Respiratory Flashcards
These two structures extend to end of bronchi?
Cartilage and goblet cells
Type of cells in terminal bronchiole?
pseudostratified ciliated columnar cells
Smooth muscle of the airway wall stops at?
Terminal bronchiole
Smooth muscles helps sweep mucous out of lungs
Respiratory zone of lung contains what type of cells?
cuboidal cells in respiratory bronchioles and then squamous cells up to alveoli– NO CILIA
These cells secrete surfactant?
Lamellar bodies of type 2 pneumocytes
2 ways to increase surfactant of fetus? dec?
Corticosteroids or thyroxine inc surfactant. Insulin decreases surfactant
What are clara cells?
nonciliated columnar cells with secretory granules
Relation of pulmonary artery to bronchus at each lung?
RALS– right anterior; Left superior
Structure that perforates diaphragm at T8, T10, and T10?
I ate ten eggs at twelve (IVC8; Esophagus10; Aorta12– also thoracic duct and azygos vein)
Inspiratory muscles during exercise?
External intercostals, Scalene, Sternocleidomastoid
Expiratory muscles?
Rectur abdonimin, internal and external obliques; transversus abdominis, internal intercostals
Physiologic dead space equations? (ventilation but no perfusion)
Vd= Vt X ((PaCO2- PECO2)/PaCO2) Taco, Paco, Peco Paco
Cyanide poisoning treatment? and MOA?
Nitrites to oxidize Hb to methemoglobin
Treatment of methemoglobin?
Methylene blue– treat met with methylene blue
What should be used to get rid of cyanide methemoglobin complex?
thisulfate– forms thiocyanate and is renally excreted
Cherry red blood?
Carbon monoxide poisoning
How does carbon monoxide effect the dissociation curve?
Shifts curve to left, but limits oxygen carrying capacity
Diffusion limited disorders?
CO, emphysema, fibrosis
Histology findings in pulmonary hypertension?
Plexiform lesions; intimal fibrosis and medial hypertrophy
Don’t forget about hypoxic vasoconstriction and its causes
Don’t forget about hypoxic vasoconstriction and its causes
Calculate A-a gradient
PAo2= PIo2- (paCO2/R)—
150-(PaCo2/R)
Oxygenation of Hb promotes dissociation of?
H+ from Hb; shifting equilibrium towards CO2 formation and CO2 release from RBCs
Patient presents with hypoxemia, delirium, and petechial rash. He broke his femus 2 days ago—?
Fat emboli– associated with bone fractures and liposuction
Remember petechial RASH
Amniotic fluid emboli can lead to?
DIC– perhaps due to anaphylactic reaction to fetal antigens
Patient presents with actue onset of dyspnea, cyanosis, respiratory acidosishypotension and bleeding after giving birth–?
Amniotic fluid embolus– bleeding is due to DIC
Histology of asthma?
Basement membrane thickening; smooth muscle hypertrophy; airway inflammation; mucous plugging; charcot leyden crystals (breakdown of eosinophils); curschmanns spirals (shed epithelium forms mucus plugs)
what are charcot leyden crystals?
Breakdown of eosinophils in asthma
Commonly associated with bronchiectasis?
Smoking, CF, Kartageners, allergic bronchipulmonary aspergillosis (45 degree angle)
2 causes of pulmonary edema caused by increased hydrostatic pressure?
Left sided heart failure; and mitral stenosis
2 causes of pulmonary edema caused by decrease oncotic pressure?
Nephrotic syndrome and Cirrhosis
Restrictive lung diseases with normal A-a gradients?
Polio, myasthenia= Muscular dysfunction
Scoliosis, morbid obesity= Structural
Honeycombing of lung?
Interstitial fibrosis
Drugs that cause interstitial lung disease?
Busulfan; methotrexate; amiodarone; bleo
Black lung?
Anthracosis
Pathophys of silicosis?
Macrophages respond to silica by release fibrogenic factors leading to fibrosis. Silica may disrupt phagolysososmes and impair macrophage–>increase susceptibility to TB
Increases susceptibility to TB?
silicosis
Egg shell calcification?
Silicosis
Ivory white calcified pleural plaque?
asbestos– affects lower lobes
Most common pulmonary lesions in asbestosis?
pleural plaque
Lobes of lung for silicosis and asbestosis?
Silicosis upper; Asbestosis lower
Pathophys of ARDS?
Acute damage–>macrophages release cytokines–>attract neutrophils–>neutrophils damage type I and type II pneumocytes–>decrease in surfactant–>atelectasis
White out on chest Xray?
ARDS
Blood gases in sleep apnea?
Respiratory acidosis
Causes of central sleep apnea?
Narcotics; renal failure; high altitude; heart failure (remember hypoxic vasoconstriction)
Decreased breath sounds; dullnees to percussion; decreased fremitus; tracheal deviation towards side of lesion?
Atelectasis (if not tracheal deviation than pleural effusion)
Golden brown fusiform rods dumbbell shaped?
Asbestos bodies
Therapeutic supplemental O2 can result in xxxxx and xxxx in neonatal respiratory distress syndrome?
Retinopathy and bronchopulmonary dysplasia
defect in BMPR2 leads to? Pathogenesis?
Primary pulmonary hypertension
BMPR2 normall functions to inhibit vascular smooth muscle proliferation
Most common lung cancer in nonsmokers and overall?
Adenocarcinoma
Cancer associated with clubbing
Adenocarcinoma (hypertropic osteoarthropathy)
Cancer that grows along alveolar septa?
Bronchioalveolar subtype of adenocarcinoma– great prognosis
Keratin pearls with intercellular bridges lung cancer?
Squamous
Cavitation lesions cancer?
Squamous cell
Lung cancer that causes hypercalcemia?
squamous cell
Tumor may produce ADH or ACTH?
Small cell
Difficulty climbing stairs and rising from seated position– cancer?
Small cell
Dark blue cells lung cancer?
Small cell
Psammoma bodies lung cancer?
Mesothelioma– malignancy of pleura results in hemorrhagic pleural effusions and pleural thickening
Cold agglutinins; dry cough, arthralgias?
Atypical pneumonia
