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Step 1 Decks > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the distinction between a lung volume and lung capacity?

A

a capacity is a sum of ≥ 2 physiologic volumes

(There are 4 volumes and 4 capacities)

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2
Q

Define tidal volume:

A

Air that moves into lung with each quiet inspiration, 6–8 mL/kg, typically ~500 mL

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3
Q

Define inspiratory reserve volume:

A

Air that can still be breathed in after normal inspiration

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4
Q

Define expiratory reserve volume:

A

Air that can still be breathed out after normal expiration

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5
Q

——— (and any lung capacity that includes it) cannot be measured by spirometry

A

residual volume

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6
Q

Define residual volume:

A

Air in lung after maximal expiration

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7
Q

What does the LITER mnemonic stand for with respect to lung volumes?

A

Lung volumes

Inspiratory reserve volume

Tidal volume

Expiratory reserve volume

Residual volume

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8
Q

Define inspiratory capacity:

A

IRV + VT; Air that can be breathed in after normal exhalation

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9
Q

Define functional residual capacity:

A

RV + ERV; Volume of gas in lungs after normal expiration; outward pulling force of chest wall is balanced with inward collapsing force of lungs

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10
Q

Define vital capacity:

A

IRV + VT + ERV; Maximum volume of gas that can be expired after a maximal inspiration

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11
Q

Define total lung capacity:

A

IRV + VT + ERV + RV = VC + RV; Volume of gas present in lungs after a maximal inspiration (6 L)

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12
Q

What is normal FEV1, FVC, and FEV1/FVC?

A

FEV1: > 80%

FVC: > 80%

FEV1/FVC: > 70%

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13
Q

Obstructive lung diseases result from ——— (——— FEV1,  ——— FVC  ——— FEV1 /FVC ratio) Ž and lead to ——— in lungs ( ——— RV, and thus, ——— Ž FRC and  ——— TLC) due to premature ——— at ——— lung volumes.

A

- obstruction of air flow

- greatly decreased

- decreased

- decreased

- air trapping

- increased

- increased

- increased

- airway closure

- high

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14
Q

List 3 key examples of obstructive lung diseases:

A

- COPD (chronic bronchitis and emphysema)

- asthma

- bronchiectasis

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15
Q

Restrictive lung diseases may lead to  ——— lung volumes ( ——— FVC and ——— TLC)

A

- decreased

- decreased

- decreased

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16
Q

With restrictive lung diseases, PFTs are:

A

normal or increased FEV1/FVC ratio

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17
Q

Restrictive lung diseases present with ——— breaths

A

short, shallow

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18
Q

List the 2 types of restrictive lung diseases (including location, diffusing capacity of the lungs for carbon monoxide (DLCO), and alveolar-arterial (A-a) gradient): ƒ

A

1. Altered respiratory mechanics (extrapulmonary, normal DLCO, normal A-a gradient)

2. Diffuse parenchymal lung diseases, also called interstitial lung diseases (pulmonary, decreased DLCO, increased A-a gradient)

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19
Q

List the 6 examples of restrictive lung diseases that are due to altered respiratory mechanics (extrapulmonary, normal DLCO, normal A-a gradient):

A

Respiratory muscle weakness:
- polio
- myasthenia gravis
- Guillain-Barré syndrome
- ALS ƒ

Chest wall abnormalities:
- scoliosis
- severe obesity ƒ

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20
Q

List the 10 examples of restrictive lung diseases that are due to diffuse parenchymal lung diseases, also called interstitial lung diseases (pulmonary, decreased DLCO, increased A-a gradient):

A

- Pneumoconioses (eg, coal workers’ pneumoconiosis, silicosis, asbestosis) ƒ

- Sarcoidosis

- Idiopathic pulmonary fibrosis ƒ

- Granulomatosis with polyangiitis ƒ

- Pulmonary Langerhans cell histiocytosis (eosinophilic granuloma) ƒ
- Hypersensitivity pneumonitis ƒ

- Drug toxicity (eg, bleomycin, busulfan, amiodarone, methotrexate) ƒ
- Acute respiratory distress syndrome ƒ

- Radiation-induced lung injury

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21
Q

What happens to the RV, FRC, TLC, FEV1, FVC, FEV1/FVC, and pressure-volume loop in obstructive vs restrictive lung disease?

A

Obstructive lung disease:
RV increased
FRC increased
TLC increased
FEV1 significant decreased
FVC decreased
FEV1/FVC decreased (FEV1 decreased more than FVC )
pressure-volume loop shifted left (higher volume)

Restrictive lung disease:
RV decreased
FRC decreased
TLC decreased
FEV1 decreased
FVC decreased
FEV1/FVC normal (FEV1 decreased proportionately to FVC ) or increased
pressure-volume loop shifted right (lower volume)

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22
Q

Relative to resistance and compliance, pulmonary circulation is normally:

A

low-resistance, high-compliance

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23
Q

A decrease in Pao2 causes ——— that shifts blood ———

A

- hypoxic vasoconstriction

- away from poorly ventilated regions of lung to well-ventilated regions of lung

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24
Q

Chronic hypoxic vasoconstriction may lead to:

A

pulmonary hypertension +/– cor pulmonale

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25
Q

Define perfusion limited gas exchange in lungs, and list gases that are perfusion limited:

A

Definition:
Gas equilibrates early along the length of the capillary (Exchange can be  increased only if blood flow increased)

Gases:
O2 in normal health, CO2, N2O (nitrous oxide)

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26
Q

Define diffusion limited gas exchange in lungs, and list gases that are diffusion limited:

A

Definition:
Gas does not equilibrate by the time blood reaches the end of the capillary

Gases:
O2 in emphysema and fibrosis, CO

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27
Q

——— diffuses slowly, while ——— diffuses very rapidly across the alveolar membrane;
Disease states that lead to diffusion limitation (eg, pulmonary fibrosis) are more likely to cause early ——— than ———

A

- O2

- CO2

- hypoxia

- hypercapnia

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28
Q

Define DLCO:

A

DLCO is the extent to which CO passes from air sacs of lungs into blood

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29
Q

Leading cause of cancer death?

A

Lung cancer

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30
Q

Describe 5 attributes of general presentation of lung cancer (including chest X-ray and CT finding):

A

cough

hemoptysis

bronchial obstruction

wheezing

pneumonic “coin” lesion on CXR or noncalcified nodule on CT

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31
Q

Sites of metastases from lung cancer:

A

liver (jaundice, hepatomegaly)

adrenals

bone (pathologic fracture)

brain

(lung ‘mets’ Love Affective BONEheads and BRAINiacs)

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32
Q

In the lung, what is more common 1° neoplasms or metastases?

A

metastases (usually multiple lesions) are more common

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33
Q

In the lung, what are the most common sources of metastases?

A

breast, colon, prostate, and bladder cancer

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34
Q

List 6 notable complications of lung cancer:

A

SPHERE of complications:

Superior vena cava/thoracic outlet syndromes

Pancoast tumor

Horner syndrome

Endocrine (paraneoplastic)

Recurrent laryngeal nerve compression (hoarseness)

Effusions (pleural or pericardial)

35
Q

List 6 risk factors for lung cancer:

A

tobacco smoking

secondhand smoke

radiation

environmental exposures (eg, radon, asbestos)

pulmonary fibrosis

family history

36
Q

List two lung cancer types that are central and often caused by tobacco smoking:

A

Squamous and Small cell carcinomas

(Remember: Sentral)

37
Q

Hamartomas are found incidentally on imaging, appearing as:

A

well-circumscribed mass

38
Q

List the small cell vs non-small cell lung cancers:

A

Small Cell:
Small cell (oat cell) carcinoma

Non-Small Cell:
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Bronchial carcinoid tumor

39
Q

List the location of each lung cancer type:

A

Central: (Sentral)
Small cell (oat cell) carcinoma
Squamous cell carcinoma

Peripheral:
Adenocarcinoma
Large cell carcinoma

Central or Peripheral:
Bronchial carcinoid tumor

40
Q

Are small cell (oat cell) carcinoma differentiated or undifferentiated? How aggressive?

A

Undifferentiated, very aggressive

41
Q

List 7 key paraneoplastic syndromes caused by small cell (oat cell) carcinoma:

A

Neurologic paraneoplastic syndromes:
- Lambert-Eaton myasthenic syndrome
- paraneoplastic myelitis
- encephalitis
- subacute cerebellar degeneration

Endocrine paraneoplastic syndromes: - Cushing syndrome
- SIADH

42
Q

For small cell (oat cell) carcinoma, amplification of ——— is common

A

myc oncogenes

43
Q

Small cell (oat cell) carcinoma
is managed with:

A

chemotherapy +/– radiation

44
Q

Small cell (oat cell) carcinoma are neoplasm of ———, which appear on histology as ———

A

- neuroendocrine Kulchitsky cells

- small dark blue cells

(Neuroendocrine cells = neurologic and endocrine paraneoplastic syndromes)

45
Q

List 3 key tumor markers for small cell (oat cell) carcinoma:

A

Chromogranin A ⊕

neuron-specific enolase ⊕

synaptophysin ⊕

46
Q

Most common 1° lung cancer?

A

Adenocarcinoma

47
Q

Most common lung cancer subtype in people who do not smoke?

A

Adenocarcinoma

48
Q

What sex is Adenocarcinoma more common among?

A

More common in females than males

49
Q

Activating mutations for Adenocarcinoma include:

A

KRAS

EGFR

ALK

50
Q

Key association for Adenocarcinoma is:

A

hypertrophic osteoarthropathy (clubbing)

51
Q

For Bronchioloalveolar subtype of Adenocarcinoma (adenocarcinoma in situ): CXR often shows ———; associated with ——— prognosis

A

- hazy infiltrates similar to pneumonia

- better

52
Q

On histology Adenocarcinoma displays ———, and often stains ———

A

- glandular pattern

- mucin ⊕

53
Q

On histology the bronchioloalveolar subtype, grows along ——— Žleading to ——— ( ——— cells containing ———)

A

- alveolar septa

- apparent “thickening” of alveolar walls

- tall, columnar

- mucus

54
Q

Squamous cell carcinoma appears as a ——— arising from ———

A

- Hilar mass

- bronchus

55
Q

List 3 key aspects of presentation/history for squamous cell carcinoma:

A

- Cavitation
- Cigarettes
- hyperCalcemia (produces PTHrP)

56
Q

On histology, squamous cell carcinoma demonstrate:

A

Keratin pearls and intercellular bridges (desmosomes)

57
Q

Large cell carcinoma: undifferentiated or differentiated?

A

Highly anaplastic undifferentiated tumor

58
Q

Large cell carcinoma are strongly associated with:

A

tobacco smoking

59
Q

Large cell carcinoma may produce ———, leading to ———

A

- hCG Ž

- gynecomastia (enLARGEd breasts)

60
Q

Large cell carcinoma: treatment/prognosis?

A

- Less responsive to chemotherapy; removed surgically

- Poor prognosis

61
Q

Large cell carcinoma: key histology?

A

Pleomorphic GIANT cells

62
Q

Bronchial carcinoid tumor: prognosis/ commonness of metastasis?

A

Excellent prognosis; metastasis rare

63
Q

Bronchial carcinoid tumor: Symptoms?

A

Symptoms due to mass effect (wheezing) or carcinoid syndrome (flushing, diarrhea)

64
Q

Bronchial carcinoid tumor: key histology?

A

Nests of neuroendocrine cells;
chromogranin A ⊕

65
Q

Pancoast tumor: Also called ———tumor; occurs in the ———, and may cause Pancoast syndrome by ———

A

- superior sulcus

- apex of lung

- invading/compressing local structures

66
Q

Pancoast tumor compression of the stellate ganglion (i.e., ——— blockade on the ——— side) causes:

A

- sympathetic

- ipsilateral

- Horner syndrome (ipsilateral ptosis, miosis, anhidrosis)

67
Q

Pancoast tumor compression of the recurrent laryngeal nerve causes:

A

hoarseness

68
Q

Pancoast tumor compression of the brachial plexus causes:

A

-Ž shoulder pain, sensorimotor deficits (eg, atrophy of intrinsic muscles of the hand) ƒ Ž

69
Q

Pancoast tumor compression of the phrenic nerve causes:

A

hemidiaphragm paralysis (hemidiaphragm elevation on CXR)

70
Q

Superior vena cava syndrome caused by ——— (eg, with ———), which impairs blood drainage from the:
1. ——— (eg, ———)
2. ——— (eg, ———)
3. ——— (eg, ———)

A

- obstruction of the SVC

- thrombus, tumor

- head

- “facial plethora” (in picture below note blanching after fingertip pressure)

- neck

- jugular venous distension, laryngeal/pharyngeal edema

- upper extremities

- edema

71
Q

List 2 common causes of SVC syndrome:

A

- malignancy (eg, mediastinal mass, Pancoast tumor)

- thrombosis from indwelling catheters

72
Q

SVC syndrome is a medical emergency: List 3 possible adverse consequences

A

- raises intracranial pressure (if obstruction is severe) Ž

- headaches/dizziness

- risk of aneurysm/rupture of intracranial arteries.

73
Q

Iron in Hb is normally in a ——— state (named ———)

A

- reduced

- ferroUS Fe2+
(just the 2 of US)

74
Q

——— form of Hb (called ———) does not bind ——— as readily as ———, but has increased affinity for ———, leads to Žtissue ——— from decreased———

A

- Oxidized

- ferric, Fe3+

- O2

- Fe2+

- cyanide

- hypoxia

- decreased O2 saturation and decreased O2 content

75
Q

Methemoglobinemia refers to the ———; While typical concentrations are ———, methemoglobinemia will occur at ——— levels

A

- Fe3+ form of iron

- 1–2%

- higher

76
Q

Methemoglobinemia may present with ——— (which does not improve with ———) and with ———

A

- cyanosis

- supplemental O2

- chocolate-colored blood

77
Q

Methemoglobinemia poisoning by ——— can be caused by (list 3 causes):

A

- oxidizing Fe2+ to Fe3+

Causes:
- Dapsone

- local anesthetics (eg, benzocaine)

- nitrites (eg, from dietary intake or polluted water sources)

78
Q

List 2 treatments for Methemoglobinemia:

A

methylene blue and vitamin C

79
Q

For pleural effusion, describe findings for breath sounds, percussion, fremitus, and tracheal deviation:

A

breath sounds: decreased

percussion: dull

fremitus: decreased

tracheal deviation: None if small; Away from side of lesion if large

80
Q

For atelectasis, describe findings for breath sounds, percussion, fremitus, and tracheal deviation:

A

breath sounds: decreased

percussion: dull

fremitus: decreased

tracheal deviation: Toward side of lesion

81
Q

For simple pneumothorax, describe findings for breath sounds, percussion, fremitus, and tracheal deviation:

A

breath sounds: decreased

percussion: hyperresonant

fremitus: decreased

tracheal deviation: none

82
Q

For tension pneumothorax, describe findings for breath sounds, percussion, fremitus, and tracheal deviation:

A

breath sounds: decreased

percussion: hyperresonant

fremitus: decreased

tracheal deviation: away from side of lesion

83
Q

For consolidation (lobar pneumonia, pulmonary edema), describe findings for breath sounds, percussion, fremitus, and tracheal deviation:

A

breath sounds: bronchial breath sounds; late inspiratory crackles, egophony, whispered pectoriloquy

percussion: dull

fremitus: increased

tracheal deviation: none

Step 1 Decks (8 decks)

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