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nplex > pulm high yield > Flashcards

pulm high yield Flashcards

1
Q

pnemothorax is result of

A

loss of vaccuum between pleura layers

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2
Q

innervation pulmonary

A

CN10; vagus

PNS: CN10/vagus - constrict bronchioles
Sensory - CN10

SNS (sympathetic chain ganglia): dilate bronchioles

Phrenic N - (C3,4,5 - keep the diaphragm alive)

Bronchi - B2 autonomic nerve fibers

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3
Q

parts of mediastinum

A

ant: thymus

middle: heart + pericardium

post: esophagus, desc aorta, azygos veins, thoracic duct, sympathetic trunk

sup: aortic arch, brachiocephalic veins

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4
Q

location of lung and pleura at MCL

A

L: 6th rib
P: 8th rib

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5
Q

location of lung and pleura at axillary line

A

L: 8
P: 10

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6
Q

location of lung and pleura at costal angle (dorsal):

A

L: 10
P: 12

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7
Q

location of apex of lung

A

4cm above rib

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8
Q

laryngeal innvervation

A

CN10 vocalization

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9
Q

nose innervation

A

CN 1 olfaction
CN 5 sensation

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10
Q

how does mucus drain out of the head

A

sphenoid > ethmoid (bridge of nose) > maxillary (under eyes)

frontal > maxillary

———maxillary > nasal cavity

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11
Q

tidal volume TV

A

normal breathing

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12
Q

inspiratory reserve volume IRV

A

deep inspiration

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13
Q

ERV

A

deep expiration

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14
Q

residual volume RV

A

volume in lungs after max expiration
cant be measured by spirometry
Prevents lung collapse

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15
Q

anatomic dead space

A

vol of conducting airways

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16
Q

physiologic dead space

A

vol of lungs that doesn’t participate in gas exchange

diff size ppl have diff size dead space

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17
Q

FEV1

A

forced expiratory volume

vol of air expired in 1 sec after max inspiration

usually 80%

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18
Q

FRC (functional residual capacity)

A

ERV + RV
Vol of gas in lungs after NORMAL expiration
Can’t measure with spirometry since it includes RV

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19
Q

VC (vital capacity)

A

TV + IRV + ERV
MAX vol of gas that can be exhaled after MAX inspiration

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20
Q

TLC (total lung capacity)

A

volume of gas present in lungs after MAX inspiration (SUM OF ALL THINGS)

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21
Q

medulla central control of breathing

A

in reticular formation:

dorsal respiratory group (inspiration, rhythym) input CN9+10, output to diaphragm - phrenic n

ventral resp group (active expiration)

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22
Q

pons central control of breathing

A

apneustic center (lower pons): inspiration (gasp)

pnemotaxic center (upper pons): inhibits inspiration (reg rate + vol)

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23
Q

cortex central control of breathing

A

hyper and hypo ventilation

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24
Q

inc/dec CO2 effect on environment

A

inc: acidic
dec: base

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25
Q

respiratory acid base problems

A

CO2

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26
Q

metabolic acid base problems

A

bicarb/HCO3-

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27
Q

causes of respiratory acidosis

A

sedation, sleep apnea, chest wall injuries, COPD

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28
Q

causes of respiratory alkalosis

A

anxiety, thyrotoxins, mountain climbing

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29
Q

causes of metabolic acidosis

A

ketoacidosis, lactoacidosis (shock), chronic diarrhea

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30
Q

causes of metabolic alkalosis

A

loop diuretics (K loss), insulin (K movement), vomiting (K loss)

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31
Q

where is normal physiologic life on the hemoglobin/oxygen dissociation curve

A

between mixed venous blood (lower) and arterial blood

anywhere else = hypoxemia

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32
Q

causes of hypoxemia

A

dec alveolar PO2 (high altitude)

hypoventilation (sedatives, COPD, neuromuscualr dz)

V/Q mismatch (fibrosis, PE, pulm edema)

venous admixture (R>L shunt)

dec O2 carrying capacity (anemia, CO poison (MOST COMMON))

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33
Q

States of CO2 transport/most common state of CO2

A

Most common - HCO3- (via bicarb chloride transport on RBC membrane)

Carbaminonemoglobin HBCO2 - bound to HB at N terminus of non heme globin

Dissolved

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34
Q

allergic rhinitis is a ___ mediated rxn

A

IgE

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35
Q

chronic rhinitis

A

superimposed bacterial infxn superimposed on infectious/allergic

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36
Q

acute sinusitis can become

A

osteomyelitis if it spreads into orbit or penetrates bone

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37
Q

epiglottitis

A

h influenza, b-hemolytic strep
thumbrint sign xray
ER; lethal
dont open their mouth

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38
Q

pressure pulmonary circulation vs systemic

A

pressure lower in pulmonary circulation (and thus lower resistance)

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39
Q

cartilage rings in trachea and bronchi are

A

C rings (smooth muscle B2 fibers in back connecting relax with sympathetic)

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40
Q

pulm edema causes

A

LHF (“cardiac asthma”, wet)
Pulm capillary membrane damage (pnemonia, toxic gas inhalation, near drowning)

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41
Q

adult respiratory distress syndrome/shock lung

A

injury to type I pneumocytes and capillary endothelial cells in lung

viral infxns, burns, near drowning, dialysis, Lyme

> pulm edema, fibrosis, infxn, dec compliance

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42
Q

pulm HTN RF

A

LHF, mitral stenosis, inc vascular resistance, emboli, scleroderma

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43
Q

atelectasis

A

collapse or incomplete expansion of acini

tumors, FB, mucus bblockage, compressive, deficiency of surfactant, contraction

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44
Q

two types of pulm edema and which is worse

A

intersitial
alveolar (progression) - dec perfusion

45
Q

compliance =

A

Distensibliity of lungs and chest wall; change in volume for a change in pressure (slope of pressure/vol curve)

Inversely proportional to wall stiffness (inc stiffness = dec compliance)

Inc by surfactant

Inc compliance = lung easier to fill

46
Q

ex of decreased compliance pathologies

A

fibrosis
lack of surfactant (premature newborn)
high pulm venous pressure (Pulm fibrosis, LHF)

47
Q

ex of increased compliance pathologies

A

emphysema

48
Q

obstructive vs restrictive (interstitial) lung dz

A

O: obstructive EXIT of air from lungs
R: inflammation/scarring of parenchyma; fibrosis

49
Q

COPD emphysema vs chronic bronchitis

A

E: “pink puffers”
normal pCO2 - chronic compensation (low O2 > chronic stim from erythropoietin > inc RBC > reactive polycythemia)
barrel chest, pursed lips, slow forced expiration
cig smokers (most common) or def of serum a1 protease inhibitor
perm dilation of acinus, destruction alveolar walls

CB: “blue bloaters”
inc pCO2
persistent cough w sputum 3+ months of year in 2 consecutive yrs
obese, cor pulmonale, cyanotic
NO hypercapnic drive to breathe
Inc bacterial superimposed infections

50
Q

consolidative pnemonias vs atypical pnemonias

A

C: broncho/lobular, lobar
A: primary/walking

51
Q

broncho/lobular pneumonia

A

one segment fills with pus

strep pnemoniae
gram + cocci
kelbseiella p gram - rod in alcoholics
rusty brown/brick dust sputum

52
Q

lobar pnemonia

A

entire lobe fills with pus

patchy opportunistic infection, aspiration pnemonia usu RUL

53
Q

lung abscess

A

infx teeth, gums, tonsils > aspiration of bacteria > septic pulmonary emboli

54
Q

TB

A

mycobacterium TB
delayed hypersensitivity type IV
fever, wt loss, acid fast bacilli

CAN BE IN ANY ORGAN; starts as granulomatous disease in lung

55
Q

asthma

A

small bronchi reactive airway disease > constriction
type I hypersens, IgE

56
Q

pnemoconiosis

A

dust inhalation, aspestos

type I IgE

57
Q

goodpastures

A

antibodies against basement membrane, type II

hemopytsis, hematuria

58
Q

pleural effusion

A

wet outside the lung

LHF, infxn
inc pressure around lung

59
Q

pnemothorax

A

air or gas in pleural cavity
traumatic or spontaneous
tension pneumothorax (pushed pulm sys away)

tympany, dec breath sounds

60
Q

most dangerous primary respiratory cancer

A

small/oat cell undifferentiated carcinoma

pancoast tumor, hormone secreting, rapid death

61
Q

lung cancer suspected in all ptswith

A

hemoptysis

62
Q

obstructive lung dz

A

asthma, COPD, cystic fibrosis

63
Q

Stages of pulmonary embryonic development

A

Every Pulmonologist Can See Alveoli

Wk 4 - lung bud comes from distal respiratory diverticulum

Embryologic (wk 4-7)
Pseudoglandular (wk5-17)
Canalicular (wk 16-25)
Saccular (wk 26-birth)
Alveolar (wk 36-8 years)

64
Q

Embryologic stage of embryonic development

A

Weeks 4-7
Lung buds > trachea > bronchial buds > main stem bronchi > secondary (lobar) bronchi, tertiary (segmental) bronchi

Errors at this stage = tracheoesophageal fistula

65
Q

Pseudoglandular stage of embryonic development

A

Weeks 5-17
Endodermal tubules > terminal bronchioles; surrounded by modest capillary network

Larynx formed by week 12

Respiration impossible, incompatible with life

66
Q

Canalicular stage of embryonic development

A

Weeks 16-25
Terminal bronchioles > respiratory bronchioles > alveolar ducts; prominent capillary network

Airways inc in diameter
Pneumocystis at 20 weeks
Respiration at 25 weeks

67
Q

Saccular stage of embryonic development

A

Weeks 26-birth
Alveolar ducts > terminal sacs separated by 1” septae

68
Q

Alveolar stage of embryonic development

A

Weeks 36-8 years
Terminal sacs > adult alveoli

In utero, respiration is aspiration and expulsion of amniotic fluid

69
Q

Microscopic anatomy of nasopharynx

A

Respiratory (stratified squamous) epithelium
Striated muscle
Lymphatics

70
Q

Microscopic anatomy of Trachea + extrapulmonary bronchi

A

Respiratory epithelium
9 C shaped cartilage with smooth muscle

71
Q

Microscopic anatomy of Intrapulmonary bronchi, large and small bronchioles

A

Transition to no cartilage
Transition from respiratory > ciliated columnar epithelium
Prominent smooth muscle
Clara/club cells (brochiolar surfactant)
Cuboidal bronchioles
Basal cells in large airways

72
Q

Microscopic anatomy of Terminal bronchioles

A

Cuboidal epithelium
No cartilage
Patches of cilia
Some Clara cells

73
Q

Microscopic anatomy of respiratory bronchioles

A

Cuboidal, transitioning to squamous
Clara cells
Surfactant

74
Q

Microscopic anatomy of Alveolar ducts

A

Porous squamous
Surfactant

75
Q

Microscopic anatomy of Alveolar sacs, alveoli

A

Porous squamous
Type I pneumocytes (thin, squamous, 95%) - gas exchange
Smooth muscle at orifices

76
Q

Microscopic anatomy of Interalveolar septum

A

Capillary I in Zona diffusa
Alveolar macrophages (dust cells)
Type II pneumocystis (septal cells) - granular, cuboidal, 5%, secrete surfactant/stem cells

77
Q

Rib types/how many

A

7 true
8-10 false
11 + 12 floating

78
Q

Layers of pleura

A

Visceral - lungs
Serous fluid
Parietal - thoracic cage

79
Q

Flow of blood to and from lungs

A

Pulm arteries: RV > lung (DEOX)
Pulm veins: lung > LA (OX)
Bronchial artery: aorta > lung tissues (OX)
Bronchial vein: lung tissues > azygos veins (DEOX)

80
Q

Flow of air through respiratory system

A

Trachea > primary bronchi > secondary (lobar) bronchi > tertiary (segmental) bronchi > bronchioles > terminal bronchioles > respiratory bronchioles > alveoli

81
Q

Chemoreceptor stimuli breathing

A

Central (medulla): acidic pH, inc pCO2
Peripheral:
-carotid(CN9) - acidic, inc pCO2
-aortic (CN10O - dec pCO2

82
Q

Muscles for respiration during exercise

A

Diaphragm + external intercostals - inspiration

Internal and abdominal - expiration

83
Q

Hypoxemia, def + MOA

A

CO poisoning, caps hemoglobin saturation at 50% (death)

84
Q

Gas diffusion rate is proportional to

A

Sum of partial pressure of gas mix

85
Q

Why is venous blood slightly more acidic than arterial blood?

A

Because of CO2

86
Q

Oxygen dissociates more easily from hemoglobin when pH is _____

A

Lower

87
Q

Pulmonary arterial pressure vs systemic

A

Pulm - 15mmHg
Systemic - 100mmHg

88
Q

surfactant biochem, cell type, production time

A

Phospho lipoprotein, 20% = protein
Made by type II alveolar cells in Saccular and alveolar phases of lung development

89
Q

Functions and biochem nitric oxide pulmonary

A

Regulates vascular and bronchial tone (stimulates dilation)

Formed from amino acid arginine by enzyme nitric oxide synthase (requires H4 biopterin as cofactor)

90
Q

under normal conditions are inspiration and expiration active or passive

A

Inspiration - active, muscles contract
Expiration - passive, muscles relax

91
Q

Inspiratory capacity (IC)

A

IRV + TV
ALL air inhaled after normal exhalation

92
Q

Minute ventilation (Ve)

A

Total volume of gas entering the lungs per minute

Ve = Vt x RR

93
Q

Normal tidal volume

A

500mL

94
Q

Alveolar ventilation (Va)

A

Volume of gas that reaches the alveoli each minute

Va = (Vt-Vd) x RR

Vd=physiologic dead space

95
Q

Elastic recoil

A

Lungs intrinsic nature to deflate with expiration

Tendency for lungs to collapse inward and chest wall to spring outward at baseline - opposite motions balance and prevent lung collapse (unbalanced = pneumothorax)

96
Q

At FRC, what are pressurez

A

Airway and alveolar presssures = atmospheric pressure

Intrapleural pressure is neg (neutral/pos = lung collapse)

97
Q

CO2 transport / gas exchange

A

Oxygenation of hemoglobin promotes dissociation of H from hemoglobin

Equilibrium shifts toward CO2 formation

CO2 released from RBCs (haldane effect)

98
Q

Pulmonary circulation is a ___ resistance, ___ compliance system

A

Low resistance
High compliance

99
Q

In pulmonary circulation oxygen diffuses ____ and CO2 diffuses ____ across alveolar membrane

A

Oxygen slowly
CO2 rapidly

100
Q

Pulmonary diffusion increases with

A

Increased area
Larger difference between partial pressures

101
Q

Pulmonary diffusion decreases with

A

Decreased area
Less difference between partial pressures
Thicker alveolar wall

102
Q

Pulmonary vascular resistance decreases with

A

Inc CO
Dec arterial resistance
Dec blood viscosity
Dec vessel length
Inc vessel radius (vasodilation)
Alkalosis
Hypocarbia

103
Q

Pulmonary vascular resistance Increased by

A

Hypoxia
Hypercarbia
Acidosis
Sympathetic stimulation
Hypervolemia

104
Q

V/Q perfusion ratios

A

V/Q = 1

Zone 1 (apex) V/Q inc (ven dec, per dec more)

Zone 2 (middle) - V/Q = 1

Zone 3 (base) - V/Q dec (ven inc, per inc more)

105
Q

Highest amount of PO2 in ___ air, lowest in ____

A

Tracheal air > alveolar air > systemic arterial blood > mixed venous blood

106
Q

Bronchial adenoma

A

Benign or malignant
Prolonged course
Both sexes
Sx or asx
Metastasis infrequent

107
Q

SCC

A

Malignant
In bronchi or near hilium
Produce parathyroid like hormone
Elevated serum Ca

108
Q

Adenocarcinoma

A

Women
Beneath pleura
In scars in lung

nplex (11 decks)

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