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DIT > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Conduction Zone

A

Nose –> Terminal bronchioles; do not participate in gas exchange

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2
Q

Respiratory Zone

A

Respiratory bronchioles –> alveoli; participate in gas exchange

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3
Q

Type II pneumocytes

A

secrete surfactant & proliferate to replace damaged Type I & II pneumocytes

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4
Q

Lecithin:Sphingomyelin ratio in mature lungs

A

> 2.0

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5
Q

The IVC traverses the diaphragm at what level

A

T8

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6
Q

The esophagus traverses the diaphragm at what level

A

T10

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7
Q

The vagus n. traverses the diaphragm at what level

A

T10

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8
Q

The aorta traverses the diaphragm at what level

A

T12

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9
Q

The azygos v. traverses the diaphragm at what level

A

T12

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10
Q

The thoracic duct traverses the diaphragm at what level

A

T12

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11
Q

Air that can still be breathed in after a NORMAL inspiration

A

Inspiratory Reserve Volume (IRV)

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12
Q

Air that can still be breathed out after a NORMAL exhalation

A

Expiratory Reserve Volume (ERV)

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13
Q

Air that move in/out of lung w/ normal breathing

A

Tidal Volume (TV)

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14
Q

Air in the lungs after MAX expiration

A

Residual Volume (RV)

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15
Q

The normal tidal volume + the air that can be inhaled after a normal inhalation TV + IRV

A

Inspiratory Capacity (IC)

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16
Q

The air that can be forced out after a normal exhalation + air that cannot be forced out of lungs (ERV + RV)

A

Functional Residual Capacity (FRC)

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17
Q

The maximum volume of gas that can be expelled after a max inhalation TV + IRV + ERV

A

Vital Capacity (VC)

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18
Q

The volume of gas in lungs after a MAX inhalation

A

Total Lung Capacity (TLC)

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19
Q

Anatomic Dead Space

A

conduction zones (no gas exchange)

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20
Q

Functional Dead Space

A

gas exchange is capable, but does not occur

Apices of healthy lungs

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21
Q

Physiologic Dead Space

A

Anatomic + Functional Dead Space

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22
Q

Physiologic Dead Space Eq

A

TV x (Paco2 - Peco2)/Paco2

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23
Q

At Functional Residual Capacity

A

there is a balance b/w lungs desire to collapse & the chest walls desire to spring outward & the atm P

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24
Q

FRC & the balance b/w opposing forces is determined by

A

lung compliance (elastic properties of the lung & chest wall)

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25
Q

Conditions w/ decreased compliance

A

Pulmonary fibrosis, pneumonia, pulmonary edema, preemie w/ insufficient surfactant

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26
Q

Conditions w/ increased compliance

A

normal aging, emphysema

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27
Q

Decreased alveolar O2 —>

A

vasoconstriction (divert blood to area of high O2 perfusion)

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28
Q

Describe how COPD can lead to cor pulmonale

A

chronic decrease in alveolar O2 –> vasoconstriction –> pulmonary HTN –> cor pulmonale

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29
Q

Gas exchange in a normal lung is limited by

A

perfusion

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30
Q

Gas exchange in a diseased lung is limited by

A

diffusion

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31
Q

Pulmonary Vascular Resistance Eq

A 
P = Q x R (Q is perfusion & R is resistance)
R = (8 x viscosity x length) / (3.14 x radius^4)
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32
Q

Primary Pulmonary HTN - defect in

A

BMPR-2 (bone morphogenetic protein receptor-2)

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33
Q

BMPR-2 (bone morphogenetic protein receptor-2) normally functions to

A

prevent proliferation of vascular SM

Defective –> SM hypertrophy, reduced arterial lumen radius, increased resistance, & increased pulmonary pressure

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34
Q

Primary Pulmonary HTN is associated w/

A

HIV & Kaposi Sarcoma (HHV-8)

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35
Q

Primary Pulmonary HTN is most common in

A

F ~36yo

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36
Q

Causes of Secondary Pulmonary HTN

A

COPD, Pulmonary fibrosis, Mitral stenosis, recurrent thromboembolism, sleep apnea, L-to-R shunt (VSD), high altitude

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37
Q

Tx of Pulmonary HTN

A

Bosentan, Ambrisentan
Prostaglandin analog
Sildenafil
Nifedipine

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38
Q

Bosentan, Ambrisentan MOA

A

antagonist of endothelin-1 receptor –> decreased vascular resistance

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39
Q

What happens to intrathoracic volume following lung collapse?

A

Chest wall expansion d/t loss of opposing force from lung

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40
Q

Normally Iron in Hb is in what state?

A

Reduced state Fe2+

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41
Q

T form of Hb is favored by

A

Acidosis, CO2, High Temp, High 2,3-BPG

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42
Q

Conditions that favor the T form of Hb would cause a ________ shift in the O2 dissociation curve

A

Right

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43
Q

R form of Hb is favored by

A

Low Temp, low CO2, low 2,3-BPG, alkalosis

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44
Q

Which form of Hb has the highest O2 affinity

A

R form (respiratory)

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45
Q

Which form of Hb favors O2 unloading?

A

T form (tissues)

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46
Q

Conditions that favor the R form of Hb would cause a ________ shift in the O2 dissociation curve

A

Left

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47
Q

What causes Methemoglobinemia?

A

Nitrites, Nitrates, Chloroquine, Primaquine, Dapsone, Sulfonamides, Lidocaine, Metoclopramide

48
Q

Methemoglobinemia pathology

A

Oxidation of Fe2+ to Fe3+ –> reduced O2 affinity, increased Cyanide affinity

49
Q

Methemoglobinemia Sx

A

Cyanosis, chocolate-colored blood

50
Q

Methemoglobinemia Tx

A

Methylene Blue, VitaminC, Cimetidine (gradual)

51
Q

Tx for Cyanide poisoning

A

Nitrites to induce Methemoglobinemia –> high cyanide affinity
Thiosulfate binds cyanide –> thiocyanate –> renal excretion

52
Q

Why is the O2 curve sigmoid shaped?

A

positive cooperativity (1 O2 bound –> increases O2 affinity)

53
Q

Fetal Hb O2 dissociation curve is shifted ________

A

Left

54
Q

Normal A-a gradient value?

A

10-15 - small indicates O2 is able to readily diffuse from alveoli (A) to arteries (a)

55
Q

Causes of an A-a gradient elevation

A

Shunting, V/Q mismatch, pulmonary fibrosis, high FIo2 (even w/ O2 mask, only so much O2 can diffuse into blood), advancing age

56
Q

What changes occur in O2 content and Saturation in anemia pts?

A

Normal PaO2 & normal O2 saturation, LOW total O2

57
Q

O2 delivery to tissues is dependent on

A

Cardiac Output + O2 content in the blood

58
Q

Causes of Hypoxemia

A

Normal A-a: high altitude, hypoventilation

High A-a: V/Q mismatch, pulmonary fibrosis, R-to-L shunt

59
Q

Causes of Hypoxia

A

Hypoxemia, Anemia, CO poisoning, Low CO

60
Q

Causes of inadequate perfusion

A

obstruction of arterial flow (MI, stroke), reduced venous drainage

61
Q

V/Q Mismatch

A

ventilation or perfusion mismatch; physiologic in apices, pathologic d/t BF obstruction or airway obstruction

62
Q

Hallmark of Obstructive Lung Disease on pulmonary function tests?

A

FEV1/FVC

63
Q

Hallmark of Restrictive Lung Disease on pulmonary function tests?

A

FEV1/FVC >/= 80% w/ low TLC

64
Q

Curschmann spirals

A

Asthma

65
Q

Asthma is Dx by

A

reversibility w/ b2-agonist (Albuterol)

66
Q

ARDS can cause

A

alveolar damage & hyaline membrane disease

67
Q

Shipbuilders, plumbers, roofers are at a higher risk of ___________ exposure

A

asbestos

68
Q

Stone-cuters, sand-blasters are at a higher risk of ___________ exposure

A

silicon

69
Q

“egg-shell calcifications of hilar lymph nodes

A

siliconiosis

70
Q

Exposure to what inorganic material increases your risk of contracting TB

A

silicon

71
Q

Key cytological feature of Pulmonary Langerhans Cell Histiocytosis

A

Birbeck granule (tennis racket)

72
Q

Aerospace manufacturer is at a higher risk of ___________ exposure

A

Beryllium

73
Q

anti-basement membrane Ab

A

Goodpastures Syndrome

74
Q

Honeycomb lung on CT

A

Idiopathic Pulmonary Fibrosis

75
Q

B/L hilar LAD

A

Sarcoidosis

76
Q

Sarcoidosis Sx

A

uveitis, erythema nodosum, B/L hilar LAD, noncaseating granulomas, high ACE

77
Q

Who is at a higher risk of developing Sarcoidosis

A

AA females

78
Q

Genetic mutations assoc w/ Idiopathic Pulmonary Fibrosis

A

telomerase, mucin MUC5B

79
Q

Asbestos exposure increases the risk of

A

mesothelioma, laryngeal carcinoma, lung cancer (adenocarcinoma, squamous cell carcinoma)

80
Q

c-ANCA

A

Granulomatosis w/ polyangiitis

81
Q

Necrotizing granulomas & necrotizing granulomatous vasculitis in the upper airways + focal necrotizing glomerulonephritis

A

Granulomatosis w/ polyangiitis

82
Q

Dumbbell shaped nodules in alveolar spaces

A

Ferruginous bodies indicating asbestos exposure

83
Q

Lung cancer causing SIADH

A

Small Cell Carcinoma (secreting ADH)

84
Q

Lung cancer causing Cushing Syndrome

A

Small Cell Carcinoma (secreting ACTH)

85
Q

Lung cancer causing Horner Syndrome

A

Pancoast Tumor (compressing cervical sympathetic ganglia)

86
Q

Lung cancer causing Hypercalcemia

A

Squamous Cell Carcinoma (secreting PTH-related peptide)

87
Q

Lung Cancer causing severe mm. weakness

A

Small Cell Carcinoma (anti-presynaptic Ca2+ channel Ab –> Lambert Eaton Syndrome)

88
Q

Lung Cancer causing flushing, diarrhea, right-sided heart lesions, bronchoconstriction

A

carcinoid tumor (secreting serotonin)

89
Q

Lung Cancer found in the periphery

A

Adenocarcinoma, Giant Cell Carcinoma

90
Q

Most common lung cancer

A

Adenocarcinoma

91
Q

Lung Cancer found in the central lung

A

Squamous Cell Carcinoma & Small Cell Carcinoma

92
Q

Lung cancer w/ keratin pearls

A

Squamous Cell Carcinoma

93
Q

Lung Adenocarcinoma is assoc w/ what gene mutations

A

KRAS, EGFR, ALK, ROS, MET, RET

94
Q

Lambert-Eaton Syndrome

A

small cell carcinoma producing ab against presynaptic Ca2+ channels –> mm. weakness (Lung or metastatic GIT)

95
Q

Carcinoid Syndrome Sx

A

Bronchoconstriction & wheezing
Flushing
Diarrhea
Right-sided heart lesion

96
Q

Lung cancer risks

A

smoking, radon (coal miner)

97
Q

lung cancer often metastasizes to

A

brain, bone, liver, & adrenal glands

98
Q

Metastatic lung cancer often comes from

A

breast, colon, prostate, bladder

99
Q

Lung cancer w/ hoarseness

A

pancoast tumor compression recurrent laryngeal n.

100
Q

Most common causes of typical lobar pneumonia

A

S. pneumo, S. aureus, H. influenzae, Group B Strep

101
Q

Most common causes of atypical pneumonia

A

Mycoplasma pneumo, Legionella pneumo, Chlamydophilia pneumo

102
Q

Pneumonia in immunocompromised ind

A

pneumocystitis jiroveci

103
Q

Pneumonia in alcholics

A

Klebsiella pneumoniae

104
Q

Pneumonia in bird handlers

A

chlamydia psittaci

105
Q

Pneumonia in someone exposed to bat & bird droppings

A

Histoplasma

106
Q

Pneumonia in a pt who recently visited S Cali, New Mexico, W Texas

A

Coccidoides

107
Q

Currant jelly sputum

A

Klebsiella pneumoniae

108
Q

Pneumonia acquired from an air conditioner

A

Legionella

109
Q

Pneumonia in an infant

A

RSV

110
Q

Pneumonia in a newborn

A

S. agalactiae or E.coli

111
Q

Pneumonia in children/young adults

A

mycoplasma pneumoniae

112
Q

Most common viral cause of pneumonia

A

RSV

113
Q

Pneumonia in a ventilator patient or Cystic Fibrosis pt

A

pseudomonas aeruginosa or MRSA

114
Q

Pontiac Fever

A

Legionella pneumophilia

115
Q

Lung abscesses are often d/t

A

aspiration & anaerobic gingival NF

116
Q

Agents causing lung abscesses

A

Peptostreptococcus, Prevotella, Bacteriodes, Fusobacterium, S. aureus, Klebsiella, G(-)

DIT (22 decks)

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