Pulm Flashcards
Histo present of nasopharyngeal carcinoma?
- Pleomorphic keratin cells in background of lymphocytes
What is kiesselbach’s plexus?
- Animostesis of four arteries anterior septum
What does IL10 do?
- Inhibit TH1
2. Stimulates TH2
To which side does trachea deviate in collapsed lung?
Towards the collapse
What does A-a gradient > 15 mean (3 possibilities)?
- Diffusion limitation
- Right to left shunt
- V/Q mismatch
* Blood is flowing through pulmonary vasculature but is not being oxygenated
Cardiac changes in pulm embolism?
- Right axis deviation
2. Right heart strain
Volumes in restrictive lung disease?
Almost all are decreased
Take of HPV that can lead to head/neck cancer?
HPV 16
Normal A-a gradient?
10 - 15
Presentation of tension pneumothorax?
Trachea pushed to other side
Composition of fetal HgB?
2 alpha
2 gamma
What causes edema at high alt?
- Can be both pulmonary and cerebral
- Increased capillary pressure and permeability
What is alveolar dead space?
Alveolar ventilation but not perfusion = no gas exchange
How to treat acquired methemoglobin?
IV methylene blue
What is normal FEV1?
75 - 80% total lung volume
What are bronchogenic cysts?
- Abnormal foregut budding leading to dilation of terminal / large bronchi and chronic infections
- **Dilation of large airways also seen in bronchiectasis
2-3 bpg impact on hemoglobin? When is it produced?
- Stabilizes taut form
- Produced at high altitude to allow more O2 delivery to peripheral tissues
2 key mediators of pain?
- Bradykinin
2. Prostaglandin E2
Does Co2 bind to heme? Does Co?
Co2: No
CO: Yes, competitively binds forming carboxy HgB
Most common CF mutation?
- F508 in CFTR
- Leads to abnormal folding and failure of glycosylation
Diseases in which bronchiectasis is seen?
- CF
- Kartagener
- Aspergillosis
* Caused by decreased ciliary motility
Primary cause of pulmonary embolism?
DVT
What is problem in bronchiectasis?
Abnormal dilation of airway leading to loss of tone and trapping
- Think of how much air you can feel being blown when you switch from a straw to a pipe
Initial presentation of pulmonary hypertension?
Exertional dyspnea
What is laplace law?
Collapsing pressure = [2 x surface tension] / radius
- As tension goes up, so will collapsing pressure
- Surfactant reduces tension so this does not happen
- Decrease tension increases compliance decreasing work of breathing
What is the Bohr effect?
Increased H in peripheral tissues shifts curve right favoring oxygen delivery
What is hypersensitivity pneumonitis? Cause?
“Farm/bird workers lung”
- Type III/IV hypersensitivity
- Usually from actinomyces or aspergillus
- Also occurs with bird droppings
Type of vaccine for strep pneumo?
Polysaccharide
What is a unique target for lung metastasis?
Adrenal
Burkhold catalse positive for negative?
Positive
What is methemoglobin?
- Oxidized form for hemoglobin containing ferric Fe3+
- Not good at binding O2 leading to functional anemia
- Has high affinity for cyanide ion: CN -
What is the alveolar gas equation?
PAo2 = 150 - [PaCo2 / .8 ]
What is responsible for the green color of puss?
Neut MPO
Disease processes associated with spontaneous pneumothorax?
- Marfan’s
- Ehlers-danlos
- Homocystinuria
2 pathologies when hyaline membranes are seen?
ARDS
NRDS
What are JVD, lower extremity edema and hepatomegaly indicative of?
Right ventricular failure (cor pulmonale) which is often caused by pulmonary hypertension
What is often associated with squamous cell carcinoma?
Production of PTHrP increase Ca
How to differentiate OSA from obesity hypoventilation syndrome?
OHS: Daytime HYPERcapnia with PaCo2 > 45
OSA: normal
Presentation of lambart eaton?
Proximal muscle weakness
What are the features of selective Iga deficiency?
- Shock with transfusion
- Recurrent infx
- Autoimmune disease
What is a pathologic cause of R - L shunt?
Pulmonary edema: edema is blocking exchange so blood returns to left side without being oxygenated
What does H flue require to grow?
- Factor X: hematin
- Factor V: NAD
- would also be able to grow on chocolate agar as these are found in blood
Which lung cancers linked to smoking?
- Squamous cell carcinoma: males
- Small cell: Males
- Adenocarcinoma: females
- Large cell
How does A1AT deficiency present in liver?
- Cirrhosis with pink, PAS + granules
- Misfolded protein is accumulating in the ER
Main component of surfactant?
- Dipalmitoylphosphatidylcholine: a phospholipid
AKA: lecithin
Appearance of asbestosis?
- Calcified, ivory white pleuro plaques in lower lobes
At what week are fetal lungs usually mature?
Week 35 with L:S > 2
Most common cancer with asbestosis?
Bronchogenic carcinoma
Next step if coin lesion found on CXR?
Compare to previous Xray, next them then would be biopsy which is necessary for diagnosis
Triad of aspirin asthma?
- Asthma
- ASA induce bronchospasm
- Nasal polyps
How do parameters changes in COPD?
- Increased RV
- Decreased FEV1: drops at greatest rate
- Decreased FVC
How to treat NRDS?
RX: maternal steroids prior to birth
- Insufficient surfactant at birth = alveolar collapse from decreased compliance
Cell type mediating delayed hypersensitivity?
T cells
Where does histamine induced dilation occur?
Arterioles
Presentation of fat emboli?
Petechial rash in addition to standard presentation
TB caseating or no caseating?
Caseating
Where does cillia span in respiratory tract?
Trachea to respiratory bronchioles
What is blood oozing from all IV sites indicative of?
DIC
How does silica impact the macs?
Impairs formation of the phagolysosomes
Where to veins and arteries run in lungs?
Arteries: center
Veins / lymphatics: along the edges
What is ischemia?
Decreased blood flow to tissues
What does bronchoalveolar carcinoma arise from?
Clara cell
Causes of high A-a gradient Hypoxemia?
- Diffusion limitation
- Right to left shunt
- V/Q mismatch
Which pleura carries pain fibers?
Parietal - P for Pain
Difference in cell type between respiratory bronchiole and alveoli?
Bronchiolar: cuboidal
Alveolar: squamous
What is defective in kartagener?
Dynein arm of cylia
- Can no longer clear mucus leading inflammation and bronchiectasis
Associations with congenital pulmonary hypoplasia?
- Congenital diaphragmatic hernia
- Bilateral renal agenesis: oligohydramnios
- Ureteral obstruction on utero
- Multicystic kidney disease
What L:S ration indicates lung maturity?
> 2
Ddx for berylliosis?
Sarcoidosis as it has non caseating granulomas in lungs but also all over the rest of body
Where do apices of lungs end?
2 - 4 cm above clavicles
What is FVC?
Max air you can blow out in one large breath
What disease cause diffusion limitation and how?
- Emphysema: Decreased surface area
2. CF: Increased thickness of membrane
Ventilation higher in apex or base?
Base, both perfusion and ventilation increase here but increase in Perfusion is greater due to gravity
What are lamellar bodies?
- Produce surfactant in type II pneumos
2 pleuras and what are they attached to?
- Parietal - chest wall
2. Visceral - Lung
Signs of CO poisoning?
- Cherry red skin: will not appear cyanotic
- Cyanosis seen in carboxy hemoglobin
- New onset headache
Diagnosis of methemoglobin?
- Clinical cyanosis with pulse ox 85-90%
- However, blood gas is normal
- Blood is chocolate brown in color
Causes of exudative effusion?
- Malignancy
- Pneumonia
- Trauma
* need to drain due to increased risk of infx
What is increased fremitus indicative of?
Pneumonia or other consolidating process
Sequelae of pancoast?
- Non small cell bronchogenic carcinoma
1. Horner’s: compression of cervical plexus
2. Weakness in hand/arm: brachial plexus compression
3. Hoarseness: recurrent laryngeal nerve compression
4. SVC syndrome
Most common site of sinus inflammation?
Maxillary sinus
Where are aspirations and tubes more likely to go?
Right main stem bronchi as it is more vertical
Leading cause of cancer death?
Lung in both mean and woman
Associated diseases with silicosis?
- TB
2. Bronchogenic carcinoma
When does fetal respiration become viable?
- Week 25: canalicular phase
- Respiratory bronch, alveolar ducts, and prominant capillaries develop
Genetic cause of methemoglobin?
- Cytochrome b5 reductase deficiency
What happens to chest in emphysema?
Lung tissue destroyed leading to no counter force to chests outward pull leading to expanded chest
What is atelectasis?
Alveolar collapse
Sarcoid caseating or non caseating?
Non
When is hyperresonance seen?
Collapsed lung
Cells in terminal bronchioles?
- Smooth muscle and
2. Ciliated, pseudostratified columnar cells
What is the respiratory zone?
Everything distal to terminal bronchioles:
- Respiratory bronchioles
- Alveolar ducts
- Alveolar sacs
What travels with esophagus through diaphragm?
Vagus nerve at T10
What does small cell carcinoma arise from?
Neuroendocrine kulchitsky cells
Cell involved in sarcoid granuloma and what is it secreting?
TH1 CD4+ secreting IL2 and INF-gamma
- Gamma is responsible for activating macs
Risk of new born oxygen admin?
- Retinopathy
2. Bronchopulmonary dysplasia
How to visualize legionella?
Silver stain
FEV1/FVC in restrictive disease?
FEV1 / FVC > 80 %
- Both quantities drop, however
What are charcot leyden crystals and creola bodies seen in?
Asthma
What does low alveolar Po2 do?
- Constriction of vessels shunting to more oxygenated areas
- Can cause pulm htn.
What lung cancer is neurogranin positive?
Carcinoid
Characteristics of Type I pneumocytes?
- Thin, flat squamous cells
- Make up majority of alveolar surface
- Conduct gas exchange
What do lines of zahn mean?
A clot was formed prior to death
What type of virus are inactivated by ether?
Enveloped
What type of allergy is asthma?
Type I
-
Where does posterior epistaxis come from?
Sphenopalatine artery: branch of maxillary that can cause life threatening hemorrhage
Signs of pulmonary emboli?
- Dyspnea
- Chest pain
- SOB
- Tachy
Where is diaphragmatic irritation referred to?
- Pain in shoulder and trapezius ridge
- Referred visceral pain
Presentation of carcinoid syndrome? Cause? Location
Excess serotonin - usually only presents if in liver otherwise the liver would metabolize serotonin
- Flushing
- Diarrhea
- Wheezing
- Fibrosis of heart valves
What cancer most common in non smokers?
Adenocarcinoma - more often in females
Where does TB usually infect?
Love oxygen so infect apex
Equation for alveolar ventilation?
[tidal volume - dead space] x RR
More O2 bound to Hg or in serum?
Bound to hemoglobin
Most common cause of hypoxia with normal arterial sat?
Anemia
What does IL4 do?
Plasma cell class switching to IgE
Is V/Q higher at base or apex?
Apex
What causes right shifts?
ACE BATs right handed: Acid CO2 Exercise BPG Altitude Temp ***All of these increase taut form allowing better delivery to tissues
Mutations in adenocarcinoma of lung?
Adenocarcinoma makes you “AKE”
- ALK
- KRAS
- EGFR
Lung volume smaller or greater in smokers?
Greater: RV increases as more leftover air stuck in lungs after expiration
Body’s response to High altitude?
- Hypoxia induced increase in EPO
- Increased BPG increasing delivery
- Increased mitochondria to increase oxidation
- Respiratory alkalosis due to hyperventilation and CO2 blow off
- Kidneys respond by wasting bicarb
- Pulm vasocinstrcition
Eosinophil role in asthma?
Release MBP causing epithelial damage and spasm
3 scenarios for increased BPG?
- Altitude
- Hypoxia
- CHF
What does high compliance mean?
Same pressure creates higher change in volume
Lung cancer associated with osteoarthropathy?
Adenocarcinoma
When is silicosis seen?
- Sandblasting in foundries and mining
- Silica leads to H2O2 causing macs to release cytokines
- Leads to egg shell calcifications in hyilar nodes