Respiratory Flashcards
type I pneumocytes
97% of aveoli surface, just thin and don’t do shit
type II pneumocytes
screte surfactant, cuboidal, differentiate into type I cells, they proliferated in response to injury
what in amniotic fluid indicates fetal lung maturity
lecithin:sphingomyelin ratio >2
of lobes of each lung
left has 2
right jhas 3
which lung more commonly gets inhaled foreign body
right
aspirate peanut while standing, where does it go?
lower portion of right inferior lung
aspirate peanut while lying (supine), where dose it go?
superior portion of right inferior lobe
location of pulmanary arteries in relation to hilum of bronchus?
RALS: Right Anterior Left Superior
perforates diaphram at T8
IVC
perforates diaphragm at T10
esophagus and vagus
perforates diaphragm at T12
aorta, thoracic duct, azygos vein
diaphragm pain refers to?
C3, 4, 5 shoulder and trapzius
muscles used during maximal inspiration?
external intercostals, scalene muscles, sternocleidomastoids
muscles used during maximal expiration
rectus abdominis, internal/external obliques , transversus abdominus, internal intercostals
functional vs anatomical dead space
functional is aveoli not being perfused (apex of lung), anatomical is conducting system
hemoglobin two states
tense: low affinity for oxygen (periphery)
relaxed: high affinity for oxygen
conditions which favor taut form of Hb?
high: Cl, H, CO2, 2,3-BPG and temp (shifts curve right)
how to treat cyanide poisoning?
Nitrates oxidize hemoglobin to methemoglobin which favors binding cyanide. then treat with thiosulfate to form thiocyanate to excrete
what is methemoglobin and how to treat methemoglobin?
methemoglobin is oxidized hemoglobin that favor cyanide. give methylene blue
what creates methemoglobin?
nitrates
histology of conducting zone vs respiratory zone (respiratory bronchioles and aveoli)
conducting zone is pseudostrat columnar ciliated
respiratory bronchioles are cuboidal
aveoli are simple squams
(no cilia cause macrophages clear)
oxygen binding curve after carbon monoxide
left shift cause CO binds waaaaaay stronger
hemoglobin vs myoglobin multimer state?
4 vs 1
effects of CO2 and O2 on pulmanary circulation
opposite of the rest of the body. hypoxia = vasoconstriction
is normal gas exchange diffusion or perfusion limited?
perfusion
cor pulmonale
enlargment of right heart due to increased pulmanary circulation resistance
normal pulm artery pressure?
10-14
gene responsible for primary pulmonary hypertension (and defect?)
BMPR2 w/ inactivating mutation
ventilation and perfusion are greatest where?
base of lung
Haldane effect
oxygenated hb dump H which causes biocarb to become CO2 at lungs (opposite of bohr effect/shift)
virchows triad of DVT risk factors
Stasis, hyper coagulability, endothelial damage
dorsiflexion of foot elicits calf pain
sign for a deep vein thrombosis
heparin vs warfarin for DVT treatment
Heparin is acute prevention and treatment. warfarin is for chronic prevention of recurrance
sudden onsent dyspneia, chest pain, tachypnea
Pulm embolism
high altitutde compensation mechanisms
acute: increase ventilation
chronic: high epo to increase hct, high 2,3-BPG, high bicarb excretion
types of pulmonary emboli
FAT BAT: Fat, Air, Bactera, Amniotic, Tumor
Fat emboli etiology and triad
long bone fractures/liposuction
triad: hypoxemia, neurological abnormalities, and petechial rash
how to distinguish between post and premortum emboli via histology?
pink = plates (pre) red = RBCs (post)
Chronic Bronchitis mechanism?
hypertrophy of mucus secreting glands, thick bronchi
Reid index (thickness of glands/bronchial wall) to diagnose chronic bronchitis?
> 50%
Mechanism of Emphysema
enlargment of airspaces due to destruction = less recoil so can’t collapse lungs to remove old air
two type of Emphysema and their respective asssociations
Centriacinar: smoking
Panacinar: alpha1-antitrypsin deficency
Emphysema elastase activity
increased resulting in loss of elastic fibers. they exhale through pursed lips
Methacholine challenge
asthma test (causes asthma acutely)
Asthma histology (3)
smooth muscle hypertrophy, Curschmann’s spirals (mucus/epi plugs), CHarcot-Leyden crystals (eosinophil breakdown product)
bronchiectasis
chronic necrotizing infxn of bronchi -> dialated airways, hemoptysis, purulent sputum. Seen in CF, obstruction, kartageners
Asthma is obstructive or restrictive?
obstructive
obstructive vs restrictive
obstructive: air trapping
restrictive: lung expansion restricted
what can cause pneumoconioses?
coal (anthracosis), silica (silicosis), asbestos (asbestosis)
anthracosis cause and where it effects
coal (BLACK LUNG), affects upper lobes
Silicosis effects where in the lungs?
upper lobes
who might get silicosis
silica exposure: foundries, sandblasting, mines
what does silicosis do to the lungs?
macrophages release fibrogenic factors. risk of TB and carcinoma
eggshell calcifications of hilar lymph nodes
Silicosis
Ivory white calcified pleural plaques
pathognomonic of asbestosis
golden-brown fusiform rods that look like dumbells
asbestosis
who might get asbestosis
shipbuilders, roofers, plumbers
risks of asbestosis?
carcinoma and mesothelioma
where does asbestosis effect?
lower lobes (only one of the pneumoconioses to hit lower lobes)
Neonatal respiratory distress syndrome cause and test
surfactant deficency. lecithin: sphingomyelin ratio
risks of neonatal respiratory distress syndrome and risk of treatment
PDA (low O2). But O2 supp leads to retinopathy of prematurity and bronchopulmonary dysplasia.
acute respiratory distress syndrome causes
trauma, uremia, sepsis, shock, gastic aspiration, acute pancreatisis, amniotic fluid embolism
ARDS pathophys
chronic: diffuse aveolar damage causes increase capillary permeability causes proteinacous fluid in aveoli which forms hyalin membrane in aveoli.
acute: neutrophils, coag cascade, oxygen derived free radicals
FEV1/FVC for normal, obstructive and restrictive
normal: 80%
Obstructive
what is sleep apnea and causes
stop breathing >10sec repeatedly while sleeping. typically very tired cause they wake up a lot. also hypoxia leads to high RBC. can be central or obstrucutive (snoring/fat/resistance present)
sleep apnea treatment
weight loss, CPAP, surgery
leading cause of cancer death? (ie type)
lung cancer
coin lesion in lung on xray or ct
lung cancer
most common lung cancer
met from another tumor
where do lung cancers met?
adrenals, brain, bone (path fracture), liver
lung cancer complications
SPHERE of complications: Superior vena cava syndrome, Pancoast tumor, Horners syndrome, Endocrine (paraneoplastic cause of ACE and stuff), Recurrenty laryngeal symptoms, Effusions
which lung cancers aren’t smoking associated?
bronchioloalveolar and bronchial carcinoid
lung adenocarcinoma location and histology
peripheral. bronchioalveolar subtype grows along septa so septal thickening
lung adenocarcinoma characteristics
most common lung cancer in non smokers. activation of k-ras. displays clubbing.
Bronchioloaveoloar subtype of lung adenocarcinoma findings and prognosis
histology has “septal thickening”, CXR has hazy infiltrates like pneumonia. Excellent prognosis
lung squamous cell carcinoma
centrally located. hilar mass from broncus. Cavitation, Cigarettes, hyperCalcemia.
keratin pearls and intercellular bridges histology in lung
squamous cell carcinoma of lung
small dark blue cells “oat cells”
small cell carcinoma of lung
small cell carcinoma of lung
located centrally. very aggressive undifferentiated neuroendocrine cells. produce ACTH, ADH, Antibodies against presynaptic Ca channels, Amplification of myc oncogenes
large cell carcinoma of lung
peripherally located. anaplastic undiff tumor with poor prognosis, surgery is only option… giant cells
bronchial carcinoid tumor
neuroendocrine cells which has great prognosis and no mets. just mass effect is dangerous (and maybe carcinoid syndrome)
lung cancer with chromogranin positive cells
bronchial carcinoid tumor
Lung Psammoma bodies
mesothelioma
mesothelioma
pleural tumor associated with asbestosis. hemorrhagic effusions
pancoast tumor
carcinoma in the apex of the lung which impinges on cervical sympathetic plexus causing Horners (ipsilateral ptosis, miosis, anhidrosis)
superior vena cava syndrome
obstructed SVC - blood cant drain from head - JVD - upper extremity edema. Caused by malig and thrombosis for catheters. Medical emergency cause high ICP causes aneurysms
lobar pneumonia
S. pneumo (Klebsiella rare). Intra-aveolar exudate/consolidation (may involve all lung but typically in one lobe)
Bronchopneumonia
S. pneumo, S. aureus, H. influ, Klebsiella. acute inflammatory infiltrates from bronchioles into aveoli = patchy distribution in 1 or more lobes
interstitial (aytpical) pneumonia
viruses, mycoplasma, legionella, chlamydia. diffuse patchy inflammation localized to interstitial areas at alveolar walls. slow indolent course
lung abscess organisms
S. aureus or anaerobes (bacteroides, fusobacterium, peptostreptococcus)
hypersensitivity pneumonitis
mixed type 3/4 hypersensitivity due to antigen causing dyspnea, cough, chest tightness. seen in farmers and bird exposures
transudate pleural effusion
low protein content due to CHF, nephrotic syndrome, or cirrhosis
exudate pleural effusion
high protien content. cloudy. due to malignancy, pneumoia, collagen cascular disease, trauma. MUST BE DRAINED
lymphatic pleural effusion
aka chylothorax. thoracic duct injury so milky pus filled
spontaneous pneumothorax
air gets into thorax despite intact chest wall. in tall thin guys cause of apical blebs rupturing. trachea deviates TOWARD lesion
tension pneumothorax
trauma or infxn causes air to enter thorax. trachea deviates AWAY from affected lung.
