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RESP Flashcards

1
Q

Causes of ↓AIR FLOW

Reversible (3), Irreversible (3)?

A

REVERSIBLE CAUSES:

  • Dynamic hyperinflation during exercise
  • Contraction of smooth muscles surrounding airways
  • Accumulation in bronchi of:
    - Exudate
    - Mucus
    - Infl cells

IRREVERSIBLE CAUSES:

  • Fibrosis -> narrowing of airways
  • Destruction of alveoli (due to their loss of elasticity)
  • Destruction of structures supporting alveoli
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2
Q

“Child with nasal polyp + resp defects”

A

Cystic Fibrosis

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3
Q

General Pres of LOWER Resp Path (9)?

A

PRES:

  • Dysnea
  • Cyanosis
  • Diaphoresis
  • Weight loss
  • Fever
  • Cough
  • Excretions
  • Chest pain
  • Hemoptysis
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4
Q

Pleural Transudate

Def’n, Seen In (3)?

A

Extravascular fluid with↓protein content.

SEEN IN:

  • CHF
  • Hepatic Cirrhosis
  • Nephrotic Sx
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5
Q

Pleural Exudate

Def’n, Appearance, Seen In (General + 4)?

A

Extravascular fluid with↑protein content.

Cloudy.

SEEN IN: states of↑vascular permeability

  • Trauma
  • Malignancy
  • Collagen Vascular Disease
  • Pneumonia

** Must be drained to avoid infection **

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6
Q

Pleural Lymphatic Effusion (Chylothorax)

Def’n, Appearance, Seen In (General + 2)?

A

Presence of lymphatic fluid in pleural space. Due to leakage from thoracic duct or one of its main tributaries.

Milky fluid.

SEEN IN: Thoracic Duct injury

  • Trauma
  • Malignancy
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7
Q

Pneumothorax

Def’n, Pres (6)?

A

Accumulation of air in pleural space.

PRES: (all UNILATERAL + on AFFECTED side)

  • Chest expansion
  • Chest pain
  • Dyspnea
  • ↓breath sounds
  • ↓tactile fremitus
  • Hyperresonance
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8
Q

Spontaneous Pneumothorax

Mech, Pres (2 Epi + 2)?

A

THINK: Trachea + Diaphragm occupy empty space
RUPTURE of subpleural bleb -> HOLE in pleura ->
Collapse of portion of lung.

PRES: MC in young, tall + thin males. Also Scuba-Divers.

  • Trachea deviates TOWARDS collapsed lung
  • Diaphragm UP
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9
Q

Tension Pneumothorax

Mech, Seen In (2), Pres (2), RX?

A

THINK: ↑P / Compression pushing everything over to OPPOSITE side

SEEN IN:

    • Trauma (penetrating chest wall injury)
  • Lung infection

PRES:

  • Trachea deviates AWAY from affected lung
  • Diaphragm DOWN

RX:
- Chest Tube

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10
Q

Pulmonary Embolus (PE)

Etiology, Pres, Appearance on Pulm CTA, Course, DX (2)?

A

ET: 95% arise from deep leg veins / DVT

PRES: Chest pain, dyspnea, tachypnea

PULM CTA: Filling defects

COURSE: Small PEs produce infarcts ONLY if there is underlying lung dz.

DX:

  • Screening: V/P Scan
  • Confirmatory: Pulm CTA
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11
Q

Fat Emboli

Assoc (2), Pres (Triad)?

A

ASSOC:

  • Liposuction
  • Long bone fractures

PRES:

 1. Hypoxemia
 2. Petechial rash
 3. Neuro abnormalities
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12
Q

Amniotic Fluid Emboli

Def’n, Pres (3), Micro Findings?

A

Emboli that enters maternal circ during labor/delivery.

PRES:

  • DIC (due to thrombogenic nature of amniotic fluid)
  • Shortness of breath
  • Neuro symptoms

FINDING = Squamous cells + Keratin debri (from fetal skin) in embolus

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13
Q

Gas Emboli

Def’n, RX?

A

Nitrogen bubbles precipitate in ascending divers.

RX = Hyperbaric Oxygen

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14
Q

CO Poisoning (Carboxyhemoglobinemia)

Mech (3), Causes (3), Pres (2), RX?

A

MECH:

  • CO very diffusable + has higher affinity for Hb than O2 does
    • > ↓O2 Sat = Cyanosis
  • Left shift of O2-Hb Dissociation Curve
  • Blocking Cytochrome Oxidase (O2 unable to accept e-)

CAUSES:

  • Closed space with room heater
  • House Fire
  • Car exhaust

PRES:

  • Headache
  • Red skin tinting (** masks signs of cyanosis **)

RX = 100% O2

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15
Q

Cyanide Poisoning

Mech, Cause, RX?

A

Cyanide (exactly like CO) blocks Cytochrome Oxidase.

CAUSE:
- House Fire (household products made of polyurethane)

RX:
- Nitrites (Thiosulfate):
(Oxidize Hb to MetHb (MetHb has higher affinity for cyanide) ->
MetHb binds cyanide ->
Cyanide no longer blocking cytochrome oxidase)

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16
Q

House Fire

2 things that produce Hypoxia?

A
  • CO Poisoning

- Cyanide Poisoning (household products made of polyurethane)

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17
Q

Uncoupling

Explanation, Uncoupling Agents (3), Assoc?

A

Inner mitochondrial memb synthesizes ATP.
Although this memb is permeable to protons, you only want protons to go through a certain hole / pore in the memb because at the base of this hole / pore is where ATP Synthase is.

Uncoupling is when protons permeate the memb at ALL locations.

  • > Protons draining right through memb -> Rxs producing these protons in the first place (rxs producing FADH + NADH) go into OVERDRIVE!
    • > ↑Rx Rate = ↑Temp (Hyperthermia)
    • > Very low ATP yield

UNCOUPLING AGENTS:

  • Alcohol
  • Dinitrophenol
  • Salicylates

ASSOC:
- Hyperthermia

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18
Q

Methemoglobinemia

Def’n, Mech, Pres / Epi (2), Blood (CLUE), RX (2)?

A

Methemoglobin = Fe3+ (oxidized).

O2 can’t bind to heme groups containing Fe3+ ->↓O2 Sat = Cyanosis.

PRES:
- Cyanotic person coming from Rocky Mountains -> give O2 ->
REMAINS cyanotic
- People on Nitro or Sulfa drugs

BL: CHOCOLATE-COLORED

RX:

  • IV Methylene Blue
  • 2nd line = Vitamin C (reducing agent)
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19
Q

Obstructive Lung Diseases

Mech (4 steps), Comp (3)?

A

Obstruction of air flow -> AIR TRAPPING in lungs ->
Enlargement of air spaces ->
Airways close prematurely at high lung volumes.

COMP:

  • Hypoxemia (due to destruction of alveolar capillaries)
  • Cor Pulmonale (due to chronic hypoxic pulm vasoconstriction)
  • ↑infection risk
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20
Q

Chronic Bronchitis

Chars (4)?

A

CHARS:

  • Thickened bronchial walls
  • Mucous gland enlargement
  • Patchy squamous metaplasia of bronchial mucosa
  • Lymphocytic infiltrate
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21
Q

COPD

Mech (2), Players (3), RF (4), DX?

A

Pulm INFL -> Small Airway dz (due to infl + remodeling)
-> Parenchymal destruction
(due to loss of alveolar connections +↓elasticity)
**↓AIR FLOW **

  • CD8 T cells
  • Macrophages
  • Neutrophils

RF:

  • a1-antitrypsin deficiency
  • Hyper-reactive airways
  • Infections
  • Exposure to tobacco and/or occupational toxins (oxidative stress)

DX:
- Spirometry (gold standard): FEV1/FVC = 25-75% (normal = 80%)

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22
Q

Bronchoconstriction

Mech (2)?

A

MECH:

  • Inflammatory processes
  • ↑Parasympathetic tone (Ach + Adenosine)
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23
Q

Emphysema (“Pink Puffer”)

Mech (2 steps), Etiology, Pres (4)?

A

Destruction of alveolar air sacs / walls (w loss of elastic recoil)
-> Permanent alveolar DILATION + COLLAPSE during EXP.

ET: Protease / Antiprotease imbalance

PRES:

  • “Barrel-shaped chest”
  • Dyspnea + Tachypnea
  • Exhalation thr pursed lips (to↑airway pressure + prevent collapse)
  • Weight loss
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24
Q

Centracinar Emphysema

Etiology, Mech (3 steps)?

A

ET: Smoking (oxidative injury to bronchioles)

Ox injury -> Alv Macrophages + Neutrophils release Proteases
-> Protease-Antiprotease imbalance

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25
Q

Asthma

Def’n, Mech / H-S Type,
Players (2), Path (Early vs Late-phase rx), Assoc,
Micro Findings (3), Pres (6), DX?

A

Reversible bronchoconstriction -> **↓AIR FLOW **.

Bronchial HYPERRESPONSIVENESS most often due to allergic stim = Type 1 H-S.

  • CD4 T cells
  • Eosinophils

Early-Phase = IgE-mediated. Late-Phase = Infl-mediated.

ASSOC:
- Churg-Strauss Sx (Small-Vessel Vasculitis)

FINDINGS:

  • Smooth muscle hypertrophy
  • Curschmann’s spirals
  • Charcot-Leyden crystals

PRES: ** Episodic clinical features **

  • Coughing + Wheezing
  • Dyspnea + Tachypnea
  • Hypoxemia
  • ↓I/E ratio
  • Mucus plugging
  • Pulsus Paradoxus

DX: Methacholine Challenge

26
Q

“Triad” Asthma

Mech (2 steps), Seen In (3)?

A

S1. Aspirin or NSAIDs block COX ->
Arachidonic acid CAN’T form PGs.
(Lipoxygenase pathway left open).
S2. … in people who are sensitive to above …
C4, D4, E4 + LT = potent bronchoconstrictors formed.

PRES:

  • Patient on Aspirin or NSAID (chronic pain sx)
  • Nasal Polyps
  • Occasional bouts of Asthma
27
Q

Bronchiectasis

Mech (3 steps), Causes (5), Pres (3)?

A

Chronic NECROTIZING INFECTION of bronchi ->
Damage to bronchial walls ->
Permanent DILATION of bronchi / bronchioles.

CAUSES:

  • Bronchial obstructions
  • Problems with ciliary motility
    • Smoking
    • Kartagener’s Sx
  • Cystic Fibrosis
  • Allergic Bronchopulmonary Aspergillosis
  • Common Variable Immunodef

PRES:

  • Recurrent infections
  • Foul-smelling purulent sputum
  • Hemoptysis
28
Q

Interstitial Pulmonary Fibrosis

Def’n, Appearance on Imaging, RX?

A

Repeated cycles of lung injury / healing with↑collagen.

“Honeycomb” Lung

RX = Lung Transplantation

29
Q

Restrictive Lung Diseases

Def’n?

A

Restricted FILLING of lungs -> Restricted lung EXPANSION ->

↓Lung Volumes.

30
Q

Pneumoconioses

Def’n, Mech?

A

Interstitial fibrosis due to chronic exposure to small fibrogenic particles.

MECH: Alveolar Macrophages engulf these particles -> Fibrosis.

31
Q

Asbestos- 3 Dz Categories

A
  • Asbestosis
  • Benign Asbestos-Related PLEURAL Diseases:
    • Pleural Effusion
    • Pleural Thickening
    • Pleural Plaques
    • Atelectasis
  • Malignant Asbestos-Related Diseases:
    • Mesothelioma
    • Asbestos-Related Lung Cancer
32
Q

Asbestosis

Location, Assoc (3), Micro Finding, Comp (2)?

A

Affects LOWER lobes.

ASSOC:

  • Roofing
  • Plumbing
  • Shipbuilding

FINDING = Asbestos bodies

COMP: advancement to fibrosis w alteration of pulm architecture

  • ↑incidence of Bronchogenic Carcinoma
  • ↑incidence of Mesothelioma
33
Q

Silicosis

Location, Mech, Assoc (3), Micro Finding, Comp?

A

Affects UPPER lobes.

MACROPHAGES respond to silica and release fibrogenic factors ->
Fibrosis.

ASSOC:

  • Foundries
  • Mines
  • Sandblasting

FINDING:
- “Eggshell” calcification of hilar lymph nodes

COMP:
- ↑susceptibility to TB
(silica disrupts phagolysosomes and impairs macrophages)

34
Q

Sarcoidosis

Def’n, Pres (Epi + 4), Micro Finding, Labs (2), Comp (2), RX?

A

Systemic disease. Noncaseating granulomas in multiple organs, however MC in lungs + Hilar lymph nodes.

PRES: African American Women

  • Bilateral Hilar lymphadenopathy
  • Cough
  • Dysnea
  • Uveitis

FINDINGS:
- Asteroid bodies / Stellate inclusions
(often seen in Giant cells of granuloma)

LABS

  • ACE ↑
  • Ca ↑(epithelioid histiocytes convert Vit D to its active form)

COMP:

  • Facial Nerve Palsy
  • Restrictive / Obliterative Cardiomyopathy

RX: ** Often resolves spontaneously without treatment **
- Steroids

35
Q

Hypersensitivity Pneumonitis

Def’n, H-S Type, Pres (2 Epi + CLUE)?

A

Granulomatous rx to inhaled organic antigens.

Mixed Type 3 / Type 4 H-S.

PRES: Farmers + Ppl exposed to Birds

  • ** Pres hrs after exposure and resolves with removal of exposure ***
  • Cough
  • Chest tightness
  • Dysnea
  • Fever
  • Headache
36
Q

NRDS

Def’n, Mech (2), Assoc (3), Pres (3), Appearance on CXR?

A

RDS due to inadequate SURFACTANT levels.

↑Surface Tension -> Collapse of air sacs (Atelectasis)
-> Hyaline memb formation

ASSOC:

  • Prematurity
  • C-section delivery
  • Maternal Diabetes

PRES:

  • “Grunting”
  • Resp distress with cyanosis + hyopoxemia + tachypnea +↑resp effort after birth
  • PDA -> “Machine-like murmur” (PDA due to hypoxemia)

CXR: “Ground glass” appearance of lung (due to diffuse granularity)

37
Q

ARDS

Mech (5 steps), Causes (2), Pres, Appearance on CXR, Comp?

A

Activation of NEUTROPHILS -> Damage to Pneumocytes
(—>↑ST + Atelectasis) ->
Damage to ALVEOLAR-CAPILLARY interface
(—> thickened diffusion barrier) ->
↑Permeability -> Leakage of protein-rich fluid into alveoli ->
Edema + Intraalveolar Hyaline memb ->
Intrapulmonary Shunting.

CAUSES:

    • Septic Shock
  • Acute Pancreatitis

PRES: “Cyanosis + Hypoxemia with resp distress”

CXR: “White out”

COMP: Interstitial Fibrosis (damage to Type II Pneumocytes ->
fibrosis + scarring)

38
Q

Alveolar Hyaline Memb

Mech of Formation (7 steps), RX?

A

** Hyaline = Pink! **

Lack of SURFACTANT -> Collapse of air sacs ->
Massive Ventilation defect -> Massive Interpulm Shunt.

Degeneration of Type II Pneumocytes -> Leakage of Fibrinogen ->
Congealing of Fibrinogen = formation of hyaline memb.

RX:
- PEEP (Positive End Exp Pressure) Therapy

39
Q

Lobar Pneumonia

Mech (2 steps), Micro Findings (3)?

A

INTRA-alveolar EXUDATE ->
CONSOLIDATION of 1 entire lobe of lung.

FINDINGS:
- Congestion (due to congested vessels + edema)
- Red Hepatization: exudate, hem and Neutrophils filling
alveolar air spaces -> gives lung solid consistency
- Gray Hepatization: degradation of red cells within exudate

40
Q

Bronchopneumonia

Def’n, Appearance (3), Micro Finding?

A

ACUTE INFL (Neutrophilic) infiltrate from bronchioles -> adjacent alveoli.

  • Often bilateral + multifocal
  • Patchy distribution
  • Areas of consolidation centered around bronchioles

FINDING = Neutrophils in alveolar spaces

41
Q

Atypical / Interstitial / “Walking” Pneumonia

Appearance on CXR?

A

CXR: Bilateral, however worse on R.

- Coarse reticular opacities

42
Q

Lung Abscess

Def’n, Causes (2), Pres, Appearance on XR?

A

Localized collection of pus within lung parenchyma.
Aspirate consists of aerobes + anaerobes.

CAUSES:

  • Aspiration of oropharyngeal contents (street people)
  • Bronchial obstruction

XR: Air-fluid levels / Fluid cavities

43
Q

Pain from Diaphragm Irritation

Cause, Pres (where referred to)?

A

CAUSE = Air or Blood in peritoneal cavity

PRES = Pain referred to shoulder / trapezius ridge

44
Q

Cor Pulmonale

Def’n, Causes (2), Pres, Comp?

A

RHF due to a pulm cause.

CAUSES:

  • Pulmonary Htn
  • Chronic lung conditions that cause prolonged low blood O2

PRES = Light-headedness or shortness of breath during activity

COMP:
- RHF

45
Q

TB

Cause, Comp (3)?

A

CAUSE = Inhalation of aerosolized Mycobacterium Tb

COMP:

  • Constrictive Pericarditis
  • Erythema Nodosum
  • Infectious Arthritis (due to mycobacterial dissemination)
46
Q

Primary TB

Def’n, Locations (2), Pres (3), Micro Finding?

A

Arises with initial exposure.

LOWER Lobe + Hilar lymph nodes.

PRES:

  • Generally asymptomatic
  • Hilar lymphadenopathy
  • PPD +

FINDING = Ghon Complex

47
Q

Secondary / Reactivation TB

Def’n, Location, Causes (3),
Pres (3), Micro Finding, Course,
Comp (2), DX?

A

Arises with reactivation of Mycobacterium Tb.

APEX of Lung.

CAUSES:

  • Aging
  • Immune compromise
  • TNF-a Inhibitor use

PRES:

  • Weight loss
  • Fever + night sweats
  • Cough with hemoptysis

FINDING = CAVITARY FOCI of caseating necrosis

COURSE = Systemic spread

COMP:

  • Tuberculous Bronchopneumonia
  • Hiliary Pulmonary TB

DX = Biopsy of caseating granulomas

48
Q

Vertebral TB (Pott Disease)

Pres?

A

PRES: 2ry TB + back pain

49
Q

Lung Cancer #1

Metastasis TO Lung from (4)?

A

** Usually multiple lesions **

  • Breast Cancer
  • Colon Cancer
  • Bladder Cancer
  • Prostate Cancer
50
Q

Lung Cancer #2

Metastasis FROM Lung to (4)?

A
  • Brain
  • Adrenals
  • Liver
  • Bone
51
Q

Lung Cancer #3

Assoc,
Pres (3), Appearance on Imaging (CXR vs CT),
DX, Comp (6: “SPHERE”)?

A

ASSOC = Smoking! (All EXCEPT Bronchial Carcinoid Tumor)

PRES:

  • Bronchial obstruction + Wheezing
  • Cough
  • Hemoptysis

Appearance on CXR = “Coin lesion”
Appearance on CT = Noncalcified nodule

DX requires Biopsy.

COMP: “SPHERE”

  • SVC Sx
  • Pancoast tumor
  • Horner Sx
  • Endocrine (paraneoplastic)
  • Recurrent Laryngeal symptoms (eg hoarseness)
  • Effusions (pleural or pericardial)
52
Q

Bronchial or Bronchioloalveolar Adenocarcinoma

Location, Genetics (3 activating mutations), Pres?

A

Devel in site of PRIOR pulm injury / infl.
Grows along alveolar septa -> apparent “thickening” of alveolar walls.

GENETICS: Activating mutations:

  • ALK
  • EGFR
  • K-ras

PRES = like Pneumonia, incl on Imaging!

53
Q

Squamous Cell Carcinoma

Char, Pres, Micro Findings (2)?

A

“Cavitation”.

PRES:
- (parathyroid-like activity) Produces PTH -> Hypercalcemia

FINDINGS:

  • Keratin pearls
  • Intercellular bridges
54
Q

Small Cell / Oat Cell Carcinoma of Lung

Def’n, Genetics, Assoc, Pres (2), Micro Finding, Comp (2)?

A

Neoplasm of neuroendocrine Kulchitsky cells (small dark blue cells).

GENETICS: myc oncogene amplification common.

ASSOC:
- Lambert-Eaton Myasthenic Sx

PRES: * Undifferentiated = very aggressive *

  • Ectopic production of ACTH + ADH -> “SIADH”
  • Production of antibodies against Ca channels -> Lambert-Eaton Sx

FINDING = “Salt + Pepper neuroendocrine-type chromatin”

COMP:

  • SIADH (due to ectopic ADH)
  • Cushing’s Sx
55
Q

Large Cell Carcinoma

Micro Finding, RX, Prognosis?

A

FINDING:
- Giant cells (pleomorphic and with leukocyte fragments) in cytoplasm

RX: Less responsive to Chemotherapy
- Surgical removal

PROG: Undifferentiated + Anaplastic => poor prognosis

56
Q

Bronchial Carcinoid Tumor

Def’n, Pres, Micro Findings (2), Comp, Prognosis?

A

Neoplasm of neuroendocrine cells.

PRES: Well differentiated
- Carcinoid Sx (flushing, wheezing, diarrhea)

FINDINGS:

  • “Nests” of neuroendocrine cells
  • Chromogranin +

COMP:
- Cushing’s Sx

PROG: Mets rare => excellent prognosis

57
Q

Mesothelioma

Def’n, Mech (2), Assoc, Pres (3), Micro Finding?

A

Malignancy of pleura (mesothelial cells).

Malignancy of pleura -> pleural thickening
-> hem pleural effusions

ASSOC:
- Asbestosis

PRES:

  • Dyspnea
  • Chest pain
  • Hem pleural effusions

FINDING = Psammoma Bodies

58
Q

Pancoast Tumor

Location, Comp?

A

APEX.

COMP:
- Horner Sx (by tumor’s compression of sym ganglia / plexus)

59
Q

Laryngeal Carcinoma (a squamous cell carcinoma)

MCC (2), Pres?

A

MCC: ** Synergistic effect **

  • Smoking
  • Alcohol

PRES = “hoarseness of throat”

60
Q

Superior Vena Cava Sx

Def’n, Locations + Consequent Pres (3), Causes (2), Comp (2)?

A

OBSTRUCTION of SVC -> Impaired bl drainage from head, neck + upper extremities.

LOCATIONS: Impaired bl drainage from…

  • Head -> “Facial plethora”
  • Neck -> JVD
  • Upper extremities -> Edema

CAUSES:

  • Thromboses
  • Neoplasms (ie Lung Cancer)

COMP:

  • ↑ICP (if obstruction severe) -> Headaches + Dizziness
  • Risk of aneurysm / rupture of cranial arteries

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