Respiratory Flashcards
What is the relation of the pulmonary artery to the bronchus at each lung hilus?
Right: Anterior
Left: Superior
What is the equation for pulmonary vascular resistance?
PVR = (Ppulm.art - Patrium)/CO
Remember P = QR
What happens to arterial PaO2 and PaCO2 during exercise?
They do not change! Your body tries to compensate for exercise by increasing perfusion through increased CO.
What happens to venous O2 and CO2 content during exercise?
CO2 increases and O2 decreases
What is the MCC of rhinosinusitis?
Viral (can cause superimposed bacterial infection)
What is the classic triad for fat emboli?
Hypoxemia, petechial rash, and neuro abnormalities
What happens with gas emboli?
Nitrogen bubbles precipitate in ascending divers
How do you treat gas emboli?
Hyperbaric Oxgen
What is the imaging test of choice for PE?
CT angiography
What do you get from shipbuilding, roofing, plumbing?
Asbestosis
What do you have if you see ivory white calcified pleural plaques?
Asbestosis but are not precancerous
What are golden brown fusiform rods resembling dumbells?
Ferruginous bodies- macrophages that have eaten asbestos fibers and coated them with ferritin. Seen with asbestosis.
What do you see eggshell hilar lymph node calcifications with?
Silicosis
What do you get from mines, sandblasting, foundries?
Silicosis
What do babies get supplemental O2 for ARDS?
Retinopathy of prematurity, bronchopulmonary dysplasia
What do you use Bethamethasone for?
Neonatal RDS
What do you use Beclamethasone for?
COPD/Asthma
What does persistently low O2 tension in neonatal ARDS increase risk for?
PDA
What do presence of bronchial breath sounds indicate?
Consolidation (lobar pneumonia, pulmonary edema)
What are kulchitsky cells?
Small dark blue cells in small cell carcinoma
What are the side effects of Salmeterol/Formoterol?
Arrhythmia, tremor
What is the MC morbidity problem with Theophylline?
Tacchyarrhythmias and seizures
What do you use for aspirin induced asthma?
Zafirlukast, Montlukast
What does airspace opacities in superior region of lower lobes suggest?
Aspiration pneumonia (especially with leukocytosis and history of dementia)
What is nasopharyngeal carcinoma associated with?
EBV
What would hamartoma of the lung show?
Hyaline cartilage
What cancer does asbestosis cause?
Bronchogenic adenocarcinoma > mesothelioma
What does nitroprusside do to your Hb?
Causes conversion to metHb
How do you treat Methemoglobinemia?
Methylene blue or ascorbic acid (converts ferric to ferrous iron)
What is usually the cause of unilateral pleural effusion?
Bacterial usually
What would you in pleural effusion (think exudate vs transudate)
LDH, protein
What do you calculate CO if given arteriovenous O2 content?
CO = O2 consumption/ arterial O2 content - venous O2 content
If surfactant is messed up what do you see?
Patchy ateclectasis
What is the 1st line treatment for chronic asthma?
Fluticasone (Glucoroticoids)
How long does bicarb compensation take?
3-5 days; so if you see acid-base question make sure to consider how long its been and hence if compensation is occurring
Where do fish bones get lodged?
Piriform recess
What is the diagnosis? Upper body rash, neurological symptoms, respiratory dress after long bone fracture or liposuction.
Fat embolus
What causes a spontaneous pneumothorax?
Spontaneous sudden onset chest pain in tall think malefrom apical subpleural blets rupturing
What happens that is important for lung devo at 26 weeks?
Phosphatidylcholine sharply increases and lecithin increases but very slowly
What causes hypercalcemia in sarcoidosis?
Activated macrophages cause 1alpha hydroxylase mediated vitamin activation
Why does resistance increase in medium sized compared to trachea?
Because of high turbulent flow
What causes panacinar emphysema?
Proteases released from alveolar macrophages and neutrophils
What does adenocarcinoma show in histology?
Mucin producing cells that cause copious amounts of fluid in sputum; does not invade
What does a mutation in CFTR cause?
Abnormal bolding and glycosylation of CFTR
What is the main hormone for implicated in surfactant production?
Cortisol
How far up are the lung apices?
Above the clavicle
What is a normal A-a gradient is?
10-15 mmHg
Which of the lung cancers is inoperable?
Small Cell Carcinoma
What happens with PaO2 in CO poisoning?
Does not change (it only lowers the saturation of Hb)
What is a major risk factor for acute onset respiratory distress?
Acute pancreatitis
What is used to treat primary pulmonary HTN (ie the heritable one)
Bosentan
What does regeneration during lung damage?
Type II pneumocytes
How long does it take to adjust to high altitude?
Two weeks
What do you give patients that come in with acute exacerbation of asthma?
Leukotriene receptor inhibitors (Zafirlukast)
What will show greater changes in PCO2, perfusion or diffusion limited?
Perfusion because CO2 diffuses better than O2
What is normal alveolar and tracheal PO2?
Alveolar: 104
Tracheal: 150
How does septic shock affect the lungs?
Causes ARDS leading to intra-alveolar edema, interstitial edema, hyaline membrane formation, inflammation
What nerve increases bronchoconstriction?
Vagus by acting on M3 receptors
How does left heart systolic failure affect the lung?
Decreases compliance of lung: LF systolic failure –> increased end systolic volume –> greater pressure for pulmonary artery to push against –> increased pulmonary artery pressure –> fluid leakage into parencyma –> decreased compliance of lung
What causes dilated vessels of upper trunk and neck, facial edema and plethora, cough, dizziness?
SVC Syndrome
What is Clindamycin used for?
Anaerobes above diaphragm and group A strep
How do you tell a staph pneumonia apart from a strep pneumonia?
Staph produces cavitary lesion and strep does not (it produces necrotizing abscessing pneumonia)
How does silicosis increase susceptibility to TB?
By impairing macrophage fusion with phagolysosome
What is the diagnosis? HIV patient with lesions that on histology look like spindle shaped small vessel proliferations?
Kaposi sarcoma
What else can Kaposi sarcoma cause besides red flat maculopapular lesions?
Diarrhea
How does PaO2 change with CO poisoning?
It doesn’t. PaO2 is unaffected by CO since it is dissolved. O2 content would be changed.
What do you see with theophylline toxicity?
Seizures, abdominal pain, arrhythmias, vomiting, diarrhea
What would you see just SVC syndrome with?
Mediastinal mass (NOT pancoast since that would also show horner’s)
Diagnosis? Interstitial fibrosis with paraseptal and subpleural cystic airpsace enlargmenet (honeycomb lung)
Idiopathic pulmonary fibrosis
What is the shake stability test?
Multiple wells with ethanol and amniotic fluid are shaken and examined for ring of stable foam. Foam stability index is highest value well that contains ring of foam. It evaluates surfactant functionality/lung maturity.
What happens to compliance in emphysema?
It increases!!
What increases in obstructive lung diseases?
RV, FRC, TLC
What is FRC equal to?
ERV + RV
At what levels do structures perforate the diaphragm?
T8: IVC
T10: Esophagus, vagus
T12: aorta, thoracic duct, azygous vein
“I ate ten eggs at twelve”
A 16-year-old boy is admitted to the emergency department because of a knife wound to the left side of his chest. An x-ray of the chest shows an air-fluid level in the left side of the chest, partial collapse of the left lung, and elevation of the stomach bubble. The mediastinum is in the midline. Which of the following is the most likely diagnosis?
Hemopneumothorax not under tension
Air fluid levels = hydropneumothorax. If there’s also a stab in the scenario then its blood instead of water.
No mediastinal shift means no tension
What does altitude sickness cause?
High altitude pulmonary edema (a type of ARDS) that would look like bilateral fluffy infiltrates on Xray
What would happen to numbers of type 1, type 2 pneumocytes and fibroblasts in chronic inflammatory interstitial pneumonitis?
Type 1 will go down (since they are destroyed)
Type 2 will go up (since they regenerate)
Fibroblasts go up (chronic inflammation causes fibrosis)
What do you think of middle aged non smoking woman with SOB?
Idiopathic pulmonary fibrosis
What is anthracosis?
Asymptomatic condition found in urban dwellers exposed to sooty air where carbon accumulates in macrophages
What are the cmplications of sleep apnea?
Pulm/systemc HTN
Arrhythmias
Sudden cardiac death
Why does maternal diabetes cause neonatal ARDS?
Insulin inhibits surfactant production
