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Flashcards in Respiratory Deck (107):
1

Which airways have cartilage and which airways do not?

large airways- cartilage
small airways- non-cartilage

2

What decreases and increases surface tension in lungs?

decreased- saline filled lungs
increased - surfactant deficiency

3

Flow limitation

point where any increase in effort makes no increase in flow because airway can collapse

4

Pcritical is a marker of

tendency of airways to collapse

5

Three Factors that contribute to maximum flow rate

decreased Elastic recoil
Increase in Pcritical
Increase in R upstream

6

decreased expiratory flow rates seen in (3)

1- increased airway resistance
2- decreased elastic recoil
3- decrease in lung volume

7

RV is increased most in

obstructive airway disease (air trapping)

8

5 general categories of restrictive lung disease

neuromuscular disease
chest wall problems
pleural disease
loss of lung
interstitial lung disease

9

Efferent impulses in respiratory control from Cranial nerves

9,10,11,12

10

Length tension, a short muscle is a

weak muscle

11

energy consumption is via 2 factors in muscles

tension produced by muscle
velocity of shortening in muscle

12

two reasons resp muscles require more energy

-asked to do more
-at a mechanical disadvantage

13

Centriacinar Emph

enlarged resp bronchioles and normal distal ascini

14

panacinar emph

resp-->distal ascini all affected

15

Paraseptal emph

distal ascinus only
associated with bullae and pneumothroax

16

charcot-leyden crystals

degranulated eosinophil membranes found in asthma

17

curschmann spirals

whorls of shed epithelium in asthma

18

acute vs late phase asthma

acute- mast cell mediated
late phase- leukocyte mediated, tissue destruction

19

3 types of medications for COPD

B-agonists, Anticholinergic, Methylxanthines

20

when are glucocorticoids appropriate for COPD patients?

<50% FEV1 and freq exaccerbations

21

airway remodeling

increase in ECM

22

pulmonary arterial hypertension

pH when fundamental abnormality arises in pulmonary vasculature

23

2 ways that pulmonary arterioles dilate

passive- thin-walled and contain little muscle (so due to CO2)
active- release of EDRF/NO

24

ihibitors vs constrictors in PVR

inhibitors- prostacyclin, NO
vasoconstriction- thrmboxane A2, endothelin-1, 5HT

25

Pressure left atrium best estimated by

pulmonary wedge pressure

26

pulmonary artery pressure equation

Ppa= (CO x PVR) + PLa

27

two types of granulomatous ILD

sarcoidosis
hypersensitivity pneumonia

28

smoking related ILD

respiratory bronchiolitis ILD
desquamative interstitial pneumonia

29

first thing that happens in ILD

type 2 pneumocyte hyperplasia

30

3 ways lung can get fibrotic

fibroblast can get activated -->interstitum thicker

epithelial gets injured-->fibrin leaks out and fibroblasts pass through

granulomas

31

caplan syndrome

rheumatoid arthritis + pneumoconiosis

32

2 forms silicosis

crystalline- most fibrogenic, 100x smaller than sand
amorphous (talc)-more clearance, less firbogenic

33

two fiber types in asbestosis

serpentine-curly and flexibile- more widely used in industry

amphibole- straight and rigid- more pathogenic

34

smoking + asbestos

55 fold increase in lung cancer-->synergistic!

35

three examples of hypersensitivity pneumonitis

1) farmers lungs
2) pigeon breeders lungs
3) humidifier lung

36

patient profile of sarcoidosis

cytokines- IL2
CD4+ lymphs
activated macrophages
class II HLA expression

37

why does ILD have decreased compliance and diffusion impairment?

deposition of collagen
thickening of interstitum

38

ILD breath patterns

rapid and shallow

39

treatments in IPF

Pirenidone-inhibits TGFB1- slows progression IPF

Nitendanib- inhibits multiple tyrosine kinases and a variety of growth factor receptors-->slows decline in lung function

40

inertial impaction increases with

large particle size
high inspiratory flow rates
tortuous pathways
interceptors

41

sedimentation increases with

lower airflow
smaller airway lumen
optimal particle size

42

three variations of disease in mucociliary disease

cystic fibrosis: sol phase
chronic bronchitis: gel phase
kartagener syndrome: cilia

43

varenicline

smoking pharmaceutic--partial agonist of A4B2 nicotinic acetylcholine receptor which may play a role in addiction

44

pleurodesis

process or intervention where inject something or do something to pleural surface to make it inflamed and when body has inflammation, responds by forming adhesions

45

opiate antidote

naloxone

46

central alveolar hypoventlation

due to altered function of brainstem resp neurons, resulting in hypoventilation

47

Obestiy-Hypoventilation/Pickwickian Syndrome

R heart failure due to plum vasoconstriction from hypoxemia

48

no hypercapnia in

asthma

49

where is periodic breathing seen

bilateral cerebral dysfunction
congestive heart failure
hypoxia

50

paraneoplastic syndrome

signs and symptoms caused by factors produced by cancer cells that act a distance from both primary cancer site and its metastases

51

ectopic ACTH secretion

small cell lung carcinoma with poor prognosis

52

inappropriate secretion of ADH

small cell lung carcinoma that does not effect prognosis

53

pancoast tumor

tumor at lung apex where pleural reflex is

horner's syndrome
pancoast syndrome
recurrent laryngeal nerve-->hoarseness

54

squamous cell carcinoma

central lesion, may cavitate

55

adenocarcinoma

peripheral lesion

56

Erlotinib

EGFR-TK1 tyrosine kinase inhibitor

57

Class 1 mutation

defective protein product

58

class 2 mutation

defective protein processing

59

class III

defective protein regulation- diminished ATP binding and hydrolysis

60

class IV

defective protein conductance- defective chloride conductance or channel gating

61

class V

promoter or splicing abnormality-reduced number of CFTR transcripts due to promoter or splicing abnormality

62

class VI

accelerated turnover-accelerated turnover from cell surface

63

fetal vasoconstriction

physical lung fluid
dec O2 and pH
leukotrienes
thrmboxane A2

64

fetal vasodilation

NO
increase O2 and pH
PGI2 prostacyclin

65

major constrictor ductus arteriosus

ET1

66

major dilator ductus arteriosus

PGE2

67

4 things that cause DA constriction

increase PaO2
decrease PVR from O2-->decrease in BP in DA
decrease PGE2 (loss of placenta and increased PG removal from lung)
decrease in PGE2 receptors in DA wall

68

indomethacin

prostaglandin synthetase inhibitors

complications-renal failure, GI perforations, necrotizing enter colitis

69

what age are alveoli close enough to caps to transmit o2?

24 weeks

70

bronchial tree developed by

16th week of intrauterine life

71

alveoli continue to grow

through life

72

preacinar blood vessels follow

airways

73

intra-acinar vessels

follow alveoli

74

aberrant subclavian artery only compresses

esophagus

75

anomalous innominate artery only compresses

trachea

76

extrathoracic obstruction produces

inspiratory stridor

77

intrathoracic obstruction

exp wheeze

78

single point of obstruction

one wheeze

79

mutiple pts of obstruction

lots of little wheezes

80

in situ means

hasn't invaded through the basement membrane yet

81

cytokeratin

intermediate filament in the cytoplasm of epithelial cells

82

vimentin

intermediate filament in the cytoplasm of tissue derived from mesoderm

83

TTF1

nuclear transcription factor expressed in lung epithelium and thyroid epithelium

84

synaptophysin

neuroendocrine marker

85

Met vs Primary

Met has sharp demarcation of metastasis

86

carcinoid tumor

ribbons of cells

87

positive synaptophysin stain

small cell carcinoma

88

virchow's triad

endothelial injury
abnormal blood flow
hypercoag

89

saddle embolus

thromboembolus that lodges at bifurcation of right and left plum arteries

associated with sudden death

90

pulmonary infarcts early

deep red color
ischemic necrosis
diffuse RBC
exudate

91

infarcts greater than 48 hrs

RBC lysis
hemosiderin laden
macrophages
lung appears paler

92

days

fibrosis (from margins inward)
gray-white color

93

compliance

deltaV/deltaP

94

Pmax=

Pelastic-Pcrit/R upstream

95

Pcrit=

>0 tendency to collapse
<0 tendency to stay rigid

Pcrit=Pcollapse-Ppleural

96

PIO2

(Pb-47)(.21)

97

sol phase

water and solute that lines resp tract

98

gel phase

glyoprotiens

99

pleurodesis

chemical irritant put to increase inflammation and remove what is bothering

100

zone 1 conditions

Palv>Ppa>Ppv
no cap perfusion; in normal conditions no zone 1

101

zone 2 conditions

Ppa>Palv>Ppv
driving pressure is difference between Ppa and Palv
as you move down the lung, driving pressure and blood flow increases

102

zone 3

Ppa>Ppv>Palv
traditional flow relationship

103

pvr=

ppa-pla/co

usually < 2

104

hemoglobin does not affect

po2 or O2sat

105

oxygen content but not saturation shift based on

polycythemia vs anemia

106

extrathoracic obstruction causes

collapse on inspiration (decrease flow on inspiration)

107

intrathoracic obstruction causes

a collapse on expiration (decrease flow on expiration)