Flashcards in Respiratory Deck (48):
Lg airways have (2)?
Lg and sm airways to term bronchioles have?
- Cartilage and goblet cells
- pseudostratified ciliated columnar cells; SmM in airway walls
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
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)
Surfactant prod begins when? Mature levels when?
Begins at 26wks
Mature levels at 35wks
Where is the PA in relation to the bronchus at ea lung hilus?
R ant, L sup
R PA is ant to the R bronchus; L PA is sup to the L bronchus
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
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)
- innervated by?
- pain from it is referred to where?
C3,4,5 keep the diaphragm alive!
Shoulder (C5) and Trapezius ridge (C3,4)
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
At FRC: P's of airway, alv and intrapleura are?
Airway and alv are 0, intrapleural space is (-) to prevent pneumothorax
- 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+
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
Diff btwn myoglobin and Hgb?
Myoglobin in monomeric -> no sigmoid binding curve (looks like sidewards upsidedown L)
1* pulm HTN due to?
Mutation in BMPR2 gene -> incr'd vasc SmM prolif, usu in yg F
Plexiform lesion =
- see in?
tuft of cap's together
- severe LT pulm HTN
[P(PA) - P(LA)] / CO
- where P(LA) = PCWP
Alv gas equ, PAO2 =
PAO2 = PIO2 - PaCO2/R
= 150 - PaCO2/0.8
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)
Virchow's triad =
Sign of DVT on PE?
Homans' sign = dorsiflexion of foot -> calf pain
Fat emboli are assoc'd w/?
3 presenting sx?
- fx of long bones, lipo
- hypoxemia, neuro abnl'ities, petechial rash
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)
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
Panacinar emphysema is usu where in lungs? Where is centriacinar?
Pan - LLs (a1AT defic)
Centri - ULs (smoke rises)
Curschmann's spirals =
- seen in?
shed epi which forms mucus plus
Charcot-Leyden crystals =
- seen in?
formed from brkdwn of MBP from Eo's in sputum
- asthma, in coughed up mucus
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
CF, Kartagener's, and bronchopulm aspergillosis are all assoc'd w/ what obstruc lung dz?
Eo'ic granuloma in lung w/ restrictive lung dz?
Langerhans cell histiocytosis
What 4 drugs can cause restrictive lung dz?
Bleomycin, busulfan, amiodarone, MTX
Why does silicosis incr your risk for Tb?
- also incr's risk for?
Impairs formation of phagolysosomes in Mphage -> risk for Tb
- lung ca
Eggshell calcification in hilar LNs?
Lower lobes, ivory white calcified pleural plaques?
Noncaseating granulomas in lung, hilar LNs and organs?
Sarcoid OR Be exposure (from aerospace workers, miners)
3 RFs for neonatal RDS?
- CXR shows?
Mat DM (incr'd fetal insulin -> inhib's surfactant prod)
Csxn deliv (decr'd release of fetal gcc's)
- diffuse granularity of lung (hazy)
What is the only lung condition w/ bronchial breath sounds and incr'd fremitus?
Consolidation (lobal pneumo - late insp crackles; or pulm edema)
Who gets nasopharyngeal ca?
- what is it assoc'd w/?
Af kids and Chinese adults
Lung ca's that start w/ S are all...
central, assoc'd w/ smoking, and cause paraneoplastic syndromes
aka SCC and sm cell ca
Where does lung ca met to?
Ad's, brain, bone, liver
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)
CXR shows hazy infiltrate like pneumo, what ca?
Bronchioloalveolar = ca along alv septa -> thickening of alv walls; derived from Clara cells
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
Sm cell lung ca
- can produce what 3 things?
- common amp of what oncogene?
- stain for what?
- histo shows?
- ACTA, ADH or Abs (LES)
- chromogranin bc is from neuroendocrine cells
- Kulchitsky cells: sm dk blue cells
- chemo, only lung ca you don't first take to surgery
What lung ca's are located in the periph?
Lg cell ca (highly anaplastic w/ pleomorphic giant cells, bad)
Chromogranin(+) cells that grow as polyp-like mass in bronchioes?
Bronchial carcinoid tumor, good prognosis
Causes of lobar pneumo?
95% STREP PNEUMO
Causes of bronchopneumo?
- if it were a CF pt?
- if it were a COPD pt?
S. aureus, S. pneumo, H. flue, Klebsiella
- Moraxella, H. flue