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Flashcards in Respiratory concepts Deck (99):
1

Why is the pO2 in the left atrium lower than in the pulmonary veins (where the blood just came from)?

b/c deoxygenated blood originating from the bronchial arteries mixes with the oxy blood ("venous admixture")

2

secreted from the lamellar bodies of type 2 pneumocytes

Surfactant

3

the main components of surfactant

phosphatidylcholine (Lethicin) & sphingomyelin (L:S ratio > 2 means lungs are mature)

4

What kind of transmembrane protein is the CFTR protein (responsible for Cystic Fibrosis)

- an ATP-gated ion transporter - pumps Cl- out against a gradient using ATP for energy

5

Normal arterial blood gas values

-pH ---> 7.35-7.45 -PaO2---> 80-95 -PaCO2 ---> 35-45 -HCO3- ---> 22-26

6

How can you tell an absolute erythrocytosis from a relative erythrocytosis?

 

(Erythrocytosis/ Polycythemia is defined as HEMATOCRIT   > 52%  in men and   >48%  in women) 

you measure the RBC mass

- if it is increased, they have an absolute erythrocytosis

- if it is normal, they have a relative erythrocytosis (ie: relative to decrs in plasma volume) 

A image thumb
7

DIff bwtween Minute Ventilation & Alveolar Ventilation?

Dead Space 

  • Minute Ventilation = Tidal Volume (L) x breaths/min
  • Alveolar Ventilation  = (Tidal volume - dead space) x breaths/min

-Alveolar ventilation only measures the vol of air participating in gas exchange per minute

8

___________ lung diseases are associated with decreased lung volumes & increased expiratory flow rates (due to decreased lung compliance/ increased recoil and increased radial traction on the airways by the lung) 

Restrictive diseases (fibrosis) 

9

Heroin overdose causes what kind of metabolic disturbance?

-Suppresses respiratory centers and causes hypoventiliation, retaining of CO2 --> Respiratory Acidosis 

10

blood flow (Q) is greatest at the _____ of the lung 

at the BASE

-Ventilation (V) is also greatest at the base

-but the perfusion (Q) is MUCH GREATER than the Ventilation at the base ((so the V/Q ratio is actually lower at the base ))

11

Where is the correct place to perform a thoracentesis along the midclavicular line, midaxillary and paravertebral line?

Midclavicular --> btw ribs 5- 7

Midaxillary --> btw ribs 7-9

Paravertebral --> btw ribs 9-11

 

-The pleural border is usually 2 intercostal spaces below the lung border

- you must go in the space past the lung border but within the pleura.. so you must stay within these rib margins

-remember: Needle goes on TOP of rib 

12

Fetal lung Lethicin (dipalmitoyl phosphatidylcholine) increases production at ___ weeks gestation 

increases sharply at 30 weeks 

13

Airway resistance is lowest at the ______________

terminal bronchioles (the smallest ) 

-Why? -- b/c they have the largest total cross sectional area 

- most resistance is in the medium and small sized bronchi 

14

At what point on a spirometry reading is the total pulmonary vascular resistance lowest?

at the end of a regular (vital capacity) expiration 

 

- Not at the end of a forced expiration (b/c then the vessles would be compressed and have higher resistance)

15

In patients with longstanding COPD, what is their main stimulator of respiratory drive??

-CO2?

-O2?

-Hypoxia (low paO2) sensed at the peripheral chemoreceptors (ie: carotid bodies) is their only stimulation of resp drive

-their prolonged hypercapnia has caused CO2 to no longer stimulate the medullay resp center 

16

T or F? 

Blood flow per minute is always the same in systemic and pulmonary circulations?

TRUE

- the rate of flow through the lungs must equal the flow rate in systemic circulation at all times ( or else the chambers of the heart wouldn't fill adequately) 

17

Oxygenated blood from the mother flows into the fetus by the Umbilical __________ --> then to the fetal IVC 

Umbilical Vein 

-1 vein (oxy)

-2 arteries (deoxy)

18

What is the main mechanism for clearing small particles (< 2 microns) from the lungs?

PHAGOCYTOSIS 

 

-largest dust particles are sneezed / coughed out 

- particles 10-15 microns are trapped in the UR tract

-particles 2.5 - 10 microns are cleared by mucociliaryelevator 

- smallest are phagocytized

 

19

What is a normal A-a gradient ?

Normally the Alveolar -arterial gradient is not more than 10-15 mmHg 

(the A-a gradient is the difference btw Alveolar and arterial Oxygen) 

20

dV / dP = 

Compliance 

- volume for a given pressure 

- reduced in Restrictive  lung dz

- increased in Obstructive lung dz

21

Which lung volume is increased in a person w/ COPD?

Residual Volume 

22

What can decrease lung compliance?

-pulmonary fibrosis

-insufficiant surfactant 

-pulmonary edema / congestion (ie: Left sided heart failure) 

23

which nerve mediates the afferent limb of the cough reflex ?

Internal laryngeal nerve

-located in the pharynx in the piriform recess 

- fish bones stuck in the piriform recess can damage this nerve and affect the cough reflex 

24

High altitude exposure lasting more than a few days results in hypoxemia and a chronic ________ _____________, that is compensated by increased renal excretion of bicarb 

Respiratory alkalosis (hyperventilate , blow off CO2)

25

Besides Histamine, what is another marker of anaphylaxis, that is released from mast cells?

TRYPTASE 

26

-a pt with a chronic disease, has hypoxia and  hypercapnia, blood flow to the brain will be incrs or decrs??

Increased

- hypercapnia causes cerebral vasodilation 

- this is common in people with COPD (be careful starting them on Oxygen b/c hypoxia drives their respiratory function-- so taking away their hypoxia state could decrease their respiratory drive)**

27

epithelium type of the TRUE VOCAL CORDS 

Stratified Squamous Epithelium 

28

the equilibrium of O2 in a normal person at rest is ________ limited

Perfusion limited

- the air is in the alveoli, exchange depends on the amount of perfusion to the lungs 

29

Mucociliary clearance is so effective that only particles ______ mm or smaller actually reach the alveoli and must be cleared by phagocytes 

2 mm 

30

Main effect of vagus nerve on lungs

bronchial smooth muscle constriction & incrs mucous secretion 

31

prolonged untreated sleep apnea can have what effect on the heart and lungs?

-each nocturnal episode of decrs ventiliation leads to transient hypercapnea and hypoxemia

- causes systemic and pulmonary vasoconstriction and sympathetic cardiac stimulation

- can lead to pulmonary HTN and Right Heart Failure!

32

-inflammation of the nasal mucosa

- mostly caused by Adenovirus

- sneezing, cough, runny nose 

Rhinitis (common cold) 

-etiology can be viral (Adenovirus) or Allergic Rhitnitis 

33

Young child with nasal polyps should be evaluated for _____________

Cystic Fibrosis 

34

benign nasal mucosa tumor in young males, with profuse epistaxis 

Angiofibroma

35

Malignant tumor of epithelium in the nasopharynx, African children or Asian adults, keratin + biopsy, assoc with a virus

Nasopharyngeal Carcinoma 

- assoc with EBV

- cervical lymphadenopathy 1st sign 

36

child w/ high fever, sore throat, drooling, dysphagia, stridor 

Epiglottitis 

- caused by H. flu 

- med emergency **

37

inflammation of the upper airway caused by parainfluenza virus

Laryngotracheobronchitis (Croup) 

- hoarse, 'barking' cough & stridor 

38

benign papillary tumor on the true vocal cords, due to HPV 6 or 11

Laryngeal Papilloma (warts) 

- single in adults

- multiple in babies 

39

Clnical picture of fever, chills, productive cough w/ yellow/green or bloody sputum, tachypnea, pleuritic chest pain, decreased breath sounds, dullness to percussion, elevated WBC count 

Pneumonia 

- infection of the lung parenchyma

- can be bacterial, viral 

- 3 patterns --->  Lobar, bronchopneumonia or interstitial 

40

Most common cause of community acquired lobar pneumonia

Strep pneumoniae (95%) 

41

pneumonia w/ 'currant jelly' sputum

Klebsiella pneumoniae 

- thick sputum b/c the bacteria has a thick, mucoid capsule 

42

Type of pneumocyte that can regenerate both type 1 & 2 pneumocytes 

Type 2 

43

 type of pneumonia w/ scattered patchy consolidations, centered around the bronchioles

Bronchopneumonia 

- bacterial cause

44

pneumonia w/ mild symptoms, minimal sputum, low fever, associated more w/ virual causes  

Interstitial (atypica) pneumonia 

- #1 bac cause --> Mycoplasma pneumonia

- Viral causes --> CMV, RSV, Influenza 

45

2 main causes of lobar pneumonia 

1- Strep. pneumo --> normal community acquired

2- Klebsiella --> malnourished, elderly, nursing homes, alcoholics, pts at aspiration risk

46

cause of secondary bacterial lung infection on top of a viral illness

Staph aureus 

47

cause of bronchopneumonia in patients with Cystic Fibrosis 

Pseudomonas aeruginosa 

48

community acquired pneumonia, transmitted from water source 

Legionella pneumophilia 

49

cause of atypical pneumonia in the elderly, immunocompromised, and those with preexisting lung dz

Influenza virus 

50

atypical pneumonia w/ high fever ("Q fever") in farmers/ veterinarians, transmitted by ticks on cattle

Coxiella burnetii 

51

First exposure to TB causes: 

-focal, caseating necrosis that undergoes fibrosis --> GHON COMPLEX 

- asymptomatic but + PPD test 

52

Secondary TB arises with the reactivation of the bacteria (commonly due to AIDS) and symptoms include: 

-fever, night sweats, chills, cough, hemoptysis, weight loss 

- can spread all over body (lumbar vertabrae is caleled "Pott's dz") 

53

Lung dz with decreased FVC, FEV1 and decreased FEV1/ FVC ratio 

Obstructive lung diseases 

- TLC is increased due to air trapping 

54

cough lasting at least 3 months over a minimum of 2 years , assoc with smoking 

Chronic Bronchitis 

- hypertrophy of mucous glands

- incresaed thickness of mucous glands compared to overall bronchial wall ("REID INDEX > 50% )

55

smoking causes _______ emphysema

and A1-antitrypsin deficiency causes __________ emphysema 

-centriacinar

- panacinar 

56

PiZZ allele associated w/ __________

panacinar emphysema & cirrhosis 

57

cell mediators in asthma 

Th2 cells -- secrete IL-4, IL-5 & IL-10 

58

diseases associated with Bronchiectasis 

1- Cystic Fibrosis

2- Kartageners

3- Tumor or foreign body

4- Necrotizing infection 

5- Allergic bronchopulmonary aspergillosis 

59

decreased TLC, FVC, and FEV1..... but FEV1/FVC ratio is increased 

Restrictive lung diseases 

60

end stage is "honey comb" lung appearance 

Idiopathic Pulmonary Fibrosis 

-TGF-beta from the injured cells causes the fibrosis 

- tx = lung transplant 

61

Interstital lung fibrosis due to occupational exposures to small particles..

Pneumoconioses :

- Coal Worker's (black lung)

- Silicosis

- Berylliosis (NASA workers/ aerospace work)

-Asbestosis 

62

NON-caseating granulomas

-Sarcoidosis (assoc w/ AA women)

- Berylliosis (assoc with aerospace workers)

63

young adult female w/ inactivating mutation of BMPR2 

Primary Pulmonary HTN 

- can lead to cor pulmonale 

64

formation of hyaline membranes thickens the air exchange barrier, "white out" on CXR 

Acute Resp Distress Syndrome (ARDS)

- free radical damage of both type 1 & 2 pneumocytes

- hundreds of causes

65

solitary 'coin lesion' on CXR

-Lung Cancer 

- benign granuloma

- bronchial hamartoma 

66

type of lung cancer NOT amendable to surgery, assoc with male smokers, central location , has many paraneoplastic syndromes 

Small cell carcinoma 

67

most common lung tumor in male smokers, central location , may produce PTHrP (& cause hypercalcemia)

Squamous Cell Carcinoma 

68

Most common lung tumor in non-smokers and female smokers

Adenocarcinoma 

- glands / mucin

- peripheral location 

69

Lung cancer with columnar cells growing along bronchioles and alveoli, arise from CLARA CELLS, not related to smoking, peripheral, GREAT PROGNOSIS

Bronchoalveolar Carcinoma 

70

Most common overall lung cancer 

METASTASIS form other cancers 

71

rupture of an emphysematous bleb in young adults

Spontaneous Pneumothorax 

- trachea deviates TOWARD collapsed lung 

72

penetrating chest wall injury, air enters with each breath but can't escape, trachea deviates away from collapsed lung 

Tension Pneumothorax 

73

definition of a Ghon complex 

-a lower lobe fibrotic lung lesion w/ an ipsilateral calcified lymph node --- sign of primary exposure to TB 

74

bronchiolitis obliterans is assoc w/ _______ lung transplant rejection 

CHRONIC rejection 

75

a cavitary lesion on CXR with an air-fluid level 

Lung abscess 

- ususally a result of aspiration

- fever, weight loss, cough, foul smelling sputum 

76

FNA of a lung lesion in your patient shows Fusobacterium, Peptostreptococcus, or Bacteroides --> what do you think caused it?

ASPIRATION of oropharyngeal contents 

-these are anaerobic bacteria

-assoc w/ alcoholism, seizure disorders, dementia, CVA

77

a worker exposed to Asbestos is at greatest risk for developing ______________

1- Bronchogenic carcinoma

2- Mesothelioma (less common than cancer) 

3- Asbestosis 

78

a pt with acute pancreatitis is at risk for what serious lung complication?

ARDS

- hyaline membranes in alveoli 

79

N-acetylcysteine works as a mucolytic by:

cleaving disulfide bonds within mucous --> loosening thick sputum 

-used in CF and in Tylenol overdose ...

80

administering ________________ to at risk HIV + patients (CD4+ count < 50)  weekly can decrease their chance of Mycobacterium Avium-Intracellulare infections

Azithromycin 

81

a patient is put on inhaled corticosteroids for asthma not well controlled with Albuterol alone... what should you instruct them to do after each puff?

Rinse their mouth out 

- these pts are at risk for oral candidiasis 

82

What are the 4 phases of Lobar pneumonia?

1- Congestion (first 24 hours) - lobe is red, heavy, boggy

2- Red Hepatization (2-3 days) - red, firm lobe

3- Gray Hepatization (4-6 days) - gray / pale firm lobe

4- Resolution - enzymatic digestion of the exudate 

83

high circulating levels of _________ increase the ESR (a non specific marker for inflammation) 

fibrinogen ( an acute phase protein) 

- brought on by IL-6, IL-1 and TNF-alpha 

84

use of oxygen therapy in premature neonates can cause _________

retinopathy 

- oxygenation induces VEGF in the retina after return to normal room air

- can lead to blindness 

85

Leukotriene C4, D4 & E4 receptor blockers are useful treatments for ___________

Atopic / allergic asthma 

86

Children who develop asthma have an imbalance of Th1 to Th2 lymphocytes....which one do they have more of?

Th2 

87

antifungals that inhibit the synthesis of the fungal CELL WALL

Caspofungin & Micafungin 

88

Which TB medication requires an acidic environment to kill the bacteria and therfore is most useful against the INTRACELLULAR organisms??

Pyrazinamide 

- works best in acidic places

- kills TB within the macrophage phagolysosomes

89

 mycobacterium treated with drug X lose their "acid fastness" and stop proliferating, which TB drug is being used?

ISONIAZID

- inhibits the synthesis of mycolic acids (cell wall)

90

Pneumoconiosis that produces calcified hilar lymph nodes and birefringent particles surrounded by dense collagen fibers 

Silicosis 

- densities form in upper lobes

- increases your risk for TB 

91

drug that blocks endothelin receptors , is used to treat Primary Pulmonary HTN (by decreasing pulmonary arterial pressure and lessening the progression of RVH) 

BOSENTAN 

92

most notable side effect of the TB drug, Ethambutol ....

OPTIC NEURITIS 

- presents as decrs visual acutiy, scotomas, color blindness

93

localized pleural thickening with calcification --> pt probably exposed to :

Asbestos 

94

best imaging test for a suspected PE

Helical CT 

95

Why do babies born to mothers with diabetes have decreased surfactant ?

b/c Insulin decreases surfactant production 

 

((the babies have been exposed to high glucose and therfore have been secreting a lot of Insulin)) 

96

non-specific Beta-agonist , used in Asthma to relax bronchial smooth muscle , but also has side effect  of tachycardia 

Isoproterenol 

97

Beta-2 agonists for Asthma treatment 

-Albuterol --for acute attacks

-Salmeterol  --long acting, for prevention of attacks

98

Asthma drug that prevents mast cell degranulation, onlt used for prevention, not for acute asthma attacks 

Cromolyn sodium 

99