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Flashcards in Respiratory Deck (48):
1

Lg airways have (2)?
Lg and sm airways to term bronchioles have?

- Cartilage and goblet cells
- pseudostratified ciliated columnar cells; SmM in airway walls

2

Cells of conducting zone?
Cells of resp zone?
Clara cells are?

- Pseudostratified ciliated columnar cells
- Cuboidal cells in resp bronchioles (type II pneumocytes) and simple sq cells (type I pneumocytes) in alv
- nonciliated columnar cells w/ secretory granules

3

Collapsing P of alv?
- Incr'd T? incr'd r?

P = 2T/r
- incr'd T -> incr'd collapsing P
- incr'd r -> decr'd collapsing P (as w/ insp)

4

Surfactant prod begins when? Mature levels when?

Begins at 26wks
Mature levels at 35wks

5

Where is the PA in relation to the bronchus at ea lung hilus?

RALS:
R ant, L sup
R PA is ant to the R bronchus; L PA is sup to the L bronchus

6

R lung fissures?
L lung fissures?

R: Horiz fissue in front sep'ing Upper from Middle loves; Oblique fissure on side/bottom sep'ing Middle from Lower lobes
L: Oblique fissure sep'ing Upper and Inf lobes

7

What struc's go thr diaphragm? At what levels?

T8 - IVC
T10 - eso (and 2 trunks of vagus)
T12 - Ao (and thoracic duct, azygous v.) (red, white and blue)

8

Diaphragm:
- innervated by?
- pain from it is referred to where?

C3,4,5 keep the diaphragm alive!
Shoulder (C5) and Trapezius ridge (C3,4)

9

Dead space of lung =

vol of inspired air that doesn't participate in gas exchange
Vd = TV x [(PaCO2 - PeCO2)/PaCO2]
aka total vol breathed in x frxn of air NOT expired

10

At FRC: P's of airway, alv and intrapleura are?

Airway and alv are 0, intrapleural space is (-) to prevent pneumothorax

11

Methemoglobin =
- trtmt of methemoglobinemia?
- nitrates -> poisoning, how?

Ox'd Hb (Fe3+) that doesn't bind O2 -> binds CN
- methylene blue + VitC (reducing agent to make Fe2+ again)
- ox'ing Fe2+ to 3+

12

Cyanide poisoning -> trtmt?

- Nitrates: oxidize Hgb to Fe3+ to bind CN (so doesn't hurt cytochrome oxidase func)
- Thiosulfate: bind CN on methemoglobin -> thiocyanate -> renal excretion

13

Diff btwn myoglobin and Hgb?

Myoglobin in monomeric -> no sigmoid binding curve (looks like sidewards upsidedown L)

14

1* pulm HTN due to?

Mutation in BMPR2 gene -> incr'd vasc SmM prolif, usu in yg F

15

Plexiform lesion =
- see in?

tuft of cap's together
- severe LT pulm HTN

16

PVR =

[P(PA) - P(LA)] / CO
- where P(LA) = PCWP

17

Alv gas equ, PAO2 =

PAO2 = PIO2 - PaCO2/R
= 150 - PaCO2/0.8

18

Haldane effect w/ CO2 in lungs?
- what happens in the tissues to make CO2 bind RBCs?

Oxygenation of Hb promotes dissociation of H+ from Hb -> CO2 is made, and thus released from RBCs
- incr'd H+ from tissue metab -> shifts curve to right (Bohr effect) -> unloading O2 so H+ can bind Hb (CO2 is carried as bicarb in the bl)

19

Virchow's triad =

stasis
hypercoag
endo damage

20

Sign of DVT on PE?

Homans' sign = dorsiflexion of foot -> calf pain

21

Fat emboli are assoc'd w/?
3 presenting sx?

- fx of long bones, lipo
- hypoxemia, neuro abnl'ities, petechial rash

22

How to tell if thrombus was made before or after death?

Lines of Zahn = alt'ing layers of plts mixed w/ fibrin (lighter) and RBCs (darker); made from thrombus being at site of rapid bl flow
-> thus was pre-mortum (thrombus also will be attached to wall)

23

COPD = chronic bronchitis or emphysema
What is the difference in mech btwn these two?

- Chronic bronchitis is dz of sm vessels, high mucus production (Reid index >50)
- Emphysema is enlargement of air spaces from destruc of alv walls -> incr'd compliance and decr'd elastic recoil so sm airways collapse on exhale

24

Panacinar emphysema is usu where in lungs? Where is centriacinar?

Pan - LLs (a1AT defic)
Centri - ULs (smoke rises)

25

Curschmann's spirals =
- seen in?

shed epi which forms mucus plus
- asthma

26

Charcot-Leyden crystals =
- seen in?

formed from brkdwn of MBP from Eo's in sputum
- asthma, in coughed up mucus

27

What is bronchiectasis?
- 2* comp of this is?

Obstruc lung dz w/ infec of bronchi -> dilated airways w/ no tone -> air trapping
- 2* amyloidosis from chronic inflamm -> acute phase rct (SAA) -> AA -> deposited as amyloid

28

CF, Kartagener's, and bronchopulm aspergillosis are all assoc'd w/ what obstruc lung dz?

Bronchiectasis

29

Eo'ic granuloma in lung w/ restrictive lung dz?

Langerhans cell histiocytosis

30

What 4 drugs can cause restrictive lung dz?

Bleomycin, busulfan, amiodarone, MTX

31

Why does silicosis incr your risk for Tb?
- also incr's risk for?

Impairs formation of phagolysosomes in Mphage -> risk for Tb
- lung ca

32

Eggshell calcification in hilar LNs?

Silicosis

33

Lower lobes, ivory white calcified pleural plaques?

Asbestosis

34

Noncaseating granulomas in lung, hilar LNs and organs?

Sarcoid OR Be exposure (from aerospace workers, miners)

35

3 RFs for neonatal RDS?
- CXR shows?

Premature
Mat DM (incr'd fetal insulin -> inhib's surfactant prod)
Csxn deliv (decr'd release of fetal gcc's)
- diffuse granularity of lung (hazy)

36

What is the only lung condition w/ bronchial breath sounds and incr'd fremitus?

Consolidation (lobal pneumo - late insp crackles; or pulm edema)

37

Who gets nasopharyngeal ca?
- what is it assoc'd w/?

Af kids and Chinese adults
- EBV

38

Lung ca's that start w/ S are all...

central, assoc'd w/ smoking, and cause paraneoplastic syndromes
aka SCC and sm cell ca

39

Where does lung ca met to?

Ad's, brain, bone, liver

40

Adenoca in lung:
- common mutation?
- common in who?
- assoc'd w/ what on PE?

- k-ras act'ing mutation
- nonsmokers and F's
- clubbing (hypertrophic osteoarthropathy)

41

CXR shows hazy infiltrate like pneumo, what ca?

Bronchioloalveolar = ca along alv septa -> thickening of alv walls; derived from Clara cells

42

SCC in lung
- on histo see what 2 things?
- can produce?

- keratin pearls and intercellular bridges (desmosomes spreading out bc cells are pulling apart)
- PTHrP -> hyperCa

43

Sm cell lung ca
- can produce what 3 things?
- common amp of what oncogene?
- stain for what?
- histo shows?
- trtmt?

- ACTA, ADH or Abs (LES)
- myc
- chromogranin bc is from neuroendocrine cells
- Kulchitsky cells: sm dk blue cells
- chemo, only lung ca you don't first take to surgery

44

What lung ca's are located in the periph?

Adenoca
Lg cell ca (highly anaplastic w/ pleomorphic giant cells, bad)

45

Chromogranin(+) cells that grow as polyp-like mass in bronchioes?

Bronchial carcinoid tumor, good prognosis

46

Causes of lobar pneumo?

95% STREP PNEUMO
5% Klebsiella

47

Causes of bronchopneumo?
- if it were a CF pt?
- if it were a COPD pt?

S. aureus, S. pneumo, H. flue, Klebsiella
- Pseudomonas
- Moraxella, H. flue

48

Atyp pneumo:
- yg adult? baby? immsupp'd? old person? farmer?

- Mycoplasma in yg adults (cold hemolytic anemia)
- RSV in infant
- CMV in immsupp'd
- Influenze -> 2* bac pneumo in old person
- Coxiella (Q Fever, high F) in farmers and vets