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Cardiovascular > Pulmonary Important Points > Flashcards

Pulmonary Important Points Flashcards

1
Q

Atelectasis

A
  • alveolar collapse

- happens when surface tension inc. possibly due to lack of surfactant

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2
Q

Cartilage and goblet cells extend to the end of the _______.

A

Bronchi.

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3
Q

Cilia terminate in the _________.

A

Respiratory Bronchioles.

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4
Q

Club (Clara Cells)

A
  • non-ciliated
  • secretory granules that secrete a component of surfactant
  • degrade toxins
  • act as reserve cells
  • present in bronchioles
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5
Q

Lecithin-sphingomyelin ratio of ______ in amniotic fluid indicates fetal lung maturity.

A

> 2.0

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6
Q

Aspirated objects will most likely go to the:

A

-lower lobe of the right lung

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7
Q

Consequence of Pulmonary Hypertension

A
  • cor pulmonale

- and subsequent right ventricular failure

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8
Q

Cor Pulmonale

A
  • alteration in the structure and function of the right ventricle caused by a primary disorder of the respiratory system
  • chronic hypoxic pulmonary vasoconstriction can lead to cor pulmonale
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9
Q

5 Causes of Hypoxemia

A
  • normal A-a gradient:
  • -high altitude
  • -hypoventilation
  • inc. A-a gradient:
  • -V/Q mismatch
  • -diffusion limitation
  • -R to L shunt
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10
Q

Epistaxis

A

-nose bleed

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11
Q

Obstructive Lung Diseases

A
  • chronic bronchitis
  • emphysema
  • asthma
  • bronchiectasis
  • FEV1/FVC ratio dec. (hallmark)
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12
Q

Chronic Bronchitis

A
  • blue bloater
  • hyperplasia of mucous secreting glands in bronchi
  • productive cough >3 months per year
  • findings: wheezing, crackles, cyanosis, dyspnea, hypercapnia
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13
Q

Emphysema

A
  • pink puffer
  • enlargement of airspaces, dec. recoil
  • dec. diffusing capacity for CO resulting from destruction of alveolar walls
  • inc. in lung compliance
  • two types: centriacinar (smoking related) and panacinar (a1-antitrypsin deficiency)
  • exhalation through pursed lips, barrel chested
  • dyspnea and cough with MINIMAL sputum
  • weight loss common due to inc. work of breathing
  • DLCO will be decreased
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14
Q

Asthma

A
  • bronchial hyperresponsiveness causes reversible bronchoconstriction
  • smooth muscle hypertrophy
  • can be triggered by viruses, allergens, stress
  • test with methacholine challenge
  • findings: cough, wheezing, tachypnea, dyspnea, hypoxemia, inc. inspiratory/expiratory ratio, pulsus paradozis, mucus plugging
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15
Q

Bronchiectasis

A
  • chronic necrotizing infection of bronchi
  • premanently dilated airways
  • purulent (pus), foul smelling sputum
  • recurrent infections
  • associated with bronchial obstruction, poor ciliary motility, cystic fibrosis, allergic bronchopulmonary aspergillosis
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16
Q

Restrictive Diseases

A
  • FEV1/FVC ratio > 80%
  • types
  • -poor breathing mechanics: polio, myasthenia gravis, scoliosis, morbid obesity
  • -interstitial lung disease (inc. A-a gradient): ARDS, neonatal respiratory distress syndrome, pneumoconioses, sarcoidosis, idiopathic pulmonary fibrosis, goodpasture, langerhans cell histiocytosis, hypersensitivity pneumonitis, drug toxicity
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17
Q

Hypersensitivity Pneumonitis

A
  • mixed type III/IV hypersensitivity reaction to environmental antigen
  • eosinophilic granulomatous reaction
  • dyspnea, cough, chest tightness, headache, fever hours after exposure
  • often seen in farmers and those exposed to birds
  • chronic exposure leads to interstitial fibrosis
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18
Q

-pneumoconioses

A
  • interstitial fibrosis due to CHRONIC occupational exposure
  • coal workers lung
  • silicosis
  • asbestosis
  • inc. risk cor pulmonale and Caplan syndrome (RA and pneumoconioses with intrapulmonary nodules)
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19
Q

Acute Respiratory Distress Syndrome (ARDS)

A
  • characterized by acute onset respiratory failure, bilateral lung opacities, no HF
  • may be caused by trauma, sepsis, shock , gastric aspiration, uremia, acute pancreatitis, amniotic fluid embolism
  • diffuse alveolar damage leads to inc. alveolar capillary permenability, leads to protein-rich leakage into alveoli and noncardiogenic pulmonary edema
  • results in formation of intra-alveolar hyaline membranes (pink rivers)
  • management: mechanical ventilation with low tidal volume, address underlying cause
20
Q

Obesity Hypoventilation Syndrome

A

-obesity leads to hypoventilation, leads to dec. PaO2 and inc. PaCO2 during sleep, leads to inc. PaCO2 during waking hours (retention)

21
Q

Pulmonary Hypertension

A
  • hypertension > 25 at rest
  • results in arteriosclerosis, medial hypertrophy, intimal fibrosis of pulmonary arteries
  • results in plexiform lesions on histology
  • 5 types:
  • -pulmonary arterial hypertension
  • -PH due to L heart disease
  • -PH due to lung diseases or hypoxia
  • -chronic thromboembolic PHH
  • -multifactorial PH
22
Q

Pleural Effusion Physical Findings

A
  • dec. breath sounds

- dull on percussion

23
Q

Atelectasis (bronchial obstruction) Physical Findings

A
  • dec. breath sounds

- dull on percussion

24
Q

Simple Pneumothorax Physical Findings

A
  • dec. breath sounds

- hyperresonant on percussion

25
Q

Tension Pneumothorax Physical Findings

A
  • dec. breath sounds

- hyperresonant on percussion

26
Q

Consolidation (lobar pneumonia, pulmonary edema) Physical Findings

A
  • bronchial breath sounds; late inspiratory crackles

- dull on percussion

27
Q

Types of Pneumonia

A
  • lobar: intra-alveolar exudate leads to consolidation and may involve lobe or entire lung
  • bronchopneumonia: acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving > 1 lobe
  • interstitial (atypical): diffuse patchy inflammation localized to interstitial areas at alveolar walls; diffuse distribution involving > 1 lobe, generally follows more indolent course (walking pneumonia)
28
Q

Mesothelioma

A
  • malignancy of the pleura associated with asbestos
  • may result in emorrhagic pleural effusion (exudative), pleural thickening
  • smoking not risk factor
29
Q

Small Cell Carcinoma

A
  • central location
  • very aggressive
  • neoplasm of neuroendocrine Kulchitsky cells (small, dark blue cells)
  • nucleus forming
30
Q

Adenocarcinoma

A
  • peripheral location
  • non-small cell
  • most common lung cancer in non-smokers
  • associated with clubbing
  • apparent “thickening” of alveolar septa (grows along alveolar septa)
  • may form gland-like structures
31
Q

Squamous Cell Carcinoma

A
  • central location
  • non-small cell
  • hilar mass arising from bronchus
  • cavitation
  • cigarettes are cause
  • hypercalcemia
  • keratin pearls and intercellular bridges
32
Q

Large Cell Carcinoma

A
  • highly anaplastic
  • poor prognosis
  • less responsive to chemo
  • pleomorphic giant cells
  • can secrete b-HCG
33
Q

Antihistamines

A
  • primary use in allergic rhinitis, minor role in viral cold symptoms
  • reversible inhibitors of H1 histamine receptors

1st gen: diphenhydramine, dimenhydrinate, chlorpheniramine

  • -clinical uses: allergy, motion sickness, sleep aid
  • -toxicity: sedation, antimuscarinic, anti-a-adrenergic

2nd gen: loratadine, fexofenadine, desloratadine, cetirizine

  • -clinical uses: allergy
  • -toxicity: far less sedating than 1st gen because of dec. entry into CNS
34
Q

Decongestants

A
  • vasoconstrictors
  • primary use in allergic rhinitis and viral cold infections
  • pseudoephedrine (oral)
  • phenylephrine (oral or topical)
  • mechanism: a-adrenergic agonists, used as nasal decongestants
  • clinical use: reduce hyperemia, edema, nasal congestion,; open obstructed eustachian tubes
  • pseudoephedrine also used to illegally make meth
  • toxocity: hypertension; can cause CNS stimulation/anxiety
35
Q

Antitussives

A
  • some use in coughs associated with viral cold symptoms, allergic rhinitis, asthma, COPD
  • dextromethorphan (synthetic codeine analog); most commonly used OTC cough-suppressent
  • has mild opioid effect when used in excess
  • naloxone can be given for overdose
  • mild abuse potential
  • may cause serotonin syndrome if combined with other serotonergic agents
  • robo-tripping possible
36
Q

Expectorants

A
  • some utility in viral cold infections, COPD
  • guaifenesin: things respiratory secretions; does not suppress cough reflex
  • N-acetylcysteine: mucolytic- can loosen mucous plugs in CF pts by disrupting disulfide bonds; also used as an antidote for acetaminophen overdose
37
Q

Mucolytics

A

-some utility in viral cold infections, COPD

38
Q

B2-Agonists

A

Asthma

  • albuterol: relaxes bronchial smooth muscle; used during acute exacerbation
  • salmeterol, formoterol: long acting agents for prophylaxis; adverse effects are tremor and arrhythmia
39
Q

Pulmonary Hypertension Drugs

A
  • endothelin receptor antagonsits: includ bosentan; competitively antagonize endotheln-1 receptors, leading to dec. pulmonary vascular resistance; hepatotoxic
  • PDE-5 inhibitors: include sildenafil; inhibit cGMP PDE5 and prolong vasodilatory effect of nitric oxide, also used to tx erectile dysfunction
  • prostacyclin analogs: include epoprostenol, iloporst; prostocyclines with direct vsodilatory effects on pulmonary and systemic arterial vascular beds; inhibit platelet aggregation; side effects: flushing, jaw pain
40
Q

Corticosteroids

A
  • fluticasone, budesonide: inhibit synthesis of virtually all cytokines; inactivate NFkB
  • first line therapy for chronic asthma
41
Q

Muscarinic Antagonists

A
  • ipratropium
  • competitively blocks muscarinic receptors, preventing bronchoconstriction
  • also used for COPD
  • tiotropium is long acting
42
Q

Antileukotrienes

A
  • montelukast, zafirlukast: block leukotriene receptors; esp. good for aspirin-induced asthma
  • zileuton: 5-lipoxygenase pathway inhibitor; blocks conversion of arachidonic acid to leukotrienes; hepatotoxic
43
Q

Omalizumab

A
  • monoclonal anti-IgE antibody
  • binds mostly unbound serum IgE and blocks binding
  • used in allergic asthma resistant to inhaled steroids and long-acting B2-agonists
44
Q

Methylixanthines

A
  • theophylline: likely causes bronchodilation by inhibiting phosphodiesterase, leading to inc. in cAMP levels due to dec. cAMP hydrolysis
  • usage is limited because of narrow therapeutic index; metabolized by cytochrome P-450
  • blocks actions of adenosine
45
Q

Idiopathic Pulmonary Fibrosis

A
  • progressive dyspnea and cough
  • fibrosis on lung CT
  • tx is lung transplantation
  • may see honeycombing
46
Q

Sarcoidosis

A
  • systemic disease characterized by non-caseating (non-necrotic) granulomas in multiple organs
  • classically seen in African American females
  • etiology is unknown; likely due to CD4+ helper T cell response to unknown antigen
  • restrictive lung disease
  • cough, SOB
  • tx: steroids, may resolve spontaneously

Cardiovascular (29 decks)

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