Respi Flashcards
1
Q
What is the major muscle of inspiration? Does 75% of the work?
A
Diaphragm
2
Q
What is the innervation if the diaphragm?
A
Phrenic nerve: C3, C4, C5
3
Q
Muscles of INspiration:
A
Diaphragm EXternal intercostals Sternocleidomastoids Serratus anterior Scalene
4
Q
Muscles if EXpiration
A
INternal intercostals
Abdominal recti
5
Q
A cervical vertebral fracture to C2 causes
A
Arrest of respiration
6
Q
Posterior diaphragmatic hernia is called __________
A
Bochdalek hernia
7
Q
Anterior diaphragmatic hernia is called __________
A
Morgagni hernia
8
Q
What is the embryologic defect in diaphragmatic hernia?
A
Pleuriperitoneal membrane
9
Q
What is the driving force for INspiration?
A
Negative intrapleural pressure
created by the movement of the diaphragm downward and chest wall outward
10
Q
What is the driving force for EXpiration?
A
Increase in intrapleural pressure
created by the movement of the diaphragm upward and chestwall inward
11
Q
Forceful breathing is seen in
A
Exercise
Restrictive lung disease
12
Q
What is the normal pleural pressure at the beginning of inspiration?
A
(-) 5cm H2O
13
Q
INspiration creates an even more negative pressure
A
(-) 7.5cm H2O
14
Q
The measure of lung distensibility is __________
A
Compliance
15
Q
The property of matter that makes it resist deformation is called __________
A
Elastance
16
Q
With respect to compliance and elastance, obstructive lung disease is characterized by
A
Increased compliance
Decreased elastance
17
Q
With respect to compliance and elastance, restrictive lung disease is characterized by
A
Increased elastance
18
Q
This states that collapsing pressure is inversely proportional to the alveolar radius, such that smaller alveoli experience a larger collapsing pressure
A
Law of Laplace
Collapsing pressure = surface tension / alveolar radius
19
Q
What cells produces surfactants in newborns?
A
Type 2 epithelial cells
20
Q
What causes ARDS in the newborn?
A
Lack of surfactant (type 2)
21
Q
What causes ARDS in adults?
A
Lack of surfactant (type 1)
22
Q
Elevated collapsing pressure are seen in babies born _____ weeks AOG
A
23
Q
Airway resistance normally accounts for approximately _____% of the work of breathing
A
20%
24
Q
__________ is the largest proportion of work of breathing also seen in COPD
A
Compliance resistance
25
Compliance resistance normally accounts for the largest proportion _____% of the total work of breathing
75%
26
What is the response of the blood vessels of the brain to hypoxia?
Vasodilation
27
What is the response of the blood vessels of the lungs to hypoxia?
Vasoconstriction. This is to shunt blood to more ventilated areas of the lungs like the apex
28
What is the volume inspired or expired with each normal breath?
Normal value?
Tidal volume
| 500 mL
29
That is the volume that can be inspired over and above the tidal volume? Normal value?
Inspiratory Reserve Volume
| 3000 mL
30
What is the volume that can be expired after the expiration if a tidal volume?
Normal value?
Expiratory Reserve Volume
| 1100 mL
31
What is the volume that remains in the lungs after maximal expiration?
Normal value?
Residual Volume
| 1000 mL
32
What are the four lung volumes?
Tidal volume
Inspiratory reserve volume
Expiratory reserve volume
Residual volume
33
What are the four lung capacities?
Inspiratory capacity
Functional residual capacity
Vital capacity
Total lung capacity
34
TV + IRV = __________
| Normal value?
Inspiratory Capacity
| ~ 3500 mL
35
ERV + RV = __________
| Normal value?
Functional Residual Capacity
| ~ 2400 mL
36
TV + IRV + ERV = __________
| Normal value?
Vital capacity
| ~ 4700 mL
37
TV + IRV + ERV + RV = __________
| Normal value?
Total Lung Capacity
| ~ 5900 mL
38
What is the most common cause of V/Q mismatch?
Hypoxemia
39
What procedure is used to assess the Medulla?
MRI
Not CT scan!
40
What is responsible for the basic control of the pneumotaxic center?
Pons
41
What is responsible for the basic control of the dorsal respiratory group (DRG)?
Medulla
42
Central control of respiration: (4)
Dorsal respiratory group
Ventral respiratory group
Pneumotaxic center
Apneustic center
43
What is the most sensitive stimulus for breathing?
Carbon dioxide
44
Groups of nerve terminals sensitive to changes in pH, PaO2, and PaCO2 are called __________
Chemoreceptors
45
It is defined as the inflow and outflow of air between the atmosphere and the alveoli
Pulmonary ventilation
46
What is the indicator of impending respiratory failure?
Paradoxical breathing
47
What is the most common preventable cause of death among hospitalized patients?
Pulmonary embolism
48
Embolus that occlude the main pulmonary artery, impact across the bifurcation
Saddle embolus
49
Embolus that pass thru an interarterial or interventricular defect to gain access to the systemic circulation
Paradoxical embolus
50
Most common source of embolism
Isolated calf vein thrombi
51
"The Great Masquerader"
Pulmonary embolism
52
Most common history of pulmonary embolism
Unexplained breathlessness
53
Most common symptom of pulmonary embolism
Dyspnea
54
Most common sign of pulmonary embolism
Tachypnea
55
Most common history of DVT
Cramp in lower calf that persists for several dats and becomes more uncomfortable
56
ECG findings if pulmonary embolism
S1Q3T3 sign
| T-wave inversion in leads v1 to v4 (most common)
57
Focal oligemia in pulmonary embolism
Westermark's sign
58
Peripheral wedge shaped density above the diaphragm seen in pulmonary embolism
Hampton's hump
59
Enlarged right descending pulmonary artery seen in pulmonary embolism
Palla's sign
60
Principal imaging test for diagnosing pulmonary embolism
Chest CT scan with IV contrast
61
Best known indirect sign of pulmonary embolism seen in echocardiography
McConnell's sign
62
Types of emboli in pulmonary embolism (2)
Saddle embolus
| Paradoxical embolus
63
Most common location, source of pulmonary embolism
Isolated deep calf vein,
| Deep leg vein thrombi
64
Natural anticoagulants of the blood
Protein C
Protein S
Antithrombin III
65
Most common inherited thrombophilic condition
Factor V Leiden Mutation
66
"The Great Masquerader"
Pulmonary embolism
67
PE: Most common HISTORY
Unexplained breathlessness
68
PE: most common SYMPTOM
Dyspnea
69
PE: most common SIGN
Tachypnea
70
Classic findings in DVT
Homan's sign
Moses sign
Palpable cord
71
Unexplained tachypnea may be seen in
Pulmonary embolism
| Spontaneous pneumothorax
72
Gold standard for diagnosis of DVT
Contrast venography:
| Constant intraluminal filling defect in 2 or more views
73
DVT Duplex USG
Non compressibility of venous segment
74
Gold standard for diagnosis of Pulmonary embolism
Pulmonary angiography
75
In chest film, abrupt tapering of a vessel caused by pulmonary embolism, focal oligemia
Westermark sign
76
In Pulmonary embolism, or infarction, wedge-shaped infiltrate that abuts the pleura, often associated with small pleura effusion that is usually exudative, may be hemorrhagic, not specific
Hampton hump
77
In pulmonary embolism, enlarged right descending artery
Palla's sign
78
Classic findings in pulmonary embolism
Westermark sign
Hampton hump
Fleishner sign
Palla's sign
79
2d echo findings in pulmonary embolism
Evidence of right ventricular volume pr pressure overload
80
ABG finding in pulmonary embolism
Hypoxemia
| Hypocapnea
81
DOC for pulmonary embolism
```
Unfractionated heparin (parenteral);
Warfarin (oral)
```
82
Diseases classified as COPD
Chronic bronchitis
Bronchiectasis
Asthma (reversible)
Emphysema
83
Persistent cough, sputum production, at least 3 months for 2 consecutive years
Chronic bronchitis
84
Pathogenesis of chronic bronchitis
Chronic irritation by inhaled substances;
| Infection
85
Reid index: increase size in bronchial mucous glands
Chronic bronchitis
86
Hallmark of acute inflammation
Increased permeability
87
Hallmark of chronic inflammation
Fibrosis
88
Blue bloaters
Chronic bronchitis
89
Pink puffers
Emphysema
90
Permanent alveolar enlargement, destruction of alveolar walls
Emphysema
91
No. 1 risk factor for emphysema
Cigarette smoking
92
Congenital cause of emphysema
Alpha-1 Anti-trypsin deficiency
93
Type of emphysema affecting central or proximal parts of the acini, formed by respiratory bronchioles, distal alveoli spared!
Central
94
Type of emphysema, acini uniformly enlarged, from respiratory to terminal alveoli
Panacinar (Panlobular)
95
Most common complication if paraseptal (distal acinar) emphysema
Spontaneous pneumothorax
96
Type of emphysema almost invariably associated with scarring
Irregular emphysema
97
Indications for ICU ADMISSION
1. Severe dyspnea that does not respond to initial emergency therapy
2. Changes in mental status
3. Persistent or worsening hypoxemia
4. Need for invasive mechanical ventilation
5. Hemodynamic instability
98
The only proven treatment for COPD
Smoking cessation
99
Hallmark of COPD
Airflow obstruction
100
Target O2 sat in COPD
88-92%
101
Classic findings in Bronchial Asthma
Curschmann spirals,
Charcot Leyden crystals,
Creola bodies
102
Most common trigger if extrinsic bronchial asthma
Atopy
103
Most commonly triggered by respiratory infections, IgE normal, hyperirritability if bronchial tree
Intrinsic (non-allergic) asthma
104
Triggered by envt antigens, common in childhood, familial tendency, type 1 IgE
Extrinsic (allergic) asthma
105
Part of the lungs where etiologic agents spread
Pores of Kohn
106
Syndrome associated with broinchiectasis
Kartageners syndrome:
1. Sinusitis
2. Bronchiectasis
3. Situs inversus
107
Abnormal irreversible dilatation of bronchial tree, proximal to terminal bronchioles
Bronchiectasis
108
Causes of foul-smelling sputum
Bronchiectasis
| Lung abscess
109
"Honeycomb Lung"
Bronchiectasis
110
Prominent cystic spaces on lungs
Bronchiectasis
111
Pathogenesis of bronchiectasis
Obstruction and Infection
112
Most common cause of post-op fever
Atelectasis (collapse)
113
Most common site of bronchiectasis
Lower lobes, bilateral
Bronchial walls show inflammation, fibrosis, lumen with pus
114
Patchy consolidation of the lungs, due to injury or old age
Bronchipneumonia
115
Acute bacterial infection of large portion of a love or of an entire lobe
Lobar pneumonia
116
Most common cause of Atypical pneumonia
Mycoplasma
117
Most common cause of lobar pneumonia
Strep pneumoniae
118
Most common cause of Otitis media (Luga)
Strep pneumoniae
119
Size of pathogen deposited on terminal airway and alveoli
1 - 5 mm
120
Size of pathogen deposited largely turbulent airflow of nose and upper airways
> 10 mm
121
Size of pathogen that lodge in trachea and bronchi
3 - 10 mm
122
Size of pathogen that remains suspended in inspired air and can be exhaled
123
Stages of pneumonia
1. Congestion (red vascular engorgement)
2. Red hepatization (massive RBC exudates)
3. Gray hepatization (RBC dessintegration)
4. Resolution (organization, enzymatic digestion)
124
Most common cause of Pneumatocoeles
Staph pneumoniae
125
Panton-Valentin-Leukocidin
Pneumatocoele
| Staph pneumoniae
126
Most common cause of necrotizing pneumonia
Pseudomonas
127
Flordelis pattern
Necrotizing pneumonia
| Pseudomonas
128
Complications if pneumonia
1. Abscess formation
2. Empyema
3. Organization (solid tissue)
4. Bacteremic dissemination
129
Atypical pneumonia is called atypical because
Lack of alveolar exudates
130
Xray looks worse than the patient
Primary atypical pneumonia
| Viral and Mycoplasmal pneumonia
131
Mycoplasma pneumonia causes what type of anemia
Hemolytic Anemia ("cold agglutinins" from Mycoplasma)
132
Pneumonia from airconditioned units
Legionella
133
Etiologic agent of SARS
SARS Coronavirus
134
Lab findings if SARS
Antibody to SARS-CoV
SARS-CoV RNA by Rt-PCR
Isolation of SARS CoV
135
"Super Bugs"
| An enzyme that makes bacteria resistant to broad range of beta lactam antibiotics
New Delhi Metallo-beta-lactamase 1 (NDM-1)
136
"Super Bugs"
E. coli
Klebsiella
Pseudomonas
137
NDM-1 was first detected from what organism
Klebsiella
138
Organisms with NDM-1 are usually susceptible only to
Polymyxins
| Tigecycline
139
What is responsible for Caseous Necrosis?
Phosphatides
140
PTB mode of transmission
Respiratory droplets
141
Most common site of extrapulmonary TB in a child
Lymph Nodes
142
Most common location of primary TB
Mid-Base lung
143
Most common location of post-primary TB or secondary TB
Apical
144
Type of hypersensitivity in post-primary or secondary TB
Type IV hypersensitivity (delayed)
145
Causes of unexplained weight loss
TB and
| Malignancy
146
Classic diagnostic for PTB
Sputum exam:
3 sputums early in the morning,
Positive if 2 out of 3 positive
147
Classic chest finding in PTB
Upper lobe infiltrates with calcification
148
Gold standard for diagnosis of PTB
Culture
149
Agar or base medium for culture of TB
Lowenstein-Jensen agar
| 37C under 5% CO2
150
Lowenstein-Jensen agar
TB
