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Pulmonary > Test #1 > Flashcards

Test #1 Flashcards

1
Q

atrial nauteric peptide

A

relaxes smooth muscles

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2
Q

Prostaglandin i2

A

relaxes vascular tone

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3
Q

pulmonary hypertension

A

above 25 or above 35 during exercise

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4
Q

causes of pulmonary hypertension

A

increased flow, increased resistance, increase in left atrial pressure

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5
Q

obstructive mnemonic

A 
Foreign body
Asthma
Chronic bronchitis
Emphysema
Small airways - brochiolitis
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6
Q

restirctive mnemonic

A 
Pleural disease
Alveolar filling
Interstial deisease
Neuromuscular disease
Thoracic cage
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7
Q

characteristics of obstructive disease

A

all airways

  • more resistance, more work of breathing
  • dyspnea, cough
  • wheezing and ronchi
  • diminished breath sounds
  • expiratory prolongation
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8
Q

tethering or radial traction

A

alveoli close together pull open airways, diminished in emphysema

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9
Q

characteristics of restrictive disease

A

no problem with airways, no problem with expiratory flow, dyspnea, cough, lower lung volumes, crackles and rales, no wheezing, normal ratio

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10
Q

hoover sign

A

inward movement of ribcage instead of outward during inspiration - indications diaphragm flattening seen in COPD

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11
Q

ERV

A

Expiratory reserve volume: the maximal volume of air that can be exhaled from the end-expiratory position

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12
Q

IRV

A

Inspiratory reserve volume: the maximal volume that can be inhaled from the end-inspiratory level

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13
Q

IC

A

Inspiratory capacity: the sum of IRV and TV

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14
Q

FRC

A

Functional residual capacity: the volume in the lungs at the end-expiratory position

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15
Q

MVV

A

Maximal voluntary ventilation: volume of air expired in a specified period during repetitive maximal effort

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16
Q

What diffuses better in alveoli

A

CO2 is 20 times more soluble than oxygen and diffuses faster

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17
Q

blood gases perfusion or diffusion limited?

A

perfusion, equilibrates quickly enough based on blood flow

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18
Q

factors leading to weaker binding of oxygen to hemoglobin

A

Increase temp
Increase in CO2
decrease in pH
increase in 2,3 DPG

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19
Q

Haldane effect

A

increasing O2 concentrations on hemoglobin leads to increase in offloading of CO2

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20
Q

four causes of hypercapnia

A
  • increased CO2 production
  • hypoventilation
  • increased dead space
  • V/Q mismatch
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21
Q

causes of low V/Q

A
  • mucus airway obstruction
  • bronchoconstriction
  • pulmonary edema
  • pulmonary fibrosis
  • prolonged anesthesia
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22
Q

Causes of high V/Q

A

emphysema

  • pulmonary embolism
  • hemorrhage
  • positve pressure ventilation
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23
Q

characteristics of a V-Q mismatch

A
  • wide A-a gradient
  • variable PaCO2
  • hyperventilation helps a little
  • improves with increased FiO2
  • most common cause of hypoxemia
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24
Q

characteristics of shunt

A
  • wide A-a gradient
    PaCO2 usually decreased
  • magnitude depends
  • no improvment iwth increased FiO2
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25
Q

characteristics of diffusion abnormality

A
  • Wide A-a
  • worse with exercise
  • improves with FiO2 increase
  • PaCO2 is usually low
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26
Q

characteristics of hypoventilation

A
  • normal A-a gradient
  • improves with FiO2
  • increase in PaCO2
  • cant breathe or wont breathe
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27
Q

indications of diaphragm weakness

A

Hoovers sign, throracoabdominal paradox, orthopnea

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28
Q

effect on PFTs of diaphragmatic weakness

A

looks like restriction, no diffusion problem - also, greater than 10% decrease in VC when supine

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29
Q

DRG

A

dorsal respiratory group - inspiratory neurons, ramp signal which then stops to allow for expiration

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30
Q

outputs of DRG

A

diaphragm, external intercostals, receives input from peripheral cardiopulmonary sensors

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31
Q

VRG

A

respiratory rhythm generator, , both inspiratory (DRG) and expiratory (do not fire during resting breathing)

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32
Q

outputs of VRG

A

cranial nerves, inspiratory muscles, caudal portion to expiratory muscles

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33
Q

apneustic center

A

in lower pons, can prolong ramp signal action

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34
Q

pneumotaxic center

A

can switch off inspiration and can regulate inspiratory volume

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35
Q

Hering Breuer reflex

A

overinflation of the lung send signals to vagus nerve to the pneumotaxic center to terminate inspriation

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36
Q

J receptors

A

small unmyelinated axons respond to interstitial edema and engorging of capillaris

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37
Q

apnea

A

lack of airflow for more than 10 sec

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38
Q

hypopnea

A

30% or less airflow for 10 sec plus 3 less SpO2 or wake from sleep

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39
Q

apnea-hypopnea index

A

(apnea + hypopnea)/hour of sleep

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40
Q

resp effort related arousal

A

RERA = sequence of breaths (for >10s) with ↓ effort and arousal (but not apnea or hypopnea)

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41
Q

leptin and OHS

A

leptin suppreses appetite and increase respiration, so with lower levels there maybe problems

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42
Q

prostacyclin

A

vasodialator

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43
Q

endothelin

A

vasoconstrictor

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44
Q

thromboxane

A

vasocronstrictor

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45
Q

NO

A

vasodialtor

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46
Q

VEGF

A

growth factor for blood vessels

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47
Q

type of cancer you can get from not smoking

A

adenocarcinoma

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48
Q

TTF stain

A

used for detecting adenocarcinoma and small cell cancers

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49
Q

celretinin

A

stains positive for mesothelioma

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50
Q

tumor that leads to hypercalcemia

A

adenocarcinoma

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51
Q

calcification

A

likely a begnin mass

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52
Q

squamous cell carcinoma

A

central lesion, firm, near a bronchus, associated with smoking, keratin, intracellular bridges squamous metaplasia,, tadpole cell

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53
Q

adenocarcinoma

A

most common, less associated with smoking, peripheral, glands, papilla and mucin production, positive for TTF-1,

54
Q

adenocarcinoma in situ (bronchiolalveolar carcinoma)

A

better prognosis, small peripheral nodule, lipidic growth pattern, does not invade past basement membrane, mucin productin

55
Q

small cell carcinoma

A

aggressive, not a surgical disease, frequent paraneoplastic issues, powdery chromatin, nuclear molding, mitotic figures, derived from neuroendocrine cells

56
Q

carciniod

A

low grade, TTF-1, neuroendocrine, low mitotic index, cells have more cytoplasm

57
Q

hamartoma

A

peripheral, well circumscribed, cartilage, focal fat, epithilium

58
Q

pleural plaques

A

secondary to asbestosis exposure, dense bands of collagen with no cells

59
Q

mesothelioma

A

asbestosos exposure, poor prognosis, epithiliod type, positive for calretinin, spindle cell

60
Q

OHS

A

obese, hypercapnia, no other explanation - leads to pulmonary hypertension

61
Q

acute resp acidosis equation

A

ph = paCO2 X 0.008

62
Q

chronic resp acidosis

A

ph = paCO2 X 0.003

63
Q

non CF bronchiectasis

A

acquired, idopathic, disease only in lung usually, permanent increase in size of airway, mucus retention, infection, dialated airways

64
Q

CF

A

CFTR, F508, cholride channel, multisystem

65
Q

CFTR

A

in skin, chloride back in, in lung, chrloride out of the cell, means in CF there is less water and more mucus

66
Q

meconium ilieus

A

pathognomonic in CF

67
Q

diagnosis of CF

A

clinical symptom in one organ and CFTR dysfunction

68
Q

clubbing

A

from abnormal growth factors in the digits, in right to left shunt conditions

69
Q

treatment of CF

A
  • chest physical therapy (flutter valve)
  • antibiotics - inhaled tobramycin - start with staph and hemophilus then pseudomonas
  • nebulized DNase
  • nebulized saline - hydrate
  • bronchodialtors - only B2 agonist - not anti cholinergic due to bowel problems
  • steriods - too many side effects
    NSAIDS - many side effects
  • macrolides - used as an antiinflammatory
70
Q

atopy

A

allergic tendency to develop IgE antibody response

71
Q

risk factors of asthma

A

Atopy, airway hyperresponsiveness, adult male, child female, obesity, genetics, expsoures

72
Q

hallmarks of asthma

A
  • airway inflammation (degree = severity)
  • airway hyperresponsiveness twitchy airways
  • airflow obstruction - smooth muscle, mucus, inflammation
73
Q

cells in asthma

A

mast cells and eosinophils and lymphocytes

74
Q

early phase and late phase of asthma

A

early - mast cells and histamine

late - cells and cytokines and eosinophils - leads to injury and bronchoconstriction, leaky vessels, mucus

75
Q

evidence of asthma

A

skin, upper airway and lung - measure lung function (bronchoprovocation)

76
Q

methocholine

A

parasympathetic agent for bronchoprovocation

77
Q

noctural asthma

A

worse in the early morning, circadian release of bronchoconstrictors and vasodialators, lung volume smaller at night, more blood in heart, less protection of airways, melatonin

78
Q

exercise induced bronchoconstriction

A

if its the only manifestation of the disease, after 10 minutes of stopping, only early phase reaction, there is a refractory period (prostaglandin?)

  • cause by cool dry gas causing a problem
79
Q

treatment of asthma

A
  • acute relief medication
  • long term = steriods and LT antagonists
  • immunotherapy
  • anti-cytokine
80
Q

most common ILD in older patient

A

idiopathic pulmonary fibrosis

81
Q

most common ILD in younger patients

A

sarcoidosis

82
Q

ILD clinical picture

A

non productive cough, rapid shallow breathing, inspiratory rales, reticular, ground glass, honeycombing, low compliance, hypoxemia and late hypercapnia

83
Q

honeycombing

A

fibrosis

84
Q

idiopathic pulmonary fibrosis

A

most common in older patients, nothing else is an option, injury to alveolar epithelium, UIP, reticular or honeycoming, unrelenting course

85
Q

sarcoid

A

granuloma, immune response to antigen, CD4 cells, hilar adenopathies, multisystem, variable course

86
Q

desquamative interstitial pneumonia

A

SMOKER - DIP, similar to RB-ILD, pigmented alveolar macrophages, ground glass opaciticies

87
Q

COP

A

cryptogenic organizing pneumonia, proliferative bronchiolitis, denser infiltrate, responds to steriods

88
Q

Pulmonary Langerhans cell histiocytosis

A

SMOKERs, birbeck granules, stain for S100, can go beyond the lung, stellate nodules

89
Q

chronic eosinophilic pneumonia

A

blood count has eosinophils, responsive to steroids

90
Q

pneumoconioses

A

inhalation of inorganic dust

91
Q

hypersensitivity pneumonitis

A

reaction to organic material, type III or type 4, CD8 cells, poorly formed granulomas, steroids help

92
Q

asbestosis

A

pulmonary fibrosis, pleural plaques - collagen in surface, exudative pleural effusion, mesothelioma

93
Q

silicosis

A

rocks, ineffective phagocytosis, risk factor for TB and cancer

94
Q

silo fillers

A

NO2 - direct injury pulmonry edema

95
Q

byssinosis

A

from LPS from cotton, like asthma

96
Q

RADS

A

injury from airway epithelium from caustic fumes - like asthma

97
Q

occupational asthma

A

yeast, red cedar, TDI - clinical diagnosis, good for looking a peak flow pattern

98
Q

acute hypoxemic respiratory failure

A

PaO2 less than 60 or PaO2/FiO2 less than 300

surge in catecholamines, high resp rate

99
Q

acute hypercapnic respiratory failure - type 11

A

PaCO2 greater than 45

  • low pH, low ICP, CO2 narcosis
  • chronically mitigated through kidney
100
Q

nasal cannula

A

cant tell how much oxygen, it has a limit, no hinderance

101
Q

high flow nasal cannula

A

can pretty much estimate FiO2, can humidify

102
Q

complications of oxygen therapy

A

retinopathy - from oxygen radicals

  • can get acute injury
  • some get increase in CO2 from more dead space
  • CO2 gets released from Haldane effect
103
Q

indications for mechanical ventilation

A

refractory hypoxemic respiratory failure

hypercapnic respiratory failure

104
Q

NIV is most effective for

A

COPD acute exacerbation and acute cardiogenic pulmonary edema and pneumonia and chronic respiratory failure

105
Q

criteria fro ARDS

A

insult in past week, abnormal CT or Xray, respriatory failure can not be explained by something else, hypoxemia

106
Q

surfactant deficiency and dysfunction

A

seen in ARDS

107
Q

how to treat ARDS

A

use low tidal volumes to prevent overdistension of lungs, also need to give enough PEEP

108
Q

when do you see ribcage paradox

A

when diaphragm is working but there is a problem with accessory muscle use

109
Q

best test for measuring diaphragm function

A

MIP

110
Q

when exercise decreases the PaO2 the cause is always due to….

A

diffusion abnormality

111
Q

Reid index

A

Size of mucus gland compared to size of bronchial wall

112
Q

disease with spatial and temporal heterogeneity

A

UIP

113
Q

UIP is a ________ diagnosis

A

pathologic

114
Q

increased ACE levels in serum

A

sarcoidosis (also hypercalcemia)

115
Q

disease with pigmented macrophage

A

DIP - desquamative interstitial pneumonitis - smokers disease

116
Q

disease with poorly formed granulomas and CD8 cells

A

hypersensitivity pneumonitis

117
Q

short acting bronchodialators

A

albuterol and ipratiopium

118
Q

long acting bronchodialators

A

salmeterol and tiotropium

119
Q

what constitutes exudative effusion

A

pleural fluid protein/ serum protein > 0.5

Pleural fluid LDH / serum LDH >0.6

120
Q

causes of tranudative effusions

A

CHF, atelectasis, nephrotic syndrome, hepatic hydrothorax from chirrosis

121
Q

causes of exudative effusions

A

anything that blocks fluid

- tumors, pneumonia, TB, PE, chylothorax, collagen vascular disease

122
Q

vasodialators

A

NO and prostacyclin

123
Q

mechanism of beta agonist

A

binds to beta receptor, increasing cAMP and releasing potissium

124
Q

mechanism of anticholinergics

A

blocks cholinergics leading to increase in cAMP

125
Q

Downsides of LABA

A

black box in asthma users, might cause early death when used alone

126
Q

mechanism of antileukotrienes

A

beneifical in athma, mediator of inflammatory response, helps, causes decrease in eosinophils

127
Q

cromylyn

A

blocks release of histamine and leukotrienes from mast cells

128
Q

defintion of hypoxemic respiratory failure

A

less then 60 PaO2 or PaO2/FiO2<300

129
Q

organized collagen bundles

A

siliciliosis

130
Q

loosley formed granulomas

A

hypersensitivity pneumonitis

131
Q

s-100, stellate, smoking, birbeck granules

A

langerhan histiocytosis

Pulmonary (1 decks)

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