Pulm Flashcards
Pulmonary Artery to the Bronchus of each lung?
RALS ~ rails in lungs
Right Anterior (Right pulm artery is anterior to bronchus)
Left Superior (Left pulm artery is superior to bronchus)
Innervation of diaphragm?
Perforations of the diapragm? Levels?
Phrenic never via C3, 4, 5
“3,4,5 keeps the diaphragm alive”
IVC at T8, Esophagus at T10, Aorta at T12
Name of point where expansion of chest wall and collapse of lung meet?
What’s the name of the feature that tells you maximal amount of air movment in lungs?
Functional Residual Capacity.
Vital Capacity.
Charcot Leyden Cystals: Composition? Condition? Associated with what else?
Crystalization of eosinophilic major basic protein
Associated with Asthma
Curschmann spirals (epithelium forms mucus plugs)
Bronchiectasis
What is it?
Conditions associated with (5)?
Necrotizing chornic infecitons of bronchi causing permamnetly dilated airways, with purlent foul smellig sputum and hemoptosis
1) Bronchial obstruction, 2) Smoking (poor cillia motility) 3) Primary cilliary dysmotility (kartengeners, broken dynein arm), 4) cystic fibrosis, 5) Allergic bronchopulmonary aspergillosis
Caplan Syndrome
Associated with exposure of (3)?
Where do each of these exposures affect?
Rheumatoid arthritis and pneumoconioses with Intrapulmonary nodules (related to dust exposure (coal, silica, asbestos).
“Coal miner who smokers”
Pneumoconioses also increase risk for Cor Pulmonale
Coal and Silica from ground so affect Apex.
Asbestos affects base of lungs.
Silicosis
Form of pneumoconiosis.
Hillar lymph nodes and apex of lungs.
Increases susceptibility to Tb by inhibiting macrophages ability to from phagolysosomes
Neonatal Respiratory Distress Syndrome.
Def in ? At risk for developing?
Risk factors?
Tx? Tx consequences?
Deficiency of lecithin (from phosphtidyl choline); decreased lecithin:sphingomyelin ratio.
Hypoxemia causing increases risk for PDA, and necrotizing enterocolitis.
Risk factors: Prematurity, Maternal DM (insulin –l surfactant production) and C-section delivery
Steroids before birth, artifical surfactant and O2.
Supp O2 puts kid at risk for retinopathy and bronchopulmonary dysplasia (from O2 forming free radicals)
Cause of Pneumonia Infections in?
- Immuno comp pnts
- Atypical/walking pneumonia
- ETOHs
- Bird handlers
- Bats/Bat droppings
- South West USA (U.S.A!)
- Currant Jelly Sputum
- PJP
- Mycoplasma Pneumonia
- Kelbseilla
- Chlyamdia Pssticcai (spelling?)
- Histoplasmosis
- Cocciodes
- Klebseilla
Sarcoidosis?
What is it? What is it associated with?
Mechanism?
Systemic Noncaseating granulomas (most often lung).
CD4+ TH1 activation to unknown antigen (Il10, Il12, IFN Gamma)
Granulomas contain elevated levels of ACE and HYPERCALCEMIA (1 alpha hydroxylase (which activates Vit D, thus hyperlevels))
Cause of Pneumonia Infections (pt2)?
- Q Fever
- Air conditioners
- 1 year olds
- Neonate
- Children/Young adults (military, college, prison, etc)
- Health problems
- Viral Pneumonia
- Wool sorter’s disease
- Endogenous flora in 20% of adults
- Ventilator Pneumonia
- Pontaic Fever
- Coxeilla
- Legionella
- RSV
- Group B strep (agalactaie), or E coli
- Mycoplasma
- Kleb
- RSV
- Anthrax
- Srep Pneumonia
- H. Flu
- Legionella
Albuterol
Asthma: Short-Acting Beta 2 Agonist; Drug of Choice for Attack Used for acute asthma symptoms and bronchospasm 15-30 min on time for 3-4 hours Similar Drugs: Metaproterenol, terbutaline (oral and parental formulations as well)
Asthma Drugs
Two Main targets: 1) Bronchoreactivity Tx w/ Bronchhodilators 2) Inflammation tx with Antiinflamms Specific Beta 2 Agonists: ONLY thing Used for acute asthma attacks (B1= Heart, B2=Lungs, cuz you have 2 lungs)–these up the cAMP levels via inducing Adenyl Cyclase Asthma Attack Mediators 1) Histamine release from crosslinked IgE cells (hyperacute response), 2) Leukotrienes (potent vasoconstrictors that “continue the asthma attack” ~10% gets inhaled rest is actually swallowed which isn’t an issue due to drugs high first pass metabolism Progression of Tx: 1) B2 agonist on an as need regiment (Mild to moderate asthma, less than 2 times per week) Prevention: 2) Inhaled Steroids 3) Oral antileukotriene (these drugs are very idosyncratic so might work wonders or be horrible) 4) Theophyline (reserved for poor responders due to fatal OD from low therapuetic index) 5) Long acting Combinations (for refractory and sever asthma) 6) Anti-IgE therapy (Omalizumab; IgE levels don’t predict efficacy but severity of response does predict efficacy of drug)
Salmeterol, Formoterol
Asthma Long acting Beta 2 Agonists, used prophylatically not for acute relief SEs=Tremor tachycardia and cardiovasuclar events (from hitting B1 receptors)
Theophylline
Asthma–prophylactically against (very great against nocturnal attacks)
PDE inhibitor preventing breakdown of cAMP from Beta recptor.
Low therapueitc index with fatal ODs Methylxanthine class Similar to Cafeine (tx ODs with Beta blockers)
Montelukast, Zafirlukast
Asthma, Leukotriene Antagonists, “-kasts” Prophylaxis of Asthma,
Kasts~lasts–block the last step (Block the LTD 4 receptors)
Montelukast–can give 1yo
Zafirlukast–5yo or later
Tiotropium
Asthma/COPD–Antimuscarinic (antagonists) used as bronchodilator better working Ipatropium
Zileuton
Asthma, Inhibitor of 5-lipxoygenase stopping leukotrienes production (Leu-ton stops Leu-kos) Idiosyncratic Efficacy 4/day dosing Used in asthma prophylaxis
Beclomethasone
Asthma, Inhaled Corticosteriod used for first line treatment (still too slow for acute attacks tho)
~90% swallowed but non consequences due to high first pass metabolism. Others include: Budesonide, Flunisolide, Fluticasone, Mometasone, Triamcinolone Acetonide
Omalizumab
Asthma Prophylaxis for non-responders Binds IgE antibodies stopping crossreactivity/anchoring to mast cells SubQ normally
Keeps your “throat in an O for Omalizumab”
Acetazolamide
Diamox, Tx for Altitude sickness Carbonic Anhydrase inhibitor used to decrease bicarb production and increase bicarb excretion thereby acidifying blood which compensates for respiratory alkolosis experienced from low O2 and needing to breathe more
Structures Transversing the Diaphragm? At what level?
I 8 Ten Eggs At Noon
IVC at T8, Esophagus T10, T12=Aorta
T12: RED (aorta) WHITE (thoracic duct) AND BLUE (azygos vein)
Ferruginous bodies?
Asbestos bodies: Golden borwn fusiform rods resmembling dumbless, see in lower lobes (cuz dumbells are heavy)
Silica and coal affect what part of the lung?
Coal at risk for?
Silica at risk for?
Upper lobes (sillicosis also has eggshell calcifications at hilar lymph nodes).
Caplan syndrome (Rheumatoid arthritis with pneumoconisosis)
Tb infection
Primary Pulm HTN? Normal function of Gene?
Inactivating mutation of BMPR2 (used to inhibit smooth muscle vascular proliferation)
Hypercalcemia in lung cancer?
Squamous cell carcinoma producing PTHrP.
Small Cell Carcinoma paraneoplastic syndrome?
Gene associated with?
ACTH (cushings), ADH (SIADH), and Lambert-Eaton Myasthenic syndrome (antibodies to post synaptic calcium channels).
Associated with L-MYC
Bronchial Carcinoid tumor associated with?
Stain?
Carcinoid syndrome (“Be FDR”: Bronchospasm + whEEzing, Flushing, Diarrhea, rihgt sided heart lesions).
Chromogranin A positive (telling you neuroendocrine origin of tumor)
Mydriasis, anhydrosis, Ptosis in lung cancer patient?
Pancoast tumor, causing horners syndrome
Facial flushing, eye puffiness, JVD?
Superior vena cava syndrome (mediastinal/lung mass obstructing SVC)…medical emergency due to risk of aneurysm/rupture intracranially
Lung abscess bacteria?
S. aureus or anaerobes (bacteroides, fusobacterium, peptostreptococcus)
H1 blockers?
en/ine or en/ate
Allergy motion sickeness, sleep aid
SEs: Sedation, antimsucarinic (dilated pupils), anti-alpha adrenergic (facial flushing)
Second Gen H1 blockers
“adines”
Allergies, less sedating than first gen.
Pseduephedrine, phenylephrine
Sympathomimetic alpha agonist used for nasal decongestion
SEs: HTN, CNS stim/anxiety (pseudoephedrine)
Isoproterenol
Non specific B agonist (B1=B2 stim)
Cromyl Sodium
Stabilizes mast cells preventing their degranulation (thus no histamine release).
Can be used as prophylaxis for asthma).
Methacholine
Muscarinic Receptor AGONIST.
Bronchial provocation challenge to dx asthma
Nasopharyngeal Carcinoma?
EBV (african children and chinese young adults)
Acute Epiglotitis?
H. Flu
Interstitial Pneumonia/Fever in a farm worker?
Coxiella Burnetti (NO SKIN RASH or arthropod vector unlike other “rickettsiak like organsims”)
Initially Asthma rxn?
Allergen–>TH2–>
Il4–>IgE
Il5–>IgA, Eosinophils
Il10–l TH1’s
Allergic Bronchopulmonary Asperillosis seen in?
Asthmatics, and cystic fibrosis patients
Upper airway hypersensitivity
Causes of Pulm Fibrosis
Cyclic irritation: causes TGF-beta from injured pneumocytes promotoing fibrosis.
Bleomycin, Busulfan, Amiodarone
Risk factors for Neonatal respitory distress syndrome?
C-section (less steroids), Maternal Diabetes (excess fetal insulin inhibits surfactant production)
Actue onset: Hypoxia, Neurologic Abnromalities, Petechial Rash
Fat emboli causing PE.
Usually from major fractures.
Diaphragm and Gall bladder pain refered to right shoulder via?
Phrenic Nerve.
Lung transplant:
Acute
Subacute
Chronic Rejection
Acute: within hours dt preformed antibodies
Subacute: 1-2wks dt CD8+ cell mediated immunity. Perivascular and peribronchial lymphocytic inflitrates. VASCULAR DAMAGE
Chronic: Inflammation of the small bronchioles (bronchioloitis obliterans)
Lung Abscesses most likley from?
Aspiration of OROPHARYNGEAL CONTENTS (not gastric)
Fusobacterium, Peptostreptococcus, Bacteriodes
Gastric aspriation causes chemical pneumonitis
Smoker presents with diarrhea and lobar consolidation?
LEGIONELLA PNEUMONIA
A-a gradient exists when (most common cause)?
What does an A-a gradient tell you?
Normal A-a?
Perfusion is greater than ventilation in the lower lobes
Increased A-a gradient tells you hypoxemia is due to pulmonary causes (as opposed with normal A-a being extrapulm cause)
Normal is less than 30.
Asthmadoes what to tactile fremitus?
Emphysema?
Pneumothroax?
Consolidations?
Decreases
Decreases (from increased AP diameter)
Absent
Increases
Inspiratory and Expiratory stridor?
Sign of fixed upper airway obstruction===cancer
