Pulmonary Flashcards
how many lobes on ea lung?
2 on left
3 on right
the only artery w deoxygenated blood is?
pulmonary artery … to R side of HT
the only vein w oxygenated blood is?
pulmonary vein
what CN constricts bronchioles?
CN 10
What organs are located in the Middle, Anterior, Posterior, and Superior regions of the MEDIASTINUM?
Middle: HT
Anterior: Thymus
Posterior: Esoph, descending aorta, azygos V.
Superior: aortic arch, brachiocephalic vein
Rib level at MCL on expiration and inspiration?
inspiration: 8 - pleura
expiration: 6 - LU
* * JUST REMEMBER 6-LU MCL (then for Axilla 8,10 and Costal Angle -10,12)
Sphenoid sinus drains to?
Sphenoid -> Ethmoid -> Maxillary -> Nasal Cavity
Frontal sinus drains to?
Maxillary -> Nasal Cavity
Larynx does what and is innervated by?
CN 10
- vocalization
What is Tidal Volume, TV?
what I’m doing now breathing
- the extra is “reserve vol”
What is “Dead Space”?
vol. of LU that does not participate in gas exchange
- anatomical vs physiologic
- – anatomical is 150ml - think dead person
- – physiological - Bohr’s Method Vd = …
What is FEV1?
Forced Expiratory Vol in 1 Sec! after max inspiration
- see that 1 there
- vs FVC, same thing wo time limit
FEV1 is usu what percentage of FVC?
80%
Can Residual Vol be measured?
NO
VC =
TV + IRV + ERV
TLC, Total Lung Capacity includes what?
*Increased TLC is indicative of?
VC (TV + IRV + ERV) + RESIDUAL VOLUME that cannot be measured
- (COPD, along w increased RV)
Medulla and LU
mediates INSPIRATION & EXPIRATION
- RHYTHM
- input from vagus and glossopharyngeal
- output via phrenic to diaphragm
- cerebral cortex overrides
Voluntary Control of breathing regulated by?
Cortex
Apneustic Center is located where and responsible for what?
Pons - lower
- Gasp
- stimulates inspiration
Pneumotaxic Center is located where and responsible for what?
upper Pons
- inhibits inspiration, regulates Rate & Vol.
What part of the brain is responsible for hyper/hypo - ventilation
Cortex
Where is the Central Chemoreceptor and what does it sense?
Medulla
pH and CO2
Where is the Peripheral Chemoreceptor and what does it sense?
CAROTID BODIES & AORTIC BODIES
pH and CO2
Respiratory vs Metabolic Acidosis/Alkalosis
Respiratory: think PCO2
Metabolic: think HCO3-
P50 means…
At 50% saturation of Hgb …
- Pressure of 02 (which is 25mmHg)
What is a Chloride Shift?
HCO3- leaves RBC in exchange for Cl-
- this happens when HCO3 is transported to LU to change back into CO2 and breathed out
when in RBC, H2CO3 dissociates into H+ + HCO3- … the protons are buffered by?
Deoxyhemoglobin
Epiglottitis
- Eti
- pop.
- what happens?
H. flu or Beta Hemolytic Strep INFX
in children
bc trachea is small, epiglottis swells and obstructs airway - head will be tilted and child will drool
- on XRAY see steeple sign (usu w Croup?)
- “THUMB PRINT SIGN”
Pulmonary Edema usu caused by?
- but can also be caused by?
- 2 types
- sequalae
L-sided HT Failure!
- also can be caused by pulmonary capillary membrane damage
- 2 types are Interstitial and Alveolar
- sequelae —> LU infx
Is Emphysema COPD or Restrictive? What happens to the LU?
OBSTRUCTIVE
- LU hyper-inflates but doesn’t let the air out (bc damaged alveolar septae and decreased elastic recoil)
- increased COMPLIANCE
In emphysema you will see normal Pressure of CO2 because?
the body compensates w rbc’s
In chronic bronchitis the pressure of CO2….
INCREASES
COPD
think “blue bloater”
Dx criteria Chronic Bronchitis?
cough + sputum for at least 3mo in 2 consecutive yrs
emphysema and bronchitis often together
Lobar Pneumonia:
ETI:
usu starts where?
LOBAR = intra-alveolar
- Strep pneumoniae diplococci gram+
- –> rust brown sputum
- Klebsiella gram- in ALCOHOLICS
- –> see hepatization (gray or red)
USU STARTS IN LOWER LU THEN MOVES UP
What is Bronchiectasis?
- sputum?
- where in LU?
- Eti?
dilation of bronchi - COPD
secondary to INFX (dilation bc damage to bronchial wall)
- usu lower LU
- foul sputum in AM (a lot of sputum)… mb hemoptysis
Is Bronchial Adenoma malignant or benign?
either
What CA of the LU is deadly?
Which has the worst prognosis?
Large Cell Undifferentiated Carcinoma
—> worst! —>Small/Oat Cell Undifferentiated Carcinoma
Pancoast Tumor is what kind?
- usu causes what?
small cell carcinoma
- Horner’s Syndrome
Which CA of the LU produce hormones?
- SCC, SQUAMOUS CELL CARCINOMA is malignant and produces parathyroid leading to an increase in Ca2+ in plasma
- located CENTRAL LU
Small Cell (oat cell) CA has a _____ prognosis and is assoc. w smoking and what hormone production?
Poor prognosis
- ectopic ACTH and ADH secretion
- located CENTRAL LU
Where is Large Cell Undiff Carcinoma of the LU located? METS?
PERIPHERAL
- mets to BRAIN
- POOR prognosis
MC carcinoma of LU?
where in LU located?
ADENOCARCINOMA
located in PERIPHERY
The common cold is accurately called?
RHINITIS
anti-glomerular basement antibody disease that affects LU and KD … commonly causes hemoptysis.
Goodpasture’s Syndrome
- AI Dz
- type ll hypersensitivity (Abs)
- middle aged men
Sarcoidosis vs TB
what type of granulomas?
TB = CASEATING Sarcoidosis = NONCASEATING
FEV1/FVC ratio: COPD vs Restrictive
Restrictive- they both decrease so remains the same
COPD: ratio DECREASES
What is Wegener Granulomatosis
in the name.. think granulomas of upper and lower LU
- vasculitis
- unknown eti
What are HEART FAILURE CELLS?
hemosiderin-laden M0
seen when you have pulmonary edema caused by heart failure
MC LU CA
METS
Unilateral vs Bilateral blunting of costophrenic angle?
unilateral -> pleural effusion, hemathorax
bilateral -> obstructive LU Dz
LR located beneath what ribs?
SP?
HT?
LR 6-11
SP 9-11
HT 3-5
blood supply to mammary glands?
Internal Thoracic A.
see a Widened Mediastinum on Xray
ddx:
esoph rupture, aortic rupture, aortic dissection, mediastinal mass (thyroid, thymoma, teratoma, lymphoma, trauma)
Which way the trachea deviate w Atelectasis?
same side
- vs pneumothorax.. think balloon
Myasthenia Gravis assoc w enlarged ___.
thymus
Hilar LA - think…
TB, Sarcoidosis, Lymphoma
Blood supply to LU from…
R and L Bronchial A
fremitus means…
consolidation
