First Aid Review-Respiratory Flashcards
Errors in _ stage of lung development can lead to tracheoesophageal fistula
Errors in embryonic stage of lung development can lead to tracheoesophageal fistula
Lung bud –> trachea –> bronchial buds –> mainstem bronchi –> secondary bronchi –> tertiary bronchi occurs during _ stage of lung development
Lung bud –> trachea –> bronchial buds –> mainstem bronchi –> secondary bronchi –> tertiary bronchi occurs during embryonic stage of lung development
Endodermal tubules –> terminal bronchioles and modest capillary network forms during _ stage of lung development
Endodermal tubules –> terminal bronchioles and modest capillary network forms during pseudoglandular stage of lung development
Respiratory bronchioles and alveolar ducts develop in _ stage
Respiratory bronchioles and alveolar ducts develop in canalicular stage
Babies are capable of respiration at _ weeks gestation
Babies are capable of respiration at 25 weeks gestation
Terminal sacs separated by primary septae develop during _ stage of lung development
Terminal sacs separated by primary septae develop during saccular stage of lung development
Secondary septation of the alveolar sacs occurs and we slowly develop towards adult alveoli
Secondary septation of the alveolar sacs occurs and we slowly develop towards adult alveoli: alveolar stage
Pulmonary hypoplasia is a congenital lung malformation that involves a poorly developed _
Pulmonary hypoplasia is a congenital lung malformation that involves a poorly developed bronchial tree
Club cells are (ciliated/nonciliated) cuboidal cells with secretory granules; they are located in the _ and function to _
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
Type I pneumocytes are _ type cells
Type I pneumocytes are squamous cells
Type II pneumocytes are _ type cells
Type II pneumocytes are cuboidal epithelial cells
What is the purpose of the lamellar bodies?
Lamellar bodies hold/secrete surfactant from the type II pneumocytes
Surfactant is composed of multiple lecithins, mainly _
Surfactant is composed of multiple lecithins, mainly dipalmitoylphosphatidylcholine (DPPC)
Collapsing pressure of alveoli (P) =
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
Alveolar macrophages, aka “dust cells” phagocytose foreign bodies in the lungs and release _ and _
Alveolar macrophages, aka “dust cells” phagocytose foreign bodies in the lungs and release cytokines and proteases
NRDS will present on chest x-ray with _ appearance
NRDS will present on chest x-ray with ground-glass appearance
Risk factors for ARDS
ARDS risk factors:
* Prematurity
* Maternal diabetes (increased insulin)
* C-section (fewer fetal glucocorticoids)
Supplemental oxygen of an infant with NRDS can have _ side effects
Supplemental oxygen of an infant with NRDS can have RIB side effects
* Retinopathy
* Intravascular hemorrhage
* Bronchopulmonary dysplasia
We screen for fetal lung maturity via the _ ratio
We screen for fetal lung maturity via the lecithin/sphingomyelin ratio
* L/S should be > 2
A lecithin/sphingomyelin ratio of < 1.5 is predictive of _
A lecithin/sphingomyelin ratio of < 1.5 is predictive of NRDS
Airway resistance is the highest in the _
Airway resistance is the highest in the large-medium sized bronchi
Cartilage and goblet cells extend to the _
Cartilage and goblet cells extend to the end of the bronchi
Terminal bronchioles have _ epithelium
Terminal bronchioles have simple ciliated cuboidal epithelium
Respiratory bronchioles have _ epithelium
Respiratory bronchioles have simple cuboidal and squamous epithelium
If you aspirate a peanut while supine it is most likely to end up in the _
If you aspirate a peanut while supine it is most likely to end up in the superior segment of the right lower lobe
If you aspirate a peanut while lying on the right side it is most likely to end up in the _
If you aspirate a peanut while lying on the right side it is most likely to end up in the right upper lobe
If you aspirate a peanut while upright it is most likely to end up in the _
If you aspirate a peanut while upright it is most likely to end up in the right lower lobe
The thoracic duct and the azygos vein travel through the diaphragm at the _ with the _ structure
The thoracic duct and the azygos vein travel through the diaphragm at the aortic hiatus with the aorta structure
Inspiratory capacity =
Inspiratory capacity = TV + IRV
Physiologic dead space estimation =
Dead space = TV * (PaCO2 - PECO2 / PaCO2)
In other words, dead space = taco paco peco paco
Minute ventilation equation
Total volume of gas entering the lungs per minute:
VE = TV * RR
Alveolar ventilation equation
Volume of gas that reaches the alveoli each minute:
VA = (TV - dead space volume) * RR
Normal RR is _
Normal RR is 12-20
What happens to intrapleural pressure as we inspire?
It will get more negative
Ex: -5 at FRC –> -10
What happens to intrapleural pressure as we expire?
It will go from more negative to less negative
Ex: -10 –> -5 (rest)
What happens to TLC in the elderly? RV?
As we age, TLC stays the same however, we get increased lung compliance due to the loss of elastic recoil –> RV increases
As we age lung compliance _ and chest wall compliance _
As we age lung compliance increases and chest wall compliance decreases
If residual volume is increasing as we age, _ is decreasing
If residual volume is increasing as we age, functional vital capacity is decreasing
Individuals with anemia have decreased hemoglobin, which will _ oxygen content of the arterial blood, _ O2 saturation and _ PaO2
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
Polycythemia will cause O2 content of the arterial blood to _
Polycythemia will cause O2 content of the arterial blood to increase
* More hemoglobin = higher total O2 content
Carbon monoxide poisoning will cause:
Hemoglobin:
Oxygen saturation of Hb:
Dissolved O2 (PaO2):
Total O2 content:
Carbon monoxide poisoning will cause:
Hemoglobin: normal
Oxygen saturation of Hb: decreased (competes with O2)
Dissolved O2 (PaO2): normal
Total O2 content: decreased
Methemoglobinemia is a condition whereby _ occurs; this presents with _ and _
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
_ are chemicals found in food preservatives that are known to induce methemoglobinemia
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
Methemoglobinemia can be treated using _ and _
Methemoglobinemia can be treated using methylene blue and vitamin C
Both cyanide and carbon monoxide poisoning inhibit aerobic metabolism; how?
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
Three treatment options for treating cyanide poisoning
Cyanide poisoning:
1. Hydroxocobalamin
2. Nitrites
3. Sodium thiosulfate
We treat carbon monoxide poisoning via _
We treat carbon monoxide poisoning via 100% oxygen or hyperbaric O2
Patient presents with cyanosis, bitter almond odor and cardiovascular collapse:
Patient presents with cyanosis, bitter almond odor and cardiovascular collapse: cyanide
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
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
Cyanide will cause the oxygen-hemoglobin to _
Cyanide will cause the oxygen-hemoglobin to stay the same
What does carbon monoxide do to the oxygen dissociation curve and O2 content?
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
Gases like O2 (healthy individuals), CO2, and N2O are (perfusion/diffusion) limited gases
Gases like O2 (healthy individuals), CO2, and N2O are perfusion-limited gases
* These gases will equilibrate early along the length of the capillary
CO is a (perfusion/diffusion) limited gas
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
O2 may become more “diffusion-limited” in states such as _
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
Alveolar gas equation
PAO2 = PIO2 - (PaCO2/R)
Respiratory quotient
CO2 produced / O2 consumed
Normal is 0.8
Wasted ventilation tends to occur at the _ region of the lung
Wasted ventilation tends to occur at the apex
Wasted perfusion tends to occur at the _ region of the lung
Wasted perfusion tends to occur at the base
What happens to the lung during exercise?
During exercise there will be an increase in cardiac output and a vasodilation of the apical capillaries –> V/Q approaches 1
100% O2 does not improve _ cause of hypoxemia
100% O2 does not improve shunts
* Example: foreign body aspiration
CO2 binds hemoglobin at _ location
CO2 binds hemoglobin at N-terminus of the globin
* It does not bind the heme
Modes of CO2 transport:
Modes of CO2 transport:
70% in HCO2-
25% in Carbaminohemoglobin
5% dissolved CO2
The majority of blood CO2 is carried as HCO3- in the _
The majority of blood CO2 is carried as HCO3- in the plasma
* Leaves the RBC via HCO3/Cl exchanger
Asthma is a type _ hypersensitivity reaction that involves smooth muscle hypertrophy and hyperplasia
Asthma is a Type I hypersensitivity reaction that involves smooth muscle hypertrophy and hyperplasia
Polio, myasthenia gravis, guillain-barre, scoliosis, and obesity are all examples of _
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
Patient presents with bilateral hilar lymphadenopathy, noncaseating granulomas and increased ACE and Ca2+
Patient presents with bilateral hilar lymphadenopathy, noncaseating granulomas and increased ACE and Ca2+: sarcoidosis
Key features of IPF
Idiopathic pulmonary fibrosis presents with repeated cycles of injury and wound healing via collagen deposition
* Honeycombing
* Traction bronchiectasis
Granulomatosis with polyangiitis causes _ type lung disease
Granulomatosis with polyangiitis (GPA) causes restrictive lung disease
4 notorious drugs that cause restrictive lung disease
- Bleomycin
- Busulfan
- Amiodarone
- Methotrexate
Hypersensitivity penumonitis is a type _ hypersensitivity reaction
Hypersensitivity penumonitis is a Type III/IV hypersensitivity reaction
Describe the granulomas we expect to see in sarcoidosis
Sarcoidosis is associated with noncaseating granulomas that contain schaumann and asteroid bodies
“Ivory white” supradiaphragmatic and pleural plaques
“Ivory white” supradiaphragmatic and pleural plaques: asbestosis
Asbestosis affects the _ lobes
Asbestosis affects the lower lobes
Berylliosis affects the _ lung lobes and is associated with _ granulomas
Berylliosis affects the upper lung lobes and is associated with noncaseating granulomas
_ is a pneumoconiosis that is thought to disrupt phagolysosomes and impair macrophages, increasing TB susceptibility
Silicosis is a pneumoconiosis that is thought to disrupt phagolysosomes and impair macrophages, increasing TB susceptibility
“Eggshell” calcification of the hilar lymph nodes on chest x-ray
“Eggshell” calcification of the hilar lymph nodes on chest x-ray: Silicosis
Psammoma bodies
Psammoma bodies: mesothelioma
ARDS can only be diagnosed via the following criteria:
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
Central sleep apnea may be caused by :
Central sleep apnea may be caused by:
* Congestive heart failure
* CNS toxicity
* Cheyne Stokes respirations
Hearing bronchial sounds in the lungs themselves (rather than the trachea) may indicate _
Hearing bronchial sounds in the lungs themselves (rather than the trachea) may indicate consolidation from pneumonia
Tracheal deviation from a pleural effusion or a tension pneumothorax is in _ direction
Tracheal deviation from a pleural effusion or a tension pneumothorax is away from the side of the lesion
Tracheal deviation from atelectasis is in _ direction
Tracheal deviation from atelectasis is towards the side of the lesion
Staph aureus and haemophilus influenzae tend to cause _ type pneumonia
Staph aureus and haemophilus influenzae tend to cause bronchopneumonia
On day two of a pneumonia we expect to see _ in _ stage
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
From day 3-4, lobar pneumonia is in _ stage
From day 3-4, lobar pneumonia is in red hepatization stage
* Red-brown consolidation
* Exudate contains fibrin, bacteria, RBCs, WBCs
* It is reversible
Day 5-7 of lobar pneumonia is marked by the _ stage
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
After 8 days, lobar pneumonia is in the _ stage
After 8 days, lobar pneumonia is in the resolution stage
* Enzymative digestion of exudate by macrophages
Lambert-Eaton myasthenic syndrome is a possible complication of lung cancer; it involves muscle weakness from _
Lambert-Eaton myasthenic syndrome is a possible complication of lung cancer; it involves muscle weakness from antibodies against presynaptic Ca2+ channels
Squamous cell carcinoma commonly causes _ electrolyte abnormality
Squamous cell carcinoma commonly causes hypercalcemia from PTHrp
Pleomorphic giant cells on histology indicate _ lung cancer
Pleomorphic giant cells on histology indicate large cell carcinoma
Squamous cell often presents with a _ on CXR
Squamous cell often presents with hilar mass arising from the bronchus on CXR
