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► Med 11 - USMLE 1 > Respiratory > Flashcards

Flashcards in Respiratory Deck (156):
1

What makes up the Conducting Zone?

Large airways: Nose, Pharynx, Trachea, Bronchi
Small airways: Bronchioles and Terminal Bronchioles

2

Function of Conducting Zone

Warms and humidifies air but does not participate in gas exchange
Anatomical Dead Space

3

Cartilage extends until

Bronchi

4

Goblet cells extend until

End of Bronchi

5

Pseudostratified, ciliated, columnar cells extend until
What is the cilia's function?

End of Terminal Bronchioles to beat mucus up and out of lung

6

Smooth muscle in airway wall extends until

terminal bronchioles

7

What makes up the respiratory zone?

= Lung Parenchyma. Respiratory bronchioles, alveolar ducts and alveoli
participates in gas exchange

8

What kind of cells are in the Respiratory zone?

Cuboidal cells in respiratory bronchioles, then simple squamous cells up to alveoli

9

Type I Pneumocytes
Percentage of alveolar surface
Kind of cell
Function

97% of alveolar surface. Squamous cells optimal for gas diffusion

10

Type II Pneumocytes
Kind of cell
Function

Clustered cuboidal cells. Secrete surfactant and act as precursors

11

Collapsing Pressure Formula

P = 2 (surface Tension) / Radius

12

When are alveoli most likely to collapse?

On Expiration

13

Function of surfactant

Decreased alveolar surface tension to prevent atelectasis

14

Composition of surfactant

Complex mix of lecithins. The most important of which is dipalmitoylphasphatidylcholine

15

When does surfactant production begin in the fetus? When does it reach mature levels? What indicates maturity?

Begins at week 26. Mature by week 35. Mature when Lecithin/Sphingomyelin > 2

16

Clara Cells:
Location
Appearance
Function

In Terminal and Respiratory Bronchioles. Non ciliated columnar cells with secretory granules. Secrete components of surfactant, degrade toxins and act as reserve cells

17

# of lobes in each lung?

R: 3, L: 2 + Lingula

18

Foreign body most likely to be lodged in

R lung because R mainstem bronchus is wider and more vertical than L

19

Aspirate a peanut:
While upright?
While supine?

Upright: Lower Portion of R Inferior Lobe
Supine: Superior Portion of R Inferior Lobe

20

Relationship bet Pul Artery to the Bronchus?

RALS
Right: Anterior, Left Superior

21

Structures perforating the Diaphragm

I ate 10 eggs at 12
T8: IVC
T10: Vagus and Esophagus
T12: Aorta, Azygous, Thoracic duct (Red White and Blue)

22

What innervates the Diaphragm? Where is pain from the Diaphragm referred?

C3, 4, 5 keeps you alive
Pain referred to shoulder (C5) and Trapezius ridge (C3, C4)

23

Muscles of respiration (quiet and exercise)

Inspiration: Quiet --> Diaphragm, Exercise --> SCM, Scalene, External Intercostals
Expiration: Quiet --> Passive, Exercise --> Obliques (Internal and External), Abdominis (Rectus and Transversus) Internal Intercostals

24

Inspiratory Reserve Vol

Air that can be breathed in after normal inspiration

25

Tidal Vol

500mL. Air that moves into the lung on quiet inspiration

26

Expiratory Reserve Vol

Air that can still be breathed out after a normal expiration

27

Reserve Volume

Air left in lung after maximal expiration

28

Inspiratory capacity

TV + IRV

29

Function Residual Capacity

RV + ERV

30

Vital Capacity

TV + IRV + ERV

31

Total Lung Capacity

IRV + TV + ERV + RV

32

Physiological Dead Space
Definition
Calculation

Vol of inspired air that does not participate in gas exchange
VD = Anatomical Dead Space of conducting airways + functional dead space in alveoli
VD = TV [(PaCO2 -PECO2)/PaCO2] Taco Paco Peco Paco

33

Largest contributor to functional dead space?

Apex of Lung

34

The tendency is for the lung to ... and for the chest wall to ...

Lung wants to collapse, Chest wall wants to spring outward

35

@ FRC: What is happening with the lung - chest wall system? What is the P in the alveoli and airway? What is the P in the Intrapleural space?

@ FRC: Inward pull of lung = outward pull of chest wall and system pressure is atmospheric. P in the alveoli and airway = 0. P in the Intrapleural space is negative to prevent pneumothorax

36

Alveolar transmural pressure is ...

Always positive. Meaning always tending to collapse

37

What determines the elastic properties of both the chest wall and lungs?

Their combined volume

38

What is compliance?
What increases compliance?
What decreases compliance?

Change in lung vol for a given change in pressure
Increases in emphysema and normal aging
Decreases in fibrosis, pneumonia and edema

39

Hemoglobin
Composed of
Exists in 2 forms
Exhibits

Composed of 2 alpha and 2 beta subunits
Exists in Taut form in tissues (low affinity) and Relaxed form in lungs (high affinity)
Exhibits positive cooperativeity and negative allostery

40

What shifts Hemoglobin dissociation curve to the R (towards T form)

CADET! Turn R!
CO2 and Cl, Acidosis and Altitude, BPG, Exercise, Increased Temp

41

Fetal Hemoglobin
Consists of
Different affinities?

Consists of 2 alpha and 2 gamma subunits
Lower affinity for BPG = higher affinity for O2 --> curve shifted to the L

42

Methemoglobin
What is it ?
Change in affinity?
Shift in curve?
Treat with

Oxidized Iron 3+ (ferric) instead of Iron 2+ (ferrous)
Lower affinity for O2, Higher affinity for cyanide
Shifts curve to R
Treat with Methylene Blue

43

Nitrite poisoning causes

Oxidization of Fe2+ to Fe3+

44

How to treat cyanide poisoning?

Use nitrites to oxidize Hemoglobin to methemoglobin. MetHem with bind cyanide and allow cytochrome oxidase to function. Then use Thiosulfate to bind cyanide --> forms thiocynate which is renally excreted

45

Carboxyhemoglobin
What is it
Affect on O2 binding curve

Hemoglobin bound to CO
Shifts curve to L --> decreased O2 unloading in tissues

46

Appearance of Hemoglobin O2 binding curve?

Sigmoidal because of cooperativity

47

Pulmonary Circulation Re Resistance and Compliance

Low Resistance and High Compliance

48

How does a decrease in PA02 (= increase in PACO2) affect pulmonary circulation?

Vasoconstriction to shift blood away from poorly ventilated areas

49

Which gases are perfusion limited? What does that mean?

O2 (normally), CO2, N2O. Diffusion Increases if Blood Flow Increases

50

Which gasses are diffusion limited? What does that mean?

O2 (in fibrosis or emphysema), CO. Gas does not equilibrate by the time the blood reaches the end of the capillary.

51

Gas diffusion equation
What happens in Emphysema?
What happens in Fibrosis?

Vgas = (A/T) x D(P1-P2)
Emphysema --> Area decreases
Fibrosis --> Thickness increases

52

Pulmonary artery pressure: Normal? PHTN?

Normal: 10-14mmHg, PHTN: >/= 25 (rest) or >/= 35 (exercise)

53

PHTN affect on pulmonary artery

Arteriosclerosis, Medial Hypertrophy, Intimal Fibrosis

54

Cause of Primary PHTN

Inactivation of BMPR2 gene which normally functions to inhibit vascular smooth muscle proliferation

55

What causes secondary PHTN? What is the course of the disease?

COPD (destruction of lung parenchyma), Mitral Stenosis (Increased resistance --> increased P), Recurrent thromboemboli (decreased cross sectional area of pulmonary vascular bed), autoimmune disease, L --> R shunt (increased sheer stress --> endothelial injury), Sleep Apnea, Living at high altitude
Respiratory distress --> Cyanosis and RVH --> cor pulmonale --> death

56

Pulmonary Vascular Resistance formula

PVR = (P pulmonary artery - P left atrium) / CO

57

O2 content of blood formula
What is normal O2 binding capacity?

O2 binding capacity x saturation + dissolved O2
O2 binding capacity normally 20ml/dL

58

1g Hb can bind how much O2?
How much Hb is normally in blood?
When does cyanosis occur?

1.34mL
15 g Hb/dL
Cyanosis occurs when deoxygenated Hb > 5g/dL

59

What happens to O2 content of blood, O2 sat and PaO2 when Hb decreases?

O2 content decreases but O2 sat and PaO2 remain the same

60

Formula for oxygen delivery to tissues

CO x O2 content of blood

61

Alveolar gas equation

PAO2 = PIO2 - PaCO2/R
PAO2 = 150 - PaCO2/.8
R = CO2 produced/O2 consumed

62

A-a gradient
Normal value
Increased in?
Causes?

Normal A-a gradient = 10-15mmHg
Increased in hypoxemia due to lesion in Lung
Causes: Shunting, V/Q mismatch, Fibrosis

63

Causes of hypoxemia with normal A-a gradient?

High altitude, hypoventilation

64

What causes hypoxemia with increased A-a gradient?

V/Q mismatch, Diffusion limitation, R-L shunt

65

Causes of Hypoxia

Decreased cardiac output, Hypoxemia, Anemia, CO poisoning

66

What can cause ischemia?

Arterial flow or venous drainage blocked

67

V/Q at apex? base?

apex = 3 (wasted ventilation). base = .6 (wasted perfusion)

68

Where in the lung is ventilation greatest? Where is perfusion greatest?

Both at base

69

What happens to V/Q during exercise?

Vasodilation of apical capillaries --> V/Q approaches 1 at apex

70

What kind of organisms thrive in the apex of the lung?

Those that thrive on high O2 like TB

71

V/Q = 0

Shunt (airway obstruction). 100% O2 wont help

72

V/Q = infinity

Blood flow obstruction (physiological dead space) Assuming

73

PAO2, PaO2, and PvO2 in apex, middle and base

Apex: PA>Pa>Pv
Middle: Pa>PA>Pv
Base: Pa>Pv>PA

74

In what forms is CO2 transported in the blood?

Bicarb: 90%, CarbaminoHb (binds at N terminus and binding favors T form): 5%, Dissolved CO2: 5%

75

How does oxygenation of Hb affect CO2 in blood?

Oxygenation --> dissociation of H from Hb. H + bicarb = CO2 thus more CO2 is released from RBC
Haldane Effect

76

Bohr Effect

Increased H in periphery --> Hb O2 curve shifted to R and O2 unloading favored

77

Response to high altitude?

Increased Mito, Increased renal excretion of bicarb (to combat alkalosis) Increase in ventilation, decreased PO2 + PCO2, Increased EPO --> Increased Hb and Hc, Increased BPG, RVH
"Mr. V. Deb"

78

Response to exercise
CO2 production
O2 consumption
Ventilation
V/Q
Pulmonary blood flow
pH
PaO2, PaCO2, venous CO2, venous O2

CO2 production increases, O2 consumption increases, Ventilation increases, V/Q becomes more uniform, Pulmonary blood flow increases, pH decreases (lactic acidosis), PaO2 NC, PaCO2 NC, venous CO2 increase, venous O2 decreases

79

DVT
What predisposes to it?
What can it lead to?
Physical Exam sign?
Treatment and prevention?

Virchow's triad of Vascular damage (exposed collagen), Increased coagulability (defect in coagulation cascade, most commonly factor V Leiden), Reduced flow [VIR]
Leads to Pul embolus
Homan's Sign --> Dorsiflexion of foot --> calf pain
Heparin for prevention and acute management. Warfarin for long-term prevention of recurrence

80

Sudden onset of dyspnea, chest pain, and tachypnea

Pulmonary embolism

81

Types of PE?

FAT BAT
Fat, Air, Thrombus, Bacteria, Amnionic fluid, Tumor

82

Fat embolus associated with...
Presents as...

Long bone fracture and liposuction
Presents as hypoxemia, neurological abnormalities, petechial rash

83

Major risk with Amnionic fluid embolus?

Can lead to DIC especially post partum

84

Imaging test of choice for PE?

CT pulmonary angiography

85

Where do most PEs arise from?

95% from deep leg veins

86

Most dangerous location for PE?

Saddle Embolus of Pulmonary Artery

87

Histology of thromboembolus formed premortem?

Lines of Zahn: interdigitating areas of pink (platelets, fibirn) and red (RBCs)

88

Obstructive Lung Disease: Names, RV, FVC, PFTs, V/Q, PO2, PCO2

Chronic Bronchitis, Emphysema, Asthma, Bronchiectasis
RV: Increases, FVC: Decreases
FEV1 decrease, FVC decreases, FEV1/FVC decreases
V/Q decreases, PO2 decreases, PCO2 increases

89

Chronic Bronchitis: Clinical definition

Productive Cough for >3 months (not necessarily consecutive) for >2 years

90

Chronic Bronchitis: Pathology and Physical Findings

Harry Reid Won 50% Securing Complete Democratic Control
Hypertrophy of Mucus secreting glands in bronchi, Reid Index > 50%, Wheezing, Small airway disease, Crackles (early) Dyspnea (late), Cyanosis (early onset hypoxemia due to shunting)

91

Emphysema: pathology and findings

PERCE
Pursed lip breathing (increased airway pressure prevents collapse), Enlarged airspace, Recoil decreased, Compliance increased, Elastase activity increased

92

Two types of emphysema

Centriacinar = smoking
Panacinar = alpha-1-antitrypsin deficiency

93

Alpha Agonists
Names
Uses
Tox

Pseudoephedrine, Phenylephrine
Reduce hyperemia, edema, nasal congestion.
Open up Eustachian tube.
Pseudoephedrine is a stimulant. Can cause HTN. Pseudoephedrine can cause CNS stimulation/anxiety

94

Dextromethorphan
Class
MoA
Uses
Risk
Antidote

Opioid (synthetic codeine analog)
Antagonizes NMDAR
Antitussive
Mild abuse potential
Naloxone treats OD

95

Bosentan
MoA
Uses

Competative antagonist of endothelin 1 receptor
Decreases Pulmonary Vascular Resistance
Used to treat Pulmonary Arterial HTN

96

N Acetylcysteine
Type of drug
Action
Uses

Mucolytic expectorant
Loosens mucus plugs in CF
Antidote for acetaminophen OD

97

Guaifenesin
Type of drug
Action

Expectorant that thins the respiratory secretions but does not suppress the cough reflex

98

Molecules that cause bronchoconstriction?

Adenosine, ACh

99

Molecules that cause Bronchodilation

cAMP

100

Ab Asthma therapy
Name
MoA
Uses

Omalizumab
Monoclonal IgE Ab that binds up serum IgE
Used in allergic asthma resistant to steroids and long acting beta2 agonists

101

Anti Leukotrienes
Names
MoA
Uses

Montelukast, Zafirlukast
--/ leukotriene receptor.
Especially good in aspirin induced asthma
Zileuton --/ 5 lipoxygenase pathway.
Blocks arachidonic acid --> leukotrienes
Both used to treat Asthma

102

Corticosteroids used to treat Asthma
Names
MoA

Beclomethasone, Fluticasone
--/ cytokine production
--/ NFkB (NFkB --> TNF alpha)

103

Antimuscarinics
Name
MoA
Uses

Ipratropium (short), Tiotropium (long)
--/ muscarinic receptors thereby preventing bronchoconstriction
Asthma and COPD

104

Methylxanthines
Names
MoA
Use
Tox
Metabolism
Blocks actions of

Theophylline--/ PDE leading to increased cAMP
Asthma treatment
Narrow therapeutic index --> cardiotoxic, neurotoxic
P450 metabolism
Blocks actions of Adenosine

105

Pneumothorax presentation

PTHORAX
Pleuritic pain, Tracheal deviation, Hyperresounant, sudden Onset, Reduced breath sounds, Absent Fremitus, XR --> Collapse

106

Beta 2 agonists
Short
Long (uses, tox)

Short: Albuterol --> Beta2 --> SM relaxation
Long: Salmeterol, Formoterol.
Used for prophylaxis.
Can cause tremors and arrhythmias

107

Asthma drug targets
Classes of drugs

Antiinflammation + Anti parasympathetic tone
First Line Therapy: Corticosteroids
Beta 2 agonists, Methylxanthines, Anti Muscarinic, Antileukotrienes, Abs

108

H1 Blockers 2nd Gen
Names
Use
Tox

Loratadine, Fexofenadine, Desloratadine (adine)
Allergy
Much less sedating because do not enter CNS

109

H1 Blockers, 1st Gen
Names
Use
Tox

Diphenhydramine, dimenhydrinate, chlorpheniramine (en/ine, en/ate)
Allergy, motion sickness, sleep aid
Sedation, antimuscarinic, anti alpha adrenergic

110

Kinds of antihistamines used in the lung?

H1 blockers

111

Pleural Effusion: Lymphatic
Name
Due to
Appearance

Chylothorax. Due to thoracic duct injury from trauma or malignancy.
Appears milky with high triglyceride content

112

Pleural Effusion: Exudate
Caused by
Action that must be taken?

High Protein content, appears cloudy
"CAPTAIN"
Due to Collagen Vascular Disease, Abdominal pathology, Pneumonia, TB, Trauma (occurs in states of increased vascular permeability), Asbestos, Infection (Pneumonia), Malignancy
Must be drained to prevent infection

113

Pleural Effusion: Transudate
Caused by

Low protein content
"CHEMN"
Due to CHF, Hepatic cirrhosis (Hypoalbuminia), Embolism, Meig Syndrome, Nephrotic syndrome

114

Hypersensitivity Pneumonitis
Type of Rxn
Presentation
Seen in what kind of pt?

Mixed Type III/IV hypersensitivity rxn to environmental antigen
"Holding Down Tough Cows on a Farm"
Presents with headache, dyspnea, tight chest, cough
Seen in farmers and bird owners

115

Interstitial (atypical) pneumonia
Organisms
Characteristics
Distribution
Course

Viruses (influenza, RSV, adenovirus), Mycoplasma, Legionella, Chlamydia
Diffuse, patchy inflammation in interstitial areas
Involves ≥ 1 lobe.
Indolent course

116

Bronchopneumonia
Organisms
Characteristics
Histo
Distribution

S pneumoniae, S aureus, H influenzae, Klebsiella
Acute inflammatory infiltrates from bronchioles into adjacent alveoli
Neutrophils in alveolar spaces
Patchy distribution involving ≥ 1 lobe

117

Lobar Pneumonia
Organisms
Characteristics

S. pneumoniae, KlebsiellaIntra
alveolar exudate --> consolidation
May involve entire lung

118

SVC syndrome
Def
Presentation
Causes
Can lead to...

Obstruction of SVC impairs blood drainage from Head (Facial Plethora) Neck (JVD) and Arms (Edema)
Caused by malignancy, thrombosis (from indwelling catheters)
Can lead to Increased ICP --> headache, dizziness, aneurysm, cranial artery rupture

119

Pancoast Tumors

Carcinomas in apex of lung affect cervical sympathetic plexus resulting in Horner's Syndrome (Ipsilateral Miosis, Anhidrosis, Ptosis)

120

Mesothelioma
Location
Associated with
Results in
Histology

Pleural. Associated with asbestosis.
Results in Hemorrhagic pleural effusions and pleural thickening.
Psommoma bodies

121

Bronchial Carcinoid Tumor
Prognosis
Metastasis
Symptoms due to
Can lead to
Histology

Excellent Prognosis.
Metastasis: rare.
Symptoms due to mass effect
Can lead to CARCinoid syndrome (5HT release --> Cutaneous flushing, Asthmatic wheezing, Right valve lesions, Cramps, Diarrhea, Salivation)
Nests of neuroendocrine cells. Chromogranin +

122

Large Cell Carcinoma
Location
Differentiation
Prognosis
Treatment
Histology

Peripheral, highly anaplastic undifferentiated tumor
Poor Prognosis
Surgery.
Poor response to chemo
Pleomorphic giant cells

123

Small Cell (Oat Cell) Carcinoma
Location
Differentiation
May produce
Genetics
Treatment
Histology

Central, undifferentiated, aggressive
May produce ACTH, ADH, Abs against presynaptic Ca channels (Lambert Eaton)
Genetics: amplification of myc oncogenes
Chemotherapy.
Inoperable
Kulchitsky cells (small dark blue cells). Salt and Pepper neuroendocrine chromatin

124

Squamous Cell Carcinoma
Location
Arise from
Characteristics
Histology

Central
Hilar mass arises from bronchus
Cavitation, Cigarettes, hyperCa (produces PTH)
Dysplastic squamous cells with Keratin Pearls and Intracellular Bridges

125

Lung Abscess
Definition
Caused by
CXR

Localized collection of pus within parenchyma
Caused by bronchial obstruction (cancer), aspiration of oropharyngeal contents (pts predisposed to LOC i.e. alcoholics), infection of S aureus or anaerobes (Bacteroides, Fusobacterium, Peptostretococcus)
Air-Fluid levels often seen on CXR

126

Bronchioloalveolar adenocarcinoma
Derived from
CXR
Histology
Prognosis

Derived from Clara Cells
Hazy infiltrates similar to pneumonia
Grows along alveolar septa --> apparent thickening of alveolar walls
Excellent prognosis

127

Adenocarcinoma
Can present as...
Location
Most common lung cancer in
Genetics
Physical Exam Findings

Can present as pneumonia
Peripheral.
Develops in scars (old Tuberculous Granulomas)
Most common lung cancer in nonsmokers and females
Activating k-ras mutation
Osteoarthropathy (clubbing)

128

Where do Lung Cancers metastasize to?

Brain, Liver (jaundice, hepatomegaly), Adrenals, Bone (pathologic fracture)

129

Most common cause of Lung Cancer?

Metastasis from Breast, Bladder, Colon, or Prostate

130

Lung Cancers Not Associated with Smoking?

Bronchioloalveolar and bronchial carcinoid

131

Complications of Lung Cancer

SPHERE
SVC syndrome, Pancoast tumor, Hornerns, Endocrine (paraneoplastic), Recurrent laryngeal symptoms (hoarseness), Effusions (pleural or pericardial)

132

Lung Cancer Presentation

ABCDE
Avalanche, Bloody cough, Cough, Coin Lesions on XR, nonCalcified nodules on CT, Disrupted bronchi (bronchial obstruction), whEezing

133

Consolidation (Lobar Pneumonia, Pulmonary Edema)
Breath sounds
Percussion
Fremitus
Tracheal deviation

Breath sounds: Bronchial, Late inspiratory Crackles
Percussion: dull
Fremitus: increased
Tracheal deviation: none

134

Tension Pneumothorax
Presentation
Pathology
Breath sounds
Percussion
Fremitus
Tracheal deviation
Most common pt

Unilateral chest pain, dyspnea, unilateral chest expansion
Air enters pleural space but cannot exit
Breath sounds: decreased
Percussion: hyperresonant
Fremitus: decreased
Tracheal deviation away from lesion
Trauma or lung infection

135

Spontaneous Pneumothorax
Presentation
Pathology
Breath sounds
Percussion
Fremitus
Tracheal deviation
Most common pt

Unilateral chest pain, dyspnea, unilateral chest expansion
Rupture of apical bleb --> accumulation of air in pleural space
Breath sounds: decreased
Percussion: hyperresonant
Fremitus: decreased
Tracheal deviation towards side of lesion
Tall thin young male

136

Atelectasis (Bronchial Obstruction)
Breath sounds
Percussion
Fremitus
Tracheal deviation

Breath sounds: decreased
Percussion: dull
Fremitus: decreased
Tracheal deviation toward side of lesion

137

Pleaural Effusion
Breath sounds
Percussion
Fremitus
Tracheal deviation

Breath sounds: decreased
Percussion: dull
Fremitus: decreased
Tracheal deviation: none

138

Obstructive Sleep Apnea
Description
Associations

Respiratory effort against airway obstruction. Associated with obesity, snoring, HTN, PHTN, Arrhythmias, Sudden Death

139

Sleep Apnea
Definition
Types
Results in
Treatment

Cessation of breathing for >10 sec
Central (no respiratory effort) vs Obstructive
Results in Hypoxia --> EPO release --> Erythropoiesis
Wt loss, CPAP, Surgery

140

ARDS
Causes
Pathology
Initial damage caused by
Histology

Caused by Aspiration, Acute pancreatitis, Air or Amnionic emboli, Radiation, DIC, Drugs, Dialysis, Diffuse Infection, Sepsis, Shock, Trauma, Uremia
Diffuse alveolar damage --> Increased capillary permeability --> protein rich exudate into alveoli --> Intraalviolar hyaline membane
Initial damage caused by release of substances toxic to alveolar wall by neutrophils, activation of coagulation cascade, ROS
Histo: Alveolar fluid and hylaline membranes

141

NRDS
Pathology
Lechithin/Sphingomyelin ratio
Because of low O2 tension -->
Therapeutic O2 -->
Risk factors
Treatment

Surfactant deficiency --> Increased Surface Tension --> alveolar collapse
L/S risk of PDA
Therapeutic O2 --> ROP and Bronchopulmonary Dysplasia
Risk factors: Prematurity, Maternal Diabetes, Cesarean delivery (decreased release of glucocorticoids)
Treatment: maternal steroids before birth. Artificial surfactant for the infant

142

Asbestosis
Associated with what kind of jobs?
Associated with what other diseases
Histology?
Appearance?

Associated with shipbuilding, roofing, plumbing
Associated with Bronchogenic Carcinoma and Mesothelioma
Asbestos bodies are golden brown fusiform rods (dumbbells) in Macs Ivory White calcified pleural plaques are pathognomonic but not precancerous

143

Silicosis
Associated with what kind of jobs?
Pathology
Increased risk for
Affects which lobes?
Appearance?

Associated with foundries, sandplansting, mines
Si --> Macs --> release fibrogenic factors
Increased risk for TB because Si --/ phagolysosomes thereby --/ macs.
Also increased risk for Bronchogenic Carcinoma
Affects Upper Lobes
Eggshell calcifications on hilar lymph nodes

144

Anthracosis
Associated with what kind of pt?
Which lobes are affected?

Coal Miners Lung. Affects Upper Lobes

145

Names of Pneumoconioses

Anthracosis, Silicosis, Asbestosis

146

Pneumoconioses + RA

Caplan Syndrome which can lead to Cor Pulmonale

147

Drugs that cause restrictive lung disease

Bleomycin, Busulfan, Amiodarone, Methotrexate

148

Interstitial Restrictive Lung Disease
Characterized by
Names

Decreased Diffusion Capacity and Increased A-a Gradient
"A Good Physician Would Never Speak Hateful, Disgusting Epithets Intentionally"
ARDS, Goodpasture, Pneumoconioses, Wegeners (granulomatosis with polyangiitis), NRDS (hyaline membrane disease), Sarcoidosis (bilateral hilar lymphadenopathy, noncaseating granulomas, Increased ACE and Ca), Hypersensitivity pneumonitis, Drugs, Eosinophilic Granulomas (Langerhans cell histiocytosis), Idiopathic (repeat injury with collagen deposition)

149

Extra-pulmonary restrictive lung disease

Muscles: Polio, MG.
Structural: Scoliosis, Morbid Obesity

150

Restrictive Lung Disease: Lung Volumes, PFTs

FVC: decreased, TLC: decreased, FEV1/FVC > 80%

151

Bronchiectasis Pathology and Associations

"No Hot Days Post September, Onto KA"
chronic Necrotizing infection of bronchi, Hemoptasis, permanently Dilated airways, Purulent Sputum, Smoking (poor ciliary motility), bronchial Obstruction, Kartageners's (Dynein arm), Allergic bronchopulmonary Aspergillosis, CF

152

Asthma physical exam findings:

"His Majesty Coughed and Wheezed In Excruciating Pain 'Till Dawn"
Hypoxia, Mucus plugging, Cough, Wheeze, I/E ratio decreased, Pulsus Paradoxus (decrease in Systolic Pressure), Tachypnea, Dyspnea

153

Test given to prove asthma

Methacholine challenge. Muscarinic agonist

154

Asthma pathological causes and course

Bronchial hyper-responsiveness causes reversible Bronchoconstriction + Smooth Muscle hypertrophy
Antigen --> IgE on mast cell. Mast cell releases inflammatory mediators (leukotrienes, histamine, etc.)
Early response to inflammation = bronchoconstriction
Late response to inflammation = Bronchial hyper-reactivity

155

Asthma triggers

URI, stress, allergens

156

Asthma histology

Cushmann's Spirals (shed epithelium from mucus plugging). Charcot-Leyden Crystals (Formed from breakdown of eosinophils in sputum)