Respiratory Flashcards by Emily Acton

What is the distinction between a lung volume and lung capacity?

a capacity is a sum of ≥ 2 physiologic volumes

(There are 4 volumes and 4 capacities)

How well did you know this?

Not at all

Perfectly

Define tidal volume:

Air that moves into lung with each quiet inspiration, 6–8 mL/kg, typically ~500 mL

How well did you know this?

Not at all

Perfectly

Define inspiratory reserve volume:

Air that can still be breathed in after normal inspiration

How well did you know this?

Not at all

Perfectly

Define expiratory reserve volume:

Air that can still be breathed out after normal expiration

How well did you know this?

Not at all

Perfectly

——— (and any lung capacity that includes it) cannot be measured by spirometry

residual volume

How well did you know this?

Not at all

Perfectly

Define residual volume:

Air in lung after maximal expiration

How well did you know this?

Not at all

Perfectly

What does the LITER mnemonic stand for with respect to lung volumes?

Lung volumes

Inspiratory reserve volume

Tidal volume

Expiratory reserve volume

Residual volume

How well did you know this?

Not at all

Perfectly

Define inspiratory capacity:

IRV + VT; Air that can be breathed in after normal exhalation

How well did you know this?

Not at all

Perfectly

Define functional residual capacity:

RV + ERV; Volume of gas in lungs after normal expiration; outward pulling force of chest wall is balanced with inward collapsing force of lungs

How well did you know this?

Not at all

Perfectly

Define vital capacity:

IRV + VT + ERV; Maximum volume of gas that can be expired after a maximal inspiration

How well did you know this?

Not at all

Perfectly

Define total lung capacity:

IRV + VT + ERV + RV = VC + RV; Volume of gas present in lungs after a maximal inspiration (6 L)

How well did you know this?

Not at all

Perfectly

What is normal FEV1, FVC, and FEV1/FVC?

FEV1: > 80%

FVC: > 80%

FEV1/FVC: > 70%

How well did you know this?

Not at all

Perfectly

Obstructive lung diseases result from ——— (——— FEV1, ——— FVC ——— FEV1 /FVC ratio) and lead to ——— in lungs ( ——— RV, and thus, ——— FRC and ——— TLC) due to premature ——— at ——— lung volumes.

- obstruction of air flow

- greatly decreased

- decreased

- decreased

- air trapping

- increased

- increased

- increased

- airway closure

- high

How well did you know this?

Not at all

Perfectly

List 3 key examples of obstructive lung diseases:

- COPD (chronic bronchitis and emphysema)

- asthma

- bronchiectasis

How well did you know this?

Not at all

Perfectly

Restrictive lung diseases may lead to ——— lung volumes ( ——— FVC and ——— TLC)

- decreased

- decreased

- decreased

How well did you know this?

Not at all

Perfectly

With restrictive lung diseases, PFTs are:

normal or increased FEV1/FVC ratio

How well did you know this?

Not at all

Perfectly

Restrictive lung diseases present with ——— breaths

short, shallow

How well did you know this?

Not at all

Perfectly

List the 2 types of restrictive lung diseases (including location, diffusing capacity of the lungs for carbon monoxide (DLCO), and alveolar-arterial (A-a) gradient):

1. Altered respiratory mechanics (extrapulmonary, normal DLCO, normal A-a gradient)

2. Diffuse parenchymal lung diseases, also called interstitial lung diseases (pulmonary, decreased DLCO, increased A-a gradient)

How well did you know this?

Not at all

Perfectly

List the 6 examples of restrictive lung diseases that are due to altered respiratory mechanics (extrapulmonary, normal DLCO, normal A-a gradient):

Respiratory muscle weakness:
- polio
- myasthenia gravis
- Guillain-Barré syndrome
- ALS

Chest wall abnormalities:
- scoliosis
- severe obesity

How well did you know this?

Not at all

Perfectly

List the 10 examples of restrictive lung diseases that are due to diffuse parenchymal lung diseases, also called interstitial lung diseases (pulmonary, decreased DLCO, increased A-a gradient):

- Pneumoconioses (eg, coal workers’ pneumoconiosis, silicosis, asbestosis)

- Sarcoidosis

- Idiopathic pulmonary fibrosis

- Granulomatosis with polyangiitis

- Pulmonary Langerhans cell histiocytosis (eosinophilic granuloma)
- Hypersensitivity pneumonitis

- Drug toxicity (eg, bleomycin, busulfan, amiodarone, methotrexate)
- Acute respiratory distress syndrome

- Radiation-induced lung injury

How well did you know this?

Not at all

Perfectly

What happens to the RV, FRC, TLC, FEV1, FVC, FEV1/FVC, and pressure-volume loop in obstructive vs restrictive lung disease?

Obstructive lung disease:
RV increased
FRC increased
TLC increased
FEV1 significant decreased
FVC decreased
FEV1/FVC decreased (FEV1 decreased more than FVC )
pressure-volume loop shifted left (higher volume)

Restrictive lung disease:
RV decreased
FRC decreased
TLC decreased
FEV1 decreased
FVC decreased
FEV1/FVC normal (FEV1 decreased proportionately to FVC ) or increased
pressure-volume loop shifted right (lower volume)

How well did you know this?

Not at all

Perfectly

Relative to resistance and compliance, pulmonary circulation is normally:

low-resistance, high-compliance

How well did you know this?

Not at all

Perfectly

A decrease in Pao2 causes ——— that shifts blood ———

- hypoxic vasoconstriction

- away from poorly ventilated regions of lung to well-ventilated regions of lung

How well did you know this?

Not at all

Perfectly

Chronic hypoxic vasoconstriction may lead to:

pulmonary hypertension +/– cor pulmonale

How well did you know this?

Not at all

Perfectly

Define perfusion limited gas exchange in lungs, and list gases that are perfusion limited:

Definition: Gas equilibrates early along the length of the capillary (Exchange can be increased only if blood flow increased) Gases: O2 in normal health, CO2, N2O (nitrous oxide)

Define diffusion limited gas exchange in lungs, and list gases that are diffusion limited:

Definition: Gas does not equilibrate by the time blood reaches the end of the capillary Gases: O2 in emphysema and fibrosis, CO

——— diffuses slowly, while ——— diffuses very rapidly across the alveolar membrane; Disease states that lead to diffusion limitation (eg, pulmonary fibrosis) are more likely to cause early ——— than ———

- O2 - CO2 - hypoxia - hypercapnia

Define DLCO:

DLCO is the extent to which CO passes from air sacs of lungs into blood

Leading cause of cancer death?

Lung cancer

Describe 5 attributes of general presentation of lung cancer (including chest X-ray and CT finding):

cough hemoptysis bronchial obstruction wheezing pneumonic “coin” lesion on CXR or noncalcified nodule on CT

Sites of metastases from lung cancer:

liver (jaundice, hepatomegaly) adrenals bone (pathologic fracture) brain (lung ‘mets’ Love Affective BONEheads and BRAINiacs)

In the lung, what is more common 1° neoplasms or metastases?

metastases (usually multiple lesions) are more common

In the lung, what are the most common sources of metastases?

breast, colon, prostate, and bladder cancer

List 6 notable complications of lung cancer:

SPHERE of complications: Superior vena cava/thoracic outlet syndromes Pancoast tumor Horner syndrome Endocrine (paraneoplastic) Recurrent laryngeal nerve compression (hoarseness) Effusions (pleural or pericardial)

List 6 risk factors for lung cancer:

tobacco smoking secondhand smoke radiation environmental exposures (eg, radon, asbestos) pulmonary fibrosis family history

List two lung cancer types that are central and often caused by tobacco smoking:

Squamous and Small cell carcinomas (Remember: Sentral)

Hamartomas are found incidentally on imaging, appearing as:

well-circumscribed mass

List the small cell vs non-small cell lung cancers:

Small Cell: Small cell (oat cell) carcinoma Non-Small Cell: Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Bronchial carcinoid tumor

List the location of each lung cancer type:

Central: (Sentral) Small cell (oat cell) carcinoma Squamous cell carcinoma Peripheral: Adenocarcinoma Large cell carcinoma Central or Peripheral: Bronchial carcinoid tumor

Are small cell (oat cell) carcinoma differentiated or undifferentiated? How aggressive?

Undifferentiated, very aggressive

List 7 key paraneoplastic syndromes caused by small cell (oat cell) carcinoma:

Neurologic paraneoplastic syndromes: - Lambert-Eaton myasthenic syndrome - paraneoplastic myelitis - encephalitis - subacute cerebellar degeneration Endocrine paraneoplastic syndromes: - Cushing syndrome - SIADH

For small cell (oat cell) carcinoma, amplification of ——— is common

myc oncogenes

Small cell (oat cell) carcinoma is managed with:

chemotherapy +/– radiation

Small cell (oat cell) carcinoma are neoplasm of ———, which appear on histology as ———

- neuroendocrine Kulchitsky cells - small dark blue cells (Neuroendocrine cells = neurologic and endocrine paraneoplastic syndromes)

List 3 key tumor markers for small cell (oat cell) carcinoma:

Chromogranin A ⊕ neuron-specific enolase ⊕ synaptophysin ⊕

Most common 1° lung cancer?

Adenocarcinoma

Most common lung cancer subtype in people who do not smoke?

Adenocarcinoma

What sex is Adenocarcinoma more common among?

More common in females than males

Activating mutations for Adenocarcinoma include:

KRAS EGFR ALK

Key association for Adenocarcinoma is:

hypertrophic osteoarthropathy (clubbing)

For Bronchioloalveolar subtype of Adenocarcinoma (adenocarcinoma in situ): CXR often shows ———; associated with ——— prognosis

- hazy infiltrates similar to pneumonia - better

On histology Adenocarcinoma displays ———, and often stains ———

- glandular pattern - mucin ⊕

On histology the bronchioloalveolar subtype, grows along ——— leading to ——— ( ——— cells containing ———)

- alveolar septa - apparent “thickening” of alveolar walls - tall, columnar - mucus

Squamous cell carcinoma appears as a ——— arising from ———

- Hilar mass - bronchus

List 3 key aspects of presentation/history for squamous cell carcinoma:

- Cavitation - Cigarettes - hyperCalcemia (produces PTHrP)

On histology, squamous cell carcinoma demonstrate:

Keratin pearls and intercellular bridges (desmosomes)

Large cell carcinoma: undifferentiated or differentiated?

Highly anaplastic undifferentiated tumor

Large cell carcinoma are strongly associated with:

tobacco smoking

Large cell carcinoma may produce ———, leading to ———

- hCG - gynecomastia (enLARGEd breasts)

Large cell carcinoma: treatment/prognosis?

- Less responsive to chemotherapy; removed surgically - Poor prognosis

Large cell carcinoma: key histology?

Pleomorphic GIANT cells

Bronchial carcinoid tumor: prognosis/ commonness of metastasis?

Excellent prognosis; metastasis rare

Bronchial carcinoid tumor: Symptoms?

Symptoms due to mass effect (wheezing) or carcinoid syndrome (flushing, diarrhea)

Bronchial carcinoid tumor: key histology?

Nests of neuroendocrine cells; chromogranin A ⊕

Pancoast tumor: Also called ———tumor; occurs in the ———, and may cause Pancoast syndrome by ———

- superior sulcus - apex of lung - invading/compressing local structures

Pancoast tumor compression of the stellate ganglion (i.e., ——— blockade on the ——— side) causes:

- sympathetic - ipsilateral - Horner syndrome (ipsilateral ptosis, miosis, anhidrosis)

Pancoast tumor compression of the recurrent laryngeal nerve causes:

hoarseness

Pancoast tumor compression of the brachial plexus causes:

- shoulder pain, sensorimotor deficits (eg, atrophy of intrinsic muscles of the hand)

Pancoast tumor compression of the phrenic nerve causes:

hemidiaphragm paralysis (hemidiaphragm elevation on CXR)

Superior vena cava syndrome caused by ——— (eg, with ———), which impairs blood drainage from the: 1. ——— (eg, ———) 2. ——— (eg, ———) 3. ——— (eg, ———)

- obstruction of the SVC - thrombus, tumor - head - “facial plethora” (in picture below note blanching after fingertip pressure) - neck - jugular venous distension, laryngeal/pharyngeal edema - upper extremities - edema

List 2 common causes of SVC syndrome:

- malignancy (eg, mediastinal mass, Pancoast tumor) - thrombosis from indwelling catheters

SVC syndrome is a medical emergency: List 3 possible adverse consequences

- raises intracranial pressure (if obstruction is severe) - headaches/dizziness - risk of aneurysm/rupture of intracranial arteries.

Iron in Hb is normally in a ——— state (named ———)

- reduced - ferroUS Fe2+ (just the 2 of US)

——— form of Hb (called ———) does not bind ——— as readily as ———, but has increased affinity for ———, leads to tissue ——— from decreased———

- Oxidized - ferric, Fe3+ - O2 - Fe2+ - cyanide - hypoxia - decreased O2 saturation and decreased O2 content

Methemoglobinemia refers to the ———; While typical concentrations are ———, methemoglobinemia will occur at ——— levels

- Fe3+ form of iron - 1–2% - higher

Methemoglobinemia may present with ——— (which does not improve with ———) and with ———

- cyanosis - supplemental O2 - chocolate-colored blood

Methemoglobinemia poisoning by ——— can be caused by (list 3 causes):

- oxidizing Fe2+ to Fe3+ Causes: - Dapsone - local anesthetics (eg, benzocaine) - nitrites (eg, from dietary intake or polluted water sources)

List 2 treatments for Methemoglobinemia:

methylene blue and vitamin C

For pleural effusion, describe findings for breath sounds, percussion, fremitus, and tracheal deviation:

breath sounds: decreased percussion: dull fremitus: decreased tracheal deviation: None if small; Away from side of lesion if large

For atelectasis, describe findings for breath sounds, percussion, fremitus, and tracheal deviation:

breath sounds: decreased percussion: dull fremitus: decreased tracheal deviation: Toward side of lesion

For simple pneumothorax, describe findings for breath sounds, percussion, fremitus, and tracheal deviation:

breath sounds: decreased percussion: hyperresonant fremitus: decreased tracheal deviation: none

For tension pneumothorax, describe findings for breath sounds, percussion, fremitus, and tracheal deviation:

breath sounds: decreased percussion: hyperresonant fremitus: decreased tracheal deviation: away from side of lesion

For consolidation (lobar pneumonia, pulmonary edema), describe findings for breath sounds, percussion, fremitus, and tracheal deviation:

breath sounds: bronchial breath sounds; late inspiratory crackles, egophony, whispered pectoriloquy percussion: dull fremitus: increased tracheal deviation: none