High Yield Flashcards
What are the characteristics of IPF?
Usual interstitial pneumonia Heterogeneous Fibroblastic foci
What are the characteristics of COOP?
Masson bodies All uniform - space throughout the lungs Loose connective tissue
Characteristics of silicosis?
Sand blasting Increased risk of TB Macrophage dysfunction
What are the characteristics of hypersensitivity pneumonitis?
Type III hypersensitivity Loose granulomas Resolves after removing stimuli
What are the characteristics of pulmonary alveolar proteinosis?
A-cellular surfactant in the intraalveolar spaces Antibodies to GM-CSF
What are characteristics of Squamous Cell Carcinoma?
Intercellular bridges Keratin pearls Many syndromes - cushing, hypercalcemia, etc
What cardiac abnormality is associated with pectus excavatum?
Mitral valve prolapse
What is the role of the subcostal muscles?
Function to depress ribs during heavy exercise, assisting with forced expiration
What are the top and bottom muscles?
Serratus posterior superior - Top
Serratus posterior inferior - bottom
What is the target of Ipratropium?
Cholinergic receptors
What can cause a diaphragmatic herina?
Incorrect folding of the pleuroperitoneal fold
What is the lowest you would hear breathe sounds on in the back mid scapula?
10th rib
COPD causes dilation of what?
Alveolar ducts and respiratory bronchiole
Adrenergic receptors are a part of what system?
Sympathetic
What are the important muscles used for forced inspiration?
Serratus posterior superior
Sternocleidomastoid
Scalene
Can you have incomplete compensation?
YES!!!
What is pancoast syndrome?
Apical bronchogenic tumor can push on adjacent structures
This graph demonstrates a person with?
Decreased lung compliance needing more pressure to generate flow
The value of PTP or a given lung volume is greater than in the normal lung.
This graph demonstrates a person with?
Increased airway resistance
compliance is normal, PALV-PPL , i.e. the volume component is also normal for any volume.
What is the equation for alveolar ventilation?
(TV-VD)xRR
What determines the stretch of the lungs?
PALV-PPL and compliance
What determines the creation of airflow?
PB-PALV and Resistance
What is venous return on blood?
PO2 = 40
How does changing diffusion affect the concentrations of PaO2 and CO2?
If decreased by too much it will lose the PO2 will go down
If only slightly decreased, then it can be normal
Unilateral chest expansion is significant for?
Pneumonia or Post intubation
Clubbing is a sign of?
Respiratory disorder
CF
If sternocleidomastoid and scalene muscles are being used for breathing, what can this be a sign of?
COPD
Increased tactile fremitus that is unilateral is indicative of?
Pleural effusion
If it is symmetric it decreases the likelihood of it
What does hyperresonance symbolize?
Pneumothorax
Unilateral sounds after intubation predict what?
Right mainstem intubation
Rales (Crackles) have what characteristics?
Inspiratory and are early
Indicative of CHF, pneumonia or pulmonary fibrosis
What are the characteristics of rhonchi?
Snoring quality, low pitched
Think airway secretions
What are the characteristics of stridor?
Loud upper airway obstruction
Epiglottitis
What are the characteristics of wheezing?
High pitched, continuous musical sound
COPD or asthma
Rales are the same as?
Crackles!
Egophony is a sign for?
Pneumonia
EEEEE to AAA change
Whispered pectoriloquy is a sign of what?
Consolidated lung
What are the common gram negative pulmonary infections?
E. coli , Klebsiella, Proteus, Pseudomonas
Legionella
When should a person worry about gram negative infection?
Aspiration leading to gram negative
At risk populations
Bronchiectasis is a dilation of what?
Bronchiole
What is the formula for carrying capacity of blood
(Hb x 1.34 x % sat) + (SaO2 x 0.003)
What do V and A stand for?
Venous saturation and Arterial saturation
Explain this graph
Changes in O2 affinity of Hb have important physiological relevance. Consider a person exercising vigorously: the Hb in the capillary blood flowing through the exercising muscles is exposed to a low pH, high PCO2, and high temperature. All these factors tend to lower Hb-O2 affinity; i.e. for a given PO2 value, Hb is less saturated. In other words, as the affinity of Hb for O2 decreases, Hb “lets go” of O2. This facilitates unloading of O2 in the exercising muscle without reducing the PO2 very much; accordingly, the PO2 gradient for O2 diffusion from the capillary to the muscle cell is maintained and allows O2 flow to continue. When the blood returns to the lungs, the Hb is exposed to a higher pH, lower PCO2 and lower temperature, all of which tend to increase Hb-O2 affinity. Now Hb likes the O2 a little more, so it picks up more O2.This facilitates loading of O2 in the lungs.
Explain this graph
Explain this graph
CO2 concentration is higher in venous blood
Explain this graph?
The arterial and venous blood O2 and CO2 content, in ml/dl, are plotted as a function of the respective partial pressures. The units for CO2 concentration here are different from those of the curve in the previous slide. The objectve of this slide is to compare the differences in the shapes of the O2 and CO2 curves. In the next chapter we will see the implications of these differences on pulmonary gas exchange. Several differences are apparent:
- In the physiologic range, blood CO2 content is about twice the blood O2 content
- In the physiologic range, the curve for CO2 is fairly linear, which means that changes in
PCO2 are accompanied by roughly proportionate changes in blood CO2 content over a fairly wide range of PCO2. On the other hand, the non-linearity of the ODC means that the changes in O2 content produced by a given change in PO2 will depend on the initial PO2 level. As we will see in the next section, this has important implications for gas exchange.
- The CO2 curve is much steeper: the v-a PCO2 difference is ~ 6 mmHg and the v-a CO2 content difference is 4-5 ml/dl; on the other hand, the a-v O2 content difference is 5-6 ml/dl but the a-v PO2 difference is ~ 60 mmHg. This also has implications for gas exchange, as we will see later.
What are the indications to used transesophageal echocardiography?
Increased dead space also means?
Decreased efficiency of gas exchange
What are the characteristics of increased dead space?
Increased total ventilation
Increased VD/VT ratio
Typically seen as low PaO2 with little CO2 retention
What are the characteristics of an airway blockage (increased shunts)?
Large PaO2 drop due to mixing
PaO2 refractory to increases in PAO2
Small increase in PaCO2
How can metabolic alkalosis shift the O2 curve?
An increase in blood pH shifts the oxygen-hemoglobin dissociation curve to the left. This creates a tighter bond between hemoglobin and oxygen, causing decreased oxygen delivery to tissues. Hypoxemia is worsened by a compensatory hypoventilation to elevate PCO2. Hypoventilation may be severe enough to cause apnea and respiratory arrest.
How can you increase VO2?
Increasing cardiac output or increasing extraction
How can you decrease diffusion?
Decreasing volume or increasing the extraction of O2 from the alveoli
What is the equation for VA?
VCO2/PaCO2
What is the difference between COPD and alpha-1 anti-trypsin in regards to where they effect?
alpha-1 antitrypsin - alveolar ducts and alveoli
Emphysema - respiratory bronchioles
How can neutrophils affect the lungs?
Infiltration leads to destruction of bronchiolar and septal elastic
In a BAL what would you see in a patient with HF?
Hemosiderin laden macrophages
How would a patient with CF have Cl- on their skin but not in their airways?
The cells of the sweat fail to reabsorb NaCl while in the airway there is decreased Cl- secretion and increase H2O and Na+ reabsorption
What is one role of Mast cells?
BALT and edema
