Respiratory 🫁 Flashcards
Intrapleural pressure
Always negative created by opposing Forces between lung and chest wall
Intrapleural pressure and transmural pressure
Same amount , different charges
IPP = - 7
IMP = + 7
Normal Intrapleural difference
5-15 mmhg
> than 15mmhg or less than 5 mmhg = pathological
Tension Pneumothorax ( become less negative )
Stab wound
Compliance mean
Distensibility
Extensibility
Decrease Surface tension
Surfactant ~ Compliance
Increase compliance similar to
Old used socks with loose elastic band
C = V/P ( meaning more volume ,loose pressure )
COPD ( get air in , can’t get air out bc pressure is not enough to push/exhale air out)
Expiration
Saline filled lung ( liquid )
Increase Elastic recoil ( tight sock after washing )
Collapse
Increase surface tension
Increase elastin
Lung Can’t expand well
Lung fibrosis
Lung fibrosis disease type
Restrictive lung disease
Normals or increase FEV1/FVC
All LFT decrease ( bc can’t get the air in»_space; TLC, FRV,FVC all reduced )
Neonatal respiratory syndrome
Lack or reduced surfactant in baby
Rx- cortisol to increase surfactant
Insulin is surfactant antagonist
(Therefore , baby with diabetic mother are at higher risk for NRDS)
Decrease compliance
Restrictive
NRDS
Chest wall disease ( MG/ dumchenne/GBS) -Extrinsic
Lung fibrosis ( Intrinsic )
How to differentiate COPD and Asthma , Dx test ?
Give Bronchodilator
Improve - Asthma ( reversible )
Not improved - COPD ( irreversible damage due to smoking )
Methacholine challenge test
Asthma - symptoms worsened
A-a gradient
Different Intrinsic and Extrinsic restrictive lung disease
Work of breathing = work of inspiration
How about expiration ?
Expiration do not require active work , only passive exhalation of air after inspiration ( pressure force air out)
In OLD, abdominal Ms breathing to get air out»_space; increase work of breathing > resp fatigue > ICM retraction >barrel chest
Chocolate color blood
Methemoglobinemia
Rx for Methemoglobinemia
Methylene blue
Vit C
Causes of Methemoglobinemia ( Fe2+ to Fe3+)
Dapsone
Anasthestic
Nitrates
Pancoast tumor
Impair blood drainage from head and neck
Headaches / dizziness
JVP distension
Dx
Risk of what condition ?
SVC syndrome
Aneurysm
Intracranial arteries rupture
H1 blocker uses?
Gen. 1 : allergy , motion sickness , gestational emmesis
Gen 2 : Allergy , less Cns toxicity
Tumor at the Apex of the lung
Risk of nearby structures compression ( SVC, Stellate ganglion , Brachial plexus ,phrenic nerves )
Pancoast tumor
SCLC significances ?
Affects
1.Neuro : LEMG , encephalitis , cerebellar degeneration)
2.Endocrine : ACTH - cushion / SIADH
Myc-oncogenes mut
Most common lung cancer
Adenocarcinoma
Happen to non-smoker
Female
Bronchoalveolar
Tall Columnar cells
Stain mucin +
SCC location
Remember “C”
Central , Ca2+ , Cavitation ,Cig
Hilar- bronchus
His- Keratin pearls
LCC (lung)
Large -giant cells
Mostly smokers
Increase b-HCG -gynecomastacia
ComplicTion of Lung Ca
SPHERE
S- SVC $
P-Pancoast Tumor
H- Horner $ (stellate Ganglion compression)
E-endocrine neoplastic
R- recurrent laryngeal n compression
E- effusion ( pleural / pericardial)
Multiple Mets lesion on the lung
More common in 2mets than 1 lung Ca
Mostly from breast /colon /bone/ bladder
Alcoholic
Choking +
Aspiration Oropharyngeal content +
Air fluid level + on CXR
DX?
Expect to see in Which side of lung?
Lung abscess ( pus )
Aerobes or s aureus
Right lung ( more vertical )
Sitting -RLL
supine- RUL
Course/natural Hx of pneumonia ?
D 1-2 : Congestion ( Bac + Exudate ) -consolidation
D3-4: Red Hepatization - WBC migration + fibrin + Exu
D5-7: Gray -Fibrin ,lyses RBC , WBC
D8+ : Resolution -Macrop enzymatic digestion of exudate
