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Resp DRX > 01a: Dyspnea, Obstructive Diseases > Flashcards

01a: Dyspnea, Obstructive Diseases Flashcards

1
Q

Hearing “velcro” on lung sounds; formally called (X).

A

X = crackles

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2
Q

(X) breath sound is normal if heard over trachea, but abnormal if heard over lungs.

A

X = bronchial

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3
Q

Obstruction of airflow in bronchial tree will present as (X) breath sounds. If obstruction is in upper airway, (Y) breath sounds heard.

A 
X = wheezing
Y = stridor
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4
Q

T/F: PaO2 is more tightly regulated by CNS than PaCO2.

A

False - PO2 detected by peripheral chemoreceptors, while PCO2 tightly regulated by CNS

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5
Q

PaO2 is determined by which three factors?

A
  1. PAO2 (in alveolus)
  2. Ability of O2 to diffuse into blood of lung cap
  3. Ability of lung to match ventilation and perfusion (V/Q ratio)
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6
Q

Write out Alveolar Gas Equation. Which factor(s) is/are measured?

A

PAO2 = FO2(PB-PH2O) - (PaCO2/R)

PaCO2 is measured

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7
Q

Respiratory quotient (R) represents (X). What’s the normal value?

A

X = CO2 produced/O2 consumed

0.8

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8
Q

The ABG provides (X) value(s) to allow clinician to calculate A-a gradient.

A
  1. PaCO2 (to calculate PAO2)

2. PaO2

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9
Q

Reduced PaO2 with normal A-a gradient are due to which potential causes? How can the clinician differentiate between these?

A
  1. Hypoventilation (will produce hypercarbia)

2. Low FIO2 (high altitude)

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10
Q

Shunt: you would expect SvO2 to be (increased/decreased).

A

Increased

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11
Q

Four main causes of low SvO2:

A
  1. Anemia
  2. Low CO (delivery)
  3. High VO2 (tissue consumption)
  4. Arterial desaturation
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12
Q

Hypoxemia is present if (X) value is (over/under) (Y).

A
  1. X = PaO2 under Y = 60mmHg

2. X = oxygen sat under Y = 90%

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13
Q

List the mechanistic causes of hypoxemia. Star the most common cause.

A
  1. V/Q Mismatch*
  2. Shunt
  3. Hypoventilation
  4. Diffusion abnormality
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14
Q

At (X) landmark, V/Q ratio equals 1.

A

X = rib 3

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15
Q

Which shunt(s) may exist in normal, healthy individual?

A
  1. Thebesian veins (heart)

2. Bronchial to pulm venous anastamoses

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16
Q

V/Q ratio equals zero in which disease state?

A

Shunt (V equals 0)

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17
Q

V/Q ratio equals infinity in which disease state?

A

Pulmonary embolism (Q equals 0)

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18
Q

Patient is hypoxemic and treatment with 100% O2 does not cause PO2 levels to rise as expected. What do you suspect is the cause of his hypoxemia?

A

R to L shunt

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19
Q

Patient has thickened blood-gas barrier. Will exercise help raise his PO2?

A

No - increase in blood flow will shorten time that RBC has in pulmonary capillary, so won’t reach full O2 saturation

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20
Q

Bronchial mucosa has (X) epithelium and which other cells/structures?

A

X = pseudostratified ciliated

Goblet cells, cartilage, submucosal (mucus) glands

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21
Q

(X), fundamental unit of lung, consists of which structures?

A

X = acinus

  1. Resp bronchiole
  2. Alveolar duct
  3. Alveolus
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22
Q

Alveolar wall: (X) lined by endothelium rests on BM in contact with (Y), which is in contact with BM of (Z).

A 
X = capillary
Y = interstitium (collagen, elastic fibers)
Z = alveolar epithelium (Type I and II pneumocytes)
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23
Q

95% of alveolar surface is covered by (X) cells.

A

X = Type I pneumocytes (flattened)

24
Q

Function(s) of Type II pneumocytes.

A
  1. Stem cells (replace Type I pneumocyte)

2. Surfactant production

25
Q

(X) structures in (bronchi/bronchioles/alveoli) walls allow communication.

A

X = pores of Kahn

Alveoli

26
Q

Most, (X)% of emphysema, is (pan/centri)-acinar emphysema and affects (Y) portion of acinus.

A

X = 95
Centriacinar;
Y = respiratory bronchiole

27
Q

(Centri/pan)-acinar emphysema occurs in heavy smokers (often with COPD) and is more severe in (upper/lower) lobes.

A

Centriacinar;

Upper

28
Q

(Centri/pan)-acinar emphysema associated with (X) deficiency and is more common in (upper/lower) lobes.

A

Panacinar;
X = alpha-1 antitrypsin
Lower

29
Q

Pathogenesis of emphysema is primarily based on (X) phenomena.

A

X = protease-antiprotease and oxidant-antioxidant imbalances

30
Q

Emphysema: loss of (X) of lung parenchyma results in collapse of (Y) structures. Hence, “obstructive” disease.

A 
X = elastic recoil
Y = respiratory bronchioles
31
Q

Chronic bronchitis is defined clinically with which symptoms?

A

Persistent cough with sputum production (for at least 3 months in at least 2 consecutive years)

32
Q

Chronic bronchitis: which histological/structural changes would you expect to find?

A
  1. Hypertrophy of submucosal glands (Reid index)
  2. Goblet cell metaplasia
  3. Mucus plugging
  4. Fibrosis
33
Q

Reid index is the ratio of (X) to (Y). What’s a normal value?

A 
X = thickness of bronchial submucosal glands
Y = thickeness of wall between epithelium and cartilage

0.4

34
Q

Bronchiectasis: (reversible/irreversible) dilation of (X) structures due to (Y).

A

Irreversible;
X = bronchi/bronchioles
Y = destruction of wall by necrotizing infections/pneumonia

35
Q

Congenital bronchiectasis is associated with (X) disease.

A

X = CF

36
Q

Bronchiectasis typically affects (upper/lower) lobes, (uni/bi)-laterally.

A

Lower;

bilaterally

37
Q

Bacterial pneumonia presents as which patterns/distributions?

A
  1. Lobar (consolidation)

2. Bronchopneumo (patchy)

38
Q

Stages of lung inflammation in pneumonia:

A
  1. Congestion
  2. Red hepatization
  3. Grey hepatization
  4. Resolution
39
Q

In (X) stage of pneumonia inflammation, there’s massive confluent exudation of RBCs, neutrophils, and fibrin in (interstitium/alveoli). Lung is red, firm, airless.

A

X = Red hepatization

Alveolar spaces

40
Q

Location of inflammation in viral/mycoplasma pneumonia is:

A

confined to alveolar septa and interstitium

41
Q

T/F: Pleuritis is more frequent in viral pneumonia than in bacterial pneumonia.

A

False

42
Q

Viral pneumonia: alveolar spaces typically contain (X).

A

X = nothing (inflammation confined to interstitium/septa)

OR may have cell exudate/fibrin due to alveolar damage

43
Q

(X) pneumonia usually occurs in markedly debilitated patients. The infectious agents originate from (Y).

A 
X = aspiration
Y = oral flora (bacteria)
44
Q

Methacholine challenge: Increasing dose of methacholine is expected to (increase/decrease) (X) in (Y) patients. Why?

A

Decrease;
X = %FEV1 (when compared to their original value)
Y = asthmatic/hyperactive airway patients

Methacholine increases twitchiness/bronchoconstriction of airway and asthmatics will react to lower doses of this drug

45
Q

Early phase response to inhaled allergen involves (sudden/gradual) decrease and then increase in (X) value. This is due to (Y) phenomenon.

A

Sudden;
X = FEV1
Y = bronchoconstriction

46
Q

Late phase response to inhaled allergen involves (sudden/gradual) decrease and then increase in (X) value. This is due to (Y) phenomenon.

A

Gradual
X = FEV1
Y = edema, secretions, inflammation

47
Q

Asthma histology: goblet cell (hypo/hyper)-plasia, (X) changes in BM, and submucosal (Y) deposition.

A

Hyperplasia;
X = thickening
Y = collagen

48
Q

Asthma histology: smooth muscle (hypo/hyper)-plasia and vascular (constriction/dilation).

A

Hyperplasia;

Dilation

49
Q

List the causes of airway obstruction in asthma.

A
  1. Bronchial/bronchiolar mucosal inflammation and edema
  2. Smooth muscle hypertrophy/constriction
  3. Excess mucous in lumen
50
Q

Early day care exposure and older siblings are factors that favor Th(1/2) phenotype, aka (X).

A

Th1;

X = protective immunity

51
Q

Widespread use of antibiotics and urban environments are factors that favor Th(1/2) phenotype, aka (X).

A

Th2;

X = allergic diseases (i.e. asthma)

52
Q

Asthma: (increase/decrease) in AP diameter and (increase/decrease) in accessory muscle use.

A

Increase both

53
Q

Which skin findings might you look for when suspecting asthma in patient?

A

Eczema

54
Q

Which upper airway findings would you look for when suspecting asthma in patient?

A
  1. Sinusitis
  2. Rhinitis
  3. Nasal polyps
55
Q

T/F: In most cases of asthma, chest X-ray is normal.

A

True

56
Q

List the primarily therapies for acute asthma exacerbation.

A
  1. Beta-2 agonist administration (repetitive, rapid-acting)
  2. Glucocorticosteroids (systemic)
  3. Oxygen supplementation

Resp DRX (9 decks)

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