Pulmonology Flashcards
List four types of cells in the lungs?
Goblet: mucus production
Type I Pneumocyte: macrophages (95%)
Type II Pneumocyte: surfactant production
Clara/Dust (Macrophages): ingest dust particles
What is the histology of the trachea?
Top 1/3: stratified squamous epithelium – protect against abrasion
Middle 1/3: mixture
Lower 1/3: tall columnar pseudostratified ciliated epithelium
What muscles are needed to breathe IN?
Innermost intercostals – contralateral chest wall
External intercostals – ipsilateral chest wall
Diaphragm
What muscles are needed to force air IN?
Scalenes
Sternocleidomastoid (SCM)
Trapezius
Pectoralis Major and Minor
What muscles are needed to breathe OUT?
Passive – recoil
What muscles are needed to force air OUT?
Internal and External Oblique
Recurs Abdominus
Transverse Abdominus
Quadratus Lumborum
What is the difference between the carotid body and the carotid?
Carotid body: chemoreceptor
Carotid sinus: baroreceptor
What color is air on X-ray?
Black “radiolucent”
What color is fluid/solids on X-ray?
White “radiopaque”
What disease has steeple sign on neck film?
Croup
What disease has thumb sign on neck film?
Epiglottitis
What is a “blue bloater”?
Bronchitis (chronic)
What is a “pink puffer”?
Emphysema
What diseases have pulmonary eosinophilia?
Aspergillosis, strongyloides
What drugs cause pulmonary eosinophilia?
Nitrofurantoin, sulfonamides
What are the risk factors for lung cancer?
Smoking, radon, 2nd hand smoke, pneumoconiosis (except anthracosis)
What diseases have hemoptysis?
Bronchiectasis, bronchitis, pneumonia, TB, lung cancer
Where is a Bokdalek hernia?
Back of diaphragm
Where is a Morgagni hernia?
Middle of diaphragm
What diseases have respiratory alkalosis?
Restrictive lung diseases – anxiety, pregnancy, Gram - sepsis, PE
What diseases have respiratory acidosis?
Obstructive lung diseases
What diseases have metabolic alkalosis?
Low volume state – vomiting, diuretics, GI blood loss
What diseases have metabolic acidosis?
Acid production – MUDPILES , RTA II, diarrhea
What is the obstructive pattern of blood gasses?
Inc pCO2 —> dec pH, inc RR —> inc pO2
What is the restrictive pattern of blood gasses?
Dec pO2 —> in RR —> dec pCO2 —> inc pH
What does stridor tell you?
Extrathoracic narrowing —> narrows when breathing in —> neck X-ray
What does wheezing tell you?
Intrathoracic narrowing —> narrows when breathing out —> chest X-ray
What does rhonchi tell you?
Mucus in airway —> obstructive lung disease
What does grunting tell you?
Blows collapsed alveoli open —> restrictive lung disease
What does dull percussion tell you?
Something between airspace and chest wall absorbing sound (fluid or solid)
What does hyperresonance tell you?
Lungs hyperinflated with air
What does tracheal deviation tell you?
Away from pneumothorax OR toward atelectasis “air phobic”
What does fremitus, egophony, and .. tell you?
Consolidation —> pathognomonic for pneumonia
What is Restrictive Lung Disease?
Small stuff lungs, trouble breathing in
What is Obstructive Lung Disease?
Big mucus filled lungs, trouble breathing out
Epiglottitis
X-ray thumb sign, drooling
Croup
X-ray steeple sign, barking cough
Tracheitis
Look toxic, grey pseudo membrane, leukocytosis
Asthma
Wheeze on expiration, IgE, eosinophils
Bronchiolitis
Asthma in kids < 2yo
Maxillary Sinusitis
Teeth pain worse with bending forward
Bronchiectasis
Bad breath, purulent sputum, hemoptysis
Chronic Bronchitis
Lots of sputum, “blue bloater”
Emphysema
Restrictive to obstructive pattern, “pink puffer”
Laryngomalacia
Epiglottis roll in from side to side
Pneumonia
Consolidation of airway
Pneumothorax
Air outside of lungs, hyperresonance on same side
How do you detect a Pulmonary Embolism?
Tachypnea, increased V/Q scan, EKG: S1Q3T3
Tamponade
Decreased breath sounds and BP, increased JVD, fluid in pericardial sac
Tracheomalacia
Soft cartilage, stridor since birth
Cystic Fibrosis
Meconium ileus, steatorrhea, bronchiectasis
Aspergillosis
Allergy to mold, dead plants, compost piles
Who gets Asbestosis?
Shipyard workers, pipe fitters, brake mechanics, insulation installers
Who gets Silicosis?
Sandblasters, glassblowers
Who gets Byssinosis?
Cotton workers
Who gets Beryliosis?
Radio, TV welders, this working with bulbs
Anthracosis
Coal workers, massive fibrosis
Carcinoid Syndrome
Flushing, wheezing, diarrhea
Small Cell Cancer
At carina, malignant, Cushing’s, SIADH, SVC Syndrome
Large Cell Cancer
Large stuff
Squamous Cell Cancer
Smoker, high PTH, high Ca2+
Bronchealveolar Cancer
Looks like pneumonia, due to pneumoconiosis