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STEP 1 Review > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Conducting Zone components and function.

Histology

A

Nose, pharynx, larynx, trachea, bronchi. Bronchioles and terminal bronchioles. Warms airways, doesn’t participate in gas xchange. Pseudostratified ciliated columnar cells, then transition to cubiodal cells. Airway smooth muscles extend to terminal bronchioles but are sparse after

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2
Q

Least airway resistance?

A

Terminal bronchioles (large numbers)

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3
Q

Respiratory zone

A

Respiratory bronchioles, alveolar ducts, alveoli. Participates in gas exchange.

Mostly cuboidal cells in respiratory bronchioles, the simple squamous cells. No cilia. macrophages clear the debris.

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4
Q

What components of type II pneumocytes make surfactant?

A

Lamellar bodies.

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5
Q

Club cells?

A

Synthesize a component of surfactant. Have cyp enzymes to degrade toxins. Nonciliated.

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6
Q

Collapsing pressure of an alveolus?

A

2xsurface tension/radius.

So as radius decreases, increased proclivity to collapse.

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7
Q

Surfactant synthesis

A

Begins at week 26, done by week 35. Check for L:S ratio in amniotic fluid. >2 is mature.

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8
Q

Aspirate food supine vs sitting up?

A

Supine will end up in upper portion of right lower lobe or lower portion of right upper lobe.

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9
Q

Structures at T12

A

Aorta, thoracic duct, azygos vein.

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10
Q

Conditions that cause decreased lung compliance?

A

Pulmonary fibrosis, pulmonary edema, pneumonia

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11
Q

Taut vs relaxed hemoglobin

A

Taut has low affinity for O2, relaxed has high affinity.

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12
Q

How does fetal hemoglobin hold onto O2 so well?

A

Decreased affinity for 2,3 BPG

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13
Q

Methemoglobin

A

Fe3 in heme. Has decreased affinity for O2 but increased affinity for cyanide. Presents with cyanosis and chocolate colored blood. Caused by nitrites, sulfa drugs, dapsone, benzocaine.

Treat with methylene blue

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14
Q

How to treat cyanide poisoning

A

Nitrates followed by thiosulfate.

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15
Q

Carboxyhemoglobin

A

Increases affinity for O2 so decreased unloading in tissues. Causes cherry red appearance.

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16
Q

Myoglobin

A

Monomeric so no increased cooperativity

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17
Q

Increased A-a gradient

A

Pulmonary fibrosis, V/Q mismatch, shunting

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18
Q

Hypoxemia with normal A-a gradient

A

High altitude and hypoventilation

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19
Q

V/Q=0?

A

Shunt, no ventilation = airway obstruction

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20
Q

V/Q=infinity?

A

No perfusion, airflow obstruction

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21
Q

How does CO2 travel in the blood?

A

90% as HCO3
5% bound to globin
5% dissolved.

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22
Q

Haldane effect?

A

In lungs, O2 binding causes dissociation of H from Hb. CO2 will form, and will be released

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23
Q

Bohr effect

A

In tissues increased H+ from metabolism shifts curve to the right allowing O2 to be released.

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24
Q

Response to high altitude?

A

Low PaO2 so hyperventilation, decreases PCO2 causes decreased cerebral blood flow and symptoms of altitude sickness.

Increased EPO, increased 2,3 BPG
Increased mitochondria
Increased renal excretion of HCO3 (increase with acetazolamide) to compensate for respiratory alkalosis.

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25
Q

During exercise, what happens to PaO2 and PaCO2

A

Do not change in arteries, but increased CO2 content in veins. Higher extraction from muscle

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26
Q

Most common sinus infected? Why?

A

Maxillary sinus because drainage is at roof.

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27
Q

Homan sign?

A

Dorsiflexion of foot causes pain during DVT.

28
Q

Angiofibroma

A

Benign tumor of mucosal tissue composed of large vessels and fibrous tissue. Seen in adolescent males and causes profuse epistaxis

29
Q

Nasopharyngeal carinoma

A

Seen in asian men due to EBV. Presents with enlargement of cervical lymph nodes.

Biopsy shows pleomorphic keratin positive epithelial cells in a background of lymphocytes.

30
Q

PE

A

V/Q mismatch with low Q. Causes hypoxemia and respiratory alkalosis.

31
Q

Fat emboli syndrome

A

Causes hypoxemia, neurologic deficits, and petechial rash.

32
Q

Most common site of DVT vs most likely to throw clot?

A

Most common site = popliteal

Most common to throw clot = femoral.

33
Q

Amniotic fluid emboli?

A

Can cause DIC

34
Q

Gas emboli

A

Divers, treat with hyperbaric oxygen.

35
Q

Obstructive lung disease spirometry

A

Decreased FEV/FVC because very decreased FEV1

36
Q

Chronic bronchitis

A

A form of COPD, hyperplasia of mucus secreting glands in the submucosa of the bronchi. Expanded reid index.

Productive cough for greater than 3 months over 2 years. Risk of infection increased due to mucus plugging.

Late onset dyspnea with CO2 retention

37
Q

Emphysema

A

Enlargement of airspaces with decreased elastic recoil. Increased compliance and decreased DLCO resulting form the destriction of alveolar walls.

No mucus, increased elastase activity. Pink puffers. Pursed lip breathing to increase airway pressure and prevent airway collapse during respiration.

Increased FRC b

38
Q

Centriacinar vs panacinar

A

Centriacinar seen with smoking, increased neutrophil elastase.

Panacinar seen with A1At deficiency. PAS positive granules in liver can cause cirrhosis. PIM is normal PIMZ is generally asymptomatic but will develop if smoker. PIZZ is bad.

39
Q

Asthma

A

TH2 mediated response that produces IL4, Il5 and Il 10

Il4 activates Ige, il5 activates eosinophils, il10 inhibits th1 response.

Bronchial hyperresponsibeness causes reversible bronchoconstriction. Curschmann spirals (shed epithelium), and charcot leyden crystals (mBP from eos)

Can be triggered by viral URI, allergen, stress.

Mast cell degranulation dumps histamine granules, causes vasodilation and increased vasc perm. Then Leukotriene response.

Test with methacholine challenge.

Can cause pulsus paradozus

40
Q

Bronchiectasis

A

Can cause secondary amyloidosis due to SAA from chronic inflammation.

Necrotizing infections of bronchi cause permanently dilated airways, purulent sputum, dyspnea, hemoptysis. Assocaited with bronchial obstruction, smoking, kartageners, cf, ABPA (in CF ans asthma)

41
Q

Restrictive lung disease spirometry

A

Increased FEV/FVC (because FVC is very down). Decreased TLC.

Caused by poor breathing mechanics, from polio, mg, obesity, scoliosis. These have normal AA

And interstitial lung diseases (with Increased Aa gradient). ARDS, NRDS (hyaline membrane disease), pneumoconioses, sarcoidosis, IPF, goodpasture syndrome, GPA, langerhands cell histiocytosis.

42
Q

Hypersensitivity pneumonitis

A

Type III/IV hypersensitivity seen in farmers.

43
Q

Pneumoconiosis definition

A

Macrophage mediated fibrosis due to chronic exposure to an antigen. Increased risk of cor pulmonale and caplan syndrome (RA and pneumoconioses)

44
Q

Asbestosis

A

Asociated with shipbuilding, roofing, and plumbing, Ivory white calcified pleural plaques. Increased risk of bronchogenic carcinoma. Affects lower lobes

45
Q

Coal workers pneumoconiosis

A

Caplan syndrome – shrunken lung

46
Q

Eggshell calcification of hilar lymph nodes seen with…

A

Silicosis

47
Q

NRDS

A

Alveolar collapse due to decreased surfactant. LS ratio of less than 1.5 is predictive. Low O2 tension causes PDA. Also associated with Retinopathy of prematurity and broncho[ulmonary dysplasia.

Risk factors include c-section, prematurity, maternal diabetes.

48
Q

Berylliosis

A

Seen in airspace workers. Noncaseating granulomas. Produce 1alpha OH which increases calcium. Looks a lot like sarcoid

49
Q

Can left to rightshunt cause pulm hypertension?

A

Yes! Increased sheer stress can cause endothelial injury. Also sleep apnea and high altitude causes hypoxic vasoconstriction..

Treat with bosentan

50
Q

Site of mets from lung cancer

A

ADRENALS

51
Q

Bronchioloaveolar carcinoma

A

From clara cells, type of adenocarcinoma. Peripheral tumor not associated with smoking. May present with consolidation. Excellent prognosis. Aka adenocarcinoma in situ.

52
Q

Squamous cell carcinoma

A

Has keratin pearls and intercellular bridges. Produced PTHrP

53
Q

Syndromes from small cell

A

ACTH, Antibodies against CA, ADH (SIADH). MYC oncogene amplification

54
Q

Amplification in adenocarcinoma

A

KRAS, EGFR, ALK

55
Q

How to treat cushingoid appearance in small cell?

A

Ketoconazole

56
Q

How to treat small cell vs others

A

Small cell has good response to chemo. No operation

57
Q

Large cell carcinoma

A

Anaplastic and undifferentiated. Causes gynecomastia and galactorrhea.

58
Q

How does carcinoid turmor appear

A

Well differentiated polyp like mass in bronchus. Can occasionally cause carcinoid syndrome. Wheezing, diarrhea, flushing. Has nests of endocrine cells that are chromogranin positive.

59
Q

Mesotheliomas…

A

Have psammoma bodies, with papillary thyroid, meningiomas, serous cystadenocarcinoma

60
Q

Pancoast tumor

A

Carcinoma at apex of lung can cause horner syndrome, SVC syndrome, sensorimotor deficits, hoarseness

61
Q

SVC syndrom2

A

Facial plethora, JVD, swelling of arms.

62
Q

Interstitial pneumonia in farmers

A

Coxiella

63
Q

Lung abcess

A

Due to aspiration of contents of oropharynx. Fusobacterium, peptostreptococcus

64
Q

Transudate

A

Decreased protein, due to CHF

65
Q

Exudate

A

Protein increased, due to malignancy, penumonia

66
Q

Chylothorax

A

Toracic duct injury from traum/malignancy. Incraesed triglycerides

STEP 1 Review (21 decks)

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