Pulm Flashcards
when and from where does lung development come from
distal end of respiratory diverticulum during week 4
errors in which stage of development can lead to tracheoesophageal fistula
embryonic stage (week 4-7) this is because trachea, mainstem bronchi, and lobar/segmental bronchi develop
when do terminal bronchioles develop
pseudoglandular (week 5-17)
when is respiration capable
25 weeks
when do alveolar ducts and prominent capillary network develop
cannalicular (week 16-25)
What stage do pneumocytes and SURFACTANT start
saccular (week 26-birth)…mature levels of surfactant not there until 36 weeks
how long does it take for all adult alveoli to develop
8 years (300-400 million alveoli)
congenital diaphragmatic hernia and bilateral renal agenesis assocaited with…
pulmonary hypoplasia
recurent respiratory infections, airway compression, discrete round sharply defined fluid filled densities on CXR
bronchogenic cysts (abnormal budding of foregut and dilation of terminal/large bronchi
purpose of club cells
secrete component of surfactantm degrade toxins, act as reserve cells
what type of pneumocytes make up 97% of alveolar surface
type I, thin and optimal for gas diffusion
components of surfactant
mix of lecithins (most important one is dipalmitoylphsphatidylcholine - DPPC)
formula for collapsing pressure
(2 x surface tension)/radius
so decrease collapsing pressureby decreasing surface tension
alveoli more likely to collapse during EXPIRATION
these cells secrete surfactant from lamellar bodies, are cuboidal and clustered and are precursors to type I and type II cells
type II pneumocytes
how does surfactant affect lung recoil and compliance
decrease recoil, increase compliance
which cells proliferate during lung damage
type II pneumocytes
prenatal screening has decreased Lecithin/sphingomyelin ratio in amniotic fluid (<1.5)…risk for….
neontal respiratory distress syndrome (NRDS) (surfactant deficiency leading to increasd surface tension and alveolar collapse)
what cardiac complication is NRDS prone to
PDA (due to persistantly low O2 tension)
gi complication of NRDS
NEC
risk of giving O2 in NRDS
RIB
retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary displasia
components of large airways
nose, pharynx, larynx, trachea, bronchi
components of small airways
bronchioles and terminal bronchioles (least airway resistance here due to largely parallel orientaiton)
large and small airways are called “anatomic dead space” why?
do not participate in gas exchange
cellular make up of conducting zone
cartilage and goblet cells extend to end of bronchi
psuedostratified clilated columnar in bronchus which transition to cuboidal as you leave terminal bronchioles
where to airway smooth muscle cells extend
until the end of terminal bronchioles
What makes up the respiratory zone
respiratory bronchioles, alveolar ducts, alveoli (all participate in gas exchange)
Cellular make up of respiratory zone
mostly cuboidal in respiratory bronchioles then transition into simple squamous cells in alveoli
where to cilia terminate
repistoary bronchioles
where to cartilage and goblet cells extend to
end of bronchi
what cell type is found in brochioles, terminal bronchioles, and respitaory bronchioles
club cells! “clara cells”
which lung has the lingula
left lobe
What is the relation of carina to ascending and descending aorta
carina (split of right and left bronchus) is posterior to ascending aorta and anteromedial to descending aorta
Which side does aspirations tend to occur more and why
right side because mainstem bronchus is more wide,shorter, and more vertical than the left
where do things aspirate when you’re supine vs standing
supine - upper right lobe, posterior
standing - basal segment of right lower lobe (preferentially)
What does RALS mean
refers to relation of pulmonary artery to bronchus
in right lung, pulmonary artery is right of bronchus
in left lung, pulmary artery is superior to bronchus
What penetrates diaphragm at T8
IVC, right phrenic nerve
What penetrates diaphragm at T10
esophagus, vagus nerve (CN 10, 2 trunks)
What penetrates diaphragm at T12
aorta (red), thoracic duct (white), azygos vein (blue)
whre does the common carotid bifurcate
C4
where does the abdominal aorta bifurcate
L4
where does the trachea bifurcate
T4
where can pain from diaphragm radiate
shoulder (C5) and trapezius ridge (C 3,4)
lung volume that can’t be measured by spirometry
any measurement that includes RESIDUAL VOLUME
air that can be inhaled after normal exhalation
inspiratory capacity
air that can still be breathed in after normal inspiration
inspiratory reserve volume
air that can be breathed out after normal expieration
expiratory reserve volume
how to calculate inspiratory capacity
IRV + TV
how to calculate vital capacity
TV + IRV + ERV….volume of air that can be exhaled after MAXIMAL respiration
how to calculate volume of physiologic dead space
(Taco) x (Peco - Paco)/Paco Vt X ([Peco-Paco)/Paco)
How to calculate FRC (functional residual capacity(
volume of air left in lungs after normal expiration
chest tube placement at 5th intercostal space at mid axilarry line pierces what muscle
serratus anterior
how do high altitudes affect blood pH, PaO2, PaCO2, and plasma HCO3 when you’re there for more than 2 days
high altitude = less PaO2 = trigger hyperventilation = less PaCO2 (respiratory alkalosis) = 2 days later compensation for respiratory alk by lowering HCO3
normal pO2 room air/trachea
normal pO2 expiratory in alveoli
normal pCO2 expiratory in alveoli
breathed in air has pO2 160 which will decrease to arteries during expiration will increase PVR due to less radial 150 mmhg in trachea…as it gets to alveoli it will equilibrate to about 104 mmhg…meanwhile blood being brought into alveoli for gas exchange will bring about pCO2 of 40 mmhg
if there is a perfusion defect, PE for example, tracheal pO2 and alveolar pO2 would equilibrate at 145 and pCO2 would be low
when is PVR the lowest
fucntional residual capacity (volume after normal expiration)
at max inspiration and max expiration, high lung volumes will stretch due to expanding alveoli and extra alveolar
how does interstitial lung disease affect lung volume, elastic recoil, and radial traction on airways
decreases lung volume due to fibrosis
fibrotic tissue will increase elastic recoil because fibrotic tissue will have INCREASED radial traction on airways
this will decrease FVC which will increase FEV1/FVC ratio
patient prior hx of TB that was treated in the past develops hemoptysis with no fevers night sweats or weight loss…imaging shows old cavities filled with new round mass
aspergillus colonization
what nerve to stimulate in OSA with loud snoring/gasping rspirations
hypoglossal….this will move tongue forards and increase anteroposterior diameter of airway reducing number of apneic events by holding airway open
SOB with normal PaO2, nml Sa02, lowered O2 conent
anemia
nml PaO2, nml Sa02 and increased O2 content
polycythemiaa
decreased PaO2, decreased Sao2, decreased O2 content
high altitiude
SOB with nml PaO2, SaO2, and oxygen content
cyanide poising
major virulence factor causing epiglottitis in Hflu
polysaccaride capsule (PRP, polyribosylribitol phosphate) Hib vaccine is composed of PRP conjugated to tetanus toxoid)
piriform recess in larynx houses what nerve
internal laryngeal nerve (branch of superior laryngeal nerve CNX)....carries only sensory fibers if damged (i.e. foreign body)...lose cough reflex
which cardiac anomaly is associated with increased risk of circle of willis abnormalities, intracerebral hemorrhage, and AVMs?
coarctation of aorta
what pattern of breathing is favored (decreased work o fbreathing) for diseases with increased elastic resistance vs obstructive disease
elastic resistance - quick shallow breaths, work o fbreathing goes down as RR goes up
obstructive - deep long breaths…work of breath goes up the faster you breathe
how long do you have to be vegetarian to become vitb12 deficiency and get anemia
years!!!!!!!!!!!!
if you get a lil hoe who’s only been vegetarian for a few months, she mostly likely got IDA from her period yo
most common predisposing condition to native valve endocarditis in developing and non developing nations
MVP - developed
rheumatic heart dx - nondeveloped
malignant cells often show decreased binding of integrin with….
fibronectin, colagen, and laminin
all components of normal extracellular matrix
composition of benign lung hamartomas
native tissue to lung but disorganized
cartilage, fibrous and adipose tissue
NOT ALVEOLAR TISSUE (bronchioalveolar carcinoma)
How far to epithelial cilia reach
terminal bronchioles
goblet cells, glands, cartilage only go up to respitary bronchioles
what does left heart failure do to lung compliance
backed up fluid accumulation into lungs WILL INCREASE lung compliance
MOA of vareniciline
partial agonist to nicotine (a4B2 nicotininc) receptor so will reduce withdrawal cravings while slightly inducing some weak reward effects of normal nicotine
MOA of succinylcholine
deploarizing block
prevents repolarizing of motor end plate….has two phases
first decreases but maintains constant stimulation in phase I
in phase II there is a fading of response across multiple stimulations
MOA of vecuronium
NONdepolarizing nmj block….depolarizes ….progressive reduction of train of four stimulation immediately by competitively inhibiting post synaptic
pancytopenia, bone marrow biopsy empty fat cells, no LAD or splenomegaly
mcc idiopathic aplastic anemia
what changes are seen 0-4 hours after post MI in myocardium
NONE BITCH
takes 4 hours to see changes
asian male smoker with painful foot ulcers and exertional calf pain demonstrates hypersensitivity to intradermal injected tobacco extract
buerger’s disease
segmental thrombosing vasculitis that extends into contiguous veins and nerves
affects medium sized vessles
priniipally tibila and radial arteries
BRCA1BRCA2 responsbile for
tumor suppressor genes involved in DNA repair
