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High Yield Concepts > Pulmo > Flashcards

Pulmo Flashcards

1
Q

Areas of gas exchange in the respiratory tract

A
  • respiratoty bronchiole
  • alveolar ducts
  • alveoli
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2
Q

4 basic lung volumes

A
  • Inspiratory Reserve volume (IRV)
  • Tidal volume (TV)
  • expiratory reserve volume (ERV)
  • residual volume (RV)
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3
Q

Amount of air inhaled/exhaled w/ each normal breath

A

TV (=0.5 L)

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4
Q

Amount of air remaining in the lungs after full exhalation

A

RV (maintains oxygenation between breaths)

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5
Q

Max amount of air that one can inhale/exhale

A

Vital capacity (IRV + TV + ERV)

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6
Q

Anatomic dead space volume

A

Area w/ no gas exchange from nose to terminal bronchiole (= 150ml)

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7
Q

Physiologic dead space volume

A

anatomic dead space volume + alveolar dead space volume

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8
Q

Alveolar ventilation per minute

A

Respiratory rate x (TV - physiologic dead space volume)

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9
Q

Minute respiratory volume

A

TV x RR

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10
Q

Stimulates central chemoreceptors in the medulla

A

carbon dioxide (as CSF H+)

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11
Q

lung zones

A
  • zone 1 ( no blood flow)
  • zone 2 ( internittent bloof flow)
  • zone 3 ( continous blood flow)
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12
Q

Increase in the ff factors would cause shift to the right of 02 -Hgb dissociation curve ( unloading of 02 from Hgb)

A
  • C02
  • Acidosis
  • 2-3 DPG
  • exercise
  • temperature

> CADET face right

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13
Q

IIncrease in the ff factors would cause shift to the left of 02 -Hgb dissociation curve ( increased binding of 02 to Hgb)

A
  • carbon monoxide

- fetal hemoglobin

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14
Q

percentage of blood that gives up 02 as it passes through the tissue capillaries

A

Utilization coefficient (25% at rest, 75-85% during exercise)

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15
Q

Central control of inspiration; sends inspiratory ramp signals

A

Dorsal respiratory group (DRG) of the medulla

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16
Q

Central control of both inspiration and expiration; sends overdrive mechanism in exercise

A

Ventral respiratory group (VRG) of the medulla

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17
Q

Limits inspiration and increases respiratory rate

A

Pneumotaxic center of the pons

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18
Q

Stimulates inspiration and decreases respiratory rate

A

Apneustic center of the pons

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19
Q

Receptors in ventral medulla; stimulated by CSF H+ from blood C02; adapts within 1-2 days

A

Central chemoreceptors ( made up of DRG and VRG)

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20
Q

Receptors in carotid bodies (CN IX) and aortic bodies ( CN X); activated when PO2 < 70 mmHg and to a lesser extent, C02

A

Peripheral chemoreceptors

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21
Q

Reversibility in asthma(spirometry) is demonstrated by

A

> 12% and 200 ml increase in FEV1:15 mins after an inhaled SABA; or
after a 2-4 week trial of oral corticosteroids ( prednisone or prednisolone 30-40 mg daily)

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22
Q

Physiologic abnormality of asthma

A

Airway hyperresponsiveness

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23
Q

Pathogenesis behind asthma

A

Imbalance favoring TH2 production over TH1 -> increases IL-1, IL-5 -> increased eosinophils

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24
Q

Putative mediators of asthma

A

SRS-A (made up of leukotrienes C4, D4, E4)

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25
Q

Whorls of shed epithelium in mucus plugs in asthma

A

Curschmann’s Spirals

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26
Q

Crystalloid made up of eosinophil membrane protein seen in both asthma & amoebiasis

A

Charcot-Leyden crystals

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27
Q

Predominant key cell involved in asthma

A

none

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28
Q

Characteristic feature of asthmatic airways

A

Eosinophil infiltration

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29
Q

Most common allergens that trigger asthma

A

Dermatophagoides ( house dust mites)

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30
Q

Most common triggers of acute severe asthma exacerbations

A

URTI: rhinovirus, respiratory syncytial virus (RSV), coronavirus

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31
Q

Mechanism of exercise-induced asthma (EIA)

A

Hyperventilation

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32
Q

EIA is best prevented by regular treatment with

A

Inhaled corticosteroids

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33
Q

Confirms airflow limitation w/ a reduced FEV1, FEV1/FVS ratio, and PEF

A

Spirometry

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34
Q

Primary action of B2 agonists

A

relax smooth muscle cells of all airways, where they act as functional antagonists

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35
Q

Most common side effects of B2 agonist

A

Muscle tremor and palpitations

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36
Q

Most common side effect of anticholinergics

A

Dry mouth

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37
Q

Most common side effects of theophylline

A

nausea, vomiting, headaches

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38
Q

Most effective controllers for asthma

A

ICS

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39
Q

Indicates the need for regular controller therapy

A

use of reliever medication > 3x a week

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40
Q

Most common reason for poor control of asthma

A

Noncompliance w/ medications, usually ICS

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41
Q

Drugs that are safe for asthma in pregnancy

A
  • SABA
  • ICS
  • Theophylline
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42
Q

Asthma and COPD are variatons of the same basic disease

A

Dutch hypothesis

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43
Q

Asthma (allergic phenomenon) and COPD (smoking- related inflammation and damage) are fundamentally different diseases

A

British hypothesis

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44
Q

Pathogenesis behind emphysema

A

imbalance between protease (elastase) and anti-protease (alpha 1- antitrypsin)

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45
Q

First symptom of emphysema

A

progressive dyspnea

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46
Q

Ratio of mucus gland layer thickness to the thickness of the wall between the epithelium and the cartilage of the trachea and bronchi

A

Reid’s index (>0.4 in Chronic Bronchitis)

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47
Q

Most highly significant predictor of FEV1

A

pack years of cigarette smoking

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48
Q

Most common form of severe alpha 1 AT deficiency

A

PiZ: two Z alleles or one Z and one null allele

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49
Q

Accounts for essentially all of the redcution in Pa02 that occurs in COPD

A

ventilation-perfusion mismatching

50
Q

Major site of increased resistance in COPD

A

small airways < 2 mm diameter

51
Q

Type of emphysema frequently assoc w/ cigarette smoking, characterized by enlarged air spaces found (initially) in association w/ respiratory bronchioles

A

Centriacinar emphysema

  • prominent in the upper lobes and superior segments of lower lobes and often focal
  • involves respiratory bronchiole

(SENTROacinar, smoking)

52
Q

Type of emphysema usually observed in patients w/ alpha1 -AT deficiency characterized by abnormally large air spaces evenly distributed w/in and across acinar units

A

Panacinar emphysema

- predilection for lower lobes and involves the entire respiratory unit (respirtory bronchiole, alveolar duct, alveoli)

53
Q

Type of emphysema assoc w/ spontaneous pneumothorax

A

Distal acinar emphysema

- predilection for upper lobes and involves alveoli

54
Q

Most common type of emphysema w/ irregular involvement and often asymptomatic

A

Irregular emphysema

55
Q

Major physiologic change in COPD

A

airflow limitation

56
Q

Newly-developed clubbing of the digits ( not a sign of COPD) should alert an investigation for

A

Lung cancer

57
Q

The only pharmacologic therapy demonstrated to unequivocally decrease mortality rates

A

Supplemental O2

58
Q

Strong predictor of future COPD exacerbations

A

Hx of prior exacerbations

59
Q

Bacteria frequently implicated in COPD exacerbations

A
  • Strep pneumonia
  • H. influenza
    M. catarrhalis
60
Q

The only 3 interventions shown to influence the natural history of COPD

A
  • smoking cessation
  • O2 therapy
  • Lung volume reduction surgery
61
Q

Most common pathogenesis of penumonia

A

aspiration

62
Q

Most common etiology of CAP

A

Streptococcus pneumoniae

63
Q

Most common etilogy of atypical pneumonia

A

Mycoplasma pneumonia

64
Q

Most common cause of nosocomial pneumonia and bronchiolitis in children

A

RSV

65
Q

Main purpose of the sputum gram stain

A

ensure suitability of sample for culture

66
Q

To be adequate for culture, a sputum sample must have

A

> 25 neutrophils

<10 squamous cells per lpf

67
Q

Most frequently isolated pathogen in blood cultures of CAP

A

Streptococcus pneumoniae

68
Q

Irreversible airway dilation that involves the lung in either a focal or a diffuse manner

A

Bronchiectasis

69
Q

Most common form of bronchiectasis

A

Cylindrical or tubular

70
Q

Most widely cited mechanism of infectious bronchiectasis

A

Vicious cycle of hypothesis

71
Q

Most common clinical presentation of bronchiectasis

A

Persistent cough w/ production of thick sputum

72
Q

Imaging modality of choice for confirming bronchiectasis

A

Chest CT

73
Q

1st step in the diagnostic approach to pleural effusion

A

Determine whether effusion is a transudate or exudate

74
Q

Leading cause of transudative pleural effusion

A
  • LV failure

- cirrhosis

75
Q

Leading causes of exudative pleural effusion

A
  • Bacterial pnuemonia
  • malignancy
  • viral infection
  • pulmonary embolism
76
Q

Most common cause of chylous pleural effusion

A

Malignancy

77
Q

3 tumors that cause 75% of all mlignant pleural effusions

A
  • Lung CA
  • Breast CA
  • Lymphoma
78
Q

Benign ovarian tumors producing ascites and pleural effusion

A

Meig’s syndrome

79
Q

The only symptom that can be attributed to the malignant effusion itself

A

Dyspnea

80
Q

Condition most commonly overlooked in the differential diagnosis of a patient w/ an undiagnosed effusion

A

Pulmonary embolism

81
Q

Most common cause of chylothorax

A

Trauma ( most frequently thoracic surgery)

82
Q

Treatment of choice for most cases of chylothorax

A

Insertion of a chest tube plus administration of Octreotide

83
Q

Population at risk for spontaneous pneumothorax

A

Tall thin men 20-40 y/o, smoker

84
Q

Tracheal deviation in spontaneous pneumothorax

A

Ipsilateral tracheal deviation

85
Q

Tracheal deviation in tension pneumothorax

A

contralateral tracheal deviation

86
Q

Co existence of unexplained excessive daytime sleepiness w/ at least 5 obstructed breathing events (apnea or hypopnea) per hour of sleep

A

Obstructive Sleep Apnea

87
Q

Breathing pause lasting >10 seconds

A

Apnea

88
Q

> 10 seconds events where ventilation is reduced by at least 50% from the previous baseline

A

Hypopnea

89
Q

1st step in evaluating a mediastianal mass

A

Place it in one of the 3 mediastinal compartments

90
Q

Most common lesions in anterior mediastinum

A
  • Thymomas
  • Teratomatous neoplasms
  • thyroid masses
  • terrible lymphomas

> terrible T’s

91
Q

Most common masses in the posterior mediastinum

A
  • neurogenic tumors
  • meningocoeles
  • meningomyelocoeles
  • gastroenteric cysts
  • esophageal diverticula
92
Q

One of the 3 major cardiovascular causes of death, along w/ MI and stroke

A

Venous Thromboembolism

93
Q

Causes of pulmonary embolism

A
  • fat
  • foreign body
  • air
  • DVT
  • Bone marrow
  • amniotic fluid
  • tumor
94
Q

Population at risk for pulmonary infarcts

A

Patients w/ pre existing heart/lung diseases (occurs in the lower lobes)

95
Q

Usual cause of death from pulmonary embolism

A

Progressive right HF

96
Q

Most frequent history in DVT

A

Cramp in the lower calf that persists and worsend for several days

97
Q

Most frequent history in PE

A

unexplained breathlesness

98
Q

Classic signs of PE

A
  • tachycardia
  • low grade fever
  • neck vein distention
99
Q

Most frequent symptom of PE

A

Dyspnea

100
Q

Most frequent sign of PE

A

Tachypnea

101
Q

Useful rule out test: > 95% of patients w/ normal levels (< 500ng/ml) don not have PE

A

Quantitative plasma D-dimer ELISA

102
Q

Most frequently cited ECG abnormality in PE (in addition to sinus tachycardia)

A

S1 Q3 T3 sign ( specific but insensitive)

103
Q

Most common ECG abnormality in PE

A

T wave inversion in lead V1 to V4

104
Q

Prinicipal imaging test for the diagnosis of PE

A

Chest CT scan w/ IV contrast

105
Q

Second line diagnostic test for PE, used mostly for patients who cannot tolerate IV contrast

A

Lung scanning

106
Q

Best known indirect sign of PE on transthoracic echo

A

McConnell’s sign

- Hypokinesis of the RV free wall w/ normal motion of the RV apex

107
Q

Definite diagnostic test for PE w/c visualized an intraluminal filling defect in more than one projection

A

Pulmonary Angiography

108
Q

Foundation for successful treatment of DVT and PE

A

anticoagulation

109
Q

Systemic arterial hypotension w/ usually anatomically widespread thromboembolism

A

Massive pulmonary embolism

110
Q

RV hypokinesis w/ normal systemic arterial pressure

A

Moderate to large pulmonary embolism

111
Q

Norma RV function and normal systemic arterial pressure (excellent prognosis w/ adequate anticoagulation)

A

Small to moderate pulmonary embolism

112
Q

Acute onset (<24 hours)
Bilateral patchy airspace disease
Absence of left atrial hypertension (PCWP < 18 mmHg)
Profound shunt physiology ( PA02/Fi02 < 200)

A

ARDS

113
Q

Top 3 caused of ARDS

A
  • Gram negative sepsis
  • gastric aspiration
  • Severe trauma
114
Q

Short term morphology of ARDS

A

Waxy hyaline membranes

115
Q

Long term morphology of ARDS

A

Intra alveolar fibrosis

116
Q

Histologic manifestation of ARDS

A

Diffuse alveolar damage

117
Q
  • Hypoxic respiratory failure
  • pulmonary edema
  • Pneumonia
  • Alveolar hemorrhage
  • ARDS

(type 1,2,3 or 4)

A

TYPE 1 ARF

118
Q
  • Hypercarbic respiratory failure
  • central hyperventilation
  • Neuromuscular asthenia
  • Increased respiratory load

(type 1,2,3 or 4)

A

TYPE 2 ARF

119
Q

Respiratory failure d/t atelectasis (aka Post Operative RF)

type 1,2,3 or 4

A

TYPE 3 ARF

120
Q

Hypoperfusion of respiratory muscles usually secondary to shock

(type 1,2,3 or 4)

A

TYPE 4 ARF

High Yield Concepts (3 decks)

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