp (2), RX?
Systemic disease. Noncaseating granulomas in multiple organs, however MC in lungs + Hilar lymph nodes. PRES: African American Women - Bilateral Hilar lymphadenopathy - Cough - Dysnea - Uveitis FINDINGS: - Asteroid bodies / Stellate inclusions (often seen in Giant cells of granuloma) LABS - ACE ↑ - Ca ↑(epithelioid histiocytes convert Vit D to its active form) COMP: - Facial Nerve Palsy - Restrictive / Obliterative Cardiomyopathy RX: *** Often resolves spontaneously without treatment *** - Steroids
35
Hypersensitivity Pneumonitis Def'n, H-S Type, Pres (2 Epi + CLUE)?
Granulomatous rx to inhaled organic antigens. Mixed Type 3 / Type 4 H-S. PRES: Farmers + Ppl exposed to Birds * ** Pres hrs after exposure and resolves with removal of exposure *** - Cough - Chest tightness - Dysnea - Fever - Headache
36
NRDS Def'n, Mech (2), Assoc (3), Pres (3), Appearance on CXR?
RDS due to inadequate SURFACTANT levels. ↑Surface Tension -> Collapse of air sacs (Atelectasis) -> Hyaline memb formation ASSOC: - Prematurity - C-section delivery - Maternal Diabetes PRES: - "Grunting" - Resp distress with cyanosis + hyopoxemia + tachypnea +↑resp effort after birth - PDA -> "Machine-like murmur" (PDA due to hypoxemia) CXR: "Ground glass" appearance of lung (due to diffuse granularity)
37
ARDS Mech (5 steps), Causes (2), Pres, Appearance on CXR, Comp?
Activation of NEUTROPHILS -> Damage to Pneumocytes (--->↑ST + Atelectasis) -> Damage to ALVEOLAR-CAPILLARY interface (---> thickened diffusion barrier) -> ↑Permeability -> Leakage of protein-rich fluid into alveoli -> Edema + Intraalveolar Hyaline memb -> Intrapulmonary Shunting. CAUSES: * - Septic Shock - Acute Pancreatitis PRES: "Cyanosis + Hypoxemia with resp distress" CXR: "White out" COMP: Interstitial Fibrosis (damage to Type II Pneumocytes -> fibrosis + scarring)
38
Alveolar Hyaline Memb Mech of Formation (7 steps), RX?
*** Hyaline = Pink! *** Lack of SURFACTANT -> Collapse of air sacs -> Massive Ventilation defect -> Massive Interpulm Shunt. Degeneration of Type II Pneumocytes -> Leakage of Fibrinogen -> Congealing of Fibrinogen = formation of hyaline memb. RX: - PEEP (Positive End Exp Pressure) Therapy
39
Lobar Pneumonia Mech (2 steps), Micro Findings (3)?
INTRA-alveolar EXUDATE -> CONSOLIDATION of 1 entire lobe of lung. FINDINGS: - Congestion (due to congested vessels + edema) - Red Hepatization: exudate, hem and Neutrophils filling alveolar air spaces -> gives lung solid consistency - Gray Hepatization: degradation of red cells within exudate
40
Bronchopneumonia Def'n, Appearance (3), Micro Finding?
ACUTE INFL (Neutrophilic) infiltrate from bronchioles -> adjacent alveoli. - Often bilateral + multifocal - Patchy distribution - Areas of consolidation centered around bronchioles FINDING = Neutrophils in alveolar spaces
41
Atypical / Interstitial / "Walking" Pneumonia Appearance on CXR?
CXR: Bilateral, however worse on R. | - Coarse reticular opacities
42
Lung Abscess Def'n, Causes (2), Pres, Appearance on XR?
Localized collection of pus within lung parenchyma. Aspirate consists of aerobes + anaerobes. CAUSES: - Aspiration of oropharyngeal contents (*street people*) - Bronchial obstruction XR: Air-fluid levels / Fluid cavities
43
Pain from Diaphragm Irritation Cause, Pres (where referred to)?
CAUSE = Air or Blood in peritoneal cavity PRES = Pain referred to shoulder / trapezius ridge
44
Cor Pulmonale Def'n, Causes (2), Pres, Comp?
RHF due to a pulm cause. CAUSES: - Pulmonary Htn - Chronic lung conditions that cause prolonged low blood O2 PRES = Light-headedness or shortness of breath during activity COMP: - RHF
45
TB Cause, Comp (3)?
CAUSE = Inhalation of aerosolized Mycobacterium Tb COMP: - Constrictive Pericarditis - Erythema Nodosum - Infectious Arthritis (due to mycobacterial dissemination)
46
Primary TB Def'n, Locations (2), Pres (3), Micro Finding?
Arises with initial exposure. LOWER Lobe + Hilar lymph nodes. PRES: - Generally asymptomatic - Hilar lymphadenopathy - PPD + FINDING = Ghon Complex
47
Secondary / Reactivation TB Def'n, Location, Causes (3), Pres (3), Micro Finding, Course, Comp (2), DX?
Arises with reactivation of Mycobacterium Tb. APEX of Lung. CAUSES: - Aging - Immune compromise - TNF-a Inhibitor use PRES: - Weight loss - Fever + night sweats - Cough with hemoptysis FINDING = CAVITARY FOCI of caseating necrosis COURSE = Systemic spread COMP: - Tuberculous Bronchopneumonia - Hiliary Pulmonary TB DX = Biopsy of caseating granulomas
48
Vertebral TB (Pott Disease) Pres?
PRES: 2ry TB + back pain
49
Lung Cancer #1 Metastasis TO Lung from (4)?
*** Usually multiple lesions *** - Breast Cancer - Colon Cancer - Bladder Cancer - Prostate Cancer
50
Lung Cancer #2 Metastasis FROM Lung to (4)?
- Brain - Adrenals - Liver - Bone
51
Lung Cancer #3 Assoc, Pres (3), Appearance on Imaging (CXR vs CT), DX, Comp (6: "SPHERE")?
ASSOC = Smoking! (All EXCEPT Bronchial Carcinoid Tumor) PRES: - Bronchial obstruction + Wheezing - Cough - Hemoptysis Appearance on CXR = "Coin lesion" Appearance on CT = Noncalcified nodule DX requires Biopsy. COMP: "SPHERE" - SVC Sx - Pancoast tumor - Horner Sx - Endocrine (paraneoplastic) - Recurrent Laryngeal symptoms (eg hoarseness) - Effusions (pleural or pericardial)
52
Bronchial or Bronchioloalveolar Adenocarcinoma Location, Genetics (3 activating mutations), Pres?
Devel in site of PRIOR pulm injury / infl. Grows along alveolar septa -> apparent "thickening" of alveolar walls. GENETICS: Activating mutations: - ALK - EGFR - K-ras PRES = like Pneumonia, incl on Imaging!
53
Squamous Cell Carcinoma Char, Pres, Micro Findings (2)?
"Cavitation". PRES: - (parathyroid-like activity) Produces PTH -> Hypercalcemia FINDINGS: - Keratin pearls - Intercellular bridges
54
Small Cell / Oat Cell Carcinoma of Lung Def'n, Genetics, Assoc, Pres (2), Micro Finding, Comp (2)?
Neoplasm of neuroendocrine Kulchitsky cells (small dark blue cells). GENETICS: myc oncogene amplification common. ASSOC: - Lambert-Eaton Myasthenic Sx PRES: * Undifferentiated = very aggressive * - Ectopic production of ACTH + ADH -> "SIADH" - Production of antibodies against Ca channels -> Lambert-Eaton Sx FINDING = "Salt + Pepper neuroendocrine-type chromatin" COMP: - SIADH (due to ectopic ADH) - Cushing's Sx
55
Large Cell Carcinoma Micro Finding, RX, Prognosis?
FINDING: - Giant cells (pleomorphic and with leukocyte fragments) in cytoplasm RX: *Less responsive to Chemotherapy* - Surgical removal PROG: *Undifferentiated + Anaplastic => poor prognosis*
56
Bronchial Carcinoid Tumor Def'n, Pres, Micro Findings (2), Comp, Prognosis?
Neoplasm of neuroendocrine cells. PRES: *Well differentiated* - Carcinoid Sx (flushing, wheezing, diarrhea) FINDINGS: - "Nests" of neuroendocrine cells - Chromogranin + COMP: - Cushing's Sx PROG: *Mets rare => excellent prognosis*
57
Mesothelioma Def'n, Mech (2), Assoc, Pres (3), Micro Finding?
Malignancy of pleura (mesothelial cells). Malignancy of pleura -> pleural thickening -> hem pleural effusions ASSOC: - Asbestosis PRES: - Dyspnea - Chest pain - Hem pleural effusions FINDING = Psammoma Bodies
58
Pancoast Tumor Location, Comp?
APEX. COMP: - Horner Sx (by tumor's compression of sym ganglia / plexus)
59
Laryngeal Carcinoma (a squamous cell carcinoma) MCC (2), Pres?
MCC: *** Synergistic effect *** - Smoking - Alcohol PRES = "hoarseness of throat"
60
Superior Vena Cava Sx Def'n, Locations + Consequent Pres (3), Causes (2), Comp (2)?
OBSTRUCTION of SVC -> Impaired bl drainage from head, neck + upper extremities. LOCATIONS: Impaired bl drainage from... - Head -> "Facial plethora" - Neck -> JVD - Upper extremities -> Edema CAUSES: - Thromboses - Neoplasms (ie Lung Cancer) COMP: - ↑ICP (if obstruction severe) -> Headaches + Dizziness - Risk of aneurysm / rupture of cranial arteries

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