Respiratory Flashcards
What ends at the Bronchi before Bronchioles?
Cartilage
Goblet cells
What Extends to terminal bronchioles?
Pseudostratified CILIATED columnar
Smooth muscle
Non ciliated cells that secrete components of surfactant and degrade toxins?
Clara cells
FRC= ?
FRC = RV + ERV
VC = ?
VC = TV + IRV + ERV
Physiological dead space equation?
Vd= Vt x (Paco2 - Peco2)/ Paco2 Vt= tidal volume Pa= arterial Pe= Expiratory
Taut vs Relaxed Hb?
Taut = Low affinity for O2 in Tissue Relaxed = High affinity for O2 Respiratory
Pt on Nitroprusside gets Oxidized Hb that has high affinity for Cyanide, Rx?
Methemoglobin = Methylene blue
Perfusion vs Diffusion limited exchange?
Perfusion = Gas equilibrates along capillary (O2, CO2, N2O) Diffusion = Does NOT equilibrate (CO + O2 in emphysema)
CO diffusion measures?
Alveolar- Capillary interaction
Emphysema = Dec SA
Fibrosis = Inc Thickness
During normal exercise Increased BF does NOT overwhelm O2 diffusion Unless?
Fibrosis = then O2 is Diffusion Limited
Pulmonary HTN (> 25mmHg):
Primary
Secondary
1 = BMPR2 mutation = Inc Vascular sm. musc Prolif
2nd = COPD (parenchyma destruction) + Recurrent thromboemboli (dec Cx Area of vasculature)
Autoimmune (Intimal Fibrosis )
Left-Right shunt = Endothelial injury = atherosclerosis
Altitude/sleep apnea = Hypoxic vasoconstriction
Pulmonary Vascular resistance= ?
PVR = [P (pul art) - P (left atrium)] / CO
O2 content = ?
O2 delivery?
O2 content = (O2 binding capacity x %sat) + dissolved O2
*1 g Hb = binds 1.34 mL O2 -> [Hb = 15]
**O2 content == 20 mL
O2 delivery = CO x content
Dec Hb causes?
Dec O2 content
Normal O2 sat
Normal Po2
Alveolar gas equation? Normal PAo2 vs Pao2?
PAo2 = PIo2 - (Paco2/ R)
*** PAo2== 150 - (Paco2 / 0.8) **
PAo2= 100
Pao2 = 95
A-a gradient is normally? Elevated in ?
A-a gradient = 10-15
Elevated A-a = Hypoxemia (shunt, V/Q mm, Fibrosis)
Pt with hypoxemia but A-a gradient= 12?
High Altitude
Hypoventilation = Barbiturates / Brain injury
URT obstruction = Epiglotitis
Obesity
Pt with Hypoxia?
Dec CO
Hypoxemia
Anemia
CO poisoning
Pt with Hypoxemia and A-a gradient = 33?
V/Q mismatch = ARDS/ PE
Diffusion limited = Fibrosis/ Edema / pneumonia
Right-Left shunt
Pt with Hypoxemia + A-a gradient 33 and 100% O2 does not correct hypoxemia?
Right - Left Shunt
V/Q mismatch @ lung zones:
Apex
Base
Exercise
Apex–> V/Q= 3 (wasted Ventilation= dead space)
Base –> V/Q= 0.6 (wasted perfusion= Shunt)
Exercise –> inc CO = Inc Perfusion @ apex = V/Q= 1
V/Q = 0 V/Q = infinity
V/Q= 0 = SHUNT (Not corrected by 100% O2) V/Q= infinity = Dead space = 100% O2 corrects issue
What 3 forms are CO2 carried in blood?
Bicarbonate= 90% Carbaminohemaglobin = 5% (bound to N terminus of GLobin not Heme) Dissolved = 5%
Signs and symptoms of Pul embolus?
Sudden onset dyspnea
Chest pain
Tachypnea
Triad for Fat embolus?
Hypoxemia
CNS abnormalities
Petechial rash
What defines Chronic bronchitis?
Productive cough > 3 mo/ yr for >2years
**Hypertrophy of mucus secreting cells (Reid index>50%)
What interleukins are involved in Asthma?
IL-4 ==> IgE
IL-5 ==> Eosinophils
LT C/D4
What are the findings seen in Asthma sputum/biopsy?
Smooth Muscle hypertrophy
Curschmann spirals = shed epithelium
Charcot-Leyden crystals= Eos breakdown
What is seen in a pt with hx of Sandblasting?
Silicosis
“Eggshell calcifications” @ UPPER lobe
TB
pt who works for the Aerospace industry has fibrosis and Noncaeseating granulomas?
Berylliosis
Infant with NRDS is treated with O2 can develop?
Retinopathy of prematurity
Bronchopulmonary dysplasia
**BOTH due to ROS
What are RFs for NRDS?
Prematurity
Maternal DM = Insulin inhibits surfactant production
C-section = dec Cortisol release
What hormones are responsible for Surfactant production?
Cortisol
Thyroxine
What is the treatment for ARDS?
Mechanical ventilation
NO
Steroids
Antibiotics
What is seen in ARDS?
Diffuse alveolar damage
Intra-alveolar hyaline membrane
PMN induced damage via ROS
Pt with decreased breath sounds, dullness to percussion, and decreased tactile fremitus?
Pleural effusion
Pt with decreased breath sounds and hyperresonant to percussion?
Pneumothorax
Pt with bronchial breath sounds, dullness to percussion, and Increased tactile fremitus?
Consolidation
Difference btwn Effusion and Consolidation?
Effusion = NO Fremitus/ Dec Consolidation= INC Fremitus
What two types of lung cancers are NOT associated with smoking?
Bronchioloalveolar
Bronchial Carcinoid
Female nonsmoker presents with clubbing of the finger, hemoptysis, and hazy CXR. What mutation is most likely caused her disease?
Adenocarcinoma ==> MC in females / Non smokers
** activating k-ras / EML4-ALK (TK) **
Malignant carcinoma that grows along the alveolar walls?
Bronchioalveolar
What are the characteristics of SCC of lung?
Cavitations Central Smokers Hypercalcemia (PTHrP) Keratin pearls / Intercellular bridges
Characteristics of Small cell lung cancer?
Central ACTH/ ADH / Eaton lambert myc Amplification NO Surgery = Chemo only Neuroendocrine
pt with a “popcorn calcification” on CXR and biopsy shows cartilage and adipose tissue?
Hamartoma
Farmer’s lung and Bird feeders lung have what Pathophysiology?
Type 3 HS == Immune complex
