Pulmonary Flashcards
COPD can cause hypoxia which can lead the cortical cells of the kidney to produce
EPO
How is the FRC in obstructive and restrictive disease
obstructive: increased, restrictive: decreased
When the vagus nerve is stimulated, what neurotransmitter is released and how does this affect the lungs
ACh, bronchoconstriction
With thoracentesis, insertion of the needle on the inferior margin of the risks striking the subcostal ________
neurovascular bundle
_________ is at risk when doing thoracentesis at the upper border of 10th rib at mid axillary line
right hepatic lobe
________ is inversely related to and considered to be the main indicator of total alveolar ventilation
Arterial PaCO2
Hypocapnia implies alveolar ________
hyperventilation
Hypercapnia implies alveolar ________
hypoventilation (upper airway obstruction, dec ventilatory drive, respiratory muscle fatigue, decreased chest wall compliance)
The rubber like properties of elastin are due to extensive _________ between elastin monomers which is facilitated by _________
cross-linking, lysyl oxidase
________ is a slowly progressive disease caused by Gram positive anaerobic bacteria. They typically lead to _________ abscesses. Typically develops from ________ and alcoholics are at increased risk
actinomycosis, cervicofacial, aspiration
ventilation/perfusion ratio _____ in lung from apex to base
decreases
What are the pressures in Zone 1 of the lung and how is the blood flow
alveolar>arterial>venous
so because arterial pressure is less than alveolar=no blood flow
What are pressures in zone 2 of the lung and how is the blood flow
arterial>alveolar>venous
so because alveolar pressure is greater than venous, blood flow is halted at venous end of capillary bed, so blood flows in pulsatile fashion
What are pressures in zone 3 of the lung and how is the blood flow
arterial>venous>alveolar
so continuous blood flow
A normal A-a gradient is from?
5-15mmHg
Hypoxemia with a normal A-a gradient can be caused by?
Obesity hypoventilation, high altitude
Hypoxemia with an elevated A-a gradient can be caused by?
- R to L shunt (septal defects, pulmonary edema)
- V/Q mismatch (pulmonary embolism, COPD)
- impaired diffusion (interstital lung disease)
PE is associated with hypoxemia and what acid base status
respiratory alkalosis
because hyperventilation can’t significantly improve blood oxygenation–> increases in breathing lead to hypocapnia because more CO2 is excreted
The pO2 in the left atrium and ventricle is lower than that in the pulmonary capillaries due to mixing _________ blood from the pulmonary veins with _________ blood from the bronchial circulation and thebesian veins
oxygenated, deoxygenated
Although ________ is the definite treatment of pulmonary hypertension. You can give __________ in the waiting period because it blocks _________ and leads to vasodilation
lung transplant, bosentan, the endothelin receptor
The ________ extend above the level of the first clavicle and first rib and can be damaged in a ________
lung apices, pneumothorax
In CF, their sweat high high levels of which two molecules? How is their serum levels
Na and Cl, hyponatremia and hypochloremia
CTFR channel functioning is ______ in sweat ducts compared to respiratory and intestinal glands
reversed
In CF, the nasal mucosa will have ______ sodium absorption
increased
small, ovoid, and budding yeast cells in macrophages
histoplasmosis
tissue damage and resultant abscess formation is primarily caused by ________
lysosomal enzyme release from neutrophils and macrophages
IL-12 stimulates the differentiation of “naive” helper T cells into the _____ subpopulation. How do you treat a deficiency in IL-12?
Th1, IFN gamma which helps activate macrophages
CD8 cells recognize foreign antigens presented with MHC _____. Each of these has what else in its molecule. Which cells have this class?
Class 1, heavy chain and beta2 microglobulin, all nucleated cells
CD4 cells recognize presentation from MHC _____ and each of these has what on its molecule. Which cells have this class?
class 2, alpha and beta polypeptide chains, antigen presenting cells ( B cells, dendritic cells, langerhans cells)
CF can lead to pancreatic insufficiency and lead to malabsorption of _______ vitamins. Deficiency of which of these contributes to pancreatic ducts with squamous metaplasia?
fat soluble, vitamin A
normal levels of vitamin A are required to maintain orderly differentiation of specialized epithelia, including mucus secreting columnar epithelium
What is the most common liver pathology finding in sarcoidosis
scattered granulomas
During aerobic exercise, increased skeletal muscle CO2 production increases the PCO2 of _________ blood
mixed venous
primary cell lines increased in stable COPD are
neutrophils, CD8 T cells, macrophages
The pulmonary vasculature is unique in that hypoxia leads to _________
vasoconstriction, so that blood flow is diverted from underventilated areas
-this is the opposite in the systemic circuit so hypoxic tissues receive blood flow
The lung is supplied by ________ from the pulmonary and bronchial systems. As a result lung ________ rarely develops as a complication of pulmonary embolism
dual, infarction
Small cell lung cancer paraneoplastic syndromes
SIADH, Lambert Eaton, ACTH (cushing syndrome), cerebellar ataxia
Squamous cell lung cancer syndrome
Inc PTHrP–> hypercalcemia
adenocarcinoma of lung syndrome
hypertrophic ostearthopathy, dermatomyositis, migratory thrombophlebitis
The Ghon complex occurs with _____ infection with TB
primary
Physiologic iron loss through ______ and ______ slows the progression of hemachromatosis in women
menstruation, pregnancy
Supplemental oxygen in patients with COPD can lead to inc CO2 retention—> ________. A major cause is inc in _______
confusion and depressed consciousness, physiologic dead space
What is the clinical triad of fat embolism syndrome
acute onset neurological abnormalities, petechial rash, and severe long bone or pelvic fracture
-see fat globules depositing in pulmonary microvessels, CNS, and dermal capillaries
Sepsis is a commom cause of ARDS. These symptoms are most likely from what?
fluid accumulation in the alveolar space
-neutrophils provoke an inflammatory response that leads to capillary damage and leakage of protein and fluid into the alveolar space
The diagnostic finding on V/Q for a PE is
a perfusion defect without a ventilation defect
-The embolus prevents adequate blood flow to certain parts of lung
Classic sputum findings in asthma
granule containing cells with crystalloid masses
The CFTR protein is a trans membrane _____ gated channel
ATP
Touch and hearing depend on _______ gated channels
mechanically
Photoreceptor and olfactory neurons depend on ________ ion channels
cyclic nucleated gated
Changes in electrical membrane potential rely on ____ gated channels
voltage
Etanercept and infliximab block what?
TNF alpha
-be careful in initiating and check for latent TB
Interstitial lung disease is associated with ______ elastic recoil which leads to ____ radial traction
increased, increased
_____________ breathing describes cyclic breathing in which apnea is followed by gradually increasing and then decreasing tidal volumes until the next apneic period
Cheyene Stokes
At the FRC, the intrapleural pressure is ____
- 5cm H2O
- when get a stab wound, intrapleural pressure equilibriates with air and lets air in and lung collapses=pneumothorax
Abnormal BMPR2 gene predisposes to excessive _______ and _______
endothelial and smooth muscle cell proliferation
Drug induced lupus is commonly caused by which 3 drugs? How are these three drugs metabolized
Hydralazine, Isoniazid, Procainamide, phase 2 acetylation in the liver (slow acetylators at greatest risk)
Pancoast syndrome is caused by a tumor at the ______ (which is also known as). What are the 4 signs of this?
lung apex (superior sulcus)
- shoulder pain (involve lower brachial plexus)
- Horner syndrome
- upper extremity edema
- spinal cord compression
-also hemoptysis, atrophy of hand muscles, pain C8-T2
superior vena cava syndrome presents with a __________ and you see what sx?
mediastinal mass, facial flushing, dilated neck vessels, dyspnea
How are the PaO2, SaO2, oxygen content in anemia
normal and oxygen content dec
Laplaces law is and what does it say about smaller spheres?
P=2T/r
smaller spheres tend to collapse before larger ones and surfactant prevents this
Reid index is the ratio of the thickness of the _______. It is a sensitive measure of _______ enlargement
muscoal gland layer in the bronchial wall submucosa to the thickness of the bronchial wall between the respiratory epithelium and bronchial cartilage, mucus gland
How is airway resistance along the bronchial tree?
It inc from trachea to medium sized bronchi (b/c of turbulent flow) and then dec all the way down to the terminal bronchioles
Small cell carcinoma of the lung is thought to be from cells of _______ origin
neuroendocrine
-see neuro adhesion molecule, chromogranin, enolase, neurofilaments
Lactic acidosis in septic shock results from tissue _______, which impairs ________
hypoxia, oxidative phosphorylation and causes shunting of pyruvate to lactate following glycolysis
Elderly patients with dementia, history of stroke (paresthesias), and soft and breathy voice may have ______ which is a risk for ______ pneumonia
dysphagia, aspiration
-if see facial nerve palsy (consider other neuro deficits liek with swallowing)
Obesity typically causes _____ lung disease pattern. How are FEV,FVC,ERV,RV,TLC
restrictive, everything is dec except RV is normal
apical sub pleural ______ can lead to pneumothorax
blebs
pt. with dyspnea and chest tightness and triad of prostate cancer, smoker history, and older age lead to inc risk of ________
venous thromboembolism, so PE from hypercoagulability
Normal bronchi are lined by ______________ epithelium that works to propel things up the ororpharynx. Chronic irritation such as smoking can change this to _________. This change is similar to what process in the esophagus?
Pseudostratified ciliated columnar epithelium, stratified squamous epithelium, Barrett’s (where esophageal squamous is replaced by intestinal columnar epithelium from chronic acid exposure
Squamous is more adapted for irritation however this leads to less effective mucociliary clearance—-> inc risk of infections
High altitude exposure results in respiratory ________. After 24-48 hrs, chronic respiratory ______ sets in and leads to a dec in serum ________ reflecting renal compensation
Alkalosis, alkalosis,bicarbonate
In left ventricular failure, fluid in the interstitium signifies dec ___________
Lung compliance
Pancoast tumor is seen in ______ of the lung and what are the 3 major symptoms
Adenocarcinoma, shoulder pain, ptosis, hoarseness because the tumor compressed the cervical sympathetic plexus
In obstructive lung disease, how is the ratio with RV and TLC
both are inc so get an inc RV/TLC ratio b/c TLC inc through an inc residual volume for more air trapping
prolonged sleep apnea can lead to
pulmonary HTN, RH failure
_______ can be given in theophylline intoxication to dec GI absorption
charcoal
Pulmonary vascular resistance is lowest at the ___________. Increased lung volumes ___ PVR due to expanding alveoli and decreased lung volumes ____ PVR due to dec radial traction
functional residual capacity, inc, inc
Cromolyn and nedocromil block _______ degranulation in asthma
mast cell
_________ have the strongest effects on the inflammatory component of asthma
corticosteroids
_______ chemoreceptors are responsible for sensing arterial PaO2 and can be suppressed with oxygen administration.
peripheral
_____ is the major stimulator of respiration in healthy individuals. However, in COPD, response to this is blunted and _______ becomes more important for respiratory drive
CO2, O2 (hypoxemia)
Pulmonary berylliosis closes resembles which disease (noncaseating granulomas, enlarged lymph nodes)
sarcoidosis
__________ from inhalation of organic dusts tends to result in diffuse nodular interstitial infiltrates
hypersensitivity pneumonitis
________ presents with nodular densities and eggshell calcifications
pulmonary silicosis
Two functions of type 2 pneumocytes
produce surfactant and regeneration of alveolar lining
Pulmonary emoboli appear as _________ wedge shaped lesions in the periphery of the lung. IV drug users are at risk of developing what in the heart that can lead to this
hemorrhagic, tricuspid valve endocarditis
Aspirated material is more likely to travel down the ______ lung. When supine, aspiration goes to the ________ segment of the upper lobes and _______ of the lower lobes. Pt.’s who are upright tend to aspirate in the ________ segments of the lower lobes
right, posterior, superior, basilar
If just suffered an MI, how are lungs going to look
transudate in alveolar lumen from pulmonary edema because of left heart failure
neutrophils in alveolar fluid signals with what kind of fluid
aspiration pneumonia, exudate
focal necrosis of alveolar walls and intra alveolar hemorrahge
goodpastures,
lung harmartomas often have islands of mature __________ , fat, smooth muscle and clefts lined by respiratory epithelium
hyaline cartilage
neuroendocrine markers are seen in which lung cancer
small cell lung cancer and also carcinoid syndrome
Presence of hemosiderin laden macrophages in pulmonary alveoli indicates ______ of pulmonary capillary hydrostatic pressures, most commonly from ________
chronic elevation, left heart failure
Man with right sided calf pain and has a thrombus, thrombus is extracted and has high levels of CK leak out, why?
cell membrane damage (repurfusion injury from oxygen free radical damage)
The work of breathing is minimized in patients with elastic resistance when their RR is ____ and tidal volume is _______
high RR, low TV
The work of breathing in patients with obstructive disease (increased airflow resistance) breathe at _____ rate and ____ TV
lower RR, higher TV
Use of oxygen supplementation for premies can lead to what problem
neovascularization (VEGF mediated) into the retina
An accentuated second heart sound signals __________
pulmonary HTN
An obstructive lung lesion in a mainstem ________ can prevent ventilation of entire lung leading to atelectasis and complete lung collapse. See unilateral pulmonary opacification on X ray and a trachea deviated ________ affected side
bronchus, affected, see a hemothorax in one lung
Silicosis impairs which immune cells and can lead to reactivation of TB
macrophages
_________ is the most common malignancy associated with asbetos and ______ is the one caused only by asvestos
bronchogenic carcinoma, mesothelioma
meconium ileum is a very strong finding for _______ and the most likely cause of death is_________. What do you see?
cystic fibrosis, pneumonia
-inspissated mass in distal ileum, abnormally viscous mucus in small bowel
elastase in the lung is produced in _________
alveolar macrophages and granules of neutrophils
In ARDS, the _______ is typically normal. You see ___lung compliance, ____work of breathing, ____ventilation perfusion matching
pulmonary capillary wedge pressure
-dec, inc, worsened
in the fetus the umbilical _____ has the highest oxygen content and then this goes and bypasses the liver and enters the _________
vein, IVC
Acute pulmonary rejection affects the _______ and chronic affects ______
acute: pulmonary and bronchial vessels
chronic: small airways=bronchiolitis obliterans
columnar mucin secreting cells that line alveolar spaces without invading stroma or vessels
adenocarcioma=malignant neoplasm
_______ cancer has the highest mortality amongst men and women
LUNG
Exposure to carbon monoxide shifts hemoglobin to carboxygemoglobin which leads to a _______ shift
Left, so that hgb is less likely to load off the tissues
cheyenne stokes breathing is common in
heart failure
alpha antirypsin is an _________ inhibitor
elastase
-so when deficient, have overactive elastase
a ______ pneumothorax patients develop tachypnea, dyspnea, tachycardia, and mediastinum, heart, and trachea all shift ______ from the affected side. Compression of the SVC—>________. How do you tx?
tension, away, inc venous pressures and jugular venous distention
-place a needle in second intercostal space midclavicular line
in pneumothorax, intrapleural pressure _____ with inspiration and this make sit harder to breathe
inc
-normally intrapleural pressure is lower than atmospheric pressure during inspiration, allowing the lungs to expand and fill with air
What does guanifesin do?
expectorant–>thins respiratory secretions, doesn’t suppress cough reflex
what does N-acytelcysteine do?
liquifies mucus in COPD, CF by disrupting disulfide bonds
TOF with pulmonary atresia, give _______ to keep open
prostaglandins (alprostadil)
In the lungs, there’s and HCO3/Cl exchanger that does what
allow HCO3 to enter and Cl to leave
in polycythemia vera, you have ____ total blood O2 content and hemoglobin concentration and _____ PaO2 and percent saturation
inc, normal
3 neuron pathway for Horner’s syndrome
first order neuron: descends from posterolateral hypothalamus to level of C8-T2
2nd order neuron: exits spinal cord at T1 and then heads to sympathetic trunk–>superior cervical ganglion
3rd order neuron: ascends along internal carotid and joins ophthalmic division of trigeminal nerve
foam stability index measures ________ ratio (mix ethanol and amniotic fluid
surfactant
How does pulmonary embolism affect CVP, CO, SVR?
inc CVP, dec CO, inc SVR
For COPD, pulm function tests show inc in what 2 variables
RV, TLC
In cough syncope you have _______ intrathroacic pressure—> ______ venous return to the heart–>____ CO and cerebral perfusion
increased, dec–>dec
In ARDS, alveolar filling with proteinaceous material and cellular debris causes _________ gas exchange and _____ shunting—>hypoxemia. Also see ______ dead space and hypercapnia
ineffective, right to left, increased
As we age how are residual volume, FVC, TLC, chest wall compliance, and lung compliance?
dec chest wall compliance and inc in lung compliance from loss of elastic recoil–>in RV, dec FVC, unchanged TLC
Central sleep apnea secondary to heart failure is for increased sensitivity to _____
CO2 and stimulation of vagal receptors, is a protective measure from hypercapnia
During a sever asthma attack, hyperventilation leads to _____ CO2–> respiratory _______
inc, respiratory
errors in the embryonic lung stage lead to
tracheoesophageal fistula
Stages of lung development
Every Pulmonologist Can See Alveoli Embryonic (mainstream bronchi) Pseudoglandular (terminal bronchioles) Canalicular (respiratory bronchioles) Saccular (alveolar ducts--> terminal sacs) Alveolar (alveoli up to 8 years)
Chronic dyspnea after lung transplantation thing
bronchiolitis obliterans
