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PHYSIO-PATHO-IM > Respi > Flashcards

Respi Flashcards

1
Q

What is the major muscle of inspiration? Does 75% of the work?

A

Diaphragm

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2
Q

What is the innervation if the diaphragm?

A

Phrenic nerve: C3, C4, C5

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3
Q

Muscles of INspiration:

A 
Diaphragm
EXternal intercostals
Sternocleidomastoids
Serratus anterior
Scalene
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4
Q

Muscles if EXpiration

A

INternal intercostals

Abdominal recti

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5
Q

A cervical vertebral fracture to C2 causes

A

Arrest of respiration

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6
Q

Posterior diaphragmatic hernia is called __________

A

Bochdalek hernia

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7
Q

Anterior diaphragmatic hernia is called __________

A

Morgagni hernia

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8
Q

What is the embryologic defect in diaphragmatic hernia?

A

Pleuriperitoneal membrane

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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

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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

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11
Q

Forceful breathing is seen in

A

Exercise

Restrictive lung disease

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12
Q

What is the normal pleural pressure at the beginning of inspiration?

A

(-) 5cm H2O

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13
Q

INspiration creates an even more negative pressure

A

(-) 7.5cm H2O

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14
Q

The measure of lung distensibility is __________

A

Compliance

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15
Q

The property of matter that makes it resist deformation is called __________

A

Elastance

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16
Q

With respect to compliance and elastance, obstructive lung disease is characterized by

A

Increased compliance

Decreased elastance

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17
Q

With respect to compliance and elastance, restrictive lung disease is characterized by

A

Increased elastance

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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

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19
Q

What cells produces surfactants in newborns?

A

Type 2 epithelial cells

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20
Q

What causes ARDS in the newborn?

A

Lack of surfactant (type 2)

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21
Q

What causes ARDS in adults?

A

Lack of surfactant (type 1)

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22
Q

Elevated collapsing pressure are seen in babies born _____ weeks AOG

A
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23
Q

Airway resistance normally accounts for approximately _____% of the work of breathing

A

20%

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24
Q

__________ is the largest proportion of work of breathing also seen in COPD

A

Compliance resistance

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25
Q

Compliance resistance normally accounts for the largest proportion _____% of the total work of breathing

A

75%

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26
Q

What is the response of the blood vessels of the brain to hypoxia?

A

Vasodilation

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27
Q

What is the response of the blood vessels of the lungs to hypoxia?

A

Vasoconstriction. This is to shunt blood to more ventilated areas of the lungs like the apex

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28
Q

What is the volume inspired or expired with each normal breath?
Normal value?

A

Tidal volume

500 mL

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29
Q

That is the volume that can be inspired over and above the tidal volume? Normal value?

A

Inspiratory Reserve Volume

3000 mL

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30
Q

What is the volume that can be expired after the expiration if a tidal volume?
Normal value?

A

Expiratory Reserve Volume

1100 mL

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31
Q

What is the volume that remains in the lungs after maximal expiration?
Normal value?

A

Residual Volume

1000 mL

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32
Q

What are the four lung volumes?

A

Tidal volume
Inspiratory reserve volume
Expiratory reserve volume
Residual volume

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33
Q

What are the four lung capacities?

A

Inspiratory capacity
Functional residual capacity
Vital capacity
Total lung capacity

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34
Q

TV + IRV = __________

Normal value?

A

Inspiratory Capacity

~ 3500 mL

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35
Q

ERV + RV = __________

Normal value?

A

Functional Residual Capacity

~ 2400 mL

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36
Q

TV + IRV + ERV = __________

Normal value?

A

Vital capacity

~ 4700 mL

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37
Q

TV + IRV + ERV + RV = __________

Normal value?

A

Total Lung Capacity

~ 5900 mL

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38
Q

What is the most common cause of V/Q mismatch?

A

Hypoxemia

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39
Q

What procedure is used to assess the Medulla?

A

MRI

Not CT scan!

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40
Q

What is responsible for the basic control of the pneumotaxic center?

A

Pons

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41
Q

What is responsible for the basic control of the dorsal respiratory group (DRG)?

A

Medulla

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42
Q

Central control of respiration: (4)

A

Dorsal respiratory group
Ventral respiratory group
Pneumotaxic center
Apneustic center

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43
Q

What is the most sensitive stimulus for breathing?

A

Carbon dioxide

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44
Q

Groups of nerve terminals sensitive to changes in pH, PaO2, and PaCO2 are called __________

A

Chemoreceptors

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45
Q

It is defined as the inflow and outflow of air between the atmosphere and the alveoli

A

Pulmonary ventilation

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46
Q

What is the indicator of impending respiratory failure?

A

Paradoxical breathing

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47
Q

What is the most common preventable cause of death among hospitalized patients?

A

Pulmonary embolism

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48
Q

Embolus that occlude the main pulmonary artery, impact across the bifurcation

A

Saddle embolus

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49
Q

Embolus that pass thru an interarterial or interventricular defect to gain access to the systemic circulation

A

Paradoxical embolus

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50
Q

Most common source of embolism

A

Isolated calf vein thrombi

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51
Q

“The Great Masquerader”

A

Pulmonary embolism

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52
Q

Most common history of pulmonary embolism

A

Unexplained breathlessness

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53
Q

Most common symptom of pulmonary embolism

A

Dyspnea

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54
Q

Most common sign of pulmonary embolism

A

Tachypnea

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55
Q

Most common history of DVT

A

Cramp in lower calf that persists for several dats and becomes more uncomfortable

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56
Q

ECG findings if pulmonary embolism

A

S1Q3T3 sign

T-wave inversion in leads v1 to v4 (most common)

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57
Q

Focal oligemia in pulmonary embolism

A

Westermark’s sign

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58
Q

Peripheral wedge shaped density above the diaphragm seen in pulmonary embolism

A

Hampton’s hump

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59
Q

Enlarged right descending pulmonary artery seen in pulmonary embolism

A

Palla’s sign

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60
Q

Principal imaging test for diagnosing pulmonary embolism

A

Chest CT scan with IV contrast

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61
Q

Best known indirect sign of pulmonary embolism seen in echocardiography

A

McConnell’s sign

62
Q

Types of emboli in pulmonary embolism (2)

A

Saddle embolus

Paradoxical embolus

63
Q

Most common location, source of pulmonary embolism

A

Isolated deep calf vein,

Deep leg vein thrombi

64
Q

Natural anticoagulants of the blood

A

Protein C
Protein S
Antithrombin III

65
Q

Most common inherited thrombophilic condition

A

Factor V Leiden Mutation

66
Q

“The Great Masquerader”

A

Pulmonary embolism

67
Q

PE: Most common HISTORY

A

Unexplained breathlessness

68
Q

PE: most common SYMPTOM

A

Dyspnea

69
Q

PE: most common SIGN

A

Tachypnea

70
Q

Classic findings in DVT

A

Homan’s sign
Moses sign
Palpable cord

71
Q

Unexplained tachypnea may be seen in

A

Pulmonary embolism

Spontaneous pneumothorax

72
Q

Gold standard for diagnosis of DVT

A

Contrast venography:

Constant intraluminal filling defect in 2 or more views

73
Q

DVT Duplex USG

A

Non compressibility of venous segment

74
Q

Gold standard for diagnosis of Pulmonary embolism

A

Pulmonary angiography

75
Q

In chest film, abrupt tapering of a vessel caused by pulmonary embolism, focal oligemia

A

Westermark sign

76
Q

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

A

Hampton hump

77
Q

In pulmonary embolism, enlarged right descending artery

A

Palla’s sign

78
Q

Classic findings in pulmonary embolism

A

Westermark sign
Hampton hump
Fleishner sign
Palla’s sign

79
Q

2d echo findings in pulmonary embolism

A

Evidence of right ventricular volume pr pressure overload

80
Q

ABG finding in pulmonary embolism

A

Hypoxemia

Hypocapnea

81
Q

DOC for pulmonary embolism

A 
Unfractionated heparin (parenteral);
Warfarin (oral)
82
Q

Diseases classified as COPD

A

Chronic bronchitis
Bronchiectasis
Asthma (reversible)
Emphysema

83
Q

Persistent cough, sputum production, at least 3 months for 2 consecutive years

A

Chronic bronchitis

84
Q

Pathogenesis of chronic bronchitis

A

Chronic irritation by inhaled substances;

Infection

85
Q

Reid index: increase size in bronchial mucous glands

A

Chronic bronchitis

86
Q

Hallmark of acute inflammation

A

Increased permeability

87
Q

Hallmark of chronic inflammation

A

Fibrosis

88
Q

Blue bloaters

A

Chronic bronchitis

89
Q

Pink puffers

A

Emphysema

90
Q

Permanent alveolar enlargement, destruction of alveolar walls

A

Emphysema

91
Q

No. 1 risk factor for emphysema

A

Cigarette smoking

92
Q

Congenital cause of emphysema

A

Alpha-1 Anti-trypsin deficiency

93
Q

Type of emphysema affecting central or proximal parts of the acini, formed by respiratory bronchioles, distal alveoli spared!

A

Central

94
Q

Type of emphysema, acini uniformly enlarged, from respiratory to terminal alveoli

A

Panacinar (Panlobular)

95
Q

Most common complication if paraseptal (distal acinar) emphysema

A

Spontaneous pneumothorax

96
Q

Type of emphysema almost invariably associated with scarring

A

Irregular emphysema

97
Q

Indications for ICU ADMISSION

A
  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
Q

The only proven treatment for COPD

A

Smoking cessation

99
Q

Hallmark of COPD

A

Airflow obstruction

100
Q

Target O2 sat in COPD

A

88-92%

101
Q

Classic findings in Bronchial Asthma

A

Curschmann spirals,
Charcot Leyden crystals,
Creola bodies

102
Q

Most common trigger if extrinsic bronchial asthma

A

Atopy

103
Q

Most commonly triggered by respiratory infections, IgE normal, hyperirritability if bronchial tree

A

Intrinsic (non-allergic) asthma

104
Q

Triggered by envt antigens, common in childhood, familial tendency, type 1 IgE

A

Extrinsic (allergic) asthma

105
Q

Part of the lungs where etiologic agents spread

A

Pores of Kohn

106
Q

Syndrome associated with broinchiectasis

A

Kartageners syndrome:

  1. Sinusitis
  2. Bronchiectasis
  3. Situs inversus
107
Q

Abnormal irreversible dilatation of bronchial tree, proximal to terminal bronchioles

A

Bronchiectasis

108
Q

Causes of foul-smelling sputum

A

Bronchiectasis

Lung abscess

109
Q

“Honeycomb Lung”

A

Bronchiectasis

110
Q

Prominent cystic spaces on lungs

A

Bronchiectasis

111
Q

Pathogenesis of bronchiectasis

A

Obstruction and Infection

112
Q

Most common cause of post-op fever

A

Atelectasis (collapse)

113
Q

Most common site of bronchiectasis

A

Lower lobes, bilateral

Bronchial walls show inflammation, fibrosis, lumen with pus

114
Q

Patchy consolidation of the lungs, due to injury or old age

A

Bronchipneumonia

115
Q

Acute bacterial infection of large portion of a love or of an entire lobe

A

Lobar pneumonia

116
Q

Most common cause of Atypical pneumonia

A

Mycoplasma

117
Q

Most common cause of lobar pneumonia

A

Strep pneumoniae

118
Q

Most common cause of Otitis media (Luga)

A

Strep pneumoniae

119
Q

Size of pathogen deposited on terminal airway and alveoli

A

1 - 5 mm

120
Q

Size of pathogen deposited largely turbulent airflow of nose and upper airways

A

> 10 mm

121
Q

Size of pathogen that lodge in trachea and bronchi

A

3 - 10 mm

122
Q

Size of pathogen that remains suspended in inspired air and can be exhaled

A
123
Q

Stages of pneumonia

A
  1. Congestion (red vascular engorgement)
  2. Red hepatization (massive RBC exudates)
  3. Gray hepatization (RBC dessintegration)
  4. Resolution (organization, enzymatic digestion)
124
Q

Most common cause of Pneumatocoeles

A

Staph pneumoniae

125
Q

Panton-Valentin-Leukocidin

A

Pneumatocoele

Staph pneumoniae

126
Q

Most common cause of necrotizing pneumonia

A

Pseudomonas

127
Q

Flordelis pattern

A

Necrotizing pneumonia

Pseudomonas

128
Q

Complications if pneumonia

A
  1. Abscess formation
  2. Empyema
  3. Organization (solid tissue)
  4. Bacteremic dissemination
129
Q

Atypical pneumonia is called atypical because

A

Lack of alveolar exudates

130
Q

Xray looks worse than the patient

A

Primary atypical pneumonia

Viral and Mycoplasmal pneumonia

131
Q

Mycoplasma pneumonia causes what type of anemia

A

Hemolytic Anemia (“cold agglutinins” from Mycoplasma)

132
Q

Pneumonia from airconditioned units

A

Legionella

133
Q

Etiologic agent of SARS

A

SARS Coronavirus

134
Q

Lab findings if SARS

A

Antibody to SARS-CoV
SARS-CoV RNA by Rt-PCR
Isolation of SARS CoV

135
Q

“Super Bugs”

An enzyme that makes bacteria resistant to broad range of beta lactam antibiotics

A

New Delhi Metallo-beta-lactamase 1 (NDM-1)

136
Q

“Super Bugs”

A

E. coli
Klebsiella
Pseudomonas

137
Q

NDM-1 was first detected from what organism

A

Klebsiella

138
Q

Organisms with NDM-1 are usually susceptible only to

A

Polymyxins

Tigecycline

139
Q

What is responsible for Caseous Necrosis?

A

Phosphatides

140
Q

PTB mode of transmission

A

Respiratory droplets

141
Q

Most common site of extrapulmonary TB in a child

A

Lymph Nodes

142
Q

Most common location of primary TB

A

Mid-Base lung

143
Q

Most common location of post-primary TB or secondary TB

A

Apical

144
Q

Type of hypersensitivity in post-primary or secondary TB

A

Type IV hypersensitivity (delayed)

145
Q

Causes of unexplained weight loss

A

TB and

Malignancy

146
Q

Classic diagnostic for PTB

A

Sputum exam:
3 sputums early in the morning,
Positive if 2 out of 3 positive

147
Q

Classic chest finding in PTB

A

Upper lobe infiltrates with calcification

148
Q

Gold standard for diagnosis of PTB

A

Culture

149
Q

Agar or base medium for culture of TB

A

Lowenstein-Jensen agar

37C under 5% CO2

150
Q

Lowenstein-Jensen agar

A

TB

PHYSIO-PATHO-IM (7 decks)

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