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Pulmonology > First Aid Review-Respiratory > Flashcards

First Aid Review-Respiratory Flashcards

1
Q

Errors in _ stage of lung development can lead to tracheoesophageal fistula

A

Errors in embryonic stage of lung development can lead to tracheoesophageal fistula

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2
Q

Lung bud –> trachea –> bronchial buds –> mainstem bronchi –> secondary bronchi –> tertiary bronchi occurs during _ stage of lung development

A

Lung bud –> trachea –> bronchial buds –> mainstem bronchi –> secondary bronchi –> tertiary bronchi occurs during embryonic stage of lung development

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3
Q

Endodermal tubules –> terminal bronchioles and modest capillary network forms during _ stage of lung development

A

Endodermal tubules –> terminal bronchioles and modest capillary network forms during pseudoglandular stage of lung development

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4
Q

Respiratory bronchioles and alveolar ducts develop in _ stage

A

Respiratory bronchioles and alveolar ducts develop in canalicular stage

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5
Q

Babies are capable of respiration at _ weeks gestation

A

Babies are capable of respiration at 25 weeks gestation

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6
Q

Terminal sacs separated by primary septae develop during _ stage of lung development

A

Terminal sacs separated by primary septae develop during saccular stage of lung development

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7
Q

Secondary septation of the alveolar sacs occurs and we slowly develop towards adult alveoli

A

Secondary septation of the alveolar sacs occurs and we slowly develop towards adult alveoli: alveolar stage

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8
Q

Pulmonary hypoplasia is a congenital lung malformation that involves a poorly developed _

A

Pulmonary hypoplasia is a congenital lung malformation that involves a poorly developed bronchial tree

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9
Q

Club cells are (ciliated/nonciliated) cuboidal cells with secretory granules; they are located in the _ and function to _

A

Club cells are nonciliated cuboidal cells with secretory granules; they are located in the bronchioles and function to degrade toxins, secrete surfactant
* They act as reserve cells

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10
Q

Type I pneumocytes are _ type cells

A

Type I pneumocytes are squamous cells

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11
Q

Type II pneumocytes are _ type cells

A

Type II pneumocytes are cuboidal epithelial cells

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12
Q

What is the purpose of the lamellar bodies?

A

Lamellar bodies hold/secrete surfactant from the type II pneumocytes

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13
Q

Surfactant is composed of multiple lecithins, mainly _

A

Surfactant is composed of multiple lecithins, mainly dipalmitoylphosphatidylcholine (DPPC)

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14
Q

Collapsing pressure of alveoli (P) =

A

Collapsing pressure of alveoli (P) = 2 * Surface tension/ radius

Law of Laplace says that alveoli have an increased tendency to collapse on expiration as the radius decreases

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15
Q

Alveolar macrophages, aka “dust cells” phagocytose foreign bodies in the lungs and release _ and _

A

Alveolar macrophages, aka “dust cells” phagocytose foreign bodies in the lungs and release cytokines and proteases

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16
Q

NRDS will present on chest x-ray with _ appearance

A

NRDS will present on chest x-ray with ground-glass appearance

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17
Q

Risk factors for ARDS

A

ARDS risk factors:
* Prematurity
* Maternal diabetes (increased insulin)
* C-section (fewer fetal glucocorticoids)

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18
Q

Supplemental oxygen of an infant with NRDS can have _ side effects

A

Supplemental oxygen of an infant with NRDS can have RIB side effects
* Retinopathy
* Intravascular hemorrhage
* Bronchopulmonary dysplasia

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19
Q

We screen for fetal lung maturity via the _ ratio

A

We screen for fetal lung maturity via the lecithin/sphingomyelin ratio
* L/S should be > 2

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20
Q

A lecithin/sphingomyelin ratio of < 1.5 is predictive of _

A

A lecithin/sphingomyelin ratio of < 1.5 is predictive of NRDS

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21
Q

Airway resistance is the highest in the _

A

Airway resistance is the highest in the large-medium sized bronchi

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22
Q

Cartilage and goblet cells extend to the _

A

Cartilage and goblet cells extend to the end of the bronchi

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23
Q

Terminal bronchioles have _ epithelium

A

Terminal bronchioles have simple ciliated cuboidal epithelium

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24
Q

Respiratory bronchioles have _ epithelium

A

Respiratory bronchioles have simple cuboidal and squamous epithelium

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25
Q

If you aspirate a peanut while supine it is most likely to end up in the _

A

If you aspirate a peanut while supine it is most likely to end up in the superior segment of the right lower lobe

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26
Q

If you aspirate a peanut while lying on the right side it is most likely to end up in the _

A

If you aspirate a peanut while lying on the right side it is most likely to end up in the right upper lobe

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27
Q

If you aspirate a peanut while upright it is most likely to end up in the _

A

If you aspirate a peanut while upright it is most likely to end up in the right lower lobe

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28
Q

The thoracic duct and the azygos vein travel through the diaphragm at the _ with the _ structure

A

The thoracic duct and the azygos vein travel through the diaphragm at the aortic hiatus with the aorta structure

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29
Q

Inspiratory capacity =

A

Inspiratory capacity = TV + IRV

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30
Q

Physiologic dead space estimation =

A

Dead space = TV * (PaCO2 - PECO2 / PaCO2)
In other words, dead space = taco paco peco paco

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31
Q

Minute ventilation equation

A

Total volume of gas entering the lungs per minute:
VE = TV * RR

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32
Q

Alveolar ventilation equation

A

Volume of gas that reaches the alveoli each minute:
VA = (TV - dead space volume) * RR

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33
Q

Normal RR is _

A

Normal RR is 12-20

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34
Q

What happens to intrapleural pressure as we inspire?

A

It will get more negative
Ex: -5 at FRC –> -10

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35
Q

What happens to intrapleural pressure as we expire?

A

It will go from more negative to less negative
Ex: -10 –> -5 (rest)

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36
Q

What happens to TLC in the elderly? RV?

A

As we age, TLC stays the same however, we get increased lung compliance due to the loss of elastic recoil –> RV increases

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37
Q

As we age lung compliance _ and chest wall compliance _

A

As we age lung compliance increases and chest wall compliance decreases

38
Q

If residual volume is increasing as we age, _ is decreasing

A

If residual volume is increasing as we age, functional vital capacity is decreasing

39
Q

Individuals with anemia have decreased hemoglobin, which will _ oxygen content of the arterial blood, _ O2 saturation and _ PaO2

A

Individuals with anemia have decreased hemoglobin, which will decrease oxygen content of the arterial blood, but maintain the same O2 saturation and PaO2
* Normal O2 binding capacity in the blood = 20 mL O2/dL

40
Q

Polycythemia will cause O2 content of the arterial blood to _

A

Polycythemia will cause O2 content of the arterial blood to increase
* More hemoglobin = higher total O2 content

41
Q

Carbon monoxide poisoning will cause:
Hemoglobin:
Oxygen saturation of Hb:
Dissolved O2 (PaO2):
Total O2 content:

A

Carbon monoxide poisoning will cause:
Hemoglobin: normal
Oxygen saturation of Hb: decreased (competes with O2)
Dissolved O2 (PaO2): normal
Total O2 content: decreased

42
Q

Methemoglobinemia is a condition whereby _ occurs; this presents with _ and _

A

Methemoglobinemia is a condition whereby increased oxidized form of hemoglobin (Fe3+) occurs; this presents with cyanosis and chocolate-colored blood
* Problematic because the oxidized form (Fe3+) does not bind O2 as readily

43
Q

_ are chemicals found in food preservatives that are known to induce methemoglobinemia

A

Nitrites are chemicals found in food preservatives that are known to induce methemoglobinemia
* Note that we can treat cyanide poisoning with nitrites because oxidized Hb has increased affinity for cyanide

44
Q

Methemoglobinemia can be treated using _ and _

A

Methemoglobinemia can be treated using methylene blue and vitamin C

45
Q

Both cyanide and carbon monoxide poisoning inhibit aerobic metabolism; how?

A

Both cyanide and carbon monoxide poisoning inhibit aerobic metabolism by inhibition of complex IV (cytochrome c oxidase)
* This causes hypoxia that does not fully correct with supplemental oxygen

46
Q

Three treatment options for treating cyanide poisoning

A

Cyanide poisoning:
1. Hydroxocobalamin
2. Nitrites
3. Sodium thiosulfate

47
Q

We treat carbon monoxide poisoning via _

A

We treat carbon monoxide poisoning via 100% oxygen or hyperbaric O2

48
Q

Patient presents with cyanosis, bitter almond odor and cardiovascular collapse:

A

Patient presents with cyanosis, bitter almond odor and cardiovascular collapse: cyanide

49
Q

Patient presents with trouble breathing, headache, and dizziness after sitting next to a warm heater in the winter; MRI shows a bilateral globus pallidus lesion

A

Patient presents with trouble breathing, headache, and dizziness after sitting next to a warm heater in the winter; MRI shows a bilateral globus pallidus lesion: carbon monoxide poisoning

50
Q

Cyanide will cause the oxygen-hemoglobin to _

A

Cyanide will cause the oxygen-hemoglobin to stay the same

51
Q

What does carbon monoxide do to the oxygen dissociation curve and O2 content?

A

Carbon monoxide binds competetively to hemoglobin with 200x the affinity that oxygen does
* The small amount of oxygen that can bind to carboxyhemoglobin will be held very tightly and won’t be offloaded to the tissues
* O2 saturation of Hb goes way down

52
Q

Gases like O2 (healthy individuals), CO2, and N2O are (perfusion/diffusion) limited gases

A

Gases like O2 (healthy individuals), CO2, and N2O are perfusion-limited gases
* These gases will equilibrate early along the length of the capillary

53
Q

CO is a (perfusion/diffusion) limited gas

A

CO is a diffusion limited gas
* It does not equilibrate by the time the blood reaches the end of the capillary
* This is because it so strongly binds hemoglobin
* DLCO is the extend to which CO passes from air sacs of lungs into blood

54
Q

O2 may become more “diffusion-limited” in states such as _

A

O2 may become more “diffusion-limited” in states such as emphysema, fibrosis, exercise
* Gas will not equilibrate by the end of the capillary if there is a diffusion problem

55
Q

Alveolar gas equation

A

PAO2 = PIO2 - (PaCO2/R)

56
Q

Respiratory quotient

A

CO2 produced / O2 consumed
Normal is 0.8

57
Q

Wasted ventilation tends to occur at the _ region of the lung

A

Wasted ventilation tends to occur at the apex

58
Q

Wasted perfusion tends to occur at the _ region of the lung

A

Wasted perfusion tends to occur at the base

59
Q

What happens to the lung during exercise?

A

During exercise there will be an increase in cardiac output and a vasodilation of the apical capillaries –> V/Q approaches 1

60
Q

100% O2 does not improve _ cause of hypoxemia

A

100% O2 does not improve shunts
* Example: foreign body aspiration

61
Q

CO2 binds hemoglobin at _ location

A

CO2 binds hemoglobin at N-terminus of the globin
* It does not bind the heme

62
Q

Modes of CO2 transport:

A

Modes of CO2 transport:
70% in HCO2-
25% in Carbaminohemoglobin
5% dissolved CO2

63
Q

The majority of blood CO2 is carried as HCO3- in the _

A

The majority of blood CO2 is carried as HCO3- in the plasma
* Leaves the RBC via HCO3/Cl exchanger

64
Q

Asthma is a type _ hypersensitivity reaction that involves smooth muscle hypertrophy and hyperplasia

A

Asthma is a Type I hypersensitivity reaction that involves smooth muscle hypertrophy and hyperplasia

65
Q

Polio, myasthenia gravis, guillain-barre, scoliosis, and obesity are all examples of _

A

Polio, myasthenia gravis, guillain-barre, scoliosis, and obesity are all examples of restrictive lung diseases that do not affect A-a gradient or DLCO
* Either due to poor muscular effort or poor structural apparatus

66
Q

Patient presents with bilateral hilar lymphadenopathy, noncaseating granulomas and increased ACE and Ca2+

A

Patient presents with bilateral hilar lymphadenopathy, noncaseating granulomas and increased ACE and Ca2+: sarcoidosis

67
Q

Key features of IPF

A

Idiopathic pulmonary fibrosis presents with repeated cycles of injury and wound healing via collagen deposition
* Honeycombing
* Traction bronchiectasis

68
Q

Granulomatosis with polyangiitis causes _ type lung disease

A

Granulomatosis with polyangiitis (GPA) causes restrictive lung disease

69
Q

4 notorious drugs that cause restrictive lung disease

A
  1. Bleomycin
  2. Busulfan
  3. Amiodarone
  4. Methotrexate
70
Q

Hypersensitivity penumonitis is a type _ hypersensitivity reaction

A

Hypersensitivity penumonitis is a Type III/IV hypersensitivity reaction

71
Q

Describe the granulomas we expect to see in sarcoidosis

A

Sarcoidosis is associated with noncaseating granulomas that contain schaumann and asteroid bodies

72
Q

“Ivory white” supradiaphragmatic and pleural plaques

A

“Ivory white” supradiaphragmatic and pleural plaques: asbestosis

73
Q

Asbestosis affects the _ lobes

A

Asbestosis affects the lower lobes

74
Q

Berylliosis affects the _ lung lobes and is associated with _ granulomas

A

Berylliosis affects the upper lung lobes and is associated with noncaseating granulomas

75
Q

_ is a pneumoconiosis that is thought to disrupt phagolysosomes and impair macrophages, increasing TB susceptibility

A

Silicosis is a pneumoconiosis that is thought to disrupt phagolysosomes and impair macrophages, increasing TB susceptibility

76
Q

“Eggshell” calcification of the hilar lymph nodes on chest x-ray

A

“Eggshell” calcification of the hilar lymph nodes on chest x-ray: Silicosis

77
Q

Psammoma bodies

A

Psammoma bodies: mesothelioma

78
Q

ARDS can only be diagnosed via the following criteria:

A

ARDS can only be diagnosed via the following criteria:
1. Abnormal chest x-ray showing bilateral opacities
2. Respiratory failure within 1 week of alveolar insult
3. Decreased PaO2/FiO2
4. Symptoms of respiratory failure not due to the heart

79
Q

Central sleep apnea may be caused by :

A

Central sleep apnea may be caused by:
* Congestive heart failure
* CNS toxicity
* Cheyne Stokes respirations

80
Q

Hearing bronchial sounds in the lungs themselves (rather than the trachea) may indicate _

A

Hearing bronchial sounds in the lungs themselves (rather than the trachea) may indicate consolidation from pneumonia

81
Q

Tracheal deviation from a pleural effusion or a tension pneumothorax is in _ direction

A

Tracheal deviation from a pleural effusion or a tension pneumothorax is away from the side of the lesion

82
Q

Tracheal deviation from atelectasis is in _ direction

A

Tracheal deviation from atelectasis is towards the side of the lesion

83
Q

Staph aureus and haemophilus influenzae tend to cause _ type pneumonia

A

Staph aureus and haemophilus influenzae tend to cause bronchopneumonia

84
Q

On day two of a pneumonia we expect to see _ in _ stage

A

On day two of a pneumonia we expect to see red-purple, partial consolidation of the parenchyma; exudate containing mostly bacteria
* This is the congestion phase
* Lasts from day 1-2

85
Q

From day 3-4, lobar pneumonia is in _ stage

A

From day 3-4, lobar pneumonia is in red hepatization stage
* Red-brown consolidation
* Exudate contains fibrin, bacteria, RBCs, WBCs
* It is reversible

86
Q

Day 5-7 of lobar pneumonia is marked by the _ stage

A

Day 5-7 of lobar pneumonia is marked by the gray hepatization stage
* Lobe is uniformly gray
* The exudate is full of WBCs, lysed RBCs, and fibrin

87
Q

After 8 days, lobar pneumonia is in the _ stage

A

After 8 days, lobar pneumonia is in the resolution stage
* Enzymative digestion of exudate by macrophages

88
Q

Lambert-Eaton myasthenic syndrome is a possible complication of lung cancer; it involves muscle weakness from _

A

Lambert-Eaton myasthenic syndrome is a possible complication of lung cancer; it involves muscle weakness from antibodies against presynaptic Ca2+ channels

89
Q

Squamous cell carcinoma commonly causes _ electrolyte abnormality

A

Squamous cell carcinoma commonly causes hypercalcemia from PTHrp

90
Q

Pleomorphic giant cells on histology indicate _ lung cancer

A

Pleomorphic giant cells on histology indicate large cell carcinoma

91
Q

Squamous cell often presents with a _ on CXR

A

Squamous cell often presents with hilar mass arising from the bronchus on CXR

Pulmonology (16 decks)

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