Chapter 9: High Yield Respiratory Flashcards
Most common cause of Rhinitis
Adenovirus
Biopsy - pleomorphic keratin-positive epithelial cells in a background of lymphocytes. Associated with EBV.
Nasopharyngeal carcinoma
Hoarse, “barking” cough and inspiratory stridor. Inflammation of the upper airway. Most common cause = parainfluenza virus
Laryngotracheobronchitis (Croup)
Consolidation of an entire lobe of the lung. Usually bacterial (S. pneumoniae 95%; Klebsiella pneumoniae) Red hepatization –> Gray hepatization
Lobar pneumonia
Scattered patchy consolidation centered around bronchioles. Multifocal and bilateral.
Bronchopneumonia
Diffuse interstitial infiltrates. Mild upper respiratory symptoms.
Interstitial (atypical) pneumonia
Most common cause of Community-acquired poneumonia
S pneumoniae. - lobar pneumonia
Pneumonia in cystic fibrosis patients
P. aeruginosa (Bronchopneumo)
Most common cause of atypical pneumonia. Military recruits
Mycoplasma pneumoniae
Most common cause of atypical penumia in infants
RSV
Farmers and vets - cattle.
Coxiella burnetii
Pneumonia in malnourished, alcoholics, diabetics. currant jelly sputum
Klebsiella pneumonia (lobar)
Gohn complex
Primary TB ( mycobacterium tuberculosis)
Caseating granulomas; AFB bacilli. Apex of lung
Secondary TB
Caseating granulomas; AFB bacilli. Apex of lung
Secondary TB
Decreased FVC; Greatly decreased FEV1; Increased TLC
COPD
Most common cause of centriacinar emphysema
smoking
You see a barrel chested ‘pink puffer’ in ___
Emphysema
Productive cough with spiral-shaped mucus plugs (curschmann spirals) and eosinophil-derived crystals (Charcot-Leyden cyrstals)
Asthma
The 4 COPDs are:
- Chronic bronchitis 2. Emphysema 3. Asthma 4. Bronchiectasis
Permanent dilation of bronchioles and bronchi due to necrotizing inflammation [Cystic fibrosis; Kartagener syndrome]. Couch, dyspnea and foul-smelling sputum. Can get secondary (AA) amyloidosis!
Bronchiectasis
Decreased TLC and greatly decreased FVC; FEV1: FVC ratio is increased (FVC reduced more than FEV1)
Restrictive diseases:
Idiopathic pulmonary fibrosis; Pneumoconioses; Sarcoidosis; Hypersensitivity pneumonitis)
Fibrosis of lung interstitium due to TGF-Beta. Subpleural patches initially, leading to diffuse fibrosis and end-stage “HONEYCOMB” Lung
Idiopathic pulmonary fibrosis
Fibrosis of lung interstitium due to TGF-Beta. Subpleural patches initially, leading to diffuse fibrosis and end-stage “HONEYCOMB” Lung
Idiopathic pulmonary fibrosis
Stellate inclusions (asteroid bodies) seen within giant cells of non-caseating granulomas. systemic disease. Granulomas of hilar lymph nodes and lungs leading to restrictive lung disease. CD4+ helper T-cell response. Elevated serum ACE and hypercalcemia.
Sarcoidosis
Plexiform lesions
Seen in severe, long standing pulmonary HTN ( MAP > 25 mmHg)
Plexiform lesions
Seen in severe, long standing pulmonary HTN ( MAP > 25 mmHg)
BMPR2
Inactivation mutation leads to proliferation of vascular smooth muscle –> primary pulmonary HTN
Tx of ARDS
ventilation with positive end-expiratory pressure (PEEP)
Tx of ARDS
ventilation with positive end-expiratory pressure (PEEP)
Surfactant production begins ____ and reaches adequate levels _____
Begins at 28 weeks;
Adequate levels at 34 weeks
What condition in the mother decreases surfactant production
Diabetes. Insulin decreases surfactant production
What condition in the mother decreases surfactant production
Diabetes. Insulin decreases surfactant production
Key risk factors for lung cancer [3]
Cigarette smoke [polycyclic aromatic hydrocarbons and arsenic]; radon; and asbestos
Lung Cancer usually metastasis to ___
adrenal gland
Male smoker. Central tumore from neuroendocrine cells. May produce ADH or ACTH or cause Eaton-Lambert syndrome [pre-synaptic Ca channel antibody - paraneoplastic syndrome]
Small cell carcinoma
Keratin pears or intercellular bridges. Most common tumore in male smokers. Central; may produce PTHrP (can get hypercalciemia)
Squamous cell carcinoma
Metastasis TO lung
Breast and colon carcinoma. Presents like multiple ‘cannon-ball’ nodules
Metastasis TO lung
Breast and colon carcinoma. Presents like multiple ‘cannon-ball’ nodules
Penetrating chest wall injury. Trachea is pushed OPPOSITE to the side of injury
Tension pneumothorax - Chest tube = medical emergency..
Equation for physiologic dead space Vd
Vd= Vt * [ (PaCO2 - PECO2) / PaCO2 ] Vt = tidal volume. PECO2 = expired air PC02 Pa = arterial
Equation for physiologic dead space Vd
Vd= Vt * [ (PaCO2 - PECO2) / PaCO2 ] Vt = tidal volume. PECO2 = expired air PC02 Pa = arterial
Normal Hb amount in blood
15 g/dL
cyanosis results when deoxygenated Hb > 5g/dL
O2 binding capacity =
20.1 mL02/dL
Bohr effect
In peripheral tissue, inc H+ from tissue metabolism shifts curve to right, unloading O2.
Haldane effect
In lungs, oxygenation of Hb promotes dissociation of H+ from hb. This shifts equilibrium toward CO2 formation; therefore CO2 is released from RBC
Dorsiflexion of foot causes calf pain
+ Homan’s sign. indicate DVT
DVT tx
heparin for prevention and acute management;
Warfarin for long-term prevention of DVT recurrence
Classic triad: hypoxemia, neurologic abnormalities and petechial rash
Fat emboli
