Respiratory 1 USMLE Flashcards
pt exhibits an extended epiratory phase. What is the dz process?
obstructive lung dz
tall, thin male teenagesr has abrupt-onset dyspnea and left sided chet pain. There is hyperresonant percussion on the affected side, and breath sounds are diminished. What is the dx?
spontaneous pneumothorax
young wife is concerned about his wifes inability to conceive and her recurrent URIs. She has dextrocardia. Which of her proteins is defective?
dynein (Kartagener’s)
pseudocolumnar ciliated cells extend to _______ bronchioles
respiratory
goblet cells extend only to the ________ bronchioles
terminal
this type pneumocytes line the alveoli (97% of the aveolar surfaces)
type I cells
this type pneumocytes secrete pulmonary surfactant (dipalmitoyl phosphatidylcholine), which decrease the alveolar surface tension.
type II cells
These cells also serve as precursors to type I cells and other type II cells. They proliferated during lung damage
type II cells
mucus secretions are swept out of the lungs toward the mouth by these cells
ciliated cells
a lecithin-to-sphingomyelin ratio of this in amniotic fluid is indicative of fetal lung maturity
> 2.0
each bronchopulmonary segment has a tertiary (segmental) bronchus and 2 of these in the center; veins and lymphatics drain along the borders
arteries (bronchial and pulmonary
mneu:arteries run with airways
the right lung has this many lobes
3
the left lung has this many lobes
2
what is the homologue of the right middle lobe
lingula
which is the more common site foir inhaled foreign body owing to the less acute angle of the main stem bronchus
right lung
The relation of the pulmonary artery to the bronchus at each lung hilus is described as this
RALS–
Right Anterior, Left superior
Stuctures perforating diaphram:
IVC
Esophagus, vagus (2 trunks)
aorta (red), thoracic duct (white), azygous vein (blue
T8
T10
T12
what is the diaphram innervatd by
phrenic nerve (C3,4,5)
pain from the diaphram can be referred here
shoulder
what are the mm of respiration in quiet breathing
inspiration-diaphram
expiration-passive
what are the mm of respiration in exercise
expiration-external intercostals, scalene muscles, sternomastoids
inspiration-rectus abdominis, internal and external obliques, transversus abdominis, internal intercostals
in high altitude respiration will ____
increasie
in high altitude erythropoietin will ____
increase leading to increase in HCT & HGB
in high altitude 2,3-DPG will ______
increase
DPG binds to HGB so that HGB releases more O2
in high altitude this cellular changes occurs _____
increase in mitochondria
in high altitude there is an increased renal excretion of this
bicarbinate
compinsatig for respiratory alkalosis
in high altitude chronic hypoxic pulmonary vasoconstriction will result in this cardiac change
RVH
this is produced by type II pneumocytes, it decreases alveolar surface tension, and inceases compliance
surfactant
surfactant or dipalmitoyl phosphatidylcholine (lecithin) is deficient in this neonatal syndrome which occurs often in premies
neonatal RDS
give 4 other important lung products
prostaglandins
histamine
Angiotensin converting enzyme (ACE)
kallikrein
how do ACE inhibitors cause cough
increase bradykinin which causes cough and causes angioedema
Kallikrein activates what?
bradykinin
what is the collapsing pressure of alveola
2 (tension)/radius
this describes the air in lung after maximal expiration
residual volume (RV)
this describes air that can still be breathed out after normal expiration
expiratory reserve volume (ERV
this describes air that moves into lung with each quiet inspiration, typically 500 mL
tidal volume (TV)
this describes air in excess of tidal volume that moves into lung on maximal inspiration
Inspiratory reserve volume (IRV
vital capacity (VC)=
TV+IRV+ERV
Functional reserve capacity (FRC)=
RV+ERV
volume in lungs after normal expiration
Inspiratory capacity (IC)=
IRV + TV
Total lung capacty(TLC)=
IRV+TV+ERV+RV
vital capacity is everything but this
residual volume
an decrease in all factors (except pH) causes a shift of the curve to the ______
left
right shift –CADET face RIGHT - stands for
CO2 Acid/Altitude DPG (2,3-DPG) Exercise Temperature
pulmonary circulation is normally a _____ resistance, ____ compliance system
low
high
PO2 & PCO2 exert opposite effects on pulmonary and systemic circulation. A decrease in PaO2 causes this
hypoxic vasoconstriction that shifts blood away from the poorly ventilated regions of the lung to well ventilated regions of the lung
what is a consequence of pulmonary hypertension
cor pulmonale and subsequent right ventricular failure
what is a physical exam finding of cor pulmonale and subsequent right ventricular failure
jugular venous distension, edema, hepatomegaly
Is this perfusion limited or diffusion limited?
O2 (normal health), CO2, N2O. Gas equilibrates early along the lenght of the capillary. Diffusion can be increased only if blood flow increases.
perfusion limited
Is this perfusion limited or diffusion limited?
O2 (exercise, emphysema, fibrosis), CO. Gas does not equilibrate by the time blood reaches the end of the capillary
diffusion limited
Determination of physiologic dead space (VD)=
VT x [(PaCO2-PeCO2)/PaCO2
PaCO2=arterial PCO2,
PeCO2=expired air PCO2
when a curve shifts to this direction there is a decreased affinity of hgb for O2 (facilitates unloading of O2 to the tissue)
right
an increase in all factors (except pH) causes a shift of the curve to the ______
right
ideally, ventilation is matched to perfusion in order to achieve adequate gas exchange. V/Q=
1
Both ventilatio and perfusion are greater at this part of the lung.
base of the lung
at the apex of the lung V/Q=
3 (wasted ventilation)
at the base of the lung V/Q=
0.6 (wasted perfusion
during this, there is an increase in cardiac output and therefore a vasodilation of apical capillaries resulting in a V/Q ratio that approaches 1
exercise
certain organisms thrive in high O2 and flurish at the apex of the lung. Give an example of such an organism
TB
when V/Q =0 this is happening
there is an airway obstruction(shunt)
when V/Q =infinity
this is happening
there is a blood flow obstruction (physiologic dead space
CO2 is transported from the tissue to the lungs in 3 forms. What are they
1) Bicarbinate (90%)
2) bound to hgb as carbinohemoglobin (5%)
3) dissolved CO2 (5%)
what is the haldane effect?
in lungs, oxygenation of hemoglobin promotes dissociation of CO2 from hgb
what is the bohr effect
in peripheral tissue, increased H+ shifts curve to the right unloading O2
alveolar-arterial O2 difference=
[(A-a)Do2]<10 mmHg
this dz results from an obstruction of air flow, resulting in air trapping in the lungs
COPD
what will PFTs show with COPD
decreased FEV1/FVC ratio
this type of COPD manifests with a productive cough for >3consecutive months in 2 or more years. There is a hypertrophy of mucus-secreting glands in the bronchiles (Reid index >50%)
chronic bronchitis (“Blue Bloater”)
what PE findings might you find with chronic bronchitis
wheezing, crackles, cyanosis
what is the leading cause of chronic bronchitis
smoking
this type of COPD manifests with enlargement of air spaces and decreased recoil resulting from destruciton of alveolar walls.
emphysema (“pink puffer”)
smoking causes this type of emphysema
centriacinar emphysema
alpha 1 antitrypsin deficiency causes this type of deficiency
panacinar
alpha 1 antitrypsin deficiency also causes this
liver cirrhosis
in emphysema there is increased activity of this enzyme
elastase
what are some PE findings in emphysema
dyspnea, decreased breath sounds, tachycarida, decreased inspiration/expiration ratio
this form of COPD is caused by bronchial hyperresponsiveness that causes reversible bronchostrinction.
asthma
name some triggers for asthma
viral URIs, allergins, and stress
give some findings in asthma
cough, wheezing, dyspnea, tachypnea, hypoxemia, decrease I/E ratio, pusus paradoxus, Curschmann’s spirals, smooth muscle hypertrophy, mucous plugging
this form of COPD is caused by chronic necrotizing infection of bronchi resulting in dilated airways purulent sputum, recurrent infections, hemoptysis. Associated with bronchial obstruction, CF, poor ciliary motility, and Kartagener’s syndrome
Bronchiectasis
in this dz, restricted lung expansion causes decreased lung volumes (decreased VC and TLC)
restrictive lung dz
what will PFTs show with restrictive lung dz
FEV1/FVC ratio > 80%
give 2 types of restrictive lung dz that result from poor breathing mechanics (extrapulmonary)
1) poor muscular effort - polio, myasthenia gravis
2) poor structural apparatus –scoliosis, morbid obesity
give 4 types of restrictive lung dz that result from interstitial lung diseases (pulmonary)
1) adult respiratory distress syndrome (ARDS)
2) neonatal rspiratory distress syndrome (hyaline membrane dz)
3) pneumoconioses (coal miner’s silicosis, asbestosis)
4) sarcoidosis
5) idiopathic pulmonary fibrosis
6) Goodpasture’s syndrome
7) Wegener’s granulomatosis
8) eosinophilic granulomas
describe the physical exam findings of bronchial obstruction BS: Resonance: Fremitus: Tracheal Deviation:
BS: absent/decreased over affected area
Resonance:↓
Fremitus:↓
Tracheal Deviation: toward side of lesion
describe the physical exam findings of pleural effusion BS:
Resonance:
Fremitus:
Tracheal Deviation:
BS: ↓ over effusion
Resonance:dullness
Fremitus:↓
Tracheal Deviation: NA
describe the physical exam findings of pneumonia BS: Resonance: Fremitus: Tracheal Deviation:
BS: may have bronchial BS over the lesion
Resonance: dullness
Fremitus: ↑
Tracheal Deviation: NA
describe the physical exam findings of pneumothorax BS: Resonance: Fremitus: Tracheal Deviation:
BS:↓
Resonance: hyperresinant
Fremitus: absent
Tracheal Deviation: away from side of lesion
obstructive lung volumes are ____ normal
> (↑TLC,↑FRC,↑RV)
restrictive lung volumes are ___ normal
<
in both obstructive and restrictive lung dz, these are reduced
FEV1 & FVC
in obstructive or restrictive lung dz is FEV1 more dramatically reduced resulting in a decreased FEV1/FVC ratio
obstructive lung dz
this syndrome causes immotile cilia due to a dynein arm defect. It results in male and female infertility (sperm immobile), bronchiectasis, and recurrent sinusitis (bacteria and particles not pushed out); associated with situs inversus
Kartagener’s syndrome
this is caused by diffuse pulmonary interstitial fibrosis caused by inhaled asbestos fibers
asbestosis
asbestosis increase the risk of these 2 malignancie
mesothelioma and bronchogenic carcinoma
asbestosis and smoking greatly increases the risk of this malignancy
bronchiogenic cancer (smoking is not additive with mesothelioma)
ivory-white pleural plaques and ferruginous bodies are often seen in the lungs of people with asbestosis. What are ferruginous bodies
asbestos fiber coated with hemosiderin
asbestosis is often seen in these 2 professions
shipbuilders and plumbers
this syndrome in neonates results from a surfactant deficiency leading to increased surface tension, resulting in alveolar collapse.
neonatal respiratory distress syndrome
surfactant is made by these pneumocytes most abundantly after 35th week of gestation
type II pneumocytes
what is the lecithin-to-sphingomyelin ratio in the amniotic fluid (measure of lung maturity) in neonatal respiratory distress syndrome
<1.5
what is surfactant
dipalmitoyl phosphatidylcholine
what is the treatment for neonatal respiratory distress syndrome
maternal streroids before birth; artificial surfactant for infant
what is the leading cause of cancer death
Lung CA
these are bronchogenic carcinomas that arise CENTRALLY
squamous cell carcinoma
small cell carcinoma
mneu: Small Squamous Center
these 2 forms of lung cancer have a clear link to smoking
squamous cell carcinoma
small cell carcinoma
mneu: S & S from Smoking
squamous cell carcinoma sometimes produces this peptide
PTH-related peptide
small cell carcinoma sometimes produces these hormones
ADH, ACTH
small cell carcinoma sometimes produces this syndrome
Lambert-Eaton syndrome
this lung cancer often presents with cough, hemoptysis, bronchial obstruction, wheezingg, pneumonic “coin” lesion on x-ray
small cell carcinoma
what are the bronchogenic carcinomas that arise peripherally
1) adenocarcinoma (most common)
2) bronchioalveolar carcinoma
3) large cell carcinoma
is bronchioalveolar carcinoma thought to be related to smoking
No
Lung CA can cause a SPHERE of complictions. name them
Superior vena cava syndrome Pancoast's tumor Horners syndrome Endocrine (paraneoplastic) Recurrent laryngeal symptoms (horseness) Effusions (pleural or paricardial)
this type of lung tumor causes flushing, diarrhea, wheezing, and salivation
carcinoid tumor
symptoms such as siezure, bone fracture, jaundice or hepatomegly may be a sign that lung cancer has done this
metastesized
this is a carcinoma that occurs in the apex of lung and may affect cervical sympathetic plexus, causing Horner’s syndrome
pancoast’s tumor
what is horner’s syndrome
ptosis, miosis, anhidrosis
this type of pneumonia involves intra-alveolar exudate which develops into consolidation. It may involve the entire lung.
lobar pneumonia
what organism is usually implicated in lobar pneumonia
pneumococcus most frequently
this type of pneumonia involves acute inflammatory infiltrates from bronchioles into adjacent alveoli. There is a patchy distribution involving >/=1 lobes
bronchopneumonia
what organism is usually implicated in bronchopneumonia
S. aureus, H. flu, Klebsiella, S. pyogenes
this type of pneumonia involves diffuse patchy inflammation localized to interstitial areas at alveolar walls. Distribution involves >/=1 lobes
intertitial (atypical) pneumonia
what organism is usually implicated in intertitial (atypical) pneumonia
viruses (RSV, adenoviruses), mycoplasma, legionella, chlamydia
the lipoxygenase pathway yields thses
Leukotrienes
mne: L for lipoxygenase and leukotriene
LTB4 is this
neutrophil chemotactic agent
LTC4,D4, and E4 fuction in this
bronchoconstriction, vasoconstriction, constrictionof smooth mm, andincreased vascular permeability
PGI2 does this
inhibits platelet aggregation and promotes vasodilation
mneu: Platelet-Gathering Inhibitor
