All of it! Flashcards
1
Q
In what stage of development is surfactant made?
A
Cannalicular
2
Q
In what stage of development are terminal bronchioles formed?
A
Pseudoglandular
3
Q
What cell type makes surfactant?
A
Type II pneumocyte
4
Q
Where are mesothelial cells?
A
Lining inside of parietal and visceral pleuras
5
Q
In what layer of the bronchial wall are leukocytes?
A
Lamina Propria
6
Q
In what layer of the bronchial wall are MALTs (mucosal-associated lymph tissue)?
A
Submucosa
7
Q
How many cell membranes must an oxygen molecule pass through to reach Hemoglobin?
A
5 (two membranes of Type I pneumocyte, two membranes of capillary, one membrane of RBC)
8
Q
How often is a Type I pneumocyte replaced?
A
~20 days
9
Q
What is the main component of surfactant?
A
Phospholipid
10
Q
What is the usual range of intrapleural pressure?
A
-5 - -30 cm H2O (1cm H2O is about 1 Torr)
11
Q
What is the formula for compliance?
A
∆V/∆P
12
Q
Where is intrapleural pressure larger (more negative): apex or base of lung?
A
Apex
13
Q
Where are bronchioles and alveoli larger: apex or base of lung?
A
Apex
14
Q
Is the apex or base more well-ventilated?
A
Base (more change in volume of alveoli)
15
Q
What is a normal tidal volume?
A
~400mL per breath
16
Q
What is a normal FEV1/FVC?
A
80%
17
Q
Define hypoxemia
A
Low O2 in blood
18
Q
Define hypoxia
A
Low O2 at tissue level
19
Q
Does a right or left shift of the oxyhemoglobin dissociation curve represent an increase in off-loading?
A
Right shift
20
Q
A decrease in pH shifts the curve in what direction?
A
To the right, more dissociation of oxygen
21
Q
What is normal arterial free oxygen concentration?
A
70-90 Torr
22
Q
What is the barometric pressure at sea level?
A
760 mmHg
23
Q
What is the barometric pressure in Denver?
A
630 mmHg
24
Q
What is the normal concentration of bicarb?
A
24 mM
25
What is the normal concentration of CO2 in the blood?
40
26
What are causes of Anion Gap Metabolic Acidosis?
MUDPILES
27
What is a normal Anion Gap value?
12 +/- 2
28
What is Winter's formula used for?
To find the expected PCO2
29
What is Winter's formula?
expected PCO2 = 1.5(HCO3) + 8 +/- 2
30
What is the relationship between the increase in CO2 and the decrease in pH in an acute setting?
For every 10 Torr increase in CO2, pH decreases by 0.08
31
What is the relationship between an increase in CO2 and an increase in bicarb?
For every 1 Torr increase in CO2, bicarb increases by 0.4 meq/L
32
Where in the brain is the respiratory center?
Medulla
33
What is the sole detector of arterial pH in the body that can mediate ventilatory changes?
Peripheral carotid chemoreceptors
34
What chemoreceptor is important in the rapid response of elevated CO2 (only 20% of the response)?
Carotid & aortic peripheral chemoreceptors
35
Is low O2 or high CO2 the main driver of peripheral chemoreceptors?
Hypoxemia
36
Do central chemoreceptors respond to O2 or CO2?
CO2 (C for central)
37
Are there any central chemoreceptors for O2?
No
38
How do the central chemoreceptors respond to CO2?
CO2 crosses blood-brain barrier, interacts with H2O to create protons and bicarb. Central chemoreceptors bind protons and send signals to increase ventilation. Strong response, takes minutes. This is an important day-to-day regulator.
39
What vessels are most often the source of hemoptysis?
Bronchial circulation
40
What is the source of the bronchial circulation?
Aorta
41
What is the equation to calculate Pulmonary Vascular Resistance (PVR)?
PVR = (PAP-LAP)/CO
42
What is a normal PVR?
43
What are the four criteria for ARDS?
1. Bilateral alveolar radiographic infiltrates
2. PaO2/FiO2
3. Not fully explained by cardiac failure or fluid overload
4. Occurs within 1 week of a known clinical insult or of worsening respiratory symptoms
44
What is the definition (cutoff) for pulmonary hypertension?
MAP pulm > 25 mmHg (normal is 15-18 mmHg)
45
What is the criteria for Pre-capillary pulmonary hypertension (PAH)?
Mean PAP > 25 mmHg, PCWP/LVEDP 3 Wood Units
46
What is the criteria for Post-capillary pulmonary hypertension (PVH)?
Mean PAP > 25 mmHg, PCWP/LVEDP > 15 mmHg
47
What are the five WHO classifications of pulmonary hypertension?
1. PAH
2. PH due to L heart disease
3. PH due to lung diseases and/or hypoxia
4. Thromboembolic PH
5. PH with unclear/multifactorial mechanisms
48
What is the prognosis of Idiopathic PAH?
Rare and fatal!! Median survival is 2.8 years without treatment, affects mostly young women
49
Idiopathic PAH is mostly idiopathic but can also be due to a mutation in what?
Bon Morphogenic Protein Receptor Type 2 (BMPR2)
50
What is the overall therapeutic treatment of PAH?
Pulmonary vasodilators
51
What are the three pathways that can be exploited in vasodilation in PAH?
Endothelin pathway, NO pathway, and prostacyclin pathway
52
What does increased fremitus usually indicate?
Pneumonia (vibrations travel well through fluid)
53
Is the trachea pulled away from or towards a large pleural effusion?
Away from
54
What does egophany usually indicate?
Pneumonia
55
What does a pleural rub usually indicate?
Inflammation of the pleura
56
What are the 5 causes of hypoxemia?
1. Altitude
2. Hypoventilation
3. V/Q Mismatch
4. Shunt
5. Diffusion problem
57
For every 1 L of supplemental O2, Fi02 increases by what?
3%
58
What is a normal A-a gradient?
5-10
59
NSCLC, specifically adenocarcinoma, has what kind of appearance on CXR?
Ground glass
60
Squamous cell carcinoma is of what origin?
Epithelium
61
SCLC is of what tissue origin?
Bronchial origin
62
What is the most common cause of metabolic acidosis?
DKA
63
A decreased FEV1/FVC ratio indicates what disease process?
Obstructive
64
If there is an extra-thoracic obstruction, will there will be a change in the Flow-Volume loop on expiration or inspiration?
Inspiration
65
If there is an intra-thoracic obstruction, will there will be a change in the Flow-Volume loop on expiration or inspiration?
Expiration
66
If there is a fixed obstruction, will there will be a change in the Flow-Volume loop on expiration or inspiration?
Both! Won't change based on expiration or inspiration.
67
What are some things that can increase diffusing capacity of CO?
Polycythemia, early CHF, asthma, alveolar hemorrhage
68
What are some things that can decrease diffusing capacity of CO?
Emphysema, pulmonary vascular disease, ILD, anemia
69
In areas of the lung with high V/Q, how does the lung compensate?
Alveolar PCO2 drops, leading to an increase in local airway resistance and decreasing ventilation --> V/Q lowers
70
In areas of the lung with low V/Q, how does the lung compensate?
Alveolar PO2 drops, leading to hypoxic vasoconstriction and decreasing local perfusion --> V/Q increases
71
What is the extreme of low V/Q called?
Shunt
72
What is the extreme of high V/Q called?
Dead space
73
Is pneumonia an example of shunt or dead space?
Shunt
74
Is emphysema an example of shunt or dead space?
Dead Space
75
How can we distinguish shunts from V/Q mismatch?
Monitor PaO2 on 100% oxygen. In cases of shunt, PaO2 will not substantially increase
76
What is the action of a beta-2 adrenergic receptor agonist on bronchial smooth muscle?
Bronchodilation
77
What is the action of a muscarinic receptor agonist on bronchial smooth muscle?
Bronchoconstriction
78
What is the action of a Leukotriene receptor agonist on bronchial smooth muscle?
Bronchoconstriction
79
What is the action of a Histamine H1 receptor agonist on bronchial smooth muscle?
Bronchoconstriction
80
What is the action of a Muscarinic receptor agonist on secretory cells?
Increased secretion
81
What is the action of a Muscarinic receptor agonist on blood vessels?
Vasoconstriction
82
What is the action of an alpha-1 adrenergic receptor agonist on blood vessels?
Vasoconstriction
83
What is the action of a Histamine H1 receptor agonist on blood vessels?
Vasodilation
84
What is the action of a Bradykinin receptor agonist on sensory pain afferents?
Increase pain
85
What is the action of a Mu opioid receptor agonist on the cough center in the medulla?
Suppress cough reflex
86
What is the action of a Bradykinin receptor agonist on blood vessels?
Vasodilation
87
What is the action of a Histamine H1 receptor agonist on sensory pain afferents?
Increase pain
88
Is edema associated with a runny or stuffy nose?
Runny
89
Is vasodilation associated with a runny or stuff nose?
Stuffy
90
What are some advantages and disadvantages of first-generation antihistamines?
Additional blocking actions at non-H1 receptors. Penetrate more readily into CNS. Sedation. Prevent nausea and vomiting.
91
What are some advantages and disadvantages of second-generation antihistamines?
Longer actions with metabolic and/or renal elimination. Much lower sedation. Do NOT prevent nausea and vomiting.
92
All drugs ending in "-amine" are what?
First-generation antihistamine drugs
93
What do second-generation antihistamines end in? (3)
-izine, -inate, -adine
94
How do antihistamines block the H1 R?
Reversible & competitive
95
What four receptors do antihistamines block?
Adrenergic Rs, H1 Rs, Muscarinic Rs, and Na channel block
96
What are the three names of the decongestant drugs?
Pseudoephedrine (Sudafed), phenylephrine, oxymetolazine
97
How do decongestant drugs works?
Sympathomimetic with vasoconstrictor action (stimulate alpha-1 receptors of vascular smooth muscle)
98
What is a side effect of topical decongestants?
Rebound congestion
99
What is the mainstream antitussive?
Codeine/Dextromethorphan
100
With is the MOA of Codeine/Dextromethorphan?
Both central and peripheral actions. Agonists at endogenous opioid Rs that act to suppress cough center in brain stem.
101
What is the name of the Expectorant drug?
Guaifenesin
102
What is the MOA of guaifenesin?
Uncertain, possibly decreases viscosity of mucus
103
What is the brand name of Guaifenesin?
Mucinex
104
What is the name of the mucolytic drug?
N-Acetylcysteine (Mucomyst)
105
What is the MOA of N-Acetylcysteine?
Splits disulfide linkages between mucoproteins resulting in decreased viscosity of pulmonary mucus secretions. Also possesses antioxidant properties.
106
What is the route of administration of N-Acetylcysteine?
Inhalation
107
What are the most common diseases that lead to ARDS?
Pancreatitis, sepsis, trauma, transfusion, and aspiration
108
What is the treatment of ARDS?
Treat underlying condition. Also prone positioning and LOW tidal volume ventilation.
