Pulm Flashcards
1
Q
what nerve innervates the larynx
A
CN 10
2
Q
describe paths of sinus drainage
A
sphenoid > ethmoid > maxillary > nasal cavity
frontal > maxillary > nasal cavity
3
Q
what are the stages of embryologic development of the respiratory tract?
A
Every Pulmonologist Can See Alveoli
Embyronic (wks 4-7) Pseudoglandular (5-17) Canalicular (16-25) Saccular (26-birth) Alveolar (36 weeks-8 years)
4
Q
errors at the embryonic stage of development can cause what
A
tracheoesophageal fistula
5
Q
what stage of embryologic development is respiration capable
A
Canalicular - week 25
6
Q
what are the types of cells in the respiratory tract?
A
Club cells: type I pneumocytes type II pnemocytes: produce surfactant alveoalr macrophages (dust cells)
7
Q
decribe anatomy of the trachea
A
9 cartilage rings
8
Q
decribe anatomy of the bronchioles
A
smooth muscle
9
Q
describe the boundaries of the lungs
A
MCL: lung at rib 6, pleura at rib 8
Axillary: Lung 8, pleura 10
CVA: lung 10, pleura 12
Apex of lung 4cm above rib 1
10
Q
how many of each “type” of rib are there?
A
7 true, 8-10 false, 11 + 12 floating
11
Q
why does pneumothorax occur?
A
blunt or penetrating chest injury, certain medical procedures, or damage from underlying lung disease. -> loss of vaccum between visceral and parietal layer of lung pleura
12
Q
describe the circulation of blood in the lungs
A
RV > pulmonary arteries (deoxy) > lung > pulmonary veins (oxy) > LA > aorta > bronchial artery (oxy) > lung tissues > bronchial vein (deoxy) > azygos veins
13
Q
describe the pathway of air in the lungs
A
trachea > primary bronchi > secondary/lobar bronchi > tertiary/segmental bronchi > bronchioles > terminal bronchioles > respiratory bronchioles > alveoli
14
Q
what are the different lung volumes?
A
tidal volume: air moving into lungs with each quiet respiration
residual volume: air in lung after max expiration (cant be measured by spirometry)
inspiratory reserve volume (IRV): air that can still be inhaled after normal inspiration
expiratory reserve volume (ERV): air that can still be exhaled after normal expiration
15
Q
what are the different lung capacities?
A
inspiratory capacity: air that can be inhaled after normal exhalation
functional residual capacity (FRC): volume of gas in lungs after normal expiration
vital capacity (VC): max vol of gas that can be expired after max inspiration
total lung capacity (TLC): vol of gas present in lungs after max inspiration
16
Q
what are the types of ventilation?
A
minute ventilation (Ve): total vol of gas entering lungs per min
alveolar ventilation (Va): vol of gas that reaches alveoli each min
17
Q
what is physiologic dead space (Vd)?
A
vol of inspired air that does not take part in gas exchange
18
Q
what are the two attributes of the lung/chest wall that play a role in ventilation?
A
elastic recoil
compliance
19
Q
what is elastic recoil? what role does it play in ventilation?
A
the lungs intrinsic nature to deflate with expiration; tendency for lungs to collapse inward and chest wall to spring outward at physiologic baseline
these opposite motinos balance each other and prevent lung collapse
at FRC, airway and alveolar pressures equal atmospheric pressure; intrapleural pressure is neg
20
Q
what is compliance? what role does it play in ventilation?
A
changes in lung volume for a change in pressure
inversely proportional to wall stiffness (increase in compliance = decrease in stiffness)
increased by surfactant
increased compliance = lung easier to fill
21
Q
where are the main respiratory centers that control ventilation and perfusion?
A
CNS: medulla
22
Q
where are the various places the medullary respiratory centers get signals from?
A
central chemoreceptors cerebral cortex pontine respiratory centers peripheral chemoreceptors pulmonary inputs
23
Q
the respiratory centers in the medulla control what?
A
lung movement; controlled via inspiratory and expiratory neurons (expiratory activated for deep expiration only)
24
Q
central chemoreceptors role in ventilation control
A
on surface of medulla; detect pH changes in CSF
acidic pH > increased Co\O2
25
peripheral chemoreceptors role in ventilation control
on carotid and aortic bodies; detect pH, CO2, and O2 changes in blood; transmit signal via vagus and glossopharyngeal nerve
26
what is the relation between CO2/O2 and ventilation control?
ventilation (RR) increases with increased need for O2 (during exercise, etc)
27
what are the respiratory control centers of the medulla and describe their path to control inspiration?
dorsal respiratory group (inspiration)
ventral respiratory group (expiration)
pre-botzinger complex (intrinsic rhythm generator)
they interact with pons at pneumotaxic center and apneustic center to inhibit or simtulate inspiration
28
what do the mechanoreceptors in the lungs do and how?
assess mechanical status of lungs via vagus nerve
stretch receptors are activated when lungs are excessibly inflated > triggers inspiration reflex > stops inspiration and prolongs expiration
fibers synapse in cervical and thoracic spine and synapse with motor neurons (phrenic nerves - diaphragm, intercostol nerves - intercostal muscles)
29
what nerves affect ventilation?
PNS: CN10 - constrict bronchioles
Sensory: CN10
SNS (sympathetic chain ganglia): dilate bronchioles
Phrenic N
30
how are pain, emotion, and voluntary control involved in ventilation control?
limbic and hypothalamus send info to respiratory center; pain and emotional state change breathing
voluntary control from the primary motor cortex; communicates directly to the spinal cord, bypassing info from brainstem
31
how is carbon diozide transported through the body?
CO2 enters RBCs from tisues and is converted into 3 forms, where it is transported from tissues to lungs:
HCO3- (most common): via bicarb/chloride transport on RBC membrane
HBCO2: carbaminohemoglobin; CO2 bound to HB at N-terminus of globin (not heme)
dissolved CO2 (least comon)
32
what is the haldane effect?
oxygenation of hemoglobin promotes dissociation of H+ from hemoglobin, then equilibrium shifts toward CO2 formation, which releases CO2 from RBCs
33
explain the qualities (level of resistance/compliance) of pulmonary circulation
low resistance, high compliance system
34
pulmonary circulation; do oxygen and CO2 diffuse quickly or slowly across alveolar membrane?
oxygen diffuses slowly across alveolar membrane
CO2 diffuses rapidly across alveolar membrane
35
pulmonary diffusion increases with..
increased area
| larger difference b/w partial pressures
36
pulmonary diffusion decreases with..
decreased area
less diff b/w partial pressures
thicker alveolar wall
37
pulmonary vascular resistance decreases with...
```
increased CO
alkalosis, hypocarbia, high FiO2
increased vessel radius (vasodilation)
decreased arterial resistance
decreased blood viscosity (ex: anemia)
decreased vessel length
```
38
pulmonary vascular resistance increases with...
hypoxia, hypercarbia, acidosis
hypervolemia, polycythemia
hypothermia, atelectasis, increased airway pressure
sympathetic stimulation (ex: a agonists, N2O/ketamine)
39
during adequate gas exchange what is the ventilation to perfusion ratio?
V/Q = 1
40
in zone 1 (apex of lung) what is the ventilation to perfusion ratio?
V/Q increased
| V decreases, Q decreases more
41
in zone 2 (middle of lung) what is the ventilation to perfusion ratio?
V/Q decreased
| V increases, but Q increases more
42
what is internal vs external respiration?
internal respiration: capillary gas exchange in body tissues
external respiration: bulk flow of air into and out of lungs
43
what are the contributing factors to alveolar gas exchange?
surface area
partial pressure gradients of gasses
matching ventilation and perfusion
44
explain the relationship between rate of diffusion and partial pressures of blood gasses
rate of diffusion of a gas is proportional to sum of partial pressure of the gas mixture
oxygen dissociates more easily from hemoglobin at lower pH
venous blood slighlty more acidic than arterial blood because of CO2
45
pulmonary circulation; avg pulmonary arterial pressure vs systemic
pulmonary arterial pressure: 15mmHg
| Systemic: 100mmHg
46
explain the biochemistry of surfactant
phospholipoprotein made by type II alveolar cells
made in saccular and alveolar phases of lung development (final 2 stages; weeks 26-birth)
20% of surfactant complex is protein
47
explain the role of nitric oxide in the pulmonary system
regulates vascular and bronchial tone (stimulates dilation)
formed from amino acid arginine by enzyme nitric oxide synthase
formation requires H4 biopterin as cofactor
48
what is a common feature of restrictive pulmonary diseases?
infiltration of inflammation and scarring of lung parenchyma
49
what is a common consequence of restrictive pulmonary diseases?
widespread lung fibrosis > increased lung elastic recoil > decreased lung compliance
lung smaller in vol, pt has to work harder to breathe against decreased compliance (lungs become like rubber)
50
explain the etiology/pathophys of respiratory distress syndrome
injury to type I pneumocytes + capillary endothelial cells in lungs
cytokines (TNF-a, IL-1) cause endothelial cells to secrete inflammatory molecules. this damage can increase risk of blood clotting, leaky endothelium (edema), and pneumocytes (I + II) die. alveoli collapse. macrophages attract and activate fibroblasts (make colalgen, leads to scar tissue > leads to restrictive lung disease)
51
common causes of respiratory distress syndrome
sepsis (most common), viral infections (pnemonia), burns, near-drowning, dialysis, lyme disease, pancreatitis
52
complications of respiratory distress syndrome
```
pulmonary edema
fibrosis
infectin
poor pulmonary compliance
high mortality rate
```
53
clinical characteristics respiratory distress syndrome
SOB > respiratory failure
hypoxemia > cyanosis
edema (crackling rales sounds)
```
Dx:
acute (< 1 wk)
CXR/CT: opacities (white out) from pulm edema
PF ratio: RAO1/FIO2 <300mmHg
resp distress not caused by HF
```
54
idiopathic pulmonary fibrosis etiology
decreased respiratory compliance
55
pnemoconiosis etiology/types
dust inhalastion, upper lobes
inorganic: silicosis, asbestosis, complicated coal miners; dysnpea, incurable
organic: allergic type I IgE hypersensitivity; recover
56
sarcoidosis etiology
immune-mediated, widespread noncaseating granulomas
bell's palsy, uveitis, granulomas, lupus pernio, interstitial fibrosis (restrictive), erythema nodosum, RA-like arthropathy, hypercalcemia, facial droop
57
sarcoidosis RF
african american females
58
sarcoidosis clinical characteristics
asymptomatic
| large lymph nodes
59
what are obstructive pulmonary diseases and some characteristics of them?
airflow limitation from obstruction that is not fully reversible
lungs gradually fill with air behind obstruction + lung tissue is destroyed by chronic infection
lungs are overinflated (increased residual vol), large, missing a lot of tissue, and have increased compliance
difficult to have efficient comfortable breathing if lungs are fully expnanded when trying to overcome resistance in airways
60
what are the restrictive pulmonary diseases (names of them)
respiratory distress syndrome
idiopathic pulmonary fibrosis
pneumoconiosis
sarcoidosis
61
what are the obstructive pulmonary diseases (names of them)
```
asthma
bronchiectasis
chronic bronchitis
emphysema
cycstic fibrosis
```
62
asthma etiology/patho
small bronchi abnormally responsive to stimuli causing constriction and inflammation
type I hypersensitivity from IgE, viral infections, pollution, food sensitivity, stress, aspirin
63
asthma complications
death - respiratory collapse and compromise
64
asthma clinical characteristics
cough, wheeze, dyspnea, hpoxemia, mucus plugging
elevated leukotriene D
65
bronchiectasis etiology
chronic dilation of bronchi from contraction of scar with secondary infection
usually lower part of lung
P aeruginosa
66
bronchiectasis complications
permanent dilation of airways
67
bronchiectasis clinical characteristics
foul smelling copious sputum usually in AM
68
chronic bronchitis etiology
"blue boaters"
increased pCO2
lymphocytic and eosinophilic involvment (like asthma)
exacerbations typically caused by viral or bacterial infection
haemophilus influenzae, strep pneumonia, moraxella catarrhalis
69
chronic bronchitis RF
smoking
70
chronic bronchitis clinical characteristics
persistent cough with sputum x3 in at least 2 consecutive years
obesity, cor pulmonale, cyanotic
do not retain hypercapnic drive to breathe
71
emphysema etiology
```
"pink puffers"
normal pCO2 (chronic stimulation of EPO)
permanent dilation of part or all of the acinus with eventual destruction of alveolar walls
```
72
emphysema RF
smoking (inactivated a1 antitrypsin > breakdown of lung tissue protein due to excess protease activity)
def of serum alpha 1 protease inhibitor in non-smokers
73
emphysema complications
reactive polycythemia
74
emphysema clinical characteristics
barrel chest, pursed lips, slow forced expiration
tympany on palpation
decreased breath sounds in lower lung fields
rely heavily on accessory muscles of inspiration (SCM, scalenes)
75
acute bronchitis etiology
inflamed bronchial tubes, most caused by viral infection
rhinovirus, adenovirus, influenza A + B, parainfluenza
76
epiglottitis etiology
swelling of epiflottis, blocking airflow
H influenzae, B-hemolytic strep
potentially lethal - imediate ER referral
77
epiglottitis RF
children
78
epiglottitis complications
airway obstruction
79
epiglottitis clinical characteristics
sudden swelling of epiglottis and voal cords, toxin, drooling child, DO NOT OPEN THEIR MOUTH
xray: thumbprint sign
80
laryngitis etiology
alone or as part of generalized respiratory infxn
81
laryngitis RF
smoking
82
laryngitis complications
carcinoma
83
rhinitis etiology
infectious: commoncold viruses
allergic: hay fever, IgE mediated
chronic: superimposed bactterial infection on other two
84
sinusitis etiology
(acute)
usually preceded by rhinitis, mixed normal flora
85
sinusitis complications
can spread into orbit or penetrate bone > osteomyelitis
86
pharyngitis etiology
group A strep
87
tonsilitis etiology
group A strep
88
pleural effusion etiology
fluid accumulation inside pleural cavity (b/w parietal and visceral pleura)
lymphatic, exudate (protein rich, inflammatory conditions) or transudate (protein poor, HF)
increased hydrostatic pressure/HF
increased vascular permeability, decreased oncotic pressure
increased negative intrapleural pressure
decreased lymphatic drainage
89
pleural effusion RF
L-HF, chest infection
90
pleural effusion clinical characteristics
tracheal deviation
Dx: decerased breath sounds, dullness to percussion, decerased tactile fremitus, CXR fluid in CVA (standing)
91
compare chylothorax and hemothorax (etiology and sx)
chylothorax: lymph build up in pleural cavity (lympphatic system injury; truama, medical procedures)
hemothorax: blood build up in pleural cavity (blunt chest trauma, malignancy, PE)
sx (same for both): absent breath sounds on affected side, dullness to percussion (fluid in pleural space), diagnostic thoracentesis (lights criteria)
92
obstructive atelectasis etiology
most common
collapse or incomplete expansion of acini
tumors, FB, mucus blockage
impaired gas exhange
airway obstruction prevents new air from reaching distal airways, old air resorbed
93
types of atelectasis
obstructive (most common), compressive, contractive, adhesive
94
obstructive atelectasis RF
```
prematurity, smoking, obesity
lung disease (COPD, asthma, CF, bacterial infection)
anything leading to hypoventilation
chest wall abnormalities
surgery
```
95
obstructive atelectasis complications
hypoxemia, pnemonia
96
obstructive atelectasis clinical characteristics
SOB, cough, respiratory distress
Dx: reduced,absent breath sounds, crackles, dullness, deceased femitus, CXR, CT
97
pleural fibrosis (asbestosis) etiology
ivory white, calcified, supradiaphragmatic and pleural plaques
98
pleural fibrosis (asbestosis) RF
shipbuilding, roofing, plumbing
99
pleural fibrosis (asbestosis) complications
risk of bronchogenic carcinoma, mesothelioma, caplan syndrome (RA + pneumoconiosis with intrapulmonary nodules), pleural effusions
100
pleural fibrosis (asbestosis) clinical characteristics
affects lower lobes, asbestos bodies golden-brown, look like dumbells
101
pneumothorax etiology
air or gas in the pleural cavity; visceral + parietal layers of pleura lose their vacuum
traumatic or spontaneous
102
pneumothorax RF
spontaneous: tall, thin, young males and smokers
103
pneumothorax complications
can lead to tension pneumothorax (air enters space but cannot exit)
104
pneumothorax clinical characteristics
tympany to palpation
| decreased breath sounds
105
pulmonary edema etiology
any factor that causes pulmonary interstitial fluid pressure to rise from negative to positive
LHF, pnemonia, toxic gas inhalation, fluid overload/renal failure, decreased albumin, lymphatic obstruction
106
pulmonary edema RF
L-HF
107
pulmonary edema complications
can be intersitial edema or progress to alveolar edema (death)
108
pulmonary emboli etiology
fat emboli: long bone fractures and liposuction
air emboli: nitrogen bubbles in ascending divers
amniotic fluid emboli: during labor or PP, but can be due to uterine trauma. rare.
109
pulmonary emboli complications
large emboli - sudden death
| amniotic fluid emboli - can lead to DIC, high mortality
110
pulmonary emboli clinical characteristics
V/Q mismatch, hypoxemia, repiratory alkalaosis
sudden onset dyspnea, pleuritic chest pain, tachypnea, tachycardia
111
pulmonary infarction etiology
lung tissue does not receive enough blood flow/oxygen
most commonly due to pulmonary thromboembolism
infection, inflammatory/infiltrative lung disease, pulmonary torsion, malignancy
112
pulmonary HTN etiology
LHF, mitral stenosis, increased pulmonary vascular resistance, emboli, scleroderma
113
adenocarcinoma etiology
peripheral, most common 1st degree lung cancer
114
adenocarcinoma RF
females, non-smokers
115
adenocarcinoma clinical characteristics
clubbing
116
bronchial carcinoid etiology
central or peripheral
| excellent prognosis, metastasis rare
117
bronchial carcinoid clinical characteristics
sx due to mass effect or carcinoid syndrome (flushing, diarrhea, wheezing)
118
laryngeal cancer RF
tobacco smoke
119
laryngeal cancer complications
30-50% have metastasis at dx
120
leukoplakia of larynx etiology
any hyperkeratonic lesion; benign or malignant, depends how much atypia is present
121
leukoplakia of larynx RF
tobacco and alcohol
122
mesothelioma etiology
malignancy of lungs and pleural cavity associated with asbestos
aggressive cancer that attacks mesothelium (lines organs, thoracic cavity, abdominal cavity)
involves mesothelial plaques that express calretinin (regulates calcium in the cell)
123
mesothelioma RF
working with asbestos (paint, insulation, roofing)
smoking is NOT a RF
124
mesothelioma complications
hemorrhagic pleural effusion (exudative), pleural thickening, poor prognosis
125
mesothelioma clinical characteristics
chest pain, SOB, pleural effusions, bloody sputum, pneumothorax
biopsy of tumor - immunostained, rx with calretinin, "fried egg" shape
Psammoma bodies on histo
fibers most commonly found in lungs, liver, spleen, bowel
126
nasopharyngeal carcinoma etiology
most common cancer of nasopharynx
EBV
127
nasopharyngeal carcinoma RF
east asia, africa
males
fhx
128
nasopharyngeal carcinoma complications
5 year survivial 60%
129
polyps etiology
reactive nodes that rarely become cancerous
130
polyps RF
vocal cords of heavier smokers or singers
131
small cell carcinoma (squamous) etiology
Smoking
(oat cell), 20% of all lung cancers
132
small cell carcinoma (squamous) RF
smoking
133
small cell carcinoma (squamous) complications
early metastasis, secrete many hormones
pancoast tumor, rapid death
very aggressive
may produce ACTH (cushing syndrome), ADH (SIADH), or antibodies against presynaptic Ca2+ channels (Lambert-eaton myasthenic syndrome), or neurons (paraneoplastic myelitis, encephalitis, subacute cerebellar degeneration)
134
non-small cell carcinoma (squamous) etiology
80% of lung cancers
135
non-small cell carcinoma (squamous) RF
smoking
136
congenital pulmonary disesaes
neonatal respiratory distress syndrome
pulmonary hypoplasia
bronchogenic cysts
137
cystic fibrosis (CF) etiology
disease of exocrine glands which results in viscous secretions due to dysfunction of chloride channels
cystic fibrosis transmembrane conductance regulator gene (CFTR) on chromo 7 - defective chloride transport and increased sodium reabsorption
138
cystic fibrosis (CF) RF
most lethal genetic disease in caucasion population
139
cystic fibrosis (CF) complications
fatal before 40; pulmonary destruction, brought on by repeated infections
thick, mucus secretions block O2 exchange, increase susceptibility to infection (S aureus or H influenza)
140
cystic fibrosis (CF) clinical characteristics
thick and viscous secretions in respiratory, GI, hepatobiliary, and reproductive tracts
wt loss, failure to thrive, nasal polyps, meconium ileus, statorrhea
dx: sweat test (elevated chloride levels) or genetic testing
141
tracheoesophageal fisula etiology
abnormal connection, congenital
142
atypical (interstitial) pneumonia etiology
primary (walking) pnemonia
```
mycoplasma
chlamydophilia pnemoniae
chlamydophilia psittaci
legionella viruses (RSV, CMV, influenza, adenovirus)
```
143
atypical (interstitial) pneumonia clinical characteristics
diffuse patchy inflammation localized to interstitial areas at alveolar walls
CXR shows bilateral multifocal opacities
no exudate in alveolar spaces
144
bronchopneumonia (lobular) etiology
patchy opportunistic infection
s pneumoniae
s aureus
h influenzae
klebsiella
145
bronchopneumonia (lobular) clinical characteristics
Cough, fever, chills, and difficulty breathing
aspiration pneumonia usually on R upper lobe
acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving 1 or more lobe
146
diphtheria etiology
pseudomembranous pharyngitis
corynebacterium diphtheriae
147
diphtheria complications
LAD, myocarditis, arrhtyhmias
148
diphtheria clinical characteristics
gray/white covering throat
| preventable by vax
149
fungal pnemonia etiology
histoplasma capsulatum
150
lobar pnemonia etiology
strep pnemonia (+) diplococcus (rusty brown sputum)
klebsiella p (-) rods (alcoholics)
legionella
151
lobar pnemonia clinical characteristics
intra-alveolar exudate > consolidation
152
lung abscess etiology
cavity filled with pus
infected teeth, gums, tonsils, obstructed bronchus, cancer, septic pulmonary emboli
bacertiodes, fusobacterium, peptostreptococcus, s aureus
153
lung abscess RF
pts predisposed to LOC (alcoholics, epileptics) or bronchial obstuction (cancer)
154
lung abscess clinical characteristics
lung abscess 2 to aspirations most often in R lung
155
pertussis etiology
whooping cough
| bordetella pertussis
156
pertussis complications
dangerous for infants
157
pertussis clinical characteristics
violent uncontrollable cough
158
respiratory synctial virus (RSV) etiology
viral infection
159
respiratory synctial virus (RSV) complications
dangerous for infants and older adults
160
respiratory synctial virus (RSV) sx
mild cold sx
161
tuberculosis (TB) etiology
delayed hypertensitivity type IV
mycobacterium TB
caseating granulomas
primary + secondary reactivation > apices of lung/high O2
acid-fast bacilli
162
tuberculosis (TB) complications
every organ system can have TB, usually starts in lungs. if not tx, can spread everywhere
163
tuberculosis (TB) sx
night sweats, fever, wt loss
164
goodpastures syndrome etiology
antibodies against basement membrance of kidneys and lungs
type II immune injury
165
goodpastures syndrome sx
coughing up blood
166
laryngotracheobronchitis etiology
parainfluenza virus
