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Flashcards in Respiratory Deck (64)
1

Dx of asthma

Methacholine --> M3 stimulation

2

Aspirin induced asthma Tx

LT receptor blockers - Zafirlukast, Montelukast

3

Restrictive lung disease

1. Fibrosis
2. ARDS
3. Sarcoid
4. Pneumoconioses
5. Goodpasture's
6. Wegener's
7. Drugs - bleomycin, amiodarone, busulfan

4

Obstructive lung diseases

Asthma, COPD

5

FVC dec
RV, TLC, FRC dec
FEV1/FVC normal or inc

Restrictive lung disease
- think of it as a small lung volume problem
- DCLO DEC

6

FVC normal
RV, TLC, FRC in
FEV1/FVC dec

Obstructive lung disease
- can't get the air out = learn to function at higher lung capacity
- DLCO INC

7

Spherules

Coccidoides immitis

8

Cells that produce surfactant

Type II pneumocytes

9

Calculate dead space

tidal volume x PACO - PECO / PACO

10

Calculate pulmonary vascular resistance

P-pul artery - P-l atrium / CO

11

Hypoxemia w/ normal A-a gradient

High altitude
Hypoventilation
= there is no impaired delivery of O2 to the blood

12

Hypoxemia w/ INC A-a gradient

V/Q mismatch
Diffusion limited - fibrosis
R-->L shunt

13

Hypoxia (dec O2 delivery to tissue) w/ normal A-a gradient

Dec CO
Hypoxemia
Anemia

14

Hypoxia w/ INC A-a gradient

CN
CO

15

V/Q of apex

3 = wasted ventilation

16

V/Q of base

0.6 = wasted perfusion

17

V/Q = 0

SHUNT blood
Airway obstruction

18

V/Q = infinity

DEAD space
BF obstruction
100% O2 improves PO2

19

#1 rhinitis

adenovirus

20

Nasal polyps

Aspirin-intolerant asthma*
CF

21

Chinese adult w/ pleomorphic keratin+ cells in a background of lymphocytes, cervical LA

Nasopharyngeal CA
- EBV*

22

Single in adults or multiple in kids growth on vocal cord

Laryngeal papilloma
- HPV 6,11

23

Pneumonia in nursing home & diabetics

Kleb

24

Pneumonia in alcoholics

Kleb

25

Pneumonia exacerbation of COPD

H. influenzae
#1 = Moraxella

26

Cold agglutinin +, Eaton agar

Mycoplasma pneumoniae
Tx = erythromycin

27

Post-transplant pneumonia

CMV

28

Hypertrophy of bronchial mucous glands, Reid index >50%, productive cough for 3+ months for >2yrs

Chronic bronchitis "blue bloaters"
- infection & cor pulmonale

29

Centriacinar emphysema

SMOKING
Upper lobes

30

Panacinar emphysema

A1AT deficiency
--> misfolded protein accumulates in hepatocytes --> PAS+
- PiZ = most common
- PiZZ = panacinar + cirrhosis

31

Curschmann spirals and charcot-leyden crystals

Asthma
Eosinophil membrane proteins

32

Causes of bronchiectasis

Necrotizing infection --> PERMANENTLY dilated airways

Allergic aspergilloma
CF*
Kartageners
Tumor or foreign body

33

Middle aged male w/ B/L rales, end-expiratory crackles, no wheezing

Idiopathic pulmonary fibrosis (restrictive)
- TGF-B
- amiodarone, bleomycin
- "honeycomb" lung

34

Diffuse lung fibrosis and RA

Caplan syndrome in coal miner
- upper lobes

35

Athracosis

carbon-laden MO

36

Fibrotic nodules in upper lobes, "egg shell" calcification of LNs, birefringent spicules, inc risk for TB

Silicosis

37

Person works at NASA, noncaseating granuloma in organs and hilar LNs

Berylliosis
- INC RISK FOR LUNG CANCER

38

Noncaseating granuloma in multiple organs, cough, elevated serum ACE, hyperCa, African-American

Sarcoidosis

39

Asteroid bodies

Sarcoidosis

40

White, calcified pleural plaques, Golden-brown fibers (ferrugenous bodies), shipyard worker, plumber, LOWER lobes

Asbestosis
- fibrosis of lung and pleura
- inc risk of lung cancer

41

Fever, cough, dyspnea in pigeon breeder that gets better when he goes home, granulomatous inflammation

Hypersensitivity pneumonitis
- resolves w/ removal

42

Exertional dyspnea, peripheral edema, Plexiform lesions

Pulmonary HTN (>25) --> RVH --> cor pulmonale
- Primary = BMPR2 in young females
- Secondary = COPD

43

White out on CXR

ARDS
- hyaline membrane
- Tx = PEEP

44

Neonatal RDS causes

B4 34wks
C-section
Maternal DM --> insulin dec surfactant production

45

Cyanosis after birth, "ground glass" CXR

Neonatal RDS
- PDA
- Necrotizing enterocolitis
- 100% O2 --> ***BLINDNESS*** & bronchopulmonary dysplasia

46

The S's of lung cancer

Small cell
Smokers
Central
Syndromes

47

Male smoker, inc ADH, ACTH, LE syndrome

Small cell
- Central

48

Most common lung tumor in MALE smokers

SCC
- squamous, sentral, smoking

49

Male smoker with hyperCa, keratin pearls and intracellular bridges

SCC
- PTHrP
- Central

50

Most common lung tumor on non-smoker and FEMALE smokers

Adenocarcinoma
- Peripheral
- Pleural effusion
- Glands or mucin

51

Columnar cells along bronchioles and alveoli, pneumonia - like consolidation

Bronchoialveolar carcinoma
- Peripheral
- Excellent prognosis
- NOT smoking related*
- Clara cells

52

Chromogranin +, collar button lesion, polyp-like mass in bronchus

Carcinoid

53

Peripheral lung cancers

Adenocarcinoma
Bronchioalveolar

54

Mets of lung cancer

ADRENAL gland

55

Trachea shift TO side of collapse

Spontaneous (bleb)
- paraseptal emphysema
- apical bullae rupture in young healthy person

56

Trachea shift OPPOSITE collapse

Tension

57

TOC for PE

helical CT

58

Hyperlucency in CXR

Emphysema
- pink puffers

59

No breath sounds, resonance, tactile fremitus

Obstruction

60

Dullness for percussion, dec tactile fremitus

Pleural effusion

61

Dullness to percussion, inc tactile fremitus

Pneumonia

62

Hyperresonant, dec fremitus

Pneumothorax

63

Sheets of tumor cells w/ nuclear molding, "salt and pepper"

Small cell lung carcinoma
"Kulchitsky cells"

64

Winter's forumla for compensation

Expected PCO2 = 1.5 x HCO3- +8 +/-2