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Respiratory Flashcards

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1
Q

type I pneumocytes

A

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

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2
Q

type II pneumocytes

A

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

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3
Q

what in amniotic fluid indicates fetal lung maturity

A

lecithin:sphingomyelin ratio >2

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4
Q

of lobes of each lung

A

left has 2

right jhas 3

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5
Q

which lung more commonly gets inhaled foreign body

A

right

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6
Q

aspirate peanut while standing, where does it go?

A

lower portion of right inferior lung

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7
Q

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

A

superior portion of right inferior lobe

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8
Q

location of pulmanary arteries in relation to hilum of bronchus?

A

RALS: Right Anterior Left Superior

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9
Q

perforates diaphram at T8

A

IVC

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10
Q

perforates diaphragm at T10

A

esophagus and vagus

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11
Q

perforates diaphragm at T12

A

aorta, thoracic duct, azygos vein

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12
Q

diaphragm pain refers to?

A

C3, 4, 5 shoulder and trapzius

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13
Q

muscles used during maximal inspiration?

A

external intercostals, scalene muscles, sternocleidomastoids

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14
Q

muscles used during maximal expiration

A

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

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15
Q

functional vs anatomical dead space

A

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

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16
Q

hemoglobin two states

A

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

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17
Q

conditions which favor taut form of Hb?

A

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

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18
Q

how to treat cyanide poisoning?

A

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

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19
Q

what is methemoglobin and how to treat methemoglobin?

A

methemoglobin is oxidized hemoglobin that favor cyanide. give methylene blue

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20
Q

what creates methemoglobin?

A

nitrates

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21
Q

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

A

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

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22
Q

oxygen binding curve after carbon monoxide

A

left shift cause CO binds waaaaaay stronger

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23
Q

hemoglobin vs myoglobin multimer state?

A

4 vs 1

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24
Q

effects of CO2 and O2 on pulmanary circulation

A

opposite of the rest of the body. hypoxia = vasoconstriction

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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.

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