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respiratory path Flashcards

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1
Q

transudative pleural effusion is caused by…

A

increased cap. Pressure or decreased oncotic pressure secondary to CHF, cirrhosis or nephrotic syndrome (ie, either more of the fluid in the caps gets pushed out from increased hydrostat p, or less of the fluid gets pushed back into the caps due to decreased oncotic P)

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2
Q

exudative pleural effusion is caused by…

A

increased vascular permeability and inflammation secondary to lung ifxn, malignancy or pulm embolism

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3
Q

what is Kartagener syndrome?

A

aka immotile cilia syndrome– a defect in the protein dynein prevents cilia from moving properly —> impaired clearance of secretions and frequent resp ifxns, infertility and situs inversus (when all the organs in the thoracic cavity are reversed in their position) or situs ambiguus (heterotaxy)- (when the organs in the chest wall are all mixed up in their position– more fatal than situs inversus)

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4
Q

a shift right on the O2-sat/Hb curve means that it’s easier to…

A

unload O2 from Hb

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5
Q

A left ward shift in the O2-sat/Hb curve means that it’s easier to…

A

bind O2 on Hb

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6
Q

5 things that cause a rightward shift on the O2sat-Hb curve (making it easier for O2 to unload from Hb)

A
  1. Decrease pH
  2. Increase in Lactic acid
  3. Increase in temp
  4. Increase in PaCO2
  5. Increase in 2,30BPG

** Note, all of these things happen during exercising, and so you need to be able to ofload more O2 into the muscles!!)

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7
Q

typical lobar pneumonia in alcoholics with red, gelatinous sputum is caused by…

A

klebsiella pneumoniae

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8
Q

klebsiella pneumoniae (which causes typical lobar pneumonia in alcoholics with red/gelatinous sputum) is gram neg or gram pos? oxidase neg or oxidase pos? what shape?

A

gram neg, oxidase neg bacillis

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9
Q

what is the treatment for Klebsiella pneumoniae?

A

third-gen cephalosporin w/or w/out an aminoglycoside

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10
Q

what is the most common paraneoplastic syndrome resulting from small cell lung cancer?

A

cushing syndrome

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11
Q

what are the characteristic elements of cushing syndrome (the most common paraneoplastic syndrome resulting from small cell lung cancer)

A

moon facies, buffalo hump, striae and central obesity

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12
Q

tumor cells of small cell lung cancer have what distinguishing them (2 things)

A

1, hyperchromatic nuclei

2. scant cytoplasm

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13
Q

5 causes of hypoxemia

A
  1. hypoventilation
  2. decreased FI02
  3. shunt
  4. V/Q mismatch
  5. diffusion
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14
Q

in hypoventilation, what happens to Pa02, PaCO2 and A-a gradient?

A

PaO2: decreases
PaCO2: increases
A-a gradient: unchanged

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15
Q

in decreased FI02, what happens to Pa02? A-a difference?

A

PaO2: decreases, due to a decrease in PAO2

A-a diff: unchanged

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16
Q

in poor gas exchange, what happens to Pa02? A-a diff?

A

Pao2: decreases

A-a diff: increases

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17
Q

in what circumstances is hypoxemia a diffusion problem? (leads to a decreased DLCO)

A
  1. strenuous exercise
  2. pulm fibrosis
  3. emphysema (decreased SA for gas diffusion)
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18
Q

when is DLCO increased?

A
  1. intraparenchymal hemorrhage
  2. increased blood volume due to CHF
  3. polycythemia (increased hematocrit)
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19
Q

In V/Q mismatch, what happens to the PaO2? A-a gradient?

A

PaO2: decreases

A-a gradient: increases

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20
Q

the difference between V/Q mismatch and shunt?

A

V/Q mismatch is when there’s air but no blood flow (like a PE)— so V/Q is close to infinity.

Shunt: there’s blood, but no air (like in obstruction)- so V/Q is close to 0

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21
Q

in shunt, where there’s bloodflow but no V (like in airway obstruction, what happens to the Pa02? PaCO2? A-a diff?

A

PaO2: decreases (from about 100 —> 40 mmHg) (same level as mixed venous P)
PaCO2: increases from about 40-46mmHG (same level as mixed venous P)
A-a diff: increases

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22
Q

is R—> L or L—-> R shunt more common?

A

L—-> R because pressures are higher on the rt side of the heart

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23
Q

what is Eisenmenger syndrome?

A

when a L—> R shunt builds up P in the R heart until it eventually equals, and then surpasses the P in the L heart, leading to a R—-> L shunt.

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24
Q

5 types of lung path

A
  1. obstructive
  2. restrictive
  3. infectious
  4. malignant
  5. vascular
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25
cause of unilateral diminished breath sounds?
pneumothorax
26
cause of acute bilateral diminished breath sounds?
respiratory distress (ARDS, asthma)
27
cause of chronic bilateral diminished breath sounds?
emphysema (reduced lung tissue)
28
fine crackles are assoc. with?
opening of collapsed alveoli in atelectasis
29
coarse crackles are assoc. w?
airway opening and fluid in the lungs
30
wheezes are assoc w?
obstructive diseases (asthma/COPD) or foreign body obstruction if sudden onset
31
what are rhonchi?
low-pitched monophonic sounds indicative of airway secretions and obstruction-- like sicking in air through a straw at the bottom of a drink
32
what is stridor? what does it indicate?
high-pitced sound heard over the trachea, reflecting tracheal or laryngeal obstruction
33
Egophany-- what is it? what is it a sign of?
Pt says E, but dr hears it as "A" in Egophany | - sign of lung consolidation (ie pneumonia)
34
dullness to percussion in lungs mt be sign of...
lung consolidation (eg pneumonia)
35
increased tactile fremitus is a sign of...
lung consolidation (pneumonia)
36
decreased tactile fremitus is a sign of
something in the pleura
37
3 major Obstructive diseases?
1. asthma 2. emphysema/chronic bronchitis 3. bronchiectasis
38
how does smoking lead to emphysema?
cig smoke attracts PMNs/macrophages ---> they produce elastase and inhibit alpha1-antitrypsin
39
presentations for emphysema
1. chronic dyspnea w/or w/out a cough
40
what is the "pink puffer" in reference to?
Pa02 in relatively normal in COPD (not cyanotic), but they have to mntn a high minute ventilation to mntn normal levels of Pa02 and PaCO2, so they "puff", working hard to get air in
41
what are the 2 major subtypes of emphysema and what are they assoc with?
panacinar- assoc with alpha 1 antitrypsis disorder | centriacinar- assoc w/smoking
42
what is chronic bronchitis?
productive cough for at least 3 months per year over 2 yrs-- characterized by excessive mucus production that is more viscous than normal in the airways
43
extrinsic asthma-
type I hypersensitivity- IgE and Mast cells, begins in childhood in pt with a fam HO allergy. Common allergens = animal dander (esp cats), pollen, mold and dust mites
44
Intrinsic asthma
asthma assoc w/chronic bronchitis as well as asthma induced by exercise, cold/hot temp, pollutants such as cig smoke, meds (esp aspirin), or stress
45
what's the methacholine/histamine challenge, and what happens in asthmatics?
pt inhales methacholine or histamine. Compared to pt with normal airways, person w/asthma will have bronchoconstriction at a lower dose of the drug- hyperreactive and increased severity (hyperresponsive)
46
what do PaO2 and PaCO2 look like during an asthma attack?
PaO2: decreases because increased V/Q mismatch PaCO2: reduced bc hyperventilation ** If PaCO2 is normal or elevated, you should start worrying bc it might indicate worsening airway obstruction or a tiring individual who can no longer mntn a high minute volume
47
why is a normal or elevated PaCO2 worrying during an asthma attack?
bc it might indicate worsening airway obstruction or a tiring individual who can no longer mntn a high minute volume
48
what type of cells do you see in asthma in the cellular infiltrates?
eosinophils and lymphocytes
49
what is status asthmaticus?
a severe attack that is refractory to bronchodilators. It may require ventilation and can result in death.
50
what is bronchiectasis?
an irreversible dilation of airways caused by inflammatory destruction of airway walls, leading to colonization by bacteria and pooling of secretions.
51
4 causes of bronchiectasis
1. Infection 2. Obstruction (often a tumor) 3. defect in airway clearance of bact. pathogens (Kartagener syndrome- genetic defect in dynein results in ciliary dysfunc and manifests as sinusitis, bronchiectasis and situs inversus) 4. CF
52
presentation of Bronchiectasis
cough, copious mucoid, mucopurulent or purulent sputum production; dyspnea; rhinosinusitis; hemoptysis
53
what are the 3 components of Virchow's triad
1. hypercoagulability 2. endothelial damage 3. stasis of blood flow
54
what causes a pleural rub like what might be heard in a PE?
fibrinous exudate that is reeased from the pleural surface overlying the region of ischemic lung tissue
55
what lab tests will confirm a PE?
a D-dimer Level- provides evidence of thrombus formation (D-dimer is a fibrin degradation product)
56
primary pulm HTN is assoc with...
mutations in genes linked to transforming growth factor beta (TGF-B) signalling and is characterized by vascular hyperreactivity and prolif. of smooth muscle
57
what is the most common cause of persistent pulm HTN of the newborn?
Meconium aspiration at birth
58
pulm HTN gives you what on heart sound exams?
Loud P2, right-sided S3 and S4
59
what is the leading cause of cancer-related death in men and women?
primary lung cancer
60
5 major types of lung cancer?
1. squamous cell carcinoma 2. adenocarcinoma (inc. the bronchioalvelar subtype) 3. small-cell carcinoma 4. large cell carcinoma 5. carcinoid tumors .
61
cigarettes are most closely assoc with what two types of lung cancer?
1. squamous cell carcinoma | 2. small cell carcinoma
62
Superior Vena Cava Syndrome
compression of the SVC by tumor leads to facial swelling, cyanosis and dilation of the veins of the head, neck and upper extrem.
63
pancoast tumor- what is it? what 3 things are commonly assoc w/it?
any type of lung cancer that arises at the apex of the lung ----> can cause 1. Horner syndrome (ptosis, anhidrosis, miosis, enophthalmos, and loss of ciliospinal reflex), 2. hoarseness (paralysis of recurrent laryngeal nerve), 3. distant metastases to the brain, bone, liver or adrenals can manifest w/organ specific symp.
64
what 2 paraneoplastic endocrine syndromes can be caused by small cell carcinoma?
1. cushing syndrome (ACTH secretion) | 2. Syndrome of inappropriate secretion f diuretic hormone (SIADH)
65
what paraneoplastic endocrine syndrome is common in squamous cell carcinoma in lungs?
hypercalcemia- due to PTH-related protein (PTHrP) secretion
66
which lung cancers tend to be centrally located?
squamous and small cell
67
which lung cancers seem to be peripherally located?
adenocarcinoma and large cell (involvement of the hilar lymph nodes or pleura can also be seen)
68
adenocarcinomas, with the exception of ____ tend to be peripherally located in the lungs
bronchioalveolar- which is more diffuse with ground glass opacity
69
sites for metastasis of primary lung cancers ranked by frequency (5)
1. hilar lymph nodes 2. adrenal glands 3. liver 4. Brain 5. bone (ostolytic)
70
nasopharyngeal carcinoma is strongly linked to...
EBV ifxn (EBV infects host by replicating in the nasopharyngeal epithelium and hen infecting nearby tonsillar B lymph.)
71
where is nasopharyngeal cancer frequent?
in the chinese population
72
EBV makes prots that modulate growth signalling in B lymphocytes. As a result it is strongly assoc with what 3 cancers?
1. nasopharyngeal 2, Burkitt lymphoma 3. Hodgkin lymphoma
73
squamous cell carcinoma presents how on histology?
keratin pearls, may cavitate
74
squamous cell carcinoma largely affects
proximal large airways
75
squamous cell carcinoma is often caused by...
smoking
76
adenocarcinomas originate from...
mucus glands
77
adenocarcinomas are often seen in the
lung periphery, sites of scarring
78
the most common primary lung cancer for non smokers is what subtype of adenocarcinoma?
bronchial
79
large cell carcinoma originates from
epithelial cells, very poorly differentiated
80
carcinoids originate from
neuroendocrine cells in lungs or GI tract
81
characteristics of carcinoid syndrome?
secretes serotonin; can cause carcinoid syndrome (flushing, diarrhea, wheezing, salivation)
82
origin of small cell lung cancer?
kulchitsky neuroendocrine cells of primary and secondary bronchi
83
where small cell lung cancer presents
central bronchi
84
the origin of a mesothelioma
pleural cells
85
what is a meningioma assoc with? (2)
1. asbestos | 2. cig smoking
86
4 pathologic findings assoc. with sarcoidosis- which is diagnostic?
1. noncaseating granuloma w/epitheliod histiocytes (this is diagnostic! cell should be pale pink on H&E with nondistinct cell borders) 2. multinuc giant cells of langerhans 3. asteroid bodies 4. schaumann bodies

Boards Respiratory (5 decks)

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