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Flashcards in Respiratory Deck (96):
1

type I pneumocytes

97% of aveoli surface, just thin and don't do shit

2

type II pneumocytes

screte surfactant, cuboidal, differentiate into type I cells, they proliferated in response to injury

3

what in amniotic fluid indicates fetal lung maturity

lecithin:sphingomyelin ratio >2

4

# of lobes of each lung

left has 2
right jhas 3

5

which lung more commonly gets inhaled foreign body

right

6

aspirate peanut while standing, where does it go?

lower portion of right inferior lung

7

aspirate peanut while lying (supine), where dose it go?

superior portion of right inferior lobe

8

location of pulmanary arteries in relation to hilum of bronchus?

RALS: Right Anterior Left Superior

9

perforates diaphram at T8

IVC

10

perforates diaphragm at T10

esophagus and vagus

11

perforates diaphragm at T12

aorta, thoracic duct, azygos vein

12

diaphragm pain refers to?

C3, 4, 5 shoulder and trapzius

13

muscles used during maximal inspiration?

external intercostals, scalene muscles, sternocleidomastoids

14

muscles used during maximal expiration

rectus abdominis, internal/external obliques , transversus abdominus, internal intercostals

15

functional vs anatomical dead space

functional is aveoli not being perfused (apex of lung), anatomical is conducting system

16

hemoglobin two states

tense: low affinity for oxygen (periphery)
relaxed: high affinity for oxygen

17

conditions which favor taut form of Hb?

high: Cl, H, CO2, 2,3-BPG and temp (shifts curve right)

18

how to treat cyanide poisoning?

Nitrates oxidize hemoglobin to methemoglobin which favors binding cyanide. then treat with thiosulfate to form thiocyanate to excrete

19

what is methemoglobin and how to treat methemoglobin?

methemoglobin is oxidized hemoglobin that favor cyanide. give methylene blue

20

what creates methemoglobin?

nitrates

21

histology of conducting zone vs respiratory zone (respiratory bronchioles and aveoli)

conducting zone is pseudostrat columnar ciliated
respiratory bronchioles are cuboidal
aveoli are simple squams
(no cilia cause macrophages clear)

22

oxygen binding curve after carbon monoxide

left shift cause CO binds waaaaaay stronger

23

hemoglobin vs myoglobin multimer state?

4 vs 1

24

effects of CO2 and O2 on pulmanary circulation

opposite of the rest of the body. hypoxia = vasoconstriction

25

is normal gas exchange diffusion or perfusion limited?

perfusion

26

cor pulmonale

enlargment of right heart due to increased pulmanary circulation resistance

27

normal pulm artery pressure?

10-14

28

gene responsible for primary pulmonary hypertension (and defect?)

BMPR2 w/ inactivating mutation

29

ventilation and perfusion are greatest where?

base of lung

30

Haldane effect

oxygenated hb dump H which causes biocarb to become CO2 at lungs (opposite of bohr effect/shift)

31

virchows triad of DVT risk factors

Stasis, hyper coagulability, endothelial damage

32

dorsiflexion of foot elicits calf pain

sign for a deep vein thrombosis

33

heparin vs warfarin for DVT treatment

Heparin is acute prevention and treatment. warfarin is for chronic prevention of recurrance

34

sudden onsent dyspneia, chest pain, tachypnea

Pulm embolism

35

high altitutde compensation mechanisms

acute: increase ventilation
chronic: high epo to increase hct, high 2,3-BPG, high bicarb excretion

36

types of pulmonary emboli

FAT BAT: Fat, Air, Bactera, Amniotic, Tumor

37

Fat emboli etiology and triad

long bone fractures/liposuction
triad: hypoxemia, neurological abnormalities, and petechial rash

38

how to distinguish between post and premortum emboli via histology?

pink = plates (pre)
red = RBCs (post)

39

Chronic Bronchitis mechanism?

hypertrophy of mucus secreting glands, thick bronchi

40

Reid index (thickness of glands/bronchial wall) to diagnose chronic bronchitis?

>50%

41

Mechanism of Emphysema

enlargment of airspaces due to destruction = less recoil so can't collapse lungs to remove old air

42

two type of Emphysema and their respective asssociations

Centriacinar: smoking
Panacinar: alpha1-antitrypsin deficency

43

Emphysema elastase activity

increased resulting in loss of elastic fibers. they exhale through pursed lips

44

Methacholine challenge

asthma test (causes asthma acutely)

45

Asthma histology (3)

smooth muscle hypertrophy, Curschmann's spirals (mucus/epi plugs), CHarcot-Leyden crystals (eosinophil breakdown product)

46

bronchiectasis

chronic necrotizing infxn of bronchi -> dialated airways, hemoptysis, purulent sputum. Seen in CF, obstruction, kartageners

47

Asthma is obstructive or restrictive?

obstructive

48

obstructive vs restrictive

obstructive: air trapping
restrictive: lung expansion restricted

49

what can cause pneumoconioses?

coal (anthracosis), silica (silicosis), asbestos (asbestosis)

50

anthracosis cause and where it effects

coal (BLACK LUNG), affects upper lobes

51

Silicosis effects where in the lungs?

upper lobes

52

who might get silicosis

silica exposure: foundries, sandblasting, mines

53

what does silicosis do to the lungs?

macrophages release fibrogenic factors. risk of TB and carcinoma

54

eggshell calcifications of hilar lymph nodes

Silicosis

55

Ivory white calcified pleural plaques

pathognomonic of asbestosis

56

golden-brown fusiform rods that look like dumbells

asbestosis

57

who might get asbestosis

shipbuilders, roofers, plumbers

58

risks of asbestosis?

carcinoma and mesothelioma

59

where does asbestosis effect?

lower lobes (only one of the pneumoconioses to hit lower lobes)

60

Neonatal respiratory distress syndrome cause and test

surfactant deficency. lecithin: sphingomyelin ratio

61

risks of neonatal respiratory distress syndrome and risk of treatment

PDA (low O2). But O2 supp leads to retinopathy of prematurity and bronchopulmonary dysplasia.

62

acute respiratory distress syndrome causes

trauma, uremia, sepsis, shock, gastic aspiration, acute pancreatisis, amniotic fluid embolism

63

ARDS pathophys

chronic: diffuse aveolar damage causes increase capillary permeability causes proteinacous fluid in aveoli which forms hyalin membrane in aveoli.
acute: neutrophils, coag cascade, oxygen derived free radicals

64

FEV1/FVC for normal, obstructive and restrictive

normal: 80%
Obstructive

65

what is sleep apnea and causes

stop breathing >10sec repeatedly while sleeping. typically very tired cause they wake up a lot. also hypoxia leads to high RBC. can be central or obstrucutive (snoring/fat/resistance present)

66

sleep apnea treatment

weight loss, CPAP, surgery

67

leading cause of cancer death? (ie type)

lung cancer

68

coin lesion in lung on xray or ct

lung cancer

69

most common lung cancer

met from another tumor

70

where do lung cancers met?

adrenals, brain, bone (path fracture), liver

71

lung cancer complications

SPHERE of complications: Superior vena cava syndrome, Pancoast tumor, Horners syndrome, Endocrine (paraneoplastic cause of ACE and stuff), Recurrenty laryngeal symptoms, Effusions

72

which lung cancers aren't smoking associated?

bronchioloalveolar and bronchial carcinoid

73

lung adenocarcinoma location and histology

peripheral. bronchioalveolar subtype grows along septa so septal thickening

74

lung adenocarcinoma characteristics

most common lung cancer in non smokers. activation of k-ras. displays clubbing.

75

Bronchioloaveoloar subtype of lung adenocarcinoma findings and prognosis

histology has "septal thickening", CXR has hazy infiltrates like pneumonia. Excellent prognosis

76

lung squamous cell carcinoma

centrally located. hilar mass from broncus. Cavitation, Cigarettes, hyperCalcemia.

77

keratin pearls and intercellular bridges histology in lung

squamous cell carcinoma of lung

78

small dark blue cells "oat cells"

small cell carcinoma of lung

79

small cell carcinoma of lung

located centrally. very aggressive undifferentiated neuroendocrine cells. produce ACTH, ADH, Antibodies against presynaptic Ca channels, Amplification of myc oncogenes

80

large cell carcinoma of lung

peripherally located. anaplastic undiff tumor with poor prognosis, surgery is only option... giant cells

81

bronchial carcinoid tumor

neuroendocrine cells which has great prognosis and no mets. just mass effect is dangerous (and maybe carcinoid syndrome)

82

lung cancer with chromogranin positive cells

bronchial carcinoid tumor

83

Lung Psammoma bodies

mesothelioma

84

mesothelioma

pleural tumor associated with asbestosis. hemorrhagic effusions

85

pancoast tumor

carcinoma in the apex of the lung which impinges on cervical sympathetic plexus causing Horners (ipsilateral ptosis, miosis, anhidrosis)

86

superior vena cava syndrome

obstructed SVC - blood cant drain from head - JVD - upper extremity edema. Caused by malig and thrombosis for catheters. Medical emergency cause high ICP causes aneurysms

87

lobar pneumonia

S. pneumo (Klebsiella rare). Intra-aveolar exudate/consolidation (may involve all lung but typically in one lobe)

88

Bronchopneumonia

S. pneumo, S. aureus, H. influ, Klebsiella. acute inflammatory infiltrates from bronchioles into aveoli = patchy distribution in 1 or more lobes

89

interstitial (aytpical) pneumonia

viruses, mycoplasma, legionella, chlamydia. diffuse patchy inflammation localized to interstitial areas at alveolar walls. slow indolent course

90

lung abscess organisms

S. aureus or anaerobes (bacteroides, fusobacterium, peptostreptococcus)

91

hypersensitivity pneumonitis

mixed type 3/4 hypersensitivity due to antigen causing dyspnea, cough, chest tightness. seen in farmers and bird exposures

92

transudate pleural effusion

low protein content due to CHF, nephrotic syndrome, or cirrhosis

93

exudate pleural effusion

high protien content. cloudy. due to malignancy, pneumoia, collagen cascular disease, trauma. MUST BE DRAINED

94

lymphatic pleural effusion

aka chylothorax. thoracic duct injury so milky pus filled

95

spontaneous pneumothorax

air gets into thorax despite intact chest wall. in tall thin guys cause of apical blebs rupturing. trachea deviates TOWARD lesion

96

tension pneumothorax

trauma or infxn causes air to enter thorax. trachea deviates AWAY from affected lung.