respiratory Flashcards
respiratory tree histology:
from bronchiloes - terminal bronchiloes - respiratory bronchiloes: histological transition?
SMCs extend to where?
histological transition: pseudostratified ciliated columnar cells extend to the begining of terminal bronchiloes , then become cuboidal cells
SMCs extend to where: end of terminal bronchiloes
surfactant:
made by?
成分？
begin at gestational age? mature at?
which value in amniotic fluid indicates fetal lung maturity
made by: type II pneumocytes
成分: mix of lecithins (卵磷脂), the most important one is dipalmitoylphosphatidylcholine 二棕榈酰磷脂酰胆碱
begin at gestational age: wk 26
mature at wk 35
which value in amniotic fluid indicates fetal lung maturity: lecithin : sphingomyelin > 2
compliance:
define:
↓ in?
↑ in?
define: change in lung volume for a given pressure change (可以理解为肺部往外张的力量）
↓ in： pulmonary fibrosis, pneumonia, edema
↑ in: emphysema
Oxygen-Hb dissociation curve: right shift means? 哪些因素导致右移？
right shift means： ↑ O2 load (需要氧气的时候）
哪些因素导致右移: BAT ACE
BPG Altitude Temperature ↑ Acid CO2 Exercise
methemoglobin:
affinity to O2?
Cx
Rx
高铁血红蛋白
oxidized form of Hb (Ferric = Fe3+; Ferrous = Fe2+ [just the 2 of us])
methemoglobin has ↓ affinity to O2, but ↑ affinity to cyanide 氰化物
Cx: cyanosis, chocolate-colored blood
Rx: Methylene blue
CO2 transportation to the lung?
哪几种途径？
- HCO3- (95%)
- bind to the N-terminus of glob in (Not heme !!!)
- dissolved CO2
Rhinosinusitis:
MCC
MC location
MCC:
- S. pneumoniae
- H. influenzae
- M. catarrhalis 粘膜炎莫拉菌 [Moraxella catarrhalis is a fastidious, nonmotile, Gram-negative, aerobic, oxidase- positive diplococcus]
MC location: maxillary sinuses
DVT:
“Virchow triad”
Sign “Homan sign”
Rx?
“Virchow triad”: stasis, hypercoagulability, endothelial damage (e.g.. smoking)
Sign “Homan sign” -calf pain
Rx:
1. prevention and acute management: heparin
- long-term prevention for recurrence: warfarin
Pulmonary embolism:
types?
How to diff PE formed before vs. after death?
types: FAT BAT
How to diff PE formed before vs. after death: Zahn area (间隔的pink and red zone) formed only before death
COPD:
定义
包括哪些疾病？
patho:
肺功能变化：RV, TV, FVC, FEV1?
定义：obstruction of air flow, - air trapping in the lung - airways close at high volume
包括哪些疾病:
- chronic bronchitis
- emphysema
- asthma
- bronchiectasis 支气管扩张
patho:
肺功能变化：RV ↑, TV ↓, FVC （forced vital capacity, 能呼吸的最大体积）↓, FEV1 （第一分钟能呼出的体积） ↓↓↓
hallmark: FEV1/FVC ↓
Chronic bronchitis:
patho:
病理变化用什么指标测量？
Cx
patho:
The major contributor of the wall thickening in bronchitis is the mucous gland enlargement (hyperplasia)
病理变化用什么指标测量: Reid index (thickness of gland layer/total thickness of bronchial wall) > 50% [normal < 40%]
Cx: productive cough > 3 m per year, for 2 yrs
Emphysema:
外观
分型，各自的association
变化： recoil, compliance, elastase activity
肺功能变化：Total lung V, FVC, FEV1, diffusion capacity
外观: “pink puffer”, barrel-shaped chest
变化：elastase activity ↑ - recoil ↓ , compliance ↑,
分型，各自的association:
- centriacinar: smokinh
- panacinar - a-antitrypsin deficiency (most important player: neutrophils)
肺功能变化：Total lung V ↑, FVC ↓, FEV1 ↓↓↓, diffusion capacity ↓
Asthma:
Patho2个特点？
Challenge test for Dx
which type of hypersensitivity?
Rx:
Patho2个特点：Curschmann spirals, Charcot-Leyden crystals
Challenge test for Dx: (in pts suspect for asthma - family history for 过敏性鼻炎，异位性皮炎， but spriometry can’t catch it): methacholine challenge test, or histamine, cold air, exercise
which type of hypersensitivity: type I (IgE-mediated)
Rx:
- alpha1 agonist (bronchidilator - albuterol)
- glucoticoids: flunisolide 氟尼缩松，9-去氟肤轻松
- 1st line for prevention and control of acute attack;
if aerosol: ask pt to rinse oral cavity and use spacer (prevent Candiditis)
3. theophylline [ˌθiə`filin] 茶碱 (PDE, ↑ cAMP)
- drugs to inhibit mast cell degrunulation: Cromolyn, nedocromil
bronchiectasis
Patho
Associated diseases
支气管扩张
Patho: chronic necrotizing infection - permanent dilated airways
Associated diseases: Kartagener syn, CF, aspergillosis infection
Restrictive lung disease:
define:
change in 肺功能：lung volumes (TLV, FVC), FEV1/FVC ratio
分类标准
define: restricted lung expansion (限制性肺病，无法在吸气时膨胀）
change in 肺功能：
↓ lung volumes (TLV, FVC),
FEV1/FVC ratio > 80% (注意：obstructive 肺病中 FEV1/FVC ratio ↓; normal = 80%）
分类标准：
- 肺外因素引起，normal A-a gradient
- 肺自身因素引起，↑ A-a gradient
hypersensitivity pneumonitis:
which type of hypersensitivity?
Cx?
人群？
which type of hypersensitivity： mixed III/IV
Cx: dyspnea, cough, chest tightness, headache
人群: farmers and those who exposed to birds
pneumoconioses, or pneumoconiosis [ˌnju:məuˌkɔni`əusis]：
包括？
↑ for ?
尘肺,
包括
1） silicosis [ˌsilikəusis] 矽肺， 石末沉着病
2）asbestosis [ˌæsbestəusis] 石棉沉着病
3) coal worker’s pneumoconiosis
↑ for cor pulmonale (肺心病) and Caplan syn
asbestosis [ˌæsbes`təusis]
associated 职业？
累及肺叶？
特征性病灶 （pathognomonic）？
associated with ↑ incidence for?
石棉沉着病
associated 职业: building (insulation里含大量石棉）， roofing, plumbing
累及肺叶: lower lobes
特征性病灶 （pathognomonic）: “Ivory white” calcified pleural plaques - but not pre-cancerous
associated with ↑ incidence for: bronchogenic carcinoma, mesothelioma 间皮瘤
coal worker’s pneumoconiosis
Patho?
which immune cells play the major role?
累及肺叶？
“black lung disease”
anthracosis[ænθrə`kəusis]
炭末沉着病，炭肺：煤尘沉着于肺所致的一种常见无症状的肺尘埃沉着病，存在于多数城市居民中；大量煤尘积聚可致煤矿工人肺尘埃沉着病
which immune cells play the major role: macrophage
累及肺叶: upper
silicosis：
associated 职业？ 累及肺叶？ 特征性病灶 ？ which immune cells play the major role? associated with ↑ incidence for?
矽肺
associated 职业： foundries (金属铸造厂）， mines, sandblasting
累及肺叶: upper [diff with asbestosis]
特征性病灶 : “eggshell” calcification of hilar lymph nodes
which immune cells play the major role: macrophage
associated with ↑ incidence for: TB, bronchogenic carcinoma
NRDS (neonatal respiratory distress syn):
Patho
how to predict
心脏risk?
supplemental O2 may cause?
risk factors?
Rx
Patho: surfactant deficiency - alveolar collapse
how to predict: lecithin : sphingomyelin ratio < 1.5 in 羊水
心脏risk：PDA
supplemental O2 may cause: retinopathy, bronchopulmonary dysplasia
risk factors: prematurity, maternal DM, C-dection
Rx: maternal steroids before birth, artificial surfactant for infants
ARDS (acute respiratory distress syn):
Cause
Patho 特征
major players
XR表现
Cause： trauma, sepsis, shock, acute pancreatitis, amniotic fluid embolism
Patho 特征: protein-rich leakage into alveoli, thickened hyaline membranes
major players: neutrophils
XR表现: near-complete opacification, obscured cardiomediastinal sihouette
PH (pulmonary hypertension):
normal pulmonary a pressure? 肺动脉高压诊断指标？
Primary (PPH): 好发人群？gene mutation? Dx? Rx?
Secondary
Course?
normal pulmonary a pressure： 10-14 mmHG
肺动脉高压诊断指标: > 25 mmHg
Primary (PPH):
- 好发人群: 20 - 40 yr women
- gene mutation: inactivation mutation of BMPR2 (which inhibit VSMC proliferation)
- Dx: 心脏echo见coronary sinus (where LA receives blood from pulmonary, 正常看不见）
- Rx: Bosentan (ET inhibitor) 波生坦; lung transplantation
Secondary
Course
Sleep apnea
define
最严重的后果
Rx
睡眠呼吸暂停
最严重的后果: pulmonary HTN - RHF, then systemic HTN; arrhythimias , sudden death
