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Resp Review Flashcards

1
Q

Lung development

  • weeks
  • respiration capable when
A

Starting at week 4 –> birth

Week 25 viable

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2
Q

Bronchogenic cysts

A

Caused by abnormal budding of the forgut and dilation of terminal or large bronchi

Discrete, round, sharply defined, fluid filled densities on CXR

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3
Q

Club cells

  • description
  • location
  • fxn (3)
A

Noncilated, low columnar/cuboidal with secretory granules

Located in small airways

Secrete components of surfactant
Degrades toxins
Act as reserve cells

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4
Q

Type I pneumocytes

  • cell type
  • fxn
A

Squamous, thin

Gas diffusion
Line alveoli

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5
Q

Type II pneumocyts

  • cell type
  • fxn
A

Cuboidal and clustered

Precursors to type I cells and other type II cells
Proliferate during lung damage

Secrete surfactant from lamellar bodies
–> decrease alveolar surface tension, prevents alveolar collapse –>
Decrease lung recoil and increase compliance

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6
Q

Pulmonary surfactant composed of

A

Mix of Lecithins

- Most important is dipalmitoylphosphatidylcholine (DPPC)

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7
Q

Screening test for fetal lung maturity

A

Lecithin-sphingomyelin ratio in amniotic fluid >2 is healthy

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8
Q

Persistently low O2 tension in newborn think

A

PDA

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9
Q

Infant, difficulty breathing, grunting

Bulging forhead

A

Intraventricular hemorrahge

  • germinal matrix hemorrhages
  • due to RDS
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10
Q

Cephalohematoma

A

rupture of subperiosteal blood

Due to forceps for birth

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11
Q

Location of ____ in respiratory tree

Pathway

1) Cartilage
2) Pseudostratified ciliated columnar
3) Smooth muscle
4) Goblet cells
5) Simple ciliated columnar
6) Club cells
7) Simple cuboidal epithelium
8) Simple cuboidal/ Squamous

A

Trachea –> Bronchi –> Bronchioles –> Terminal bronchioles –> Respiraotry bronchioles –> Alveolar sacs

1) Cartilage
- Trachea
- Bronchi

2) Pseudostratified ciliated columnar
- Trachea
- Bronchi

3) Smooth muscle
- Trachea –> Terminal bronchiles (Respiratory bronchioles sparse)

4) Goblet cells
- Trachea
- Bronchi

5) Simple ciliated columnar
- Bronchioles

6) Club cells
- Bronchioles
- Terminal bronchioles
- Respiratory bronchioles

7) Simple cuboidal epithelium, ciliated
- Terminal bronchioles

8) Simple cuboidal/ Squamous
- Respiratory bronchioles

9) Loss at cilia
- Respiraotry bronchioles

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12
Q

Common site for inhaled foreign bodies

A

Right lung

Right main stem bronchus wider and more vertical and shorter than left

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13
Q

Inhale peanut while upright

A

Basal segment of right lower lobe

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14
Q

Inhale peanut while supine

A

Enters posterior segment of right upper lobe

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15
Q

Pathologic dead space

A

When part of the respiratory zone becomes unable to perform gas exchange

Ventilated but not perfused

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16
Q

Compliance

High compliance

Low compliance

A

Complaint lungs comply (cooperate) and fill easily with air

High compliance

  • Easier to fill
  • emphysema, normal aging

Lower compliance

  • lungs harder to fill
  • pulmonary fibrosis, pneumonia
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17
Q

Surfactant effect on compliance

A

Increases compliance

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18
Q

Right sift in oxygen hemoglobin dissociation curve (6)

A

Increase

  • Acid
  • CO2
  • Exercise
  • 2,3 BPG
  • Alititude
  • Temperature
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19
Q

Resistance =

A

R= (P pulm artery - P L atrium ) / Cardiac output

R= Change P/ Q

Q= perfusion

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20
Q

V/Q at apex of lung

A

3

Wasted ventilation

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21
Q

V/Q at base of lungs

A

0.6 wasted perfusion

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22
Q

Rhinosinusitis most commonly from

A

S. pneumoniae
H. influenza
M catarrhalis

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23
Q

Epistaxis

- anterior vs posterior segment

A

Most commonly
- anterior

Life threatening

  • posterior segment
  • sphenopalatine artery, branch of maxillary artery
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24
Q

Test to rule out DVT

Diagnosis

Prophylaxis/ Acute management

Long term management

A

D-dimer lab test
- High sensitivity Low specificity

Compression ultrasound with Doppler

Prophylaxis or acute management
- Heparin or low molecular weight heparins (enoxaparin)

Tx: Intravenous heparin drip

Long term prevention

  • Warfarin
  • rivaroxaban
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25
Hypoxemia Neurlogic abnormalities Petechial rash
Fat emboli Hypoexemia: low O2 in blood
26
Obstructive lung volumes ``` TLC FRC RV FEV1 FVC FEV1/FVC ``` Due to
Increased TLV Increased FRC Increased RV Decreased FEV1 more than FVC Decreased FEV1/FVC Air trapping in lungs Obstruction of air flow COPD Chronic bronchitis Emphysema
27
Restrictive lung volumes ``` FEV1 FVC FEV1/FVC TLC FRC RV ``` Due to
FVC is more reduced or same as FEV1 Normal FEV1/FVC Decreased TLV Decreased FRC Decreased RV ``` Pneumoconioses Sarcoidosis Pulmonary fibrosis Granulomatosis with polyangiitis Langerhans cell histocytosis Drug toxicity ```
28
Chronic bronchitis pathology clinical presentation
Wheezing, crackles, cyanosis Hypoxemia due to shunting Dyspnea Polycythemia (secondary) Hypertrophy and hyperplasia of mucus secreting glands in bronchi
29
Emphysema - two types - pathology - due to - CXR - clinical presentation (2)
Centriacinar - assoc with smoking - upper lobes Panacinar: - associated with alpha 1 antitrypsin - Lower lobes Enlargement of air spaces, decreased recoil, increased compliance Increased elastase activity --> increase loss of elastic fibers --> increase lung compliance CXR: increased AP diameter, flattened diaphragm, increase lung field lucency Barrel shaped chest Pursed lips breathing
30
Smooth muscle hypertrophy in lungs
Asthma
31
COPD increase in what cells
Neutrophils Macrophages CD8 T cells
32
Purulent sputum Recurrent infections Hemoptysis Digital clubbing - pathology - assoc with
Bronchiectasis Chronic necrotizing infections of bronchi --> permanently dilated airways Kartagener syndrome Cystic fibrosis Aspergillosis
33
Asbestos affects what part of lungs
Lower lobes
34
Silica affects what part of lungs
Upper lobes
35
Coal affects what part of lungs
Upper lobes
36
Ivory white calcified plaques what type of work
Asbestosis Shipbuilding Roofing plumbing
37
Golden brown dumbbells on sputum sample
Asbestosis
38
Aerospace | Granulomatous on histology
Berylliosis
39
Fibrosis | Eggshell calcifications of hilar LN on CXR
Silicosis
40
Mesothelioma associated with seen on histology positive for
Asbestosis Psammoma bodies on histology + Cytokeratin + calretinin
41
Pulmonary HTN value
> 25 mm Hg at rest
42
Physical findings pleural effusion - Breath sounds - Percussion - Fremitus - Tracheal deviation
Breath sounds= decreased Percussion= Dull Fremitus= Decreased Tracheal deviation= None or away from side of lesion if large
43
Physical findings Atelectasis - Breath sounds - Percussion - Fremitus - Tracheal deviation
Bronchial obstruction Breath sounds= decreased Percussion= Dul Fremitus= Decreased Tracheal deviation= Toward side of lesion
44
Physical findings Simple pneumothorax - Breath sounds - Percussion - Fremitus - Tracheal deviation
Breath sounds= Decreased Percussion= Hyperresonant Fremitus= Decreased Tracheal deviation = None
45
Physical findings Tension pneumothorax - Breath sounds - Percussion - Fremitus - Tracheal deviation
Breath sounds= Decreased Percussion= Hyperresonant Fremitus= Decreased Tracheal deviation = Away from side of lesion
46
Physical findings of Consolidation (lobar pneumonia) - Breath sounds - Percussion - Fremitus - Tracheal deviation
Breath sounds= Bronchial breath sounds; late inspiratory crackles, egophony, bronchophony, whispered pectoriloquy Percussion= Dull Fremitus= Increased Tracheal deviation = None
47
Physical findings of pulmonary edema - Breath sounds - Percussion - Fremitus - Tracheal deviation
Consolidation Breath sounds= Bronchial breath sounds; late inspiratory crackles, egophony, bronchophony, whispered pectoriloquy Percussion= Dull Fremitus= Increased Tracheal deviation = None
48
Pleural effusions are
Excess accumulation of fluid between pleural layers --> restricted lung expansion during inspiration
49
Lobar pneumonia - organism - characteristics
S pneumonia (more frequently ) Legionella Klebsiella Consolidation
50
Interstitial (atypical) pneumonia - organism - characteristics
``` Mycoplasma Chlamydophila pneumoniae Chlamydia psittaci legionella Viruses (RSV, CMV, influenza, adenovirus) ``` DIffuse patchy inflammation localized to interstitial areas at alveolar walls Diffuse more than 1 lung
51
Tx Lung abscess
Clindamycin
52
Lung abscess organisms
Due to anaerobes - Bacteroides - Fusobacterium - Peptostreptococcus S. Aureus
53
Carcinoma in apex of lung - type - does what - symptoms
Pancoast tumor (superior sulcus tumor) Invades cervical sympathetic chain Compression of locoregional structures - Recurrent laryngeal n= hoarseness - Stellate ganglion= Horner syndrome** (ispl ptosis, miosis, anhidrosis) - Superior vena cava= SVC syndrome - Brachiocephalic vein= brachiocephalic syn - Brachial plexus= sensormotor deficits
54
SVC syndrome
Obstruction of SVC impairs blood drain from head ``` Facial plethora (red face) - blanches with poking ``` JVD Upper extremity edema Increased risk fo aneurysm
55
Coin lesion on CXR
Lung cancer
56
Small cell carcinoma - Location - Prognosis - Produce - Key feature - Amplication of - Cels - Positive for
Central Very aggressive Product - ACTH - SIADH - Ab against Ca channel High nucleus to cytoplasm ratio Amplification of myc oncogenes (nyc) Abbrevations in TP53, Rb Neuroendocrine Kulchitsky cells --> small dark blue cells + Chromogranin A + Neuron-specfiic enolase
57
``` A 71-year-old man is brought to the emergency department by ambulance after he was found by his neighbor walking around his garden confused and unable to answer questions. He is confused and oriented only to person. His temperature is 37.6° C (99.7° F), heart rate is 110/min, respiratory rate is 20/min, and blood pressure is 130/92 mm Hg. While in the emergency department the patient has a seizure. Laboratory tests show a serum sodium level of 115 mEq/L, potassium of 3.8 mEq/L, glucose of 100 mg/dL, and osmolality of 250 mOsm/ kg. Urine electrolyte testing show a urine osmolality of 500 mOsm/kg. X-ray of the chest shows a mass in the lung. Which of the following is the most likely etiology of the mass? (A) Foreign body aspiration (B) Metastatic brain cancer (C) Prostate cancer (D) Small cell carcinoma (E) Tuberculosis ```
D. Small cell carcinoma
58
Adenocarcinoma - location - most common in - mutation - physical feature - CXR - Histology - positive for
Peripheral Most common lung cancer in nonsmokers and overall Mutations "MARKER" - MET, ALK, RET, KRAS, EGFR, ROS Hypertrophic osteoarthropathy (clubbing) CXR: hazy infiltrates similar to pneumonia; better prognosis Glandular pattern on histology + Mucin
59
Squamous cell carcioma - location - description - produces - risk - histology
Central Hilar mass arising from bronchus Cavitation Cigarattes Hypercalcemia (PTHrP) Keratin pearls and intercellular bridges
60
Large cell carcinoma - Location - Prognosis - Associated with - Histology
Peripheral Highly anaplastic undifferentiated tumor Poor prognosis Smoking Pleomorphic GIANT cells
61
Bronchial carcinoid tumor - Prognosis - Symptoms - Histology - Positive for
Excellent prognosis; metastasis rare Symptoms due to mass effect or carcinoid syndrome - Flushing, diarrhea, wheezing Nests of neuroendocrine cells + Chromogranin A
62
Decrease of alveolar oxygen in lungs
--> Vasoconstriction --> reduce perfusion of lung, shunting of blood toward well-ventilated regions of lung COPD --> Low alveolar oxygen --> chronic vasoconstriction --> pulmonary HTN --> Cor pulmonale
63
Perfusion
How much blood to an area
64
Tx Pulmonary HTN
Competitive antagonist for endothelium 1 receptors --> decrease pulmonary vascular resistance - Bosentan - Ambrisentan Prostaglandin analog (dilate vessel like pulmonary arteries) - Iloprost - Epoprostenol Sildenafil - phosphodiesterase inhibitor that causes vasodilation Nifedipine - dihydropyridine Ca channel blocker
65
Tx for SEVERE primary pulmonary htn
Inhaled nitric oxide
66
Primary pulmonary hypertension | - assoc with
Associated with abnormalities in BMPR2: bone morphogenic protein receptor type II BMPR2 protein prevents proliferation of vascular smooth muscle Mutation leads to excessive vascular smooth muscle proliferation --> reduced vessel radius, increased resistance and increased pulmonary arterial pressure
67
Defective tyrosine kinase gene
Bruton agammaglobulinemia
68
Hypoxemia Hypoxia
Hypoxemia: low oxygen in blood Hypoxia: body or region deprived of oxygen
69
High A-a gradient indicates
Shunting of blood Diffusion limitation (pulmonary fibrosis) V/Q mismatch Advanced age
70
Oxygenation in Anemia
Hemoglobin decreases --> oxygen content decreases Decrease total O2 content No change in O2 saturation No change in arterial PO2 (amount dissolved in blood)
71
V/Q at apex and base
Apex V/Q > 1 Base V/Q <1
72
Exercise on V/Q ratio
V/Q ratio goes down towards one Vasodilation of capillaries in apex Perfusion increases
73
V/Q --> zero
``` Low ventilation (outside body --> alveoli) High perfusion ``` Airway obstruction - pneumonia - pulmonary edema - lung cancer Supplemental O2 ineffective
74
V/Q --> infinity
High ventilation, low perfusion Blood flow obstruction or physiologic dead space Supplemental O2 effective
75
Response to exercise
Increase O2 consumption Increase CO2 production V/Q more uniform Increase pulmonary blood flow due to increase CO Decrease pH No change in arterial PO2 and PCO2 Increased venous CO2 levels
76
Acute motion sickness clinical presentation
Headache Fatigue Extreme - Acute cerebral edema due to hypoxia induced vasodilation - Acute pulmonary edema
77
Response to high altitudes (6)
``` Increase ventilation Increased erythropoietin Increase 2,3 BPG Increase meitochondria Increase efficiency of O2 utililzation Increased renal excretion bicarb ```
78
Physiologic changes in chronic mountain sickness
``` Increase RBC mass and hematocrit Increased blood viscosity Decreased tissue blood flow Elevated pulmonary artery pressure (constricts due to hypoxia) Right sided heart enlargement Peripheral artery pressure falls Congestive heart failure ```
79
Positive G force does a visual " blackout" occur | - due to
4-6 G Due to insufficient blood return to heart Insufficient pumping of blood to brain
80
How is body affected at zero gravity (5)
``` Decreased blood volume Decreased RBC mass Decreased muscle strength/ work capacity Decreased maximum and cardiac output Loss of calcium and phosphate resulting in loss of bone mass ```
81
The BENDS
Breathing problems Extremity pain Neurologic changes Death
82
``` Elevated D dimer Pleuritic chest pain SOB Tachypnea High A-a gradient ``` - CXR? - gold standard - ECG changes
Pulmonary embolism CXR: normal Pulmonary angiogram S1Q3T3 deep S in lead I large Q and inverted T in lead III
83
Ankle pain with dorsiflexion
Homan's sign DVT
84
Primary spontaneous pneumothorax due to
Apical blebs Tall and thin
85
Charcott Leyden crystals
Asthma
86
Drop in systolic pressure by 10 mm/Hg during inspiration - Disease - what happens - seen in
Pulsus Paradoxus Decreased intrathoracic pressure --> increased right ventricle blood return Right ventricle pushed into left ventricle --> poor cardiac output and drop in systolic pressure Cardiac tamponade Asthma Pulmonary embolism (severe)
87
Cyprohepatadine - type - use
Antihistamine Use: Appetite stimulant Antidote for serotonin syndrome
88
Promethazine - type - use
Antihistamine Use: Nausea, vomiting
89
Hydroxyzine - type - use
Antihistamine | Use: Sedation itching
90
Meclizine - type - use
Antihistamine | Vertigo
91
Formoterol - type - use - risk
Long Acting beta agonist Mainstay of COPD tx For asthma must also be on inhaled corticosteriod Increased risk when used alone
92
Muscarinic Antagonists used in COPD asthma | - MOA
Ipratropium (short acting) Tiotropium ( long acting) Decrease overall vagal or parasympathetic tone in lungs
93
Zileuton - type - MOA
5-lipoxygenase inhibitor Blocks conversion of arachidonic acid into leukotrienes
94
Salmeterol - type - Use - risk
Long Acting beta agonist Mainstay of COPD tx For asthma must also be on inhaled corticosteriod Increased risk when used alone
95
Steroids - examples - MOA
Fluticasone Budesnoide Beclomethasone Inhibit cytokine synthesis Inhibit TNF-alpha production
96
Cromolyn | - MOA
Prevents release of histamines from mast cells Prevents bronchoconstriction and inflammation
97
Montelukast - MOA - Use
Prevents bronchogenic and chemotactic effects of leukotriene D4 Aspirin and allergy induced asthma
98
COPD tx
Long Acting beta agonist Formoterol Salmeterol
99
Theophylline - type - MOA - characteristic - side effect
Methylxanthines Can cause bronchiodilation by inhibiting phosphodiesterase - Increase cAMP - decrease hydrolysis Narrow therapeutic index Side effects - Tremor - Tachycardia - Can cause seizure
100
Guaifenesin - type - Fxn - Does not do what
Expectorant Thin mucus Does not suppress cough + dextromethorphan to suppress cough
101
Omalizumab - type - use - MOA - reduces
Anti IgE monoclonal Ab Severe asthma with allergic component Binds IgE in serum and blocks receptor Reduces exacerbation and use of rescue inhaler
102
Diphenhydramine - type - others - effects - Uses - Toxicity
1st generation H1 blockers Diphenhydramine Dimenhydrinate Chlorpheniramine Very sedating Antimuscarinic and anti-alpha adrenergic effects Uses: - Allergies - Motion sickness - Sleep aids Toxicity - Sedation - Dry mouth - Delirum in elderly
103
N- acetylcysteine - type - uses - MOA
Expectorant Tylenol overdose Use for contrast induce nephropathy Mucolytic that breaks disfulide bonds in patients with obstructive lung disease
104
2nd Generation H1 blockers - examples - use
Loratadine Fexofenadine Desloratadine Cetirizine Allergy Much less sedating
105
``` Phenylephrine Pseudoephedrine - type - Use - MOA - Reduces - Adverse ```
Nasal decongestant Works as alpha adrenergic agonist Constrict dilated arterioles in nasal mucosa Reduce airway resistance, swelling and nasal congestion Adverse - Long term use can cause rebound congestion
106
Epoprostenol iloprost - MOA - Use - Side effects
Works by directly vasodilating the pulmonary vascular beds Reducing the pressures in both systems Pulmonary HTN Side effects - Jaw pain - Flushing
107
Bosentan - type - use - side effect
Antagonizing endothelial receptor 1 Pulmonary HTN Side effect: hepatotoxicity
108
Sarcoidosis
A GRUELING Disease ``` ACE enzyme increase Gammaglobulinemia Rheumatoid factor Uveitis Erythema nodosum Lymphadenopathy (bilateral, hilar) Idiopathic Noncaseating Granulomas vitamin D increase ```
109
Honeycomb lung on CT - disease - Genetic mutation - CT
Idiopathic pulmonary fibrosis Genetic mutation: telomerase, mucin MUC5B Patchy interstitial fibrosis
110
What medications cause restrictive lung disease
Bleomycin - Pneumonitis with infiltrates Busulfan - Acute lung injury - Chronic interstitial fibrosis - Alveolar hemorrhage Amiodarone - Pulmonary fibrosis Methotrexate - Hypersensitivity like lung reaction
111
Tx Langerhans Cell Histiocytosis
Quit smoking
112
Bilateral hilar adenopathy | Uveitis
Sarcoidosis
113
Lung metastasis to
Brain Bone Liver Adrenal glands
114
Pontiac fever
Legionella pneumophilia
115
Causes of transudate pleural effusion
Low protein high electrolyte Increased hydrostatic pressure Decreased oncotic pressure CHF Cirrhosis Nephrotic syndrome Fluid overload
116
Causes of Exudate pleural effusion
High protein Results from pleural and lung inflammation --> increased membrane permeabililty Cancer Pneumonia, infections, TB Uremia Connective tissue disease
117
Obstructive sleep apnea medication
Modafinil | - Wake up during day
118
Salicylate intoxication what occurs
Respiratory alkalosis - immediately Anion gap metabolic acidosis - after 12 hrs
119
Cystic fibrosis pathogenesis
CFTR gene mutation 3 base pair deletion of phnylalanine at amino acid position 508. Mutations causes impaired post-translational processing (improper folding and glycosylation) of CFTR
120
Inhaled anesthetic Large arteriovenous concentration gradient
Difference between the concentration of gas anesthetic in arterial and venous blood If tissue solubility is high, results in large amount of anesthetic taken up from arterial blood and low venous concentration Need more anesthetic to replace what was absorbed by tissues Blood saturation takes longer Brain saturation also delayed
121
Pain sensation in anterior tongue
Mandibular division of trigeminal nerve
122
Progressive weakness Gets better as day goes on Dry mouth and episodic double vision Difficulty with erections even though good libido Decreased strength of hip flexors and diminished knee reflexes, repeat shows normalization of strength and reflexes Condition Due to
Lambert Eaton Ab to voltage gated calcium channel Small cell lung cancer
123
Achondroplasia abnormality involving
Chondrocytes AD Point mutation FGFR3
124
Vomiting from chemotherapy is due to what region
Chemoreceptor trigger zone (CTZ) located on dorsal surface of the medulla at the caudal end of the fourth ventricle known as area postrema
125
Cells with eye glasses Tx
malaria plasmodium falciparum Trophozoites African species are chloroquine resistant Tx Chloroquine Tx Atovaquone-proguanil or artemisinin P. Vivax and P ovale Tx primaquine addition
126
Diabetes medication Weight loss - Type - Examples - MOA - Adverse
GLP-1 agonist - Exenatide - Liraglutide Increase glucose dependent insulin secretion Decrease glucagon secretion Delay gastric emptying Pancreatitis
127
Vaccine to C. tetani how does it prevent symptoms
Circulating ab that neutralize bacterial products Black neurotoxic exotoxin called tetanospasmin
128
Child Language regression Tantrums Hemoglobin 9 Due to Inhibition of
Anemia Regression Lead toxicity Inhibition of ferrochelatase delta-aminolevulinic acid
129
Accident | Bleeding complications oozing from catheters and venipuncture sites
DIC
130
HSV Tx MOA
Acyclovir Incorporation into newly replicating viral DNA
131
``` 2 day hx reduced sensation in legs Fatigue especially with exercise Six months ago visual blurring Psoriasis hx Glucocorticoid use Decreased pain and light tough below level of umbilicus Bilateral spasticity ``` Brain lesion?
Multiple sclerosis Perivenular inflammatory cells made up of autoreactive T lymphocytes and macrophages directly against myelin components

AM- STEP1 (20 decks)

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