Respiratory Flashcards
Type 1 pneumocytes
line alveoli
for gas exchange
Type 2 pneumocytes
produce surfactant
proliferate during lung damage
precursor to pneumocytes I and II
Expiratory muscles
abs
internal intercostals
Hysteresis
difference b/t inspiration and expiration Vol/P graph
due to overcoming surface tension in inspiration
Functional reserve capacity
after normal expiration
chest wall expansion=lung elasticity
Bohr effect
oxygen more readily released by Hb with increased 2,3-BPG, H+, Cl-, CO2, temp
Methemoglobin
ferric iron bound (Fe3+)
does not readily bind oxygen
tx with methylene blue
Pulmonary hypoxia
causes vasoconstriction (unlike other tissues)
Primary PAH
BMPR2 gene inactivating mutation
PAH over 25mmHg
Secondary PAH
from COPD or recurrent thromboemboli
Cor pulmonale
RVH and cyanosis
V/Q mismatches
V/Q=0, airway obstruction
V/Q=infinity, infarct/no blood flow
V/Q values of the lung
ideal=1
apex of lung is higher (less blood flow)
base of lung is low (more blood flow)
overall base has more V and Q though
Haldane effect
RBC’s release CO2 when increased O2 present (in lungs)
High altitudes on blood chemistry
decreased PCO2 (hyperventilation)
increased RBC’s/EPO
increased 2,3-BPG (increased oxygen release)
Virchow’s triad and Homan’s sign
Stasis hypercoagulability endothelial damage all for DVT Homan's-dorsiflexion of foot causes pain=DVT
DVT treatment
heparin for acute
warfarin for long term
Sign of pulmonary emboli
hypoxemia
CNS sx
petechial rash
Obstructive lung disease characteristics
barrel chest (increased residual volume) increased FEV1/FVC ration
Chronic bronchitis
COPD with emphysema
hypertrophy of mucous glands
hypercapnea/wt gain (blue bloaters)
productive cough over 3 mo for over 2 years
Emphysema
pink puffers
pursed lips/erythematous
increased lung compliance
Centriacinar emphysema
increased proteases
from smoking
Panacinar emphysema
decreased antiprotease (A1AT deficiency)
Paraseptal emphysema
giant bullae
spontaneous pneumothorax in young males
Asthma characteristics
Curschmann spirals (mucus plugs)
Charcot Leyden crystals (eosinophil breakdown)
hyperresponsiveness
smooth muscle hypertrophy
Bronchiectasis characteristics
chronic necrotizing bronchi infection
permanently dilates airways
assc with Cystic fibrosis/Kartagener’s syndrome/allergic bronchopulmonary aspergillosis
Restrictive lung disease characteristics
decreased lung volume
normal FEV1/FVC
caused by fibrosis/damage to lungs
Sarcoidosis/Goodpasture’s/Wegener’s
Anthracosis
upper lungs
assc with coal miners
Silicosis
increased TB/bronchogenic carcinoma
sandblasting/foundry work
disruption of macrophages
fibrosis/upper lungs
Asbestosis
lower lungs
calcified pleural plaques
increased mesothelioma/carcinoma
golden-brown fusiform rods (asbestos bodies)
Neonatal respiratory distress syndrome
tx with corticosteroids before birth
decreased surfactant
risk of PDA with low oxygen levels
risk with maternal DM
Acute respiratory distress syndrome
ARDS
intra alveolar hyaline membrane
ROS damage lungs
triggered by traumatic event
Obstructive sleep apnea
assc with obesity
HTN
hypoxia causes increased EPO/RBC production
Resorption atelectasis
airway obstruction
deviates toward obstruction
Compression atelectasis
air/fluid in pleural space
deviates away
Contraction atelectasis
fibrotic, irreversible lung damage
prevents full expansion
Lung cancer
most common is metastatic (breast,colon,prostate)
coin lesion on x-ray
Adenocarcinoma of lungs
nonsmoking females
K-RAS mutation
SSC of lungs
hilar mass
cavitation/cigarettes/hypercalcemia
keratin pearls
Small cell carcinoma of lung
undifferentiated
Lambert-Eaton assc
myc oncogene mutation
Kulchitsky cells (dark blue cells)
Mesothelioma
assc with asbestos
hemorrhagic pleural effusions
pasammoma bodies
SVC syndrome
impaired blood drainage from head
assc with malignancy or indwelling catheters
Lobar pneumonia
Strep pneumo
Klebsiella
bacterial
Interstitial pneumonia
viral/intracellular origin
mycoplasma/legionella/chlyamydia
influenza/RSV/adenovirus
Cause of lung abscesses
S. aureus
anaerobes (Bacteroides/fusobacterium)
air fluid levels on CXR
Transudate cause
CHF
cirrhosis
1st gen H1 blockers
diphenhydramine/dimenhydrinate/chlorpheniramine
cross BBB
cause sedation and antimuscarinic effects
Theophylline
inhibits phosphodiesterase (bronchodilates) can cause cardio/neurotoxicity
MOA of ipratoprium
blocks muscarinic receptors
prevents bronchoconstriction
1st line for long term asthma
corticosteroids
Use of antileukotrienes (montelukast/zileutin/zafirlukast)
aspirin induced asthma
long term asthma if steroids contraindicated
MOA of omalizumab
anti IgE Ab
allergic asthma when steroids do not work
Bosetan MOA
antagonizes endothelin 1 receptor
decreases pulmonary resistance
for PAH
