Pulmonary Flashcards
1
Q
Conduction Zone
A
Nose –> Terminal bronchioles; do not participate in gas exchange
2
Q
Respiratory Zone
A
Respiratory bronchioles –> alveoli; participate in gas exchange
3
Q
Type II pneumocytes
A
secrete surfactant & proliferate to replace damaged Type I & II pneumocytes
4
Q
Lecithin:Sphingomyelin ratio in mature lungs
A
> 2.0
5
Q
The IVC traverses the diaphragm at what level
A
T8
6
Q
The esophagus traverses the diaphragm at what level
A
T10
7
Q
The vagus n. traverses the diaphragm at what level
A
T10
8
Q
The aorta traverses the diaphragm at what level
A
T12
9
Q
The azygos v. traverses the diaphragm at what level
A
T12
10
Q
The thoracic duct traverses the diaphragm at what level
A
T12
11
Q
Air that can still be breathed in after a NORMAL inspiration
A
Inspiratory Reserve Volume (IRV)
12
Q
Air that can still be breathed out after a NORMAL exhalation
A
Expiratory Reserve Volume (ERV)
13
Q
Air that move in/out of lung w/ normal breathing
A
Tidal Volume (TV)
14
Q
Air in the lungs after MAX expiration
A
Residual Volume (RV)
15
Q
The normal tidal volume + the air that can be inhaled after a normal inhalation TV + IRV
A
Inspiratory Capacity (IC)
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)
17
Q
The maximum volume of gas that can be expelled after a max inhalation TV + IRV + ERV
A
Vital Capacity (VC)
18
Q
The volume of gas in lungs after a MAX inhalation
A
Total Lung Capacity (TLC)
19
Q
Anatomic Dead Space
A
conduction zones (no gas exchange)
20
Q
Functional Dead Space
A
gas exchange is capable, but does not occur
Apices of healthy lungs
21
Q
Physiologic Dead Space
A
Anatomic + Functional Dead Space
22
Q
Physiologic Dead Space Eq
A
TV x (Paco2 - Peco2)/Paco2
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
24
Q
FRC & the balance b/w opposing forces is determined by
A
lung compliance (elastic properties of the lung & chest wall)
25
Conditions w/ decreased compliance
Pulmonary fibrosis, pneumonia, pulmonary edema, preemie w/ insufficient surfactant
26
Conditions w/ increased compliance
normal aging, emphysema
27
Decreased alveolar O2 --->
vasoconstriction (divert blood to area of high O2 perfusion)
28
Describe how COPD can lead to cor pulmonale
chronic decrease in alveolar O2 --> vasoconstriction --> pulmonary HTN --> cor pulmonale
29
Gas exchange in a normal lung is limited by
perfusion
30
Gas exchange in a diseased lung is limited by
diffusion
31
Pulmonary Vascular Resistance Eq
```
P = Q x R (Q is perfusion & R is resistance)
R = (8 x viscosity x length) / (3.14 x radius^4)
```
32
Primary Pulmonary HTN - defect in
BMPR-2 (bone morphogenetic protein receptor-2)
33
BMPR-2 (bone morphogenetic protein receptor-2) normally functions to
prevent proliferation of vascular SM
| Defective --> SM hypertrophy, reduced arterial lumen radius, increased resistance, & increased pulmonary pressure
34
Primary Pulmonary HTN is associated w/
HIV & Kaposi Sarcoma (HHV-8)
35
Primary Pulmonary HTN is most common in
F ~36yo
36
Causes of Secondary Pulmonary HTN
COPD, Pulmonary fibrosis, Mitral stenosis, recurrent thromboembolism, sleep apnea, L-to-R shunt (VSD), high altitude
37
Tx of Pulmonary HTN
Bosentan, Ambrisentan
Prostaglandin analog
Sildenafil
Nifedipine
38
Bosentan, Ambrisentan MOA
antagonist of endothelin-1 receptor --> decreased vascular resistance
39
What happens to intrathoracic volume following lung collapse?
Chest wall expansion d/t loss of opposing force from lung
40
Normally Iron in Hb is in what state?
Reduced state Fe2+
41
T form of Hb is favored by
Acidosis, CO2, High Temp, High 2,3-BPG
42
Conditions that favor the T form of Hb would cause a ________ shift in the O2 dissociation curve
Right
43
R form of Hb is favored by
Low Temp, low CO2, low 2,3-BPG, alkalosis
44
Which form of Hb has the highest O2 affinity
R form (respiratory)
45
Which form of Hb favors O2 unloading?
T form (tissues)
46
Conditions that favor the R form of Hb would cause a ________ shift in the O2 dissociation curve
Left
47
What causes Methemoglobinemia?
Nitrites, Nitrates, Chloroquine, Primaquine, Dapsone, Sulfonamides, Lidocaine, Metoclopramide
48
Methemoglobinemia pathology
Oxidation of Fe2+ to Fe3+ --> reduced O2 affinity, increased Cyanide affinity
49
Methemoglobinemia Sx
Cyanosis, chocolate-colored blood
50
Methemoglobinemia Tx
Methylene Blue, VitaminC, Cimetidine (gradual)
51
Tx for Cyanide poisoning
Nitrites to induce Methemoglobinemia --> high cyanide affinity
Thiosulfate binds cyanide --> thiocyanate --> renal excretion
52
Why is the O2 curve sigmoid shaped?
positive cooperativity (1 O2 bound --> increases O2 affinity)
53
Fetal Hb O2 dissociation curve is shifted ________
Left
54
Normal A-a gradient value?
10-15 - small indicates O2 is able to readily diffuse from alveoli (A) to arteries (a)
55
Causes of an A-a gradient elevation
Shunting, V/Q mismatch, pulmonary fibrosis, high FIo2 (even w/ O2 mask, only so much O2 can diffuse into blood), advancing age
56
What changes occur in O2 content and Saturation in anemia pts?
Normal PaO2 & normal O2 saturation, LOW total O2
57
O2 delivery to tissues is dependent on
Cardiac Output + O2 content in the blood
58
Causes of Hypoxemia
Normal A-a: high altitude, hypoventilation
| High A-a: V/Q mismatch, pulmonary fibrosis, R-to-L shunt
59
Causes of Hypoxia
Hypoxemia, Anemia, CO poisoning, Low CO
60
Causes of inadequate perfusion
obstruction of arterial flow (MI, stroke), reduced venous drainage
61
V/Q Mismatch
ventilation or perfusion mismatch; physiologic in apices, pathologic d/t BF obstruction or airway obstruction
62
Hallmark of Obstructive Lung Disease on pulmonary function tests?
FEV1/FVC
63
Hallmark of Restrictive Lung Disease on pulmonary function tests?
FEV1/FVC >/= 80% w/ low TLC
64
Curschmann spirals
Asthma
65
Asthma is Dx by
reversibility w/ b2-agonist (Albuterol)
66
ARDS can cause
alveolar damage & hyaline membrane disease
67
Shipbuilders, plumbers, roofers are at a higher risk of ___________ exposure
asbestos
68
Stone-cuters, sand-blasters are at a higher risk of ___________ exposure
silicon
69
"egg-shell calcifications of hilar lymph nodes
siliconiosis
70
Exposure to what inorganic material increases your risk of contracting TB
silicon
71
Key cytological feature of Pulmonary Langerhans Cell Histiocytosis
Birbeck granule (tennis racket)
72
Aerospace manufacturer is at a higher risk of ___________ exposure
Beryllium
73
anti-basement membrane Ab
Goodpastures Syndrome
74
Honeycomb lung on CT
Idiopathic Pulmonary Fibrosis
75
B/L hilar LAD
Sarcoidosis
76
Sarcoidosis Sx
uveitis, erythema nodosum, B/L hilar LAD, noncaseating granulomas, high ACE
77
Who is at a higher risk of developing Sarcoidosis
AA females
78
Genetic mutations assoc w/ Idiopathic Pulmonary Fibrosis
telomerase, mucin MUC5B
79
Asbestos exposure increases the risk of
mesothelioma, laryngeal carcinoma, lung cancer (adenocarcinoma, squamous cell carcinoma)
80
c-ANCA
Granulomatosis w/ polyangiitis
81
Necrotizing granulomas & necrotizing granulomatous vasculitis in the upper airways + focal necrotizing glomerulonephritis
Granulomatosis w/ polyangiitis
82
Dumbbell shaped nodules in alveolar spaces
Ferruginous bodies indicating asbestos exposure
83
Lung cancer causing SIADH
Small Cell Carcinoma (secreting ADH)
84
Lung cancer causing Cushing Syndrome
Small Cell Carcinoma (secreting ACTH)
85
Lung cancer causing Horner Syndrome
Pancoast Tumor (compressing cervical sympathetic ganglia)
86
Lung cancer causing Hypercalcemia
Squamous Cell Carcinoma (secreting PTH-related peptide)
87
Lung Cancer causing severe mm. weakness
Small Cell Carcinoma (anti-presynaptic Ca2+ channel Ab --> Lambert Eaton Syndrome)
88
Lung Cancer causing flushing, diarrhea, right-sided heart lesions, bronchoconstriction
carcinoid tumor (secreting serotonin)
89
Lung Cancer found in the periphery
Adenocarcinoma, Giant Cell Carcinoma
90
Most common lung cancer
Adenocarcinoma
91
Lung Cancer found in the central lung
Squamous Cell Carcinoma & Small Cell Carcinoma
92
Lung cancer w/ keratin pearls
Squamous Cell Carcinoma
93
Lung Adenocarcinoma is assoc w/ what gene mutations
KRAS, EGFR, ALK, ROS, MET, RET
94
Lambert-Eaton Syndrome
small cell carcinoma producing ab against presynaptic Ca2+ channels --> mm. weakness (Lung or metastatic GIT)
95
Carcinoid Syndrome Sx
Bronchoconstriction & wheezing
Flushing
Diarrhea
Right-sided heart lesion
96
Lung cancer risks
smoking, radon (coal miner)
97
lung cancer often metastasizes to
brain, bone, liver, & adrenal glands
98
Metastatic lung cancer often comes from
breast, colon, prostate, bladder
99
Lung cancer w/ hoarseness
pancoast tumor compression recurrent laryngeal n.
100
Most common causes of typical lobar pneumonia
S. pneumo, S. aureus, H. influenzae, Group B Strep
101
Most common causes of atypical pneumonia
Mycoplasma pneumo, Legionella pneumo, Chlamydophilia pneumo
102
Pneumonia in immunocompromised ind
pneumocystitis jiroveci
103
Pneumonia in alcholics
Klebsiella pneumoniae
104
Pneumonia in bird handlers
chlamydia psittaci
105
Pneumonia in someone exposed to bat & bird droppings
Histoplasma
106
Pneumonia in a pt who recently visited S Cali, New Mexico, W Texas
Coccidoides
107
Currant jelly sputum
Klebsiella pneumoniae
108
Pneumonia acquired from an air conditioner
Legionella
109
Pneumonia in an infant
RSV
110
Pneumonia in a newborn
S. agalactiae or E.coli
111
Pneumonia in children/young adults
mycoplasma pneumoniae
112
Most common viral cause of pneumonia
RSV
113
Pneumonia in a ventilator patient or Cystic Fibrosis pt
pseudomonas aeruginosa or MRSA
114
Pontiac Fever
Legionella pneumophilia
115
Lung abscesses are often d/t
aspiration & anaerobic gingival NF
116
Agents causing lung abscesses
Peptostreptococcus, Prevotella, Bacteriodes, Fusobacterium, S. aureus, Klebsiella, G(-)
