Pulmonary Flashcards
aging and its effects on pulmonary function
- decrease in chest wall compliance
- increase lung compliance due to loss of elastic recoil
- dilation of alveolar ducts is homogenous
- increase in residual volume
- total lung capacity= unchanged
- decrease in forced vital capacity
what test to use to test for asthma
methacholine challenge test- muscarinic cholinergic agonists that acts by inducing bronchial smooth muscle contraction and increasing bronchial mucus production
findings of idiopathic pulmonary fibrosis
progressive exertional dyspnea, dry cough, restrictive profile, interstitial fibrosis with cystic air space enlargement, patchy involvement with dense fibrosis , “honeycomb” changes
why does supplemental oxygen administration in patients with COPD lead to oxygen-induced hypercapnia and thus lead to confusion and depressed consciousness?
reversal of hypoxic pulmonary vasoconstriction–> increases physiologic dead space as blood is shunted away from well-ventilated alveoli
hypoxia stimulates _________ production from the renal cortex
erythropoietin–> to stimulate erythrocyte production
________ deficiency is associated with reddish-pink, periodic acid-Schiff-positive granules
alpha-1 antitrypsin (AAT)
associated with panacinar emphysema
signs of sarcoidosis
accumulation of CD4+ cells, noncaseating granulomas in parenchyma and hilar lymph nodes, dyspnea, enlarged mediastinal and hilar lymph nodes on x-ray, high ACE levels, hypercalcmia
______ is a competitive antagonist of endothelin receptors used for pulmonary arterial hyptertension
Bosentan
electrical stimulation of the ______ nerve increases the opening of the orophyngeal airway to decrease obstructive sleep apnea episodes
hypoglossal
side effect of inhaled glucocorticoids/ corticosteroids (1st line for chronic asthma)
oral thrush/ oropharyngeal candidiasis
*use a spacer and rinse mouth after use to reduce risk
leukotriene B4
stimulates neutrophil migration to sites of inflammation
immune response to pulmonary tuberculosis infection to control it
CD4+ TH1 lymphocytes and macrophages
why do lung infarction only rarely develops as a complication of pulmonary embolism?
lung is supplied by dual circulation from the pulmonary and bronchial systems (collateral circulation)
how does pulmonary emboli usually appear on the lung?
multiple wedge-shaped hemorrhagic lesions in the periphery of the lung
IV drug users are at risk for developing septic pulmonary emboli as a complication of __________
tricuspid valve endocarditis
which has a more significant effect on cerebral blood flow: pCO2 or pO2?
pCO2
CO2 causes cerebral vasodilation, so decreases CO2 like with asthma, then decreased cerebral blood glow and lead to dizziness, weakness, and blurred vision
peripheral chemoreceptors found in __________________ are the primary sites for sensing arterial PaO2 and are stimulated by hypoxemia
carotid and aortic bodies
antibiotic good for lung abscess, oral infections and aspiration pneumonia
Clindamycin
Vitamin ___ maintains orderly differentiation of specialized epithelia, including mucus-secreting columnar epithelia of the ocular conjuctiva, respiratory and urinary tracts, and pancreatic and other exocrine ducts
A
primary cell lines that are increased in stable COPD
neutrophils, macrophages, and CD8+ T lymphocytes
*secrete enzymes and proteases that perpetuate both alveolar destruction of emphysema and mucus hypersecretion found in chronic brochitis
complication of using concentrated oxygen therapy for neonatal respiratory distress syndrome
retinopathy of prematurity
major cause of blindness
ventilation/perfusion scan finding for pulmonary embolism
perfusion defect with ventilation defect
Cystic fibrosis is an autosomal ______ disease caused by mutations in the _________ gene
recessive; CF transmembrane conductance regulator (CFTR)
*CFTR protein=transmembrane ATP-gated Cl- channel
Chyne-Stokes breacthing
cyclic breathing in which apnea is followed by gradually increasing then decreasing tidal volumes until the next apneic period
- associated with advanced congestive heart failure
what is the Reid index? like how is it measured?
ratio of the thickness of the mucous gland layer in the branchial wall submucosa to the thickness of the bronchial wall between the respiratory epithelum and bronchial cartilage—> does not include the cartilage part
for chronic bronchitis
arterial blood gas changes associated with high altitudes
hypoxemia–> reduced PaO2–> triggers chemoreceptors in carotid bodies–> hyperventilation–> decrease PaCO2–> respiratory alkalosis–> compensation would decrease bicarb
Pancoast tumor (key findings)
*key: shoulder pain and Horner’s syndrome
superior sulcus tumor arise at lung apex
4 major causes of hypoxemia
alveolar hypoventilation, ventilation-perfusion mismatch, diffusion impairment, and right-to-left shunting
A-a gradient is normal with alveolar hypoventilation- distinguishes it from others
fat embolism syndrome: the classic triad
acute-onset neurologic abnormalities, hypoxemia, and petechial rash
fat embolism syndrome caused by
severe long bone and/or pelvic fratures
fat globules dislodges from bone marrow and travel to lung–> can cause ARDS
normal A-a oxygen gradient
5-15 mm Hg, with older people having a higher gradient
untreated obstructive sleep apnea can lead to (2 things)
pulmonary hypertension and right heart failure
why is it thought that small cell carcinoma of the lung have a neuroendocrine origin?
tumor cells express neuroendocrine markers and have neurosecretory granules in the cytoplasm
adverse effects of theophyline (asthma drugs that causes bronchodilation by inhibiting phosphodiesterase)
seizures and tachyarrhythmias (do not usually case QT prolongation)
seizures=major cause of morbidity and mortality in theophylline intoxication
