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RESPIRATORY Flashcards

0
Q

What the collapsing pressure formula?

A

Collapsing pressure (P) = 2 (surface tension)/ radius

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1
Q

What is the most important lecithins in surfactant?

A

Dipamitoylphosphatidylcholine

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2
Q

What lecithin/sphingomyelin ratio indicates fetal lung maturity?

A

Lecithin/sphingomyelin >2.0

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3
Q

Relation pulmonary artery and it’s each bronchus RALS

A

Right anterior

Left superior

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5
Q

Lung volumes and capacities (4.4)

A

Inspiratory reserve volume (IRV)
Tidal volume (TV)
Expiratory reserve volume (ERV)
Residual volume (RV). Cannot be exalated nor measured by spirometry
Inspiratory capacity (IC) TV+IRV
Functional residual capacity (FRC) ERV+RV
Vital capacity (VC). TV+IRV+ERV
Total lung capacity (TLC) IRV+TV+ERV+RV

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5
Q

Levels and structure which pass throughout diagram(3)

A

ƒ At T8: IVCƒ At T10: esophagus, vagus (CN 10; 2 trunks)ƒ At T12: aorta (red), thoracic duct (white),a zigs vein(blue)

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6
Q

Levels of Principal bifurcations (3)

A

Common carotid C4
Trachea T4
Abdominal aorta L4

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7
Q

Physiologic dead space formula

A

VD = VT × (Paco2 – Peco2)/ Paco2

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8
Q

Ecuation of alveolar ventilation

A

VA = (VT − VD) × RR

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9
Q

Situations where there is a compliance change? (4-2)

A

⬇️in pulmonary fibrosis, pneumonia, pulmonary edema; 

⬆️in emphysema, normal aging.

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11
Q

When there is low affinity hemoglobin for O2 ?(7) turns to the right .

A 
⬆️Cl−
⬆️H+
⬆️CO2
⬆️2,3-BPG
⬆️temperature
⬆️altitude
⬆️exercise
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11
Q

Oxygen content formula

A

O2 content = (O2 binding capacity × % saturation) + dissolved O2.

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12
Q

What is methemoglobin and its use?

A

Hb to ferric form Fe3+ (normal ferrous of Fe+2)
Using nitrites and Thiosulfate
methylene blue to normal

TREAT CYANIDE POISONING

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13
Q

What is the O2 binding capacity?

A

O2 binding capacity ≈ 20.1 mL O2/dL.

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14
Q

What’s the O2 delivery to tissues formula?

A

O2 delivery to tissues = cardiac output × O2 content of blood.

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15
Q

What’s the diffusion formula?and situations of alterations?

A

Diffusion: Vgas = A/T × Dk(P1 – P2)
A = area
T = alveolar wall thickness

Dk(P1 – P2) ≈ difference in partial pressures: ƒ
A ⬇️ in emphysema.
ƒT ⬆️ in pulmonary fibrosis

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16
Q

What’s the pulmonary vascular resistance formula?

A

PVR = (Ppulm artery – PL atrium) / cardiac output

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17
Q

What’s the alveolar gas equation ?

A

PAo2 = PIo2 – (Paco2/0.8)

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18
Q

How the CO2 is transported from tissues to lungs?

A

ƒHCO3− (90%).
ƒCarbaminohemoglobin or HbCO2 (5%)
ƒDissolved CO2 (5%).

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19
Q

What’s the Virchow triade?

A

Stasis
Hypercoagulability
Endothelial damage

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20
Q

What type of Thrombi is find only in pulmonary embolism Vs post Mortem emboli?

A

Thrombi whit Lines of Zahn

Pink ( platelets fibrin) and red (RBCs)

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21
Q

Classic triad of fat emboli

A

Hypoxemia
Neurological abnormalities
Petechial rash

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22
Q

What’s the spirometry hallmark of obstructive lung disease?

A

⬇️FEV1/FVC ratio

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23
Q

Clinical diagnosis of chronic bronchitis? COPD

A

Productive cough for > 3 months per year (not necessarily consecutive) for > 2 years.

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24
Q

Two diferent types of emphysema

A

Centriacinar SMOKING

Panacinar ALFA1-ANTITRIPSINA DEFICIT

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25
Q

Two important microscopic findings in asthma

A

Curschmann spirals ( epithelium/mucus plugs)
Charcot-Leyden crystals (eosinophils in sputum)

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26
Q

What’s the spirometry hallmark for restrictive lung disease?

A

FEV1/FVC ratio ≥ 80%

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27
Q

What’s Caplan syndrome?

A

rheumatoid arthritis and pneumoconioses with intrapulmonary nodules

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28
Q

What drugs cause restrictive lung disease?

A

Bleomycin
Busulfan
Amiodarone
Methotrexate

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30
Q

Efects of therapeutic supplemental O2 in NRDS?(3)

A

Retinopathy
Intraventricular hemorraghe
Bronchopulmonary dysplasia

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30
Q

Pathognomonic findings in the four Pneumoconioses?

A

ASBESTOSIS supradiaphragmatic and pleural plaques
BERYLOSIS aerospace
COAL WORKERS ANTRHACOSIS macrophages carbon
SILICOSIS fibrosis ⬆️TB. ⬆️CA bronchogenic BECAUSE IMPAIRED MACROPHAGE FUNCTION!!! Birefringent silica particles .

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31
Q

What’s is the relation of lecithin/sphingomyelin ratio in neonatal respiratory distress syndrome?

A
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32
Q

What’s the principal risk factor to mesothelioma?

A

ASBESTOSIS!!!

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33
Q

What is the localization of Squamous and Small cell lung cancer?S

A

SENTRAL!!!

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34
Q

Four principal features of small cell carcinoma?

A

ACTH
SIADH
Lambert-Eaton myasthenic syndrome
Paraneoplasic encephalitis

myc oncogene
15% incidence

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35
Q

Most common cancer in non smokers?prognosis and histologic finding

A

Adenocarcinoma subtype Bronchioalveolar
Excellent prognosis
Thickening of alveolar wall

50% incidence

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36
Q

Principal features of Squamous cell carcinoma (3)

A

Cigarette
HyperCalcemia
Cavitation

25%incidence

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38
Q 
Tumor marker of large cell carcinoma
clinical signs  (2)  incidence.
A

Beta hCG

GYNECOMASTIA
GALACTORRHEA

10% incidence

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39
Q

Prognosis of bronchial carcinoid tumor?

and clinical sign.

A

Excellent

Carcinoid syndrome

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40
Q

What’s dextromethorphan?

A

Antitussive

Codein analog

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40
Q

Genes implicated in adenocarcinoma lung cancer (3)

A

KRAS
EGFR
ALK

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41
Q

Different H1 blockers and its uses .

2

A

Ine-ate Allergy, motion sickness, sleep aid.

Adine allergy NO SLEEP!!!

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43
Q

What is bosentam?and use?

A

Antogonist of endotheline receptor

Use in pulmonary hypertension

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43
Q

Principal indication of montelukast and zafirlukast?

A

Aspirin-induced asthma

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44
Q

What’s epoprostenol and iloprost?

side efect.

A

Prostacyclins PGI2
Vasodilator
❎Platelet aggregation

JAW PAIN FLUSHING

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45
Q

Use of omalizumab

A

Monoclonal anti-Ig E antibody

For asthma resistant to inhalants and corticoids

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46
Q

What’s zileuton? and efect?

A

5-lipoxygenase inhibitor

⬇️Leukotrienes

47
Q

Action of methylxanthines ( theophylline)

A

Inhibition of phosphodiesterase
⬆️cAMP
❎Adenosine

48
Q

What’s Hamartoma?

A 
Coin lesion on CRX
Pop corn calcification
Hyaline cartilage
Fat 
Smooth muscle
49
Q

Use of methacholine and site of action

A

M3 agonist

Challenge test to asthma.

50
Q

What is the mechanism implicated in the low effect after 3 consecutive days of using decongestants?

A

TACHYPHYLAXIS

negative feed backs of NE release

52
Q

What cells secrete proteases in enphysema?(2)

A

Macrophages

Neutrophils

53
Q

In a long-standing chronic obstructive pulmonary disease what is the principal contributor to respiratory drive vs normal patient?

A

longstanding DPOC. PaO2 carotid bodies CNXII

Healthy PaCO2 central chemoreceptors

54
Q

Which vitamin deficiency is related with squamous metaplasia to a keratinizing epithelium?

A

Vit. A!!!!!!!!!

54
Q

Phrenic nerve carries pain sensation from what kind of pleura?(2)

A

Diaphragmatic

Mediastinal

55
Q

What pathway takes both left and right recurrent laryngeal nerves ?

A

Right loop under subclavian artery

Left loop under aortic have arch

56
Q

What muscles are innervated by accessory nerve?

A

Sternocleidomastoid

Trapezius

57
Q

Which procedure has to be done if there is an indication of intubation but there is an massive pharynx edema?

A

Cricothyrotomy

Trough Cricothyroid membrane

58
Q

What is the final stage of sarcoidosis?

A

PULMONARY FIBROSIS!!!

NO hepatic cirrhosis

59
Q

What are the last cell seen in smallest bronchi and respiratory bronchioles?

A

smallest bronchi GLANDS AND GLOBET CELLS

bronchioles terminal and respiratory: CILIATED SIMPLE CUBOIDAL CELLS

60
Q

How is the chemical feature of sweet in cystic fibrosis ?

A

⬆️Cl
⬆️Na
⬆️Water

61
Q

Sequence of pulmonary embolism damage(5)

A 
After orthopedic CX or immobility 
⬇️
Emboli stuck in pulmonary artery
⬇️
V/Q mismatch  due increased blood flow in the remainder arteries
⬇️
Ischemia ⬆️inflammatory products ⬇️surfactant
⬇️ 
atelectasi  right to left shunt
62
Q

High risk in the neonate after use of terbutaline as tocolityc? (4)

A

Intraventricular hemorraghe
Hypoglycemia
Hypocalcemia
Ileus

63
Q

Other names for abnormal retinal vascularization after NRDS?(2)

A

Retinopathy of prematurity

Retrolental fibroplasia

64
Q

Complications of surfactant treatment in neonates? (4)

A

Transient hypoxia
Hypotension
Blockage of an endotracheal tube
Pulmonary hemorrhage

65
Q

What Leukotriene has a potent chemotactic activity?

A

LTB4!!!!!

67
Q

Function of thromboxanes ? (2)

A

Vasoconstriction

Platelet aggregation

67
Q

What are the function of LTC4, LTD4, LTE4?(2)

A

Bronchospasm

⬆️ bronchial mucus secretion

68
Q

Functions of bradykinin ? (3)

A

Vasodilatation
⬆️Vascular permeability
Pain

69
Q

Explain the relationship among Palv,Part,Pv in the 3 pulmonary zones.

A

ZONE 1 Palv>Part>Pv no flow (hypovolemic)
ZONE 2 Part>Palv>Pv flow intermitent
ZONE 3 Part>Pv>Palv flow continuos

71
Q

Which anatomic structure lacks in cystic fibrosis?

A

VAS DEFERENTS MALE

72
Q

Explain the effect in cystic fibrosis in the respiratory - gastric glands and in the sweet glands. in trems of Cl and Na concentration.

A

respiratory - gastric glands
⬇️CL secretion ⬆️Na absorption dehydrated mucus

sweet glands
⬆️CL secretion ⬇️ Na absorption hypercloride sweet

72
Q

What’s the most common cause of superior vena cava syndrome?

A

Non-Hodgkin Lymphoma

73
Q

What lung cancers are associated whit SMOKING!!!!!(2)

A

Squamous cell carcinoma

Small cell carcinoma

75
Q

Principal clinical presentation of pancoast tumor (superior sulcus tumor) (2)

A

Shoulder pain

Horner’s syndrome

76
Q

What are the risks of secondhand smoke exposure in children? (5)

A 
Prematurity , low birth weight 
Sudden infant dead syndrome 
Middle ear disease
Asthma
Respiratory track infections
76
Q

What is the clinical presentation of chronic rejection after lung transplant?

A

Obstructive pattern

BRONCHIOLITIS OBLITERANS
Fibrosis, scarring

77
Q

Stages of sarcoidosis (4)

A

Stage I bilateral hilliar lymphadenopathy
Stage II PLUS pulmonary infiltrates in upper lobes
Stage III ONLY lungs infiltrates
Stage IV LUNG FIBROSIS

78
Q

Histologic characteristic in cytomegalovirus infection

A

Owl’s eye inclusion in infected cells

Intranuclear inclusion surrounded by a clear halo

79
Q

Where the vagus nerve innervated the ear?

A

Posterior part of the external auditory canal

80
Q

What autoimmune disease is associated whit Pulmonary Arterial Hypertension???(2)

A

CREST!!!!

Systemic Sclerosis

81
Q

Which nerve innervated the tympanic membrane?

A

CN V3

82
Q

How the pulmonary vascular resistance change in the maximal expiration, maximal inspiration, and normal expiration?

A

Maximal expiration ⬆️⬆️ PVR
Maximal inspiration ⬆️⬆️ PVR

Normal expiration ⬇️⬇️ PVR

83
Q

How bronchitis and emphysema cause hypoxia?

A

bronchitis decreasing diameter of conducting airways

emphysema Dilating alveolar space ⬇️contact whit capillaries

85
Q

Where the thoracentesis have to be done in midclavicular, midaxilar,paravertebral lines?

A

midclavicular 6-8th ribs
midaxilar 8-10th ribs
paravertebral lines 10-12 th ribs

85
Q

Which part of the Serratous anterior muscle facilitate the arm elevation?

A

The inferior part fiber to the last 3 ribs (1-8 ribs)

86
Q

How are the relations of visceral and parietal pleura in the midclavicualr line , midaxilar line and paravertebral line ?

A

▪️. Visceral P. Parietal P.
🔹midclavicular 6th. 8th
🔹midaxilar 8th. 10th
🔹paravertebral 10th. 12th

87
Q

Why the sputum from bacterial pneumonia is green?

A

MUPYELOPEROXIDASE!!!

produce hypochlorus acid
From chloride and hydrogen peroxide

88
Q

The alpha-1 anti trypsin deficiency cause what type of pneumopathy?

A

OBSTRUCTIVE!!!!!!

PANACINAR EMPHISEMA!!!!!

90
Q

How the patients whit pulmonary fibrosis and obstructive pneumopathy change its breathing in orther to minimize the breathing work?

A

Fibrosis ⬆️ respiratory rate

DPOC ⬇️ respiratory rate

91
Q

In the restrictive disease there is a diminishing of all volumes less…

A

Reserve volume

91
Q

What is Reid index?

A

Index of disease severety of obstructive pulmonary disease

Reid index = gland thickness/ wall thickness
Normal

92
Q

What are the symptoms of theophylline intoxication?(3) and where is metabolized?

A

CNS ( tremor, insomnia, seizures )
Gastrointestinal (vomit , nausea)
Cardiac ( arrythmias )

Metabolized by liver

93
Q

How is the air flow resistance along the bronchial tree?

A

Medium size bronchi> trachea > terminal bronchioles

94
Q

What kind of markers have small cell carcinoma of the lung?

A

Neuroendocrine markers

95
Q

Which cells have the clearance of particles lodge at up to terminal bronchioles and distal to terminal bronchioles?

A

Proximal to terminal bronchioles. CILIATED CELLS

distal to terminal bronchioles MACROPHAGES

96
Q

Which kind of channels are impaired in cystic fibrosis?

A

ATP-gated Cl Pump

97
Q

What are the principal and second risk of asbestosis?

A

BRONCHOGENIC CARCINOMA!!!!

mesothelioma

98
Q

Which pulmonary segments are implied in aspiration pneumonia at supine position? (2)

A

Posterior segments of upper lobes

Superior segments of lower lobes

99
Q

What cavitation of upper lobes means in TB?

A

SECUNDARY TUBERCULOSIS!!!! REACTIVATION

100
Q

What is the fat embolism syndrome (4)

A

Pulmonary insuffiency
Diffuse neurological impairment
Thrombocytopenia
Anemia

101
Q

What type of patients have negative skin tuberculine test After M. Tuberculosis exposure ?

A

Immunossuppresed patients
WEAK CELL MEDIATED IMMUNE RESPONSE

HIV sarcoidosis

102
Q

Difference between chronic rejection of lung and kidney transplant?

A

LUNG bronchiolitis obliterans

KIDNEY vascular obliteration

103
Q

Explain the cheyne-stokes,kussmaul breathing.

A

Cheyene-stokes apnea-crescendo-decrescendo-apnea
HCF, TCE, brain tumor , strokes

Kussmaul Apnea-deep breathing-apnea
Diabetic ketoacidosis

104
Q

What are the function of club cells (Clara)

A
  1. Secrete club secretory protein ( protects against airway inflammation and oxidative stress)
  2. SURFACTANT

Terminal bronchioles

105
Q

Principal side effects of theophylline? (2)

A

SEIZURES

TACHYARRYTHMIAS (⬆️ QT)

106
Q

What is H. influenzae non-typable?

A

H. Influenzae whit out capsule
Responsible for 90% of HaEMOPhilus infection
It has no Vaccine

107
Q

Are pulmonary adenocarcinomas in situ benigns?

A

NO!!!!!!

108
Q

why in pulmonar fibrosis there is high flow expiration volume?

A

wide airways by high radial traction on airway walls

109
Q

Which gas is block and what does not block in diffusion -limited equilibration at capillary-alveolar system ?

A

❎O2 cannot pass – cannot equilibrate

✅CO2 can pass– can equilibrate

110
Q

Physiologic response to left shifting oxygen-hemoglobin dissociation curve?

A

ERYTROCYTOSIS!!!

111
Q

How is the oygen-hemoglobin dissociation curve in sickle cell anemia?

A

SHIFTED TO THE RIGHT

112
Q

Microscopic findings in ARDS?

A

Interstitial and intraalveolar edema

Fribrin deposition whit HYALINE MEMBRANES

113
Q

Stages of Lobar pneumonia ?(4)

A

Congestion (24 hrs) bacteria in alveoli
Red hepatization (2-3 days) RBCs, Neutrophilis, fibrin
Gray hepatization(4-6 days) RBCs disintegrated
Resolution enzymatic digestion

114
Q

Situations with elevated alveolar to arterial gradient (notmal 5-15)?(3)

A

Right-to-left shunt
Ventilatory/perfusion mismatch
Impaired diffusion

115
Q

Drugs used in Cystic Fibrosis .(2)

A

Lumacaftor

Ivacaftor

117
Q

arterial blood gases changes after acute salicylate intoxication?

A

FIRST respiatory alkalosis

SECOND metabolic acidosis

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