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Patho > Resp 4 > Flashcards

Resp 4 Flashcards

1
Q

Hypersensitivity of rep center to CO2;

Period of waxing & waning of VT separated by periods of apnea

A

Cheyne-Stokes Respiration

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2
Q

Causes of Cheyne-Stokes Respiration

A

Drug overdose, CHF, hypoxia

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3
Q

Obesity-hypoventilation syndrome

A

Pickwickian Syndrome

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4
Q

Clinical signs of Pickwickian Syndrome

A 
Partial airway obs causes snoring;
Hypoxia;
Cyanosis;
Rarely hypercapnia;
Polycythemia;
Poor sleep at night/day time sleepiness
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5
Q

“Reversible” increased resistance to airflow d/t airway narrowing

A

Ashtma

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6
Q

What would a CXR show with asthma?

A

Hyperinflation, flattening of diaphragm, mucus plugging, atelectasis

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7
Q

What is 40@40?

A

A respiratory emergency seen with asthma where CO2 is 40 (normal or high) and PO2 is 40. (Means nothing is going in or out)

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8
Q

Diagnostic findings with asthma

A

Peak flow exp rate decreased;
FVC, FEV1, & FEV1/FVC decreased;
Increased RV;
Normal diffusion capacity (DLCO)

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9
Q

Management of acute asthma attack:

A
  1. B2 agonist + steroid + ipratropium;

2. Systemic steroid (IV);

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10
Q

Management of chronic asthma disease

A
  1. Inhaled steroid as maintenance + inhaled B2 steroid for symptomatic control;
  2. Add ipratropium;
  3. Aminophylline;
  4. Short course of oral steroid
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11
Q

How does Terbutaline affect bronchial smooth muscles?

A

B2 stimulant acts on B2 receptors > Gs protein > adenyl cyclase > increase cAMP > activation of protein kinases > bronchodilaiton

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12
Q

How does Aminophylline affect bronchial smooth muscle?

A

PDE inhibitor > increase cAMP > bronchodilation

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13
Q

Nitric Oxide (NO)

A

Converts GDP to cGMP > bronchodilation;

No cell receptor/crosses cell membrane

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14
Q

Destruction of alveolar walls and abnormal enlargement of air spaces distal to terminal bronchiole

A

Chronic pulmonary emphysema

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15
Q

Prevents mast cell degranulation and exercise induced asthma

A

Cromolyn

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16
Q

How does emphysema lead to RHF “Cor pulmonale”?

A

The hypoxia causes vasoconstriction which leads to pulm HTN

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17
Q

Diagnostic findings of COPD

A 
Airflow obstruction of PFTs;
Decreased FEV1 & FEV1/FVC;
Prolonged FR time > 6 sec;
Decreased DLCO;
Increased RV & TLC
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18
Q

Tx for COPD

A

Smoking cessation, abx, bronchodilators, steroid, supplemental O2 with PO2, 55mmHg

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19
Q

Restrictive dz w/ decreased lung compliance in which inspiration is impaired

A

Pulmonary Fibrosis

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20
Q

Pulm. Fibrosis is characterized by a ____ in all lung volumes. The FEV1/FVC is ______.

A

Decrease; increased or normal

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21
Q

Rales, cough, infiltration, and fatal fibrosis

A

Bleomycin lung

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22
Q

Alveoli are filled w/ fluid & cellular debris (consolidation);
Impaired gas exchange;
Low V/Q ratio;
Hypoxia & hypercapnia

A

Pneumonia

23
Q

The development of active tubercles throughout the body

A

Miliary tuberculosis

24
Q

Positive Mantoux test shows:

A

Recent immunization; previous TB test, past exposure to M. Tuberculosis; need further tests

25
Q

Abx used to tx TB

A

INH, pyrazinamide, rifampin

26
Q

PHTN (mmHg)

A

> 25 mmHg or > 35 mmHg during exercise

27
Q

Primary pulmonary HTN

A

D/t an inactivating mutation in the BMPR2 gene (normally fxns to inhibit vascular smooth muscle proliferation)

28
Q

Pathological consequences from PE

A

Increased PVR;
Increased PAP;
Increased RV afterload

29
Q

Risk factors for PE

A

FAT BAT: fat, air, thrombus, bacteria, amniotic fluid, tumor

30
Q

Clinical features of PE

A

Sudden onset of dyspnea, pleuritic CP, tachypnea >resp alkalosis, RV overload (loud P2, RV heave)

31
Q

Homan’s sign

A

Tender calf muscle with dorsiflexion of foot. Sign of DVT

32
Q

Most sensitive & specific test for PE. Look for filling defect

A

CT arteriography

33
Q

PTT w/ Heparin

A

1.5-2.5 x normal + 30 sec

34
Q

PT with warfarin

A

12 sec

35
Q

Indications for PEEP

A

PO2 < 60 mmHg;
Widespread alveolar collapse/atelectasis;
ARDS;
Pulm edema

36
Q

Dose of PEEP

A

5-10 cmH2O

37
Q

Complications of PEEP

A

Decreased CO d/t interference w/ venous return;
Barotrauma (pneumo);
Fluid retention d/t obstruction of lymph flow & capillary damage;
Redistribution of pulm blood flow > decrease V/Q > Decrease PO2

38
Q

CPAP level

A

< 14- 15 cmH2O (lower than LES pressure)

39
Q

Produced by dynamic compression of the airways during a forced expiration, occupies most of expiratory limb of the loop

A

Effort independent flow

40
Q

F/V loop shows lung volumes are smaller

A

Restrictive disease

41
Q

F/V loop shows expiratory limb is prolonged & lung volumes are greater

A

Obstructive disease

42
Q

F/V loop shows Inspiration is impaired

A

Extrathoracic obstruction

43
Q

F/V loop shows Expiration is impaired

A

Intrathoracic obstruction

44
Q

F/V loop shows both inspiration & expiration are impaired

A

Tracheal obstruction

45
Q

During a forced expiration, airways begin to close. The volume that can subsequently exhaled is?

A

Closing volume

46
Q

Closing capacity =?

A

Closing volume + residual volume

47
Q

Closing volume ______ with age, COPD, airway secretion, anesthesia

A

Increases

48
Q

Blood flow & ventilation to dependent lung are ____ than nondependent lung in the unanesthetized pt

A

Greater

49
Q

In the anesthetized/paralyzed pt the ________ lung is well ventilated but poorly perfused (dead spacing). The _____ lung is poorly ventilated and well perfused (shunting).

A

Nondependent; dependent

50
Q

Chronic necrotizing infxn of bronchi leading to dilatation and destruction of airways, purulent sputum, recurrent infxns, & hemoptysis

A

Bronchiectasis

51
Q

Sx of bronchiectasis

A

Chronic purluent cough w/ large amt of sputum, clubbing, & air fluid levels on CXR

52
Q

Non-cardiogenic pulm edema d/t damage to alveolar-capillary membrane (stiff lungs);
Severe Hypoxemia (PO2 < 60, FIO2 > 60, large A-a gradient);
Bilateral pulm infiltrates

A

Adult respiratory distress syndrome (ARDS)

53
Q

Loud ___ suggest pulm HTN

A

P2

Patho (13 decks)

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