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Flashcards in Respiratory Deck (74):
1

ABPA

Hypersensitivity to Aspergillus in patients w/ asthma

2

Equation for Alveolar-arterial oxygen Gradient

PAO2 = 150-(PaCO2/.8)
- Can be used to determine the cause of hypoxemia/if there is a significant difference

3

Acinar wall destruction

Elastase is in neutrophils

4

Alveolar Ventilation includes:

The tidal volume and dead space volume

5

Bronchial smooth muscle relaxation by:

Increased intracellular cAMP (via B agonists)

6

Reid Index in Chronic Bronchitis

>40%

7

Silicosis Increases Susceptibility to TB because:

It may disrupt Macrophage Phagolysosomes preventing killing of intracellular mycobacteria

8

ARDS

Caused by injury to endothelial cells lining pulmonary capillaries adjacent to alveoli
Tx: Positive Pressure ventilation

9

Pulmonary Embolism Gas Changes

Hypoxemia and respiratory alkalosis:
- increased pH
- decreased PaCO2
- low PaO2
- normal HCO3 because no renal compensation for Acute PE (Renal compensation takes 3-5 days)

10

Tx for Pneumothorax

Chest tube placement or needle aspiration

11

PTHrp

Squamous cell lung cancer → makes PTHrp (related peptide) which acts like PTh → hypercalcemia

12

Normal Tracheal pO2 and Alveaolar pO2

- Normal tracheal pO2 is 150 and normal alveolar pO2 is 104
- At rest: the equilibrium is perfusion limited
- Diffusion limited during exercise, emphysema, or pulmonary fibrosis

13

Silicosis Appearance

Egg shell calcification w/ birefringent silica particles

14

Cheyne Stokes

- Cyclic breathing in which apnea is followed by increasing then gradually decreasing tidal volumes until the next apneic period
- Seen w/ advanced congestive heart failure

15

Secondary Pulmonary HTN: COPD vs CHF

- COPD: due to hypoxia induced vasoconstriction and obliteration of the vasculature
- CHF: pulmonary venous congestion due to backup that causes impaired secretion of NO (and increased endothelin → vasoconstriction) resulting in increased vascular tone

16

Increased Resistance in Medium-size Bronchi due to:

More turbulence
- Otherwise everything else decreases in resistance w/ more branching

17

If Radius Decreases by 50%, Flow will:

Decrease by a factor of 14

18

Intrapleural Pressure at Rest (FRC)

Slightly negative (-5)

19

Filters to Prevent DVTs from becoming PEs placed in:

IVC

20

Effect of Vagus on Airway

Bronchoconstricts which increases the work of breathing by increasing airway resistance

21

Metabolic Disturbances w/ PE

Respiratory alkalosis (due to compensatory hyperventilation) and hypoxemia

22

Bleomycin: Side effect

Pulmonary fibrosis as a side effect (diffuse ground glass opacity)

23

Obstructive Lung Disease

Emphysema (pink puffer), Chronic bronchitis (blue bloater), asthma, bronchiectasis
- Decreased FEV1/FVC ratio; very decreased FEV1

24

Restrictive Lung Disease

Interstitial lung diseases
- Decreased FVC and TLC; mostly preserved FEV1/FVC

25

Methacholine

Challenge to test for asthma

26

Ried Index

Increased thickness of mucus layer in Chronic Bronchitis

27

Curschmann spirals

In asthmatic patients (mucus casts of small airways)

28

Lung Abscess & Aspiration Pneumonia

- will see an air-fluid level and cavitary lesion
- Release of enzymes from lysosomes of macrophages and neutrophils
- Commonly caused by oropharyngeal anaerobic bacteria
- Aspiration pneumonia: peptostreptococcus, bacteroides, fusobacterium

29

Atypical Pneumonia in AIDS

pneumocystis jirovecci

30

Prophylaxis for MAC in AIDS patients

Azithromycin

31

Aspiration

(into right lobe; shorter/vertical)
- Supine: posterior upper lobe or superior lower lobe
- Upright: lower inferior lobe

32

Arterial Alveolar Gradient

does not normally exceed 10-15

33

Bosentan

treat pulmonary arterial HTN (antagonizes endothelin 1 receptors)

34

Pneumonia + Diarrhea

Legionella (not visible w/ gram stain)
- Will have hyponatremia

35

Pneumonia + mild transient anemia

Mycoplasma (cold agglutinins)

36

Squamous cell lung cancer --> Hypercalcemia

Due to PTHrP release

37

Major basic protein

causes bronchial damage in atopic asthma (also used to kill helminths)

38

Hypocapnia

- indicates alveolar hyperventilation
- Arterial PaCO2 is the best indicator of alveolar ventilation

39

Thoracocentesis

- should be performed about the 7th rib in midclavicular line, 9th rib along the midaxillary line, and the 1th rib along posterior scapular line

40

ARDS

- Normal wedge pressure
- Requires absence of cardiogenic pulmonary edema for diagnosis
- Leaky alveolar capillary membrane
- Intra-alveolar edema, inflammation, and hyaline formation

41

TB Infection

- one week → intracellular replication
- 2-4 weeks → cytokine release due to T cell stimulation

42

Transudate in alveoli lumen w/:

Cardiogenic pulmonary edema

43

Sarcoidosis: Bronchioalveolar Lavage Findings

high CD4/CD8 ratio

44

Omalizumab

anti IgE antibody used for resistant allergic asthma

45

Effects of CO Poisoning

No change in PaO2 (dissolved oxygen), decreased O2 content, increased carboxyhemoglobin, does not increase methemoglobin

46

Goodpasture's

Antibodies to Type IV collagen (alpha3chain) in basement membrane

47

Pulmonary vascular resistance is lowest at ______

FRC
- Increased lung volumes AND decreased lung volumes increase resistance
(Increased causes stretching of alveolar capillaries) &
(Decreased causes decreased radial traction on the large extra alveolar vessels)

48

Recurrent laryngeal nerve can be compressed or injured by:

Left atrium enlargment or injured by ligation of the inferior thyroid artery

49

Tx of Small Cell Lung Cancer

Surgery not indicated, it is very sensitive to chemo
- Some express neurofilaments
- Neuroendocrine markers: chromogranin, synpatophysin

50

Drugs that can cause Pulmonary Edema

Aggressive Osmotic Diuretics

51

Reduce work of Breathing with higher elastic resistance (pulmonary fibrosis) by:

Breathing fast and shallow breaths

52

Reduce work of Breathing with increased airflow resistance (asthma, COPD) by:

Breathing slower and deeper minimizes work

53

Chest C ray looks much worse than it is

Mycoplasma Pneumoniae (can culture on cholesterol)

54

Radial Traction

outside fibrotic tissue opens up airways so lower airflow resistance, air flows out faster with restrictive lung diseases

55

Cromylin Sodium and Nedocromil

Mast cell stabilizers (prevent degranulation)
- Tx for allergic rhinitis and bronchial asthma

56

Must be careful with giving _____________ to COPD patients

Supplementary O2
- their respiratory drive depends on O2

57

Lung Cancer in Non-smoking woman

Adenocarcinoma (MC lung cancer)

58

Obstructive Lesion in Mainstem Bronchus: X ray findings

Opacified/white lung (only on side of lesion) due to atelectasis
Tracheal deviation towards lesioned side

59

Tumor w/ numerous long slender microvilli and abundant tonofilaments

Mesothelioma
(adenocarcinoma has small plump microvilli)

60

Neonatal Oxygen Supplementation for RDS

May cause retinopathy of prematurity and bronchopulmonary dysplasia

61

Foam Stability Index

Evaluates surfactant functionality
(mix ethanol and amniotic fluid) --> ring of stable foam

62

Smoking cessation at any age will:

prolong life expectancy, decrease risk of MI, lung cancer, and cerebrovascular accident, and slow the rate of pulmonary function loss

63

Development of Respiratory acidosis and hypoxemia in setting of Fixed ventilation suggests:

Pulmonary pathology that increases both dead space and right to left shunt

64

Hydropneumothorax

Air and fluid = hydropneumothorax
If fluid is blood (eg. w/ stabbing), it’s a hemopneumothorax Lack of mediastinal shift indicates that it’s not under tension

65

Altitude sickness

- high-altitude pulmonary edema (a type of ARDS)
- x-ray demonstrates diffuse bilateral fluffy infiltrates

66

Amiodarone: Side Effect

Interstitial Lung Disease

67

Heart Sound Aw/ Pulmonary Hypertension

P2 louder than A2

68

Chronic Inflammatory Pneumonitis

- Damage to lung parenchyma (composed primarily of type I pneumocytes)
- Type II pneumocytes, in addition to making surfactant, can replicate in order to replace type I pneumocytes, so they will be increased
- Chronic interstitial inflammation results in fibrosis, hence an increase in fibroblasts

69

Lung Transplant Chronic Rejection

Bronchiolitis Obliterans syndrome
- immune reaction affecting small airways
- dyspnea and wheezing
- inflammation and fibrosis of bronchiolar walls

70

Charcot Leyden Crystals

Found in Asthma
- formed from the breakdown of eosinophils in sputum

71

Increased Radial Traction w/

Interstitial lung disease
- leads to increased expiratory flow

72

Kulchitsky cells (dark blue cells)

Small Cell Lung Cancer
- neuroendocrine neoplasm

73

Keratin pearls and intracellular bridges

Squamous cell lung cancer

74

Theophylline

PDE antagonist used for asthma