DIT Pulm Flashcards
Mnemonic for shit peircing diaphragm?
I ate 10 eggs at 12.
Ivc 8
10 EsophaGus (vAGus)
Aorta Azygous Thoracic duct (AT) 12
so it is Ivc 8 10 EsophaGus vaGus AAT 12
(also vagus is cranial nerve 10)
What cells are able to divide in lung to fix damaged?
Type II cells
Volume of Physiologic Dead Space equation?
Think about it, no dead space, the PaCO2=PeCO2 b/c blowing off all the CO2 and it would be zero.
Taco paco peco paco
Vtidal volume X (paco2-peco2)/paco2
What can cause pulmonary HTN?
> /=25 mmHg at rest
Primary pulm HTN: BMPR2 gene inhibits vasc smooth muscle proliferation. Poor prognosis. QBANK. HIV and HHV-8 association (kaposi sarcoma)
Secondary: COPD, mitral stenosis, autoimmune L-R shunt, sleep apnea, recurrent thrombi, high altitude (hypoxic vasoconstriction)
Tx of pulmonary HTN?
Bosentan ambriensentan antagonize endothelin 1 receptors
Prostaglandin relax vessels
Sildenafil
Nifedipine
What favors T form of hemoglobin?
CO2, H+, increased temp, 2,3 DPG. cause release of oxygen, ALTITUDE (shifts curve to the right)
THINK ABOUT HOW muscle action makes heat so it would release oxygen when muscles are working and it needs oxygen.
What is a clinical use of methehemoglobin?
Soaks up cyanide! b/c cyanide binds Fe+++ ferric hemoglobin (thats what oxygen does not bind)
So giving nitrates will oxidize blood to soak up cyanide.
Thiosulfate also binds cyanide to excrete renal.
What can cause methemoglobinemia?
Nitrates Chloroquine Dapsone Sulfonamides Lidocaine Metaclopramide
Alveolar gas equation?
PAO2 = PIO2-PaCO2/R
easier:
PAO2=150-PaCO2/0.8
Normal A-a gradient? What would mean it is bad?
PAO2-PaO2=10-15 normally. If higher, usually bad news.
REMEMBER big A is ALVEROLAR and little a is arterial
High A-a gradient is not necessarily a bad thing when?
High altitude with lower partial pressure of O2 or hypoventilating
What is EKG finding of pulmonary embolism?
S1Q3T3: Wide S in lead 1, a large Q in III and inverted III
Virchows triad?
Stasis, hypercoagulability, endothelial damage
FEV/FVC for normal? COPD? Restricted?
80%
less than 80
80 or more
What is pulses paradoxes?
Inhale, more venous return, RV can fill and push inter ventricular septum to left and decrease CO and BP drops ten points.
Happens in:
asthma
tampanade
Eosinonphilia differential?
DNAAACP
Drugs neoplasm Atropic diseaes (asthma, allergy, churg straus) Addisons acute interstitial nephritis collagen vascular diseaes parasites
Where is emphysema from smoking affecting you?
centriacinar emphysema in upper and superior segments of lower lobes
Destrucion of central portion of acini. Respiratory bronchioles are affected most
What are Curschman spirals?
shed epithelium forms mucous plugs in Asthma
Muscarinic antagonist in asthma?
ipratropium
Theophylline mechanism?
What do you need to know?
Bronchodiolate by inhibiting phosphodiesterase (could it give you boners?)
Narrow TI
Cardiotoxicity and neurotoxicity
Antidote is beta blocker for tachycardia (remember it is basically caffeine)
It blocks actions of adenosine (REMEMBER THATS WHAT CAFFEEINE DOES, blocks adenosine receptors when you a tired!)
What is guaifenesin?
Expectorant: thins respiratory secretions: so you can cough up shit
more antihistamine uses on page 396 of DIT
if you care
omalizumab?
anti IgE
Bilateral hilar lymphadenopathy and erythema nodosum in restrictive lung disease?
Sarcoidosis is widespread noncaseating granulomas (in black women). Tx steroids
A GRUELING Disease ACE increase Granulomase (noncaseating) Rh arthritis Uveitis of eye Erythema noosum Lymphadenopathy bilateral and hilar Idiopathic Noncaseating granuloma Gammaglobulinemia vit D increase
How and where is damage from pneumoconiosis?
Macrophage damage after taking up shit you inhaled. Normally upper lobes. CAUSES FIBROSIS
Restrictive
Asbestosis?
Bronchogenic carcinoma and mesothelioma risk
Berylliosis?
cell mediated immunity causing noncaseating granolamas and looks like sarcoid
Aerospace engineers
Bilateral hilar adenpathy and uveitis?
sarcoidosis
What is risk of silicosis? Describe how you recognize silicosis.
Silicone exposure with sand blasting and such. It may impair macrophage and INCREAASE RISK FOR TB and bronchogenic carcinoma
Describe findings with squamous cell carcinoma of the lung.
Locaiton
Histo
symptoms
C cancer of lung
Central
Cavitation, Cigarettes, hyperCaclemia (produces parathyroid related protein PTHrP and hypercalcemia may be first symptom)
Keratin (Ceratin for C theme) pearls in sheets of dysplastic squamous cells on histo.
Lambert Eaton syndrome?
Small cell carcinoma b/c Anti Ca++ channels causing myawsthenic syndrome (weakness, improves with use)
S mnemonic for lung cancer
Squamous cell Small cell smoking central secreting
Carcinoid syndrome symptoms?
B-FDR
Bronchospasm
Flushing
Diarrhea
Right sided heart lesions
Histo of mesotheliom?
Psammoma bodies
NOT ASSOCIATED WITH SMOKING.
can be in peritoneum
What is secreted in small cell carcinoma? Mnemonic alert!
ACTH, ADH, Antibodies against presynaptic Ca++ (lambert eaton syndrome)
Amplicifaction of myc oncogene is common
Not operable, need to do chemo, so poor prognosis
Where are the most common locations of cancer mets?
Brain, bone, adrenal, liver
Practice q’s pg 404 of DIT
“if youc an handle these you will do well on step 1 pneumonia”
Most common cause of pneumonia in:
Birth-28 days old
Children less than a year
Children and young adults
Ventilator patients
E coli or GBS (neonate)
RSV (less than a year)
Mycoplasma (kids and young adults)
Psuedomonas (ventalator)
