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Flashcards in Shit -Respiratory Deck (64):
1

club cell functions

  • Secrete component of surfactant
  • degrade toxins
  • Reserve cells

2

VIP surfactant lecithin

dipalmitoylphosphatidylcholine

3

Lecithin:sphingomyelin ratio

>2 in amniotic fluid = mature lungs

4

Aspiration: upright vs supine

upright = inferior of R. inf. lobe

 

supine = superior of R. inf. lobe

5

Collapsing pressure on alveoli equation

Pc = 2 (ST) / r

6

Physiological deadspace calculation

phys deadspace = anatomical + alveolar

VD = VT + VA

P1V1 = P2V2

VA*PA = VT*PT

(VT-VD)*PaCO2 = PECO2*VT

7

Lung area providing most of alveolr dead space

Apex

(because decreased BF)

8

Minute ventilation

=VT*RR

9

Alveolar ventilation

= VA*RR

= (VT - VD)*RR

10

Taut vs Relaxed Hb

Taut = tissues = low affinity for oxygen

 

Relaxed = respiratory = high affinity

11

Hb exhibits:

positive cooperativity and negative allosterity  (23DPG decreases affinity)

12

Cheynne stokes breathing:

delayed response but high sensitivity to PCO2

13

MetHb: what, how, s/s, rx, use

Hb 3+

Nitrites, benzocaine, dapsone

s/s = cyanosis/dusky skin (baby with sulfa drug)

Rx = Vitamin C + methylene blue

Use: rx for cyanode poisoning (Hb3+ has increased affinity for cyanide)

14

cyanide poisoning s/s

rapidly developing tachypnea, tachycardia, flushing, HA, NV, confusion, weakness

Severe lactic acidosis with low A-V gradient

Burnt almond smell

15

Left shift seen with:

CO

Fetal Hb (dereased 23DPG binding)

Myoglobin (no + cooperativity)

16

Perfusoin vs. diffusion limited

Perfusion = normal

Diffusion = emphysema or fibrosis

 

During exercise still perfusion, but close

17

PVR equation 

PVR = (Ppulm a. - Pwedge (LA) )/CO

18

Alveolar gas equation

PAO2 = PIO2 - (PaCO2/R)

19

HYpoxemia (low PaO2) via:

High altitude

Hypoventilation

V/Q mismatch 

Diffusion-limited

right-to-left shunt

20

where in lung are ventilation and perfusion greatest?

base

21

shunt vs dead space

shunt = V/Q = 0

(no ventilation; blood shunted away)

 

deadspace = V/Q = œ

(no blodo flow, so like a dead space)

22

Exercise and VQ

increases Q at apex via vasodilation; lung zones more uniform

23

Haldane vs Bohr

Haldane = lung

Bohn = peripher

24

Bacterial superimposed infections on rhinosinutisis

s.  pneumoniae

h. flu

m. catarrhalis

 

25

Samter's triad

ASA-intolerance:

- asthma

- nasal polyps

- bronchospasms

26

Epistaxis locations

MC = ant = Kisselback plexus

 

Most severe = post = sphenopalatine artery

27

pleuritic chest pain with tachycardia and tachypnea

PE

28

Fat embolism triad

- Hypoxemia

- Neurological

- Petechial rash

29

PE test

CT angiography

30

Reid index

Chronic bronchitis

>50% from LP to MP is glands

31

Curshman spirals vs. Charcot-leyden crystals

Curshman spirals = shed epithileum 

 

Charcot = eosinophil breakdown releases MBP; hexagonal double-needle crystals

32

pulsus paradoxus seen in:

cardiac tamponade, pericarditis, croup, asthma, OSA

33

Chronic necrotizing infection of bronchi: disease, causes

Bronchiectasis

 

Poor ciliary motility (CF, Kartageners, smoking), bronchial obstructions (tumour, foreign body), allergic bronchopulmonary asthma

34

Elastase: from where, what breaks it down?

PMN; A1-AT

Macrophages; TIMPS

35

sarcoidosis causes increased:

Ca and ACE

36

Restrictive disease with eosinophilic granulomas

langerhans cell histiocytosis or hypersensitivity pneumonitis

37

drugs causing restrictive lung disease

Bleomycin, busulfan, MTX, amiodarone 

38

Decreased FVC and FEV1 seen in:

BOTH obstructive and restrictive

 

obstructive has much lower FEV1

39

Hypersensitiyivty pneumonitis: who, s/s, histo

farmer/bird people

s/s = dyspnea, cough, tight chest, headache

histo = type III and IV (non-caseating granulomas in alveoli)

40

pneumoconiosis complications

cor pulmonale

Caplan syndrome: RA + intrapulmonary nodules

41

lobe and pneumoconiosis

Lower = asbestos

Uppers = beryliosis, coal workers, silliosis

42

pneumoconiosis with pleural and superdiaphragmatic nodules

Asbestosis

43

ferruginous bodies

asbestosis; golden-brown dumbbells in alveolar septae

44

Job and pneumoconiosis:

- roofer, plummer, shipbuilder

- aerospace + manufacturing

- coal

- foundries, sandblasting, mines

- roofer, plummer, shipbuilder: asbestosis

- aerospace + manufacturing: berylliosis

- coal: CWP

- foundries, sandblasting, mines: sillicosis 

45

lecithin:spingomyelin

NRDS

46

complications of NRDS:

metabolic acidosis

PDA

necrotizing enterocolitis 

47

complications of NRDS Rx (supplemental O2)

Retinopathy of prematurity

Intraventricular hemorhage

Bronchopulmonary dysplasia 

48

Causes of ARDS

trauma, sepsis, shock, gastric aspiration, uremia, backterial pneumonia, acute pancreatitis, amniotic fluid embolism

49

complications of nocturnal hypoxia in sleep apnea

systemic/pulmonary HTN

arrythmyas (a fib//flutter)

sudden death

50

plexiform lesions

tufts of capillaries after long term PulmHTN

51

Pulmonary arterial hypertension (PAH)

1' = BMPR2 activating mutation (2 hits), AD, variable penetrance, no prevention of sm proliferation

 

2' = long-term cocaine/amphetamines (appetitie suppressants), CT disease, HIV, portal HTN, congenital heart disease, schistosomiasis.

 

Pther 2' PHTN: hypoxic VC, lung destructoin, recurrent microthrombi

52

Trachea movements and lung lesiosn

AWAY = large pleural effusion or tension pneumothorax

 

TOWARDS = atelectasis or simple pneumothorax

53

increased fremitus

consolidation ONLY i.e. lobar pneumonia, pulmonary edema

54

signs of consolidation (lobar pneumonia, pulmonary edema)

- tactile fremitus

- dull resonance

- bronchial breath sounds

- late inspiratory crackles 

55

chylothorax via:

Thoracic duct injury (left) from trauma or malignancy

 

56

Lung abscess: via disease + bugs; classic sign, Rx

Disease = aspiratoin of OROPHARYNGEAL contents or bronochial obstruction

Bugs = fusobacterium, peptostreptococcus, bacteroides, s. aureus

Classic sign = air-fluid level

Rx = clindamycin (anaerobes above diaphragm)

57

Mesothelioma can cause:

hemorrhagic pleural effusion (exudate), pleural thickening, psammomma bodies

58

mesothelioma RFs

asbestos (MC cause lung cancer)

 

NOT smoking

59

Pancoast tumour can casue: (4)

SVC syndrome [also via catheter thrombosis]

Horners

hoarseness

sensorimotor deficits 

60

lung cancers mets to:

 

lung cancer mets from:

TO: adrenals, brain, bone, liver

 

FROM: breast, colon, brostate, bladder

61

Paraneoplastics in lung cancer:

small cell = ACTH, SIADH, Lamber-Eaton

Squamous cell = PTHrp

62

Gene mutatoins in lung cancers:

small cell = amplification of L-myc

adenoCA = activating mutations in KRAS, EGFR, ALK

Squamous cell = erb-B1

63

Markers in lung cancer

small = neuroendocrine (chromogrannin A, synaptophysin, enolase, neurophysin); kulchinsky cells

Adeno = mucin

Squamous = keratin and intercellular bridges

large = b-HCG

brochial carcinoid = neuroendocrine

 

64

chemo vs surgery for lung cancer:

small cell = chemo

large cell = surgery