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Respiratory Flashcards

1
Q

What intracellular signal is affected by beta adrenergic agonists?

A

Smooth muscle relaxes (from B2 stim) from increased cAMP

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2
Q

Cause of hypoxemia with a normal A-a difference?

A

alveolar hypoventilation
OR
high altitude (less O2 in the air)

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3
Q

trachea deviates toward normal lung

A

Pulmonary effusion

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4
Q

Trachea deviates away from normal lung

A

atelectasis (collapsed lung)

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5
Q

kerley B lines tell you

A

edema of interlobular septa

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6
Q

flattened diaphragm on Xray

A

COPD

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7
Q

ARDS causes

A

pneumonia
trauma
aspiration
sepsis

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8
Q

Acute rejection of lung affects

A

pulmonary and bronchial circulation

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9
Q

Chronic rejection of lungs affects

A

Small airways

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10
Q

In healthy individuals, respiration is perfusion rather than diffusion limited (exercise, pulmonary embolism, etc).

Which is more affected in diffusion limitation, CO2 or O2 levels?

A

O2 levels. CO2 levels have a much higher diffusion capacity across the respiratory membrane. If you see VERY low pCO2 at the alveoli, this indicates a perfusion not a diffusion limitation

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11
Q

How do you measure fetal lung maturity?

A

Lecithin/Sphingomyelin ratio. They are equal until 3rd trimester, when Type II pneumocytes start secreting surfactant

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12
Q

Eggshell calcifications of hilar nodes and birefringent silica particles surrounded by fibrous tissue

A

silicosis

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13
Q

fusiform rods seen with iron protein (prussian blue stain)

A

pulmonary asbestos. Will see an interstitial pattern on Xray

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14
Q

Chloride shift in RBCs caused by

A

Carbonic anhydrase

  • -CO2 carried in bicarb form predominantly
  • -when bicarb leaves the RBC to dissolve in plasma, chloride enters the cell to maintain charge neutrality
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15
Q

how does hemoglobin carry CO2

A

15% as carbamate Hb-NH-CO2

85% as HCO3 (carbonic anhydrase

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16
Q

Which cancer causes SVC syndrome

A

small cell lung cancer. Causes headache, facial/upper extremity edema, and dilated veins

  • -hoarseness: recurrent laryngeal
  • -dysphagea: esoph. compression
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17
Q

Sx of phrenic nerve irritation

A
  1. hiccups, SOB, elevation of hemidiaphragm on X ray
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18
Q

Small airways

A

bronchioles and terminal bronchioles

–Large bronchi are part of the large airways

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19
Q

What cells do you find in bronchi

A

cartilage
goblet cells
glands

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20
Q

What do you find in the terminal bronchioles

A

pseudostratified ciliated columnar cells

–smooth muscles of airway walls(disappear after terminal bronchioles

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21
Q

type of cell in respiratory bronchioles

A

cuboidal cells without cilia

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22
Q

What secretes elastase

A

neutrophils and macrophages

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23
Q

Where is there mixing of blood normally?

A

bronchial veins mix in

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24
Q

Collapsing pressure=

A

2*T/R. This is the PRESSURE YOU NEED INSIDE THE BALLOON TO KEEP IT OPEN

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25
Q

what indicates fetal lung maturity?

A

lecithin: sphingomyelin ratio of 2

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26
Q

when are mature levels of pulmonary surfactant achieved?

A

Week 35. synthesis starts at week 26

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27
Q

When do alveoli tend to collapse

A

when radius is small (with expiration)

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28
Q

Which is the MOST important component of surfactant

A

dipalmitoylphosphatidylcholine

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29
Q

type II cells

A

cuboidal clustered cells that secrete pulmonary surfactant

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30
Q

clara cells

A

columnar cells that secrete component of surfactant and degrade toxins

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31
Q

Relation of pulmonary artery to bronchus

A

RALS

  • Right PA anterior to bronchus
  • Light PA superior to bronchus
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32
Q

Which lung are you more likely to inhale a foreign body into?

A

Right lung

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33
Q

What enters the diaphragm at T12?

A

Aorta
thoracic duct
azygous vein

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34
Q

Where should you do a thoracentesis?

A

MCL: 5-7th rib
Mid axillay: 7-9th rib
paravertebral: 9th-11th rib

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35
Q

Muscles of inspiration during exercise

A

scalene
sternocleidomastoids
external intercostals

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36
Q

IRV

A

amount of air that can still be breathed in after normal inspiration

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37
Q

FRC+IC

A

TLC

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38
Q

Inspiratory capacity

A

IRV+TV

how much more can you breathe in after a normal breath

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39
Q

FRC

A

ERV+RV
TLC-IC
how much more can you breathe out after a normal breath

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40
Q

TLC

A

IRV+TV+ERV+RV

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41
Q

Dead space calcuation

A

Vt x (Paco2-Peco2)/Paco2

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42
Q

Which part of the lungs is the biggest contributor to functional dead space?

A

apex of lungs

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43
Q

Taut vs relaxed forms of hemoglobin (2alpha + 2beta)

A

Taut: low affinity for O2
Relaxed: high affinity for O2

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44
Q

What factors cause taut form to dominate?

A

increased chloride, 2,3 BPG, H+, and CO2

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45
Q

how do you treat methemoglobinemia?

A

methylene blue

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46
Q

How do nitrites cause poisoning?

A

Convert Fe2+ to Fe3+

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47
Q

fetal hemoglobin has a lower affinity for

A

2,3-BPG

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48
Q

How do you treat cyanide poisoning?

A

Nitrites–make methemoglobin which can bind cyanide.

Also give thiosulfate to bind cyanideq

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49
Q

how does CO shift the oxygen hemoblogin curve?

A

LEFT shift. Decreased maximum bound and loss of sigmoidal shape
Increased affinity for O2, less unloading

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50
Q

When hemoglobin curve shifts to the right

A

decreased affinity for O2 (more unloading, at tissue level)

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51
Q

Causes of right shift

A 
C-BEAT
CO2
BPG
Exercise
Acid/altitude
Temperature
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52
Q

Pulmonary vascular resistance is lowest at

A

FRC

–increased lung volume: compresses alveolar vessels, but less resistance in extra-alveolar vessels

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53
Q

are you perfusion or diffusion limited during exercise?

A

perfusion limited. Still able to reach normal PA at the end of the capillary

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54
Q

When might you be diffusion limited?

A

Emphysema (decreased surface area)

Fibrosis (increased thickness)

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55
Q

Normal pulmonary artery pressure

A

10-14 mmHg

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56
Q

Cause of primary pulmonary HTN

A

BMPR2

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57
Q

Cause of secondary pulmonary HTN

A 
COPD
Mitral stenosis
Recurrent emboli
autoimmune dz like systemic sclerosis
sleep apnea
high altitude
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58
Q

How do you calculated pulmonary vascular resistance?

A

PVR= (Ppa-Pla)/CO

Resistance=deltaP/Q

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59
Q

Diffusion calculation

A

Vgas=A/T x Dk(P1-P2)

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60
Q

PAO2=

A

150-PaCo2/0.8

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61
Q

When do you see an increased Aa gradient

A

Shunting
V/Q mismatch
Fibrosis

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62
Q

cause of hypoxemia with a normal Aa gradient

A

high altitude

hypoventilation

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63
Q

V/Q ratio at apex of lung

A

3 (wasted ventilation)

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64
Q

V/Q ratio at the base of lung

A

0.6 (wasted perfusion)

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65
Q

are ventilation/perfusion greater at the lung base or apex?

A

both are greater at the base than the apex

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66
Q

VQ ratio during exercise

A

1–>apical arteries expand

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67
Q

V/Q=0

A

SHUNT. Lots of blood flow, no ventilation. Airway obstruction!

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68
Q

V/Q=infinity

A

DEAD SPACE. Lots of airflow, no blood. pulmonary embolism

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69
Q

Who would benefit from high flow 100% O2?

A

Person with Deadspace. We assume there are some areas of the lung that are still getting blood.

Shunt does NOT improve with 100% oxygen because the air is not even reaching the blood!

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70
Q

Most of CO2 is transported in what form?

A

bicarbonate in the plasma

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71
Q

Haldane effect

A

oxygenation of Hb promotes dissociation of H+ from Hb within the RBC

–H+ binds HCO3 and forms free CO2 with carbonic anhydrase

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72
Q

How else is CO2 transported?

A
  • carbaminohemoglobin (CO2 bound to the N terminus of hemoglobin)
  • dissolve CO2
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73
Q

Bohr effect

A

H+ in peripheral tissues causes shift to the right=unloading O2

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74
Q

Changes at high altitude

A 
Increased 2,3-BPG
Increased mitochondria
Decreased PO2 and PCO2
Increased renal excretion of bicarbonate (increase this with acetazolamide)
-->Watch out for cor pulmonale
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75
Q

Changes in the lungs with exercise

A

V/Q ratio –>1
decreased pH
No change in PaO2 and PaCO2!!
Increase in venous CO2 content and decrease in venous O2 content

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76
Q

dorsiflexion of foot causes calf pain

A

Homan’s sign, think DVT

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77
Q

Treatment for acute DVT

A

heparin

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78
Q

Treatment for long-term prevention of DVT

A

warfarin

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79
Q

hypoxemia
neuro changes
petechial rash

A

Think pulmonary emboli!

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80
Q

What is bronchiolitis obliterans pneumonia?

A

Formation of granulation tissue with pneumonia. Causes obstruction of airways

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81
Q

How od you treat bronchiolitis obliterans pneumonia?

A

Corticosteroids

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82
Q

How do you tell whether a patient died because of a pulmonary embolism or if the thromboembolism formed after death?

A

Lines of Zahn

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83
Q

Reid index

A

Tells you thickness of glandular layer compared to bronchial wall

–Over 50% in patients with bronchitis

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84
Q

Cause of chronic bronchitis

A

Hypertrophy of mucus secreting glands

85
Q

Cause of emphysema

A

enlargement of airspaces and decreased recoil with destroyed alveolar walls

86
Q

breathing through pursed lips

A

emphysema. Increased airway presure and prevent airway collapse resulting from increased compliance

87
Q

centriacinar emphysema, upper lobes

88
Q

panacinar emphysema, lower lobes

A

a1-antitrypsin

89
Q

Cause of asthma

A

bronchial hyperresponsiveness

90
Q

Histology of asthma

A

smooth muscle hypertrophy
Curschmann’s spirals (mucus plugs)
Charcot-leyden crystals (breakdown of eosinophils)

91
Q

pulsus paradoxus seen in

A

asthma

obstructive sleep apnea

92
Q

bronchiectasis

A

necrotizing infection of bronchi causing dilated airways, purulent sputum, infections, and hemoptysis

93
Q

bronchiectasis associated with

A

smoking (ciliary motility)
kartagener’s
cystic fibrosis
bronchopulmonary aspergillosis

94
Q

Cause of restrictive lung disease with an abnormal A-a gradient

A

Interstitial lung diseases

  • ARDS
  • pneumoconioses
  • sarcoidosis
  • idiopathic pulmonary fibrosis
  • goodpasteur’s
  • wegener’s
  • hypersensitivity pneumonitis
95
Q

which drugs can cause interstitial lung disease?

A

bleomycin
busulfan
amiodarone
methotrexate

96
Q

coal miner’s lung

A

anthracosis

97
Q

sandblasting, mines, foundries

98
Q

pathogenesis of silicosis

A

macrophages release fibrinogenic factors in response to silica

99
Q

pts with silicosis are susceptible to

A

TB and bronchogenic carcinoma

100
Q

eggshell calcifications of hilar lymph nodes

101
Q

shipbuilding, roofing, plumbing

A

asbestosis

102
Q

affects upper lobes

A

anthracosis silicosis

103
Q

affects lower lobes

A

asbestosis

104
Q

golden brown fusiform dumbbells

A

asbestosis

105
Q

Ivory white calcified pleural plaques

A

asbestos exposure! But they do not indicate precancerous lesion

106
Q

Asbestos associated with

A

mesothelioma and bronchogenic carcinoma

107
Q

neonatal respiratory distress syndrome caused by:

A

surfactant deficiency.

Lecithin: sphingomyelin ratio will be less than 1.5

108
Q

What is your other concern with neonatal respiratory distress syndrome?

A

Low O2 tension could lead to a PDA

109
Q

You decide to administer supplemental O2 to a neonate with respiratory distress. What are some complications?

A

retinopathy of prematurity

bronchopulmonary dysplasia

110
Q

Treatment for neonatal respiratory distress syndrome

A

maternal steroids before birth

artificial surfactant for baby

111
Q

Risk factors for neonatal respiratory distress syndrome

A

prematurity
materal diabetes
cesarean delivery (less CRH)

112
Q

Causes of ARDS

A 
sepsis, shock, trauma, 
--gastric aspiration
uremia
pancreatitis
amniotic fluid embolism
113
Q

Pathophysiology of ARDS

A

diffuse alveolar damage

  • capillary permeability
  • protein rich leakage into alveoli
  • intra-alveolar hyaline membrane
114
Q

what causes the initial damage precipitating ARDS?

A

neutrophil toxins
coagulation cascade
oxygen derived free radicals

115
Q

What hormone might be elevated in sleep apnea?

116
Q

decreased breath sounds, dullness to percussion and decreased fremitus

A

pleural effusion

117
Q

decreased breath sounds, dullness to percussion, decreased fremitus and tracheal deviation towards lesion

A

atelectasis

118
Q

decreased breath sounds, hyperresonance, and decreased fremitus with tracheal deviation toward lesion

A

spontaneous pneumothorax

119
Q

decreased breath sounds, hyperresonance, and decreased fremitus and deviation away from lesion

A

tension pneumothorax

120
Q

bronchial breath sounds with crackles, dullness to percussion, and increased fremitus

A

consolidation (lobar pneumonia or pulmonary edema)

121
Q

alpha1 antitryptase is synthesize in

122
Q

Which TB drug does not affect hepatic fxn

A

ethambutol

123
Q

histology: chronic lung rejection

A

lymphocytic infiltrate
bronchiolitis obliterans
necrosis
FIBROSIS

124
Q

histology: acute lung rejection

A

perivascular mononuclear infiltrate

125
Q

Common complications of lung cancer

A

SPHERE

  • superior vena cava
  • pancoast
  • horner’s
  • endocrine
  • recurrent laryngeal compression
  • effusions (pleural/pericardial)
126
Q

cough, hemoptysis, bronchial obstruction, coin lesion on x ray or nodule

A

lung cancer

127
Q

most common cause of lung cancer

A

metastates

128
Q

Where do lung cancer metastasize from?

A

breast
colon
prostate
bladder

129
Q

Where to lung cancers metastasize to?

A

adrenals
brain
bone
liver

130
Q

Which lung cancers are NOT associated with smoking?

A

bronchioloalveolar

bronchial carcinoid

131
Q

kras

A

adenocarcinoma

132
Q

myc

A

small cell carcinoma

133
Q

Most common cause of lung cancer in nonsmokers and women

A

adenocarcinoma

134
Q

which cancer is associated with clubbing?

A

adenocarcinoma

135
Q

What subtype of adenocarcinoma shows hazy infiltrates and shows thickening of alveolar walls?

A

bronchioloalveolar subtype

136
Q

prognosis of bronchioloalveolar subtype adenocarcinoma

137
Q

Which cancers are found centrally?

A

squamous and small cell

138
Q

Which cancers are found peripherally?

A

adenocarcinoma and large cell carcinoma

139
Q

hilar mass with keratin pearls located centrally

A

squamous cell

140
Q

features of squamous cell carcinoma

A

cavitation
cigarettes
hypercalcemia

141
Q

Histology of small cell carcinoma

A

undifferentiated with small dark blue cells

142
Q

paraneoplastic syndrome of small cell carcinoma

A

ACTH
ADH
lambert eaton

143
Q

the small cell carcinoma cells are derived from

A

neuroendocrine cells of kulchisky

144
Q

which kind of cancer can you NOT operate on?

A

small cell carcinoma

145
Q

histology of large cell carcinoma

A

pleomorphic giant cells that are highly anaplastic

146
Q

how do you treat large cell carcinoma?

A

remove surgically! chemotherapy is less effective

147
Q

lung tumor that shows nests of neuroendocrine cells that are chromogranin positive

A

bronchial carcinoid tumor

148
Q

Sx of bronchial carcinoid tumor

A

mass effect, sometimes carcinoid syndrome with serotonin secretion=flushing, diarrhea, wheezing

149
Q

Pancoast tumor

A

carcinoma in the apex of the lung that can affect cervical sympathetics and cause horner’s syndrome

150
Q

psamomma bodies in lung cancer located in the pleura with pleural effusions and pleural thickening

A

mesothelioma

151
Q

Which cancers show psamomma bodies?

A

papillary thyroid cancer
serous cystadenoma of the ovary
meningioma
mesothelioma

152
Q

Causes of bronchopneumonia

A

Strep pneumo
S aureus
H flu
Klebsiella

153
Q

Causes of Lobar pneumonia

A

S pneumo

Klebsiella

154
Q

What is hypersensitivity pneumonitis

A

mixed type III/IV hypersensitivity rxn to environmental antigens

155
Q

who is predisposed to hypersensitivity pneumonitis?

A

farmers and birds

156
Q

bronchopneumonia characteristics

A

inflammation from bronchioles to adjacent alveoli

–patchy distribution involving more than 1 lobe

157
Q

Cause of a spontaneous pneumothorax

A

apical blebs

–tall, thin, males

158
Q

Cause of tension pneumothorax

A

trauma or lung infection

159
Q

Name the first generation H1 blockers

A

diphenhydramine
dimenhydrinate
chlorpheniramine

160
Q

Name the second generation H2 blockers

A 
loratadine
fexofenadine
desloratadine
cetirizine 
-ADINE
161
Q

What are the additional benefits of H2 blockers?

A

Far less sedating than first generation blockers because less entry into the CNS–> good for old people!

162
Q

What else can you use H1 blockers for?

A

sleep aid

motion sickness

163
Q

formoterol

A

long acting B2 agonist

164
Q

side effect of salmeterol, formoterol

A

tremor and arrhythmia

165
Q

theophylline=category?

A

methylxanthine

166
Q

theophylline mechanism

A

inhibits phosphodiesterase

-decreases cAMP

167
Q

tox: theophylline

A

cardiotoxicity, neurotoxicity

168
Q

theophylline blocks action of

169
Q

which drug is metabolized by p450?

A

theophylline

170
Q

Mech: iptratropium

A

competitively blocks muscarainic receptors, preventing bronchoconstriction

171
Q

iptratropium uses

A

asthma, COPD

172
Q

category: beclomethasone

A

corticosteroid

173
Q

category: fluticasone

A

corticosteroid

174
Q

corticosteroid mechanism

A

inhibits synthesis of all cytokines.

  • -Inactivates NF-kB
  • -inhibits TNF-a production
175
Q

What is the first line therapy for chronic asthma?

A

corticosteroids beclomethasone and fluticasone

176
Q

omazlizumab

A

monoclonal IgE antibody

177
Q

inications for omalizumab

A

allergic asthma resistant to inhaled steroids and b2 agonists

178
Q

good for aspirin induced asthma

A

montelukast zafirlukast

179
Q

mechanism of montelukast zafirlukast

A

Block leukotriene receptors

180
Q

mechanism zileuton

A

5-lipoxygenase pathway inhibitor

181
Q

B2 agonist mechanism

A

increases cAMP causing bronchodilation

182
Q

effect of Ach and adenosine on bronchi

A

Both cause bronchoconstriction

183
Q

Expectorants

A

guaifenesin

N-acetylcysteine

184
Q

Guaifenesin mechanism

A

thins secretions

185
Q

N-acetylcystein mechanism

A

loosens mucous plugs in CF

186
Q

Bosentan

A

Used for pulmonary arterial hypertension:

Antagonizes endothelin 1 receptors to decrease PVR

187
Q

Mechanism dextromethorphan

A

Decreases cough reflex by antagonizing NMDA glutatmate receptor. Has mild opioid effect when used in excess (give naloxone)

188
Q

mechanism methacholine

A

Muscarinic agonist

189
Q

side effects of pseudoephedrine/phenylephrine

A

Hypertension

-CNS stimulation/anxiety

190
Q

Nasal polyps caused by

A

repeated bouts of rhinitis

Aspirin intolerant asthma

191
Q

Child with nasal polyps

192
Q

Angiofibromas occur in

A

in adolexcent males. continued nose bleeds

193
Q

naspharyngeal carcinoma associated with

A

EBV–Naspharyngeal carcinoma and AA.

194
Q

pleomorphic keratin-positive epithelial cells in a background of lymphocytes

A

`nasopharyngeal carcinoma

195
Q

fever, drooling, muffled voice, and inspiratory stridor in a kid

A

epiglottitis caused by Hflu

196
Q

cause of bilateral vocal cord nodule

A

excessive use (singers)

  • -presents with hoarseness, resolves with rest.
  • -composed of myxoid CT
197
Q

laryngeal papilloma caused by

A

HPV 6 and 11

198
Q

laryngeal carcinoma

A

alcohol and tobacco. presents with hoarseness, cough, stridor

199
Q

thick mucoid capsule bug

A

klebsiella. usually aspiration pneumonia

200
Q

Four phases of lobar pneumonia

A

congestion
red hepatization
grey hepatization (RBCs broken down)
resolution

201
Q

causes of bronchopneumonia

A 
Staph aureus
-Haemophilus
pseudomonas
moraxella
legionella
202
Q

most common cause of secondary pneumonia

A

staph aureus

203
Q

pneumonia in COPD

A

Haemophilus or moraxella

204
Q

complication of mycoplasma pneumonia

A

autoimmune hemolytic anemia

205
Q

pneumonia in farmers and veterinarians with high fever

A

Q fever

  • -cattle spores
  • -no vector
  • -no skin rash
206
Q

where can TB spread to?

A
  1. meninges
  2. cervical lymph
  3. kidney=sterile pyuria
  4. lumbar vertebrae=potts
207
Q

ABG of someone with pulmonary embolism

A 
hypoxemia
respiratory alkalosis (blowing off all your CO2)
208
Q

Clubbing is associated with

A

Prolonged hypoxia:

  • lung cancer
  • CF
  • TB
  • empyema, bronchiectasis, lung abscess
  • OR cyanotic congential heart disease

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