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Flashcards in Respiratory Deck (208):
1

What intracellular signal is affected by beta adrenergic agonists?

Smooth muscle relaxes (from B2 stim) from increased cAMP

2

Cause of hypoxemia with a normal A-a difference?

alveolar hypoventilation
OR
high altitude (less O2 in the air)

3

trachea deviates toward normal lung

Pulmonary effusion

4

Trachea deviates away from normal lung

atelectasis (collapsed lung)

5

kerley B lines tell you

edema of interlobular septa

6

flattened diaphragm on Xray

COPD

7

ARDS causes

pneumonia
trauma
aspiration
sepsis

8

Acute rejection of lung affects

pulmonary and bronchial circulation

9

Chronic rejection of lungs affects

Small airways

10

In healthy individuals, respiration is perfusion rather than diffusion limited (exercise, pulmonary embolism, etc).

Which is more affected in diffusion limitation, CO2 or O2 levels?

O2 levels. CO2 levels have a much higher diffusion capacity across the respiratory membrane. If you see VERY low pCO2 at the alveoli, this indicates a perfusion not a diffusion limitation

11

How do you measure fetal lung maturity?

Lecithin/Sphingomyelin ratio. They are equal until 3rd trimester, when Type II pneumocytes start secreting surfactant

12

Eggshell calcifications of hilar nodes and birefringent silica particles surrounded by fibrous tissue

silicosis

13

fusiform rods seen with iron protein (prussian blue stain)

pulmonary asbestos. Will see an interstitial pattern on Xray

14

Chloride shift in RBCs caused by

Carbonic anhydrase
--CO2 carried in bicarb form predominantly
--when bicarb leaves the RBC to dissolve in plasma, chloride enters the cell to maintain charge neutrality

15

how does hemoglobin carry CO2

15% as carbamate Hb-NH-CO2
85% as HCO3 (carbonic anhydrase

16

Which cancer causes SVC syndrome

small cell lung cancer. Causes headache, facial/upper extremity edema, and dilated veins
--hoarseness: recurrent laryngeal
--dysphagea: esoph. compression

17

Sx of phrenic nerve irritation

1. hiccups, SOB, elevation of hemidiaphragm on X ray

18

Small airways

bronchioles and terminal bronchioles
--Large bronchi are part of the large airways

19

What cells do you find in bronchi

cartilage
goblet cells
glands

20

What do you find in the terminal bronchioles

pseudostratified ciliated columnar cells
--smooth muscles of airway walls(disappear after terminal bronchioles

21

type of cell in respiratory bronchioles

cuboidal cells without cilia

22

What secretes elastase

neutrophils and macrophages

23

Where is there mixing of blood normally?

bronchial veins mix in

24

Collapsing pressure=

2*T/R. This is the PRESSURE YOU NEED INSIDE THE BALLOON TO KEEP IT OPEN

25

what indicates fetal lung maturity?

lecithin: sphingomyelin ratio of 2

26

when are mature levels of pulmonary surfactant achieved?

Week 35. synthesis starts at week 26

27

When do alveoli tend to collapse

when radius is small (with expiration)

28

Which is the MOST important component of surfactant

dipalmitoylphosphatidylcholine

29

type II cells

cuboidal clustered cells that secrete pulmonary surfactant

30

clara cells

columnar cells that secrete component of surfactant and degrade toxins

31

Relation of pulmonary artery to bronchus

RALS
-Right PA anterior to bronchus
-Light PA superior to bronchus

32

Which lung are you more likely to inhale a foreign body into?

Right lung

33

What enters the diaphragm at T12?

Aorta
thoracic duct
azygous vein

34

Where should you do a thoracentesis?

MCL: 5-7th rib
Mid axillay: 7-9th rib
paravertebral: 9th-11th rib

35

Muscles of inspiration during exercise

scalene
sternocleidomastoids
external intercostals

36

IRV

amount of air that can still be breathed in after normal inspiration

37

FRC+IC

TLC

38

Inspiratory capacity

IRV+TV
how much more can you breathe in after a normal breath

39

FRC

ERV+RV
TLC-IC
how much more can you breathe out after a normal breath

40

TLC

IRV+TV+ERV+RV

41

Dead space calcuation

Vt x (Paco2-Peco2)/Paco2

42

Which part of the lungs is the biggest contributor to functional dead space?

apex of lungs

43

Taut vs relaxed forms of hemoglobin (2alpha + 2beta)

Taut: low affinity for O2
Relaxed: high affinity for O2

44

What factors cause taut form to dominate?

increased chloride, 2,3 BPG, H+, and CO2

45

how do you treat methemoglobinemia?

methylene blue

46

How do nitrites cause poisoning?

Convert Fe2+ to Fe3+

47

fetal hemoglobin has a lower affinity for

2,3-BPG

48

How do you treat cyanide poisoning?

Nitrites--make methemoglobin which can bind cyanide.
Also give thiosulfate to bind cyanideq

49

how does CO shift the oxygen hemoblogin curve?

LEFT shift. Decreased maximum bound and loss of sigmoidal shape
Increased affinity for O2, less unloading

50

When hemoglobin curve shifts to the right

decreased affinity for O2 (more unloading, at tissue level)

51

Causes of right shift

C-BEAT
CO2
BPG
Exercise
Acid/altitude
Temperature

52

Pulmonary vascular resistance is lowest at

FRC
--increased lung volume: compresses alveolar vessels, but less resistance in extra-alveolar vessels

53

are you perfusion or diffusion limited during exercise?

perfusion limited. Still able to reach normal PA at the end of the capillary

54

When might you be diffusion limited?

Emphysema (decreased surface area)
Fibrosis (increased thickness)

55

Normal pulmonary artery pressure

10-14 mmHg

56

Cause of primary pulmonary HTN

BMPR2

57

Cause of secondary pulmonary HTN

COPD
Mitral stenosis
Recurrent emboli
autoimmune dz like systemic sclerosis
sleep apnea
high altitude

58

How do you calculated pulmonary vascular resistance?

PVR= (Ppa-Pla)/CO

Resistance=deltaP/Q

59

Diffusion calculation

Vgas=A/T x Dk(P1-P2)

60

PAO2=

150-PaCo2/0.8

61

When do you see an increased Aa gradient

Shunting
V/Q mismatch
Fibrosis

62

cause of hypoxemia with a normal Aa gradient

high altitude
hypoventilation

63

V/Q ratio at apex of lung

3 (wasted ventilation)

64

V/Q ratio at the base of lung

0.6 (wasted perfusion)

65

are ventilation/perfusion greater at the lung base or apex?

both are greater at the base than the apex

66

VQ ratio during exercise

1-->apical arteries expand

67

V/Q=0

SHUNT. Lots of blood flow, no ventilation. Airway obstruction!

68

V/Q=infinity

DEAD SPACE. Lots of airflow, no blood. pulmonary embolism

69

Who would benefit from high flow 100% O2?

Person with Deadspace. We assume there are some areas of the lung that are still getting blood.

Shunt does NOT improve with 100% oxygen because the air is not even reaching the blood!

70

Most of CO2 is transported in what form?

bicarbonate in the plasma

71

Haldane effect

oxygenation of Hb promotes dissociation of H+ from Hb within the RBC

--H+ binds HCO3 and forms free CO2 with carbonic anhydrase

72

How else is CO2 transported?

-carbaminohemoglobin (CO2 bound to the N terminus of hemoglobin)
-dissolve CO2

73

Bohr effect

H+ in peripheral tissues causes shift to the right=unloading O2

74

Changes at high altitude

Increased 2,3-BPG
Increased mitochondria
Decreased PO2 and PCO2
Increased renal excretion of bicarbonate (increase this with acetazolamide)
-->Watch out for cor pulmonale

75

Changes in the lungs with exercise

V/Q ratio -->1
decreased pH
No change in PaO2 and PaCO2!!
Increase in venous CO2 content and decrease in venous O2 content

76

dorsiflexion of foot causes calf pain

Homan's sign, think DVT

77

Treatment for acute DVT

heparin

78

Treatment for long-term prevention of DVT

warfarin

79

hypoxemia
neuro changes
petechial rash

Think pulmonary emboli!

80

What is bronchiolitis obliterans pneumonia?

Formation of granulation tissue with pneumonia. Causes obstruction of airways

81

How od you treat bronchiolitis obliterans pneumonia?

Corticosteroids

82

How do you tell whether a patient died because of a pulmonary embolism or if the thromboembolism formed after death?

Lines of Zahn

83

Reid index

Tells you thickness of glandular layer compared to bronchial wall

--Over 50% in patients with bronchitis

84

Cause of chronic bronchitis

Hypertrophy of mucus secreting glands

85

Cause of emphysema

enlargement of airspaces and decreased recoil with destroyed alveolar walls

86

breathing through pursed lips

emphysema. Increased airway presure and prevent airway collapse resulting from increased compliance

87

centriacinar emphysema, upper lobes

Smoking

88

panacinar emphysema, lower lobes

a1-antitrypsin

89

Cause of asthma

bronchial hyperresponsiveness

90

Histology of asthma

smooth muscle hypertrophy
Curschmann's spirals (mucus plugs)
Charcot-leyden crystals (breakdown of eosinophils)

91

pulsus paradoxus seen in

asthma
obstructive sleep apnea

92

bronchiectasis

necrotizing infection of bronchi causing dilated airways, purulent sputum, infections, and hemoptysis

93

bronchiectasis associated with

smoking (ciliary motility)
kartagener's
cystic fibrosis
bronchopulmonary aspergillosis

94

Cause of restrictive lung disease with an abnormal A-a gradient

Interstitial lung diseases
-ARDS
-pneumoconioses
-sarcoidosis
-idiopathic pulmonary fibrosis
-goodpasteur's
-wegener's
-hypersensitivity pneumonitis

95

which drugs can cause interstitial lung disease?

bleomycin
busulfan
amiodarone
methotrexate

96

coal miner's lung

anthracosis

97

sandblasting, mines, foundries

silicosis

98

pathogenesis of silicosis

macrophages release fibrinogenic factors in response to silica

99

pts with silicosis are susceptible to

TB and bronchogenic carcinoma

100

eggshell calcifications of hilar lymph nodes

silicosis

101

shipbuilding, roofing, plumbing

asbestosis

102

affects upper lobes

anthracosis silicosis

103

affects lower lobes

asbestosis

104

golden brown fusiform dumbbells

asbestosis

105

Ivory white calcified pleural plaques

asbestos exposure! But they do not indicate precancerous lesion

106

Asbestos associated with

mesothelioma and bronchogenic carcinoma

107

neonatal respiratory distress syndrome caused by:

surfactant deficiency.

Lecithin: sphingomyelin ratio will be less than 1.5

108

What is your other concern with neonatal respiratory distress syndrome?

Low O2 tension could lead to a PDA

109

You decide to administer supplemental O2 to a neonate with respiratory distress. What are some complications?

retinopathy of prematurity
bronchopulmonary dysplasia

110

Treatment for neonatal respiratory distress syndrome

maternal steroids before birth
artificial surfactant for baby

111

Risk factors for neonatal respiratory distress syndrome

prematurity
materal diabetes
cesarean delivery (less CRH)

112

Causes of ARDS

sepsis, shock, trauma,
--gastric aspiration
uremia
pancreatitis
amniotic fluid embolism

113

Pathophysiology of ARDS

diffuse alveolar damage
-capillary permeability
-protein rich leakage into alveoli
-intra-alveolar hyaline membrane

114

what causes the initial damage precipitating ARDS?

neutrophil toxins
coagulation cascade
oxygen derived free radicals

115

What hormone might be elevated in sleep apnea?

EPO

116

decreased breath sounds, dullness to percussion and decreased fremitus

pleural effusion

117

decreased breath sounds, dullness to percussion, decreased fremitus and tracheal deviation towards lesion

atelectasis

118

decreased breath sounds, hyperresonance, and decreased fremitus with tracheal deviation toward lesion

spontaneous pneumothorax

119

decreased breath sounds, hyperresonance, and decreased fremitus and deviation away from lesion

tension pneumothorax

120

bronchial breath sounds with crackles, dullness to percussion, and increased fremitus

consolidation (lobar pneumonia or pulmonary edema)

121

alpha1 antitryptase is synthesize in

the liver

122

Which TB drug does not affect hepatic fxn

ethambutol

123

histology: chronic lung rejection

lymphocytic infiltrate
bronchiolitis obliterans
necrosis
FIBROSIS

124

histology: acute lung rejection

perivascular mononuclear infiltrate

125

Common complications of lung cancer

SPHERE
-superior vena cava
-pancoast
-horner's
-endocrine
-recurrent laryngeal compression
-effusions (pleural/pericardial)

126

cough, hemoptysis, bronchial obstruction, coin lesion on x ray or nodule

lung cancer

127

most common cause of lung cancer

metastates

128

Where do lung cancer metastasize from?

breast
colon
prostate
bladder

129

Where to lung cancers metastasize to?

adrenals
brain
bone
liver

130

Which lung cancers are NOT associated with smoking?

bronchioloalveolar
bronchial carcinoid

131

kras

adenocarcinoma

132

myc

small cell carcinoma

133

Most common cause of lung cancer in nonsmokers and women

adenocarcinoma

134

which cancer is associated with clubbing?

adenocarcinoma

135

What subtype of adenocarcinoma shows hazy infiltrates and shows thickening of alveolar walls?

bronchioloalveolar subtype

136

prognosis of bronchioloalveolar subtype adenocarcinoma

excellent

137

Which cancers are found centrally?

squamous and small cell

138

Which cancers are found peripherally?

adenocarcinoma and large cell carcinoma

139

hilar mass with keratin pearls located centrally

squamous cell

140

features of squamous cell carcinoma

cavitation
cigarettes
hypercalcemia

141

Histology of small cell carcinoma

undifferentiated with small dark blue cells

142

paraneoplastic syndrome of small cell carcinoma

ACTH
ADH
lambert eaton

143

the small cell carcinoma cells are derived from

neuroendocrine cells of kulchisky

144

which kind of cancer can you NOT operate on?

small cell carcinoma

145

histology of large cell carcinoma

pleomorphic giant cells that are highly anaplastic

146

how do you treat large cell carcinoma?

remove surgically! chemotherapy is less effective

147

lung tumor that shows nests of neuroendocrine cells that are chromogranin positive

bronchial carcinoid tumor

148

Sx of bronchial carcinoid tumor

mass effect, sometimes carcinoid syndrome with serotonin secretion=flushing, diarrhea, wheezing

149

Pancoast tumor

carcinoma in the apex of the lung that can affect cervical sympathetics and cause horner's syndrome

150

psamomma bodies in lung cancer located in the pleura with pleural effusions and pleural thickening

mesothelioma

151

Which cancers show psamomma bodies?

papillary thyroid cancer
serous cystadenoma of the ovary
meningioma
mesothelioma

152

Causes of bronchopneumonia

Strep pneumo
S aureus
H flu
Klebsiella

153

Causes of Lobar pneumonia

S pneumo
Klebsiella

154

What is hypersensitivity pneumonitis

mixed type III/IV hypersensitivity rxn to environmental antigens

155

who is predisposed to hypersensitivity pneumonitis?

farmers and birds

156

bronchopneumonia characteristics

inflammation from bronchioles to adjacent alveoli
--patchy distribution involving more than 1 lobe

157

Cause of a spontaneous pneumothorax

apical blebs
--tall, thin, males

158

Cause of tension pneumothorax

trauma or lung infection

159

Name the first generation H1 blockers

diphenhydramine
dimenhydrinate
chlorpheniramine

160

Name the second generation H2 blockers

loratadine
fexofenadine
desloratadine
cetirizine
-ADINE

161

What are the additional benefits of H2 blockers?

Far less sedating than first generation blockers because less entry into the CNS--> good for old people!

162

What else can you use H1 blockers for?

sleep aid
motion sickness

163

formoterol

long acting B2 agonist

164

side effect of salmeterol, formoterol

tremor and arrhythmia

165

theophylline=category?

methylxanthine

166

theophylline mechanism

inhibits phosphodiesterase
-decreases cAMP

167

tox: theophylline

cardiotoxicity, neurotoxicity

168

theophylline blocks action of

adenosine

169

which drug is metabolized by p450?

theophylline

170

Mech: iptratropium

competitively blocks muscarainic receptors, preventing bronchoconstriction

171

iptratropium uses

asthma, COPD

172

category: beclomethasone

corticosteroid

173

category: fluticasone

corticosteroid

174

corticosteroid mechanism

inhibits synthesis of all cytokines.
--Inactivates NF-kB
--inhibits TNF-a production

175

What is the first line therapy for chronic asthma?

corticosteroids beclomethasone and fluticasone

176

omazlizumab

monoclonal IgE antibody

177

inications for omalizumab

allergic asthma resistant to inhaled steroids and b2 agonists

178

good for aspirin induced asthma

montelukast zafirlukast

179

mechanism of montelukast zafirlukast

Block leukotriene receptors

180

mechanism zileuton

5-lipoxygenase pathway inhibitor

181

B2 agonist mechanism

increases cAMP causing bronchodilation

182

effect of Ach and adenosine on bronchi

Both cause bronchoconstriction

183

Expectorants

guaifenesin
N-acetylcysteine

184

Guaifenesin mechanism

thins secretions

185

N-acetylcystein mechanism

loosens mucous plugs in CF

186

Bosentan

Used for pulmonary arterial hypertension:
Antagonizes endothelin 1 receptors to decrease PVR

187

Mechanism dextromethorphan

Decreases cough reflex by antagonizing NMDA glutatmate receptor. Has mild opioid effect when used in excess (give naloxone)

188

mechanism methacholine

Muscarinic agonist

189

side effects of pseudoephedrine/phenylephrine

Hypertension
-CNS stimulation/anxiety

190

Nasal polyps caused by

repeated bouts of rhinitis
Aspirin intolerant asthma

191

Child with nasal polyps

CF

192

Angiofibromas occur in

in adolexcent males. continued nose bleeds

193

naspharyngeal carcinoma associated with

EBV--Naspharyngeal carcinoma and AA.

194

pleomorphic keratin-positive epithelial cells in a background of lymphocytes

`nasopharyngeal carcinoma

195

fever, drooling, muffled voice, and inspiratory stridor in a kid

epiglottitis caused by Hflu

196

cause of bilateral vocal cord nodule

excessive use (singers)
--presents with hoarseness, resolves with rest.
--composed of myxoid CT

197

laryngeal papilloma caused by

HPV 6 and 11

198

laryngeal carcinoma

alcohol and tobacco. presents with hoarseness, cough, stridor

199

thick mucoid capsule bug

klebsiella. usually aspiration pneumonia

200

Four phases of lobar pneumonia

congestion
red hepatization
grey hepatization (RBCs broken down)
resolution

201

causes of bronchopneumonia

Staph aureus
-Haemophilus
pseudomonas
moraxella
legionella

202

most common cause of secondary pneumonia

staph aureus

203

pneumonia in COPD

Haemophilus or moraxella

204

complication of mycoplasma pneumonia

autoimmune hemolytic anemia

205

pneumonia in farmers and veterinarians with high fever

Q fever
--cattle spores
--no vector
--no skin rash

206

where can TB spread to?

1. meninges
2. cervical lymph
3. kidney=sterile pyuria
4. lumbar vertebrae=potts

207

ABG of someone with pulmonary embolism

hypoxemia
respiratory alkalosis (blowing off all your CO2)

208

Clubbing is associated with

Prolonged hypoxia:
-lung cancer
-CF
-TB
-empyema, bronchiectasis, lung abscess
-OR cyanotic congential heart disease