pulmo Flashcards
what causes a rigth shift in the oxy. diss. curve?
co2, h+, 2,3bp and temp increase
what causes a left shift in the oxy. diss. curve?
co2, h+, 2,3bp and temp decrease
epistaxis occurs?
kiesselbach plexus, anterior segment of the nostril
Mediastinis cause that is very commen?
histoplasma capsulatum
What is assci. with asthma?
charcot-leyden crystals
what guaifenesin?
exspectorant, thins the secretion but not the cough reflex?
what is phenylephrine?
alpha-adrenergic agonist, for nasal cogestion
what is dextromethorphan?
antitussive that antago. NMDA glutamate recepteos, mild opoidd effect
endothlin receptor antagonist are used?
antagoninizes endothlin-1 reducin pulmonary vascular resistance
protacycline analoges are used?
PGI2 (prostacycline) with direct vasodilation on pulmol and systemic, inhibilts aggregation
what is albuterol?
short acting beta 2 agonist, can cause arrhytmia
what are salmeterol, fometerol
long acting beta2 agonist, can cause tremor + arrhytmias
tiopropium is ?
competetive muscarinic antagonist, long acting
what is fluticasone, budisonide?
coticosteroids inactivate NFkapa
Transudate
Transudate is extravascular fluid with low protein content and a low specific gravity (< 1.012)
Adnocarcinoma
Most common, more Females none smoker, EGFR, KRAS, ALK mutations, location: peripheral, hist: Glands and mucine
SCC
30%, Smoker, TP53 CDKNZA, mutation, paraneoplastic: PTHrP, located: centrally, histo: Spinosom: Desmosomes (intracellular bridges), keratin whorls/pearls
Small cell carcinoma
15%, TP53 RB mutation, smokers,
Paraneoplastic: SIADH=decreased Na+, or Antibodies agianst presynatic Ca2+, ACTH=cushungs
location: centrally, Hist: small cells (kulchitsky cells—> small dark blue cells, chromogranin A, synaptophysin
Large cell
highly undiff. tumor
Hist: huge cells: Pleomorphic giant cells/Anaplastic cell with allot of cyplasm
Brochial carcinoid
carcinoid sy.: flushing, wheezing, valve fibrosis and diarrhea
Hist: well organized
trabecula/ nest of neuroendocrine cells
low mito. rate
Mesothelioma
associ. abestos, location pleural thickining
histo: (Psammoma bodis), calretinin
Lung cancer
complications
and metastases
complications: SPHERE Sup. vena cava Pancoast tumor Honer syndrome Endocrine (paraneoplastic) Recurrent laryngeal nerve compression (horseness) Effusion
Metastases:
Love Affecting BONEheads and BRAINcs
Liver, Adrenal, Bone, Brain
Tumors that metas. to the lung are: Breast, Colon, Postate and bladder
Pancoast tumor
superio sulcus tumor. Carcinoma that appears at the apex of the lung. causes pancoast sy. by invading/ compressing local structures
causing:
hoarseness,
horner syn. (stellate ganglion), SVC syndrome, brachiochephalic sy.,
brachial plexus sy.
SVC
obstruction of the SVC impairs blood draininge frpm the head (facial plethora), jug. venous dist., upper edema
cause: malignancy (mediast. mass, pancoast tumor
Emergency: can cause ICP increase—-> headaches, dizziness, increased risk of aneurism/ rapture of the intracraneal arteries
Rhinosinusistis
superior meatus—> drains spenoid, post. ethmoid
middle meatus—> drains frontal, maxillary and anterior ethmoid
inferior—> drains nasolascrimal duct
VC
TV+IRV+ERV
FRC
RV+ERV
OLD
only: RV increases, TLC increases
FEV1 decreased
FEV1/ VC= decrease because VC is increased
decrease in elastin and therefore recoil
RLD
all volumes are decrease
FEV1 decreased
FEV1/ VC= normal because all volumes are decreased
pleural effusion
lung sounds decrease and the fremitus will reduce
Consolidation
increased fremitus/ solid, dullness to percussion
pulmonary edema is
crackels
obstruction
wheezing= obstruction of expiration Strider= same soud on expiration/ its the upper airways
Pulmonary Edema
Hydrostatic forces equation=
J=K(H-O)
O= OSI
Cirrhosis
Nephrosis
Gastrosis >= Albumen will be low
H= Clot Cancer Compression Cuts Cirrhosis !CHF!
K= Inlammation: Infec. or Cancer
!ACI!
Pulmonary Edema
cardiogenic
1 Cariogenic:
Transudate: protein are low, cells are low
Hydrostatic cause increase in PCWP ( estimates the left atrial pressure/ brach of the pulmonary artery) CHF symp. dyspne on exsurgen, parox. dyspnoe, orthopnea, JVD, per. edema
Hist: Hemoseriderin laden marophages
noncardiogenic effusion
hyaline membrane around the alveoli
Exudative effusion (increased protein and increased cells): Cause is leaky capillaries
ALI=ARDS=DAD=hyaline membrane
no CHF/ no volume overload
ALI: occurs in SIRS:
Septic Shock, Pancreatisis, Transfusion related Lung Injury
SIRS—>vasodil—> neutro. fibro,macro—–>hyline membranes—-> collagen
Pleural Effusion
horizontal minicus on x-ray, Transudate: (H)ydrostatic, (O)ncotic
Exudate: K (vascular permeability), Cancer, Inf.
pneumothorax
vertical lung shadow on x-ray: large simple
tensionpneumo
the collpased lung and shift of organs
hypotension, obstruction of the IVC=JVD, tracheal divation
Asthma
rev. airway remod.
COPD
irrv. Ephysem, Bronchitis
Brochitis
conducting airways
Path: inflam. of the Large Airways
Bronchitis
conducting airways
Path: inflam. of the Large Airways Old, Smoker chronic productive cough > 3months, 2yrs Cyanosis, pulm. HTN, CHF, peri. edema, JVD "blue bloaters"
Hist: Hypertrophy +hyperplasia of submucosal glands =Reed index
Reed in index> 40%= mucosal hyperplasia
Emphysema
Path: Alveoli, loss of elastin/septa=loss of recoil
pt: smoker=centriacinar Apixes
prologe exp. phase, purged lips, intercoastal hypertrophy, cachexia, icreased AP diamether XR: Hyperinflation, Chronic CO2 retainers, Ph normal, co2 elevated, increased bicarb
1Inflammation: Debris—>PMN–>Proteases—> decrease elastin
2) Antitryprotease=Panacinar lower lobes
Alpha1 anti D.—–> cirrhosis and emphysema
((((3)Apoptosis?= loss of septa
VFGF-endothelial
Rtp80l- mTor
NRF2 oxidant stress))))))
pink puffer
Astma
rev. broncho, typeI, IGE, Mast, Eo
Wheeze, Dyspnea, Cough, low O2
1) Early Phas=Bonchocontriction
Histamine=vasodilation
leukotriane= brochcontriction
Vagus—>M3—->Brochcon.
2late Phase=Mucus Th2:---->IL4 class switch IgE ---->IL5 eosiniphiles( Chorcot layden Cry) summoning (MBP)--->epithelial detashments ---->IL13 Mucous (Plug= Cruschmann spirals)
Air Remodeling:
Submocosal Hyperplasia and trophy, goble hyplasia, smooth muscle hypertrophy
leading to subbasement fibrosis
pulmonary hypertension
10-14mmhg, above 25 is hypertension
Pulmonary arterial hypertension
Class1
2° PAH—- intimal thickining, fibroblast prol, collagen–collapse of the lumen
iPAH—Plexoform lesions, BMRP-2
Young weman
Treament works only for iPAH (of fibro. prolif): PDE-5 inhib, Entholin inhitors Bosentan, Epoprostal inhibits procyclin
Class 2
LV dysfunction
will lead to pulmonary venous HTN, venous medial thickening, arterialization, CHF SxS, Pulmonary Edema hemosideren macrophages
Class 3
Hypoxic Lung D.
Medial thickining+Hyperplasia, OLD, RLD, OSA
Classs 4
CTE, Chronic Thrombpembolic
Hx:DVT/PE
V/A scan
RLD diff.
DLCO (assess the diff barrier)
DLCO is normal: mucular or Obesity
DLCO is low: fibrotic: ILD=DPLD
IPF Asbestosis etc
Idiopathic pulm fibrosis
Path: progressive firo. in the septa, never smoke
HRCT: subpelural fibrosis, lower lobes, Honey combing
histo: usu intersti. pneumonia, subpleural fibrosis, progressive sparing of central alveoli
Hypersensitivity pneumonitis
typeII/III hyper. due to enviro. antigen seen in farmers and those exposed to birds
