PP Pulmonary Flashcards
What color is air on an x-Ray?
Black “radiolucent”
What is the difference between a carotid body and a carotid sinus?
Body: chemoreceptors
Sinus: baroreceptors
What color is fluid/solid on x-Ray?
White “radiopaque”
What disease has a steeple sign on neck film?
Croup
What disease has a thumb sign on neck film?
Epiglottitis
What is a “blue bloater”?
Bronchitis
What is a “pink puffer”?
Emphysema
What disease have pulmonary eosinophilia?
Aspergillosis
What drugs cause pulmonary eosinophilia?
Nitrofurantoin
Sulfonamide a
What are the risk factors for lung cancer?
Smoking
Radon
2nd hand smoker
Pneumoconiosis (except anthracosis)
What disease have hemoptysis?
Bronchiectasis Bronchitis Pneumonia TB Lung cancer
Where is a Bokdalek hernia?
Back of diafragma
Where is a Morgagni hernia?
Middle of diafragm
What disease have respiratory alkalosis?
Restrictive lung Dz ( anxiety, pregnancy, Gram - sepsis, PE)
What disease have respiratory acidosis?
Obstructive lung Dz
What disease have metabolic alkalosis?
Low volume state ( vomiting, diuretics, GI blood loss)
What disease have metabolic acidosis?
Acid production ( MUDPULES, RTA II, Diarrhea)
What does stridor tell you?
Extrathoracic narrowing => narrows when breath in => neck x-Ray
What does wheezing tell you?
Intrathoracic narrowing => narrows when breath out => chest x-Ray
What does rhonchi tell you?
Mucus in airway => OLD
What does grunting tell you?
Blows collapsed alveoli open => RLD
What does dull percussion tell you?
Something b/w airspace and chest wall absorbing sound ( fluid or solid)
What does hyperresonance tell you?
Air in lung
What does tracheal deviation tell you?
Away from pneumothorax OR toward atelectasis “ air phobic”
What does fremitus, egophony and bronchophony tell you?
Consolidation “pathognomonic for pneumonia”
What is RLD?
Small stiff lungs
Trouble breathing in
What is OLD?
Big mucus-filled lungs
Trouble breathing out
What is Epiglotitis?
X-Ray thumb sign
Drooling
What is Croup?
X-Ray steeple sign
Barking cough
What is tracheitis?
Look toxic
Grey pseudomembrane
Leukocytosis
What is Asthma?
Wheeze on expiration
IgE
Eosinophils
What is bronchiolitis?
Asthma in kids < 2y/o
What is Sinusitis?
Teeth pain worse with bending forward
What is Bronchiectasis?
Bad breath
Purulent sputum
Hemoptysis
What is Bronchitis?
Lots of sputum
“Blue bloater”
Cough for >3 month per year for >2 years
What is Emphysema?
Restrictive to Obstructive pattern
“Pink puffer” barrel-shaped chest
Decrease recoil
What is Laryngomalacia?
Epiglottis roll in from side to side
The bulky arytenoid cartilage prolapse anteromedially on inspiration resulting in stridor ( 6 pharyngeal arch is responsible for the formation of these structure)
What is Pneumonia?
Consolidation of airway
What in Pneumothorax?
Decreased breath sound on one side
How do you detect a Pulmonary Embolus?
Tachypnea
Increased V/Q scan
EKG: S1Q3T3
What is Tamponade?
Decreased breath sound/ BP
Increased JVD
What is Tracheomalacia?
Soft cartilage
Stridor since birth
What is Cystic Fibrosis?
Meconium ileus
Steatorrhea
Bronchiectasis
What is Aspergillosis?
Allergy to: mold, dead plants, compost piles
What is Silicosis?
Sandblasters
Glassblowers
Icrease susceptibility to TB
What is Byssinosis?
Cotton workers
Chest tightness
What is berylliosis?
Radio
TV welders
What is Anthracosis?
Coal workers
Massive fibrosis
Black lung
What is Sarcoidosis?
Non-caseating granulomas
Eggshell calcification of lymph node
What is Carcinoid syndrome?
Flushing
Wheezing
Diarrhea
What is Small cell CA?
At carina Malignant Cushing's SIADH SVC syndrome
What is Large cell CA?
Periferal
Large stuff
Poor prognosis
What is Squamous cell CA?
Central Smoker High PTH High Ca Cavitation Kerating pearls
What is Broncheoalveolar CA?
Looks like pneumonia; due to pneumoconiosis
Embryologic structure that form the diafragm
Septum transversum
Pleuroperitoneal mm
Dorsal mesentery of the esophagus
Abdominal wall
Who innervates the diaphragm?
The phrenic nerve by C3,C4 and C5
What structures perforated the Diaphragm?
T8 - IVC
T10 - esophagus and vagus nerve
T12 - aorta, thoracic duct and azygos vein
Muscles of respiration in Quiet breathing?
Inspiration: Diaphragm
Expiration: passive
Muscles of respiration in Exercise?
Inspiration: external intercostals, scalene, sternocleidomastoids
Expiration: rectus abdominis, internal and external obliques,
transversus abdominis, internal intercostals
Hypoxemia?
Decrease PaO2
- normal A-a gradient { high altitude, hypoventilation}
- increase A-a gradient { V/Q mismatch, diffusion limitation, R to L shunt, pulmonary fibrosis}
Hypoxia?
Decrease O2 delivery to tissue
- Decrease CO
- Hypoxemia
- Anemia
- CO poisoning
Ischemia?
Los of blood flow
- impeded arterial flow
- reduce venous drainage
How the body compensate hypoxia at high altitude?
Increase of
- ventilation
- ematopoyesis
- renal excretion of HCO3
- mitochondrial tissue
- 2,3-DPG
What enzyme converts CO2 in to HCO3?
Carbonic anhydrase
Virchow’s triad?
Stasis
Hypercoagulability
Endothelial damage
Which are the OLD?
Chronic bronchitis
Emphysema
Asthma
Bronchiectasis
Two type of emphysema?
Centriacinar - smoking
Panacinar - alfa1-anti trypsin defi
Asbestosis?
Pluming
“Ivory white” calcified pleura
Associated with Carcinoma y Mesothelioma
Iron containing nodules in alveoli
Adenocarcinoma?
Periferal
MC lung cancer
K-Ras mutation
Mesothelioma?
Malignancy of the pleura associated with Asbestosis
Histology: Psammoma bodies
Pancoast tumor?
Carcinoma that occur in the apex of the lung
Affect cervical sympathetic plexus, causing Horner’s syndrome ( Ptosis, miosis, anhidrosis)
Which are the 1st generation H1blocker?
Diphenhydramine
Dimenhydrinate
Chlorpheniramine
*LIPOPHILIC SEDATION
Which are the 2nd generation H1blocker?
Loratadine Fexofenadine Desloratadine Cetrizine *LIPOPHOBIC LESS SEDATING
Which are the Asthma drugs Beta-agonists?
Short acting agonist : - albuterol - methaproterenol - terbutaline Long acting agonist : - salmterol ( combined with corticosteroids as prophylactic) - formoterol
Function of the Asthma drugs Theophylline ?
Bronchodilator by inhibit PDE to increase cAMP
Blocking Adenosine receptors
Which are the Asthma drugs Muscarinic antagonists?
Ipratropium
Ipratropium?
Preventing bronchoconstriction
For COPD
Long acting Muscarinic antagonist
Corticosteroids for Asthma?
Beclomethasone
Fluticasone
* 1st line therapy for Chronic Asthma
Mechanism of corticosteroids?
Inhibits synthesis of cytokines
- by inhibiting phospholipase A2
- inactivation of transcription factor NF-kB -> decrease TNF gama
Antileukotrienes?
Montelikast, Zafirlukast
- block leukotriene (LTD4) receptor
Zileuton
- inhibidor of 5-lipoxygenase pathway( blocks the convention of arachidonic acid to leukotriene)
Omalizumab?
Monoclonal anti-IgE antibody
Which are the expectorant?
Guaifenesin ( expectorant- thins respiratory secretions, do NOT suppress cough reflex)
N-acetylcysteine ( mucolytic)
Bosentan?
Treat Pulmonary Artery Hypertension ( antagonizes endothelin-1 receptor)
Dextromethorphan?
Antitussive
Synthetic codeine analog
Which are the nasal decongestant?
Pseudoephedrine
Phenylephrine
Which are the types of pneumonia?
Lobar
Bronchopneumonia
Interstitial
Organism causing Lobar pneumonia?
S. pneumoniae
Klebsiella
Organism causing Bronchopneumonia?
S. pneumoniae
S. Aureus
H. Influenza
Klebsiella
Organism causing Interstitial pneumonia?
Virus ( influenza, RSV, adenovirus)
Mycoplasma
Legionella
Chlamydia
