RESPIRATORY Flashcards
What the collapsing pressure formula?
Collapsing pressure (P) = 2 (surface tension)/ radius
What is the most important lecithins in surfactant?
Dipamitoylphosphatidylcholine
What lecithin/sphingomyelin ratio indicates fetal lung maturity?
Lecithin/sphingomyelin >2.0
Relation pulmonary artery and it’s each bronchus RALS
Right anterior
Left superior
Lung volumes and capacities (4.4)
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
Levels and structure which pass throughout diagram(3)
At T8: IVC At T10: esophagus, vagus (CN 10; 2 trunks) At T12: aorta (red), thoracic duct (white),a zigs vein(blue)
Levels of Principal bifurcations (3)
Common carotid C4
Trachea T4
Abdominal aorta L4
Physiologic dead space formula
VD = VT × (Paco2 – Peco2)/ Paco2
Ecuation of alveolar ventilation
VA = (VT − VD) × RR
Situations where there is a compliance change? (4-2)
⬇️in pulmonary fibrosis, pneumonia, pulmonary edema;
⬆️in emphysema, normal aging.
When there is low affinity hemoglobin for O2 ?(7) turns to the right .
⬆️Cl− ⬆️H+ ⬆️CO2 ⬆️2,3-BPG ⬆️temperature ⬆️altitude ⬆️exercise
Oxygen content formula
O2 content = (O2 binding capacity × % saturation) + dissolved O2.
What is methemoglobin and its use?
Hb to ferric form Fe3+ (normal ferrous of Fe+2)
Using nitrites and Thiosulfate
methylene blue to normal
TREAT CYANIDE POISONING
What is the O2 binding capacity?
O2 binding capacity ≈ 20.1 mL O2/dL.
What’s the O2 delivery to tissues formula?
O2 delivery to tissues = cardiac output × O2 content of blood.
What’s the diffusion formula?and situations of alterations?
Diffusion: Vgas = A/T × Dk(P1 – P2)
A = area
T = alveolar wall thickness
Dk(P1 – P2) ≈ difference in partial pressures:
A ⬇️ in emphysema.
T ⬆️ in pulmonary fibrosis
What’s the pulmonary vascular resistance formula?
PVR = (Ppulm artery – PL atrium) / cardiac output
What’s the alveolar gas equation ?
PAo2 = PIo2 – (Paco2/0.8)
How the CO2 is transported from tissues to lungs?
HCO3− (90%).
Carbaminohemoglobin or HbCO2 (5%)
Dissolved CO2 (5%).
What’s the Virchow triade?
Stasis
Hypercoagulability
Endothelial damage
What type of Thrombi is find only in pulmonary embolism Vs post Mortem emboli?
Thrombi whit Lines of Zahn
Pink ( platelets fibrin) and red (RBCs)
Classic triad of fat emboli
Hypoxemia
Neurological abnormalities
Petechial rash
What’s the spirometry hallmark of obstructive lung disease?
⬇️FEV1/FVC ratio
Clinical diagnosis of chronic bronchitis? COPD
Productive cough for > 3 months per year (not necessarily consecutive) for > 2 years.
Two diferent types of emphysema
Centriacinar SMOKING
Panacinar ALFA1-ANTITRIPSINA DEFICIT
Two important microscopic findings in asthma
Curschmann spirals ( epithelium/mucus plugs)
Charcot-Leyden crystals (eosinophils in sputum)
What’s the spirometry hallmark for restrictive lung disease?
FEV1/FVC ratio ≥ 80%
What’s Caplan syndrome?
rheumatoid arthritis and pneumoconioses with intrapulmonary nodules
What drugs cause restrictive lung disease?
Bleomycin
Busulfan
Amiodarone
Methotrexate
Efects of therapeutic supplemental O2 in NRDS?(3)
Retinopathy
Intraventricular hemorraghe
Bronchopulmonary dysplasia
Pathognomonic findings in the four Pneumoconioses?
ASBESTOSIS supradiaphragmatic and pleural plaques
BERYLOSIS aerospace
COAL WORKERS ANTRHACOSIS macrophages carbon
SILICOSIS fibrosis ⬆️TB. ⬆️CA bronchogenic BECAUSE IMPAIRED MACROPHAGE FUNCTION!!! Birefringent silica particles .
What’s is the relation of lecithin/sphingomyelin ratio in neonatal respiratory distress syndrome?
What’s the principal risk factor to mesothelioma?
ASBESTOSIS!!!
What is the localization of Squamous and Small cell lung cancer?S
SENTRAL!!!
Four principal features of small cell carcinoma?
ACTH
SIADH
Lambert-Eaton myasthenic syndrome
Paraneoplasic encephalitis
myc oncogene
15% incidence
Most common cancer in non smokers?prognosis and histologic finding
Adenocarcinoma subtype Bronchioalveolar
Excellent prognosis
Thickening of alveolar wall
50% incidence
Principal features of Squamous cell carcinoma (3)
Cigarette
HyperCalcemia
Cavitation
25%incidence
Tumor marker of large cell carcinoma clinical signs (2) incidence.
Beta hCG
GYNECOMASTIA
GALACTORRHEA
10% incidence
Prognosis of bronchial carcinoid tumor?
and clinical sign.
Excellent
Carcinoid syndrome
What’s dextromethorphan?
Antitussive
Codein analog
Genes implicated in adenocarcinoma lung cancer (3)
KRAS
EGFR
ALK
Different H1 blockers and its uses .
2
Ine-ate Allergy, motion sickness, sleep aid.
Adine allergy NO SLEEP!!!
What is bosentam?and use?
Antogonist of endotheline receptor
Use in pulmonary hypertension
Principal indication of montelukast and zafirlukast?
Aspirin-induced asthma
What’s epoprostenol and iloprost?
side efect.
Prostacyclins PGI2
Vasodilator
❎Platelet aggregation
JAW PAIN FLUSHING
Use of omalizumab
Monoclonal anti-Ig E antibody
For asthma resistant to inhalants and corticoids
What’s zileuton? and efect?
5-lipoxygenase inhibitor
⬇️Leukotrienes
Action of methylxanthines ( theophylline)
Inhibition of phosphodiesterase
⬆️cAMP
❎Adenosine
What’s Hamartoma?
Coin lesion on CRX Pop corn calcification Hyaline cartilage Fat Smooth muscle
Use of methacholine and site of action
M3 agonist
Challenge test to asthma.
What is the mechanism implicated in the low effect after 3 consecutive days of using decongestants?
TACHYPHYLAXIS
negative feed backs of NE release
What cells secrete proteases in enphysema?(2)
Macrophages
Neutrophils
In a long-standing chronic obstructive pulmonary disease what is the principal contributor to respiratory drive vs normal patient?
longstanding DPOC. PaO2 carotid bodies CNXII
Healthy PaCO2 central chemoreceptors
Which vitamin deficiency is related with squamous metaplasia to a keratinizing epithelium?
Vit. A!!!!!!!!!
Phrenic nerve carries pain sensation from what kind of pleura?(2)
Diaphragmatic
Mediastinal
What pathway takes both left and right recurrent laryngeal nerves ?
Right loop under subclavian artery
Left loop under aortic have arch
What muscles are innervated by accessory nerve?
Sternocleidomastoid
Trapezius
Which procedure has to be done if there is an indication of intubation but there is an massive pharynx edema?
Cricothyrotomy
Trough Cricothyroid membrane
What is the final stage of sarcoidosis?
PULMONARY FIBROSIS!!!
NO hepatic cirrhosis
What are the last cell seen in smallest bronchi and respiratory bronchioles?
smallest bronchi GLANDS AND GLOBET CELLS
bronchioles terminal and respiratory: CILIATED SIMPLE CUBOIDAL CELLS
How is the chemical feature of sweet in cystic fibrosis ?
⬆️Cl
⬆️Na
⬆️Water
Sequence of pulmonary embolism damage(5)
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
High risk in the neonate after use of terbutaline as tocolityc? (4)
Intraventricular hemorraghe
Hypoglycemia
Hypocalcemia
Ileus
Other names for abnormal retinal vascularization after NRDS?(2)
Retinopathy of prematurity
Retrolental fibroplasia
Complications of surfactant treatment in neonates? (4)
Transient hypoxia
Hypotension
Blockage of an endotracheal tube
Pulmonary hemorrhage
What Leukotriene has a potent chemotactic activity?
LTB4!!!!!
Function of thromboxanes ? (2)
Vasoconstriction
Platelet aggregation
What are the function of LTC4, LTD4, LTE4?(2)
Bronchospasm
⬆️ bronchial mucus secretion
Functions of bradykinin ? (3)
Vasodilatation
⬆️Vascular permeability
Pain
Explain the relationship among Palv,Part,Pv in the 3 pulmonary zones.
ZONE 1 Palv>Part>Pv no flow (hypovolemic)
ZONE 2 Part>Palv>Pv flow intermitent
ZONE 3 Part>Pv>Palv flow continuos
Which anatomic structure lacks in cystic fibrosis?
VAS DEFERENTS MALE
Explain the effect in cystic fibrosis in the respiratory - gastric glands and in the sweet glands. in trems of Cl and Na concentration.
respiratory - gastric glands
⬇️CL secretion ⬆️Na absorption dehydrated mucus
sweet glands
⬆️CL secretion ⬇️ Na absorption hypercloride sweet
What’s the most common cause of superior vena cava syndrome?
Non-Hodgkin Lymphoma
What lung cancers are associated whit SMOKING!!!!!(2)
Squamous cell carcinoma
Small cell carcinoma
Principal clinical presentation of pancoast tumor (superior sulcus tumor) (2)
Shoulder pain
Horner’s syndrome
What are the risks of secondhand smoke exposure in children? (5)
Prematurity , low birth weight Sudden infant dead syndrome Middle ear disease Asthma Respiratory track infections
What is the clinical presentation of chronic rejection after lung transplant?
Obstructive pattern
BRONCHIOLITIS OBLITERANS
Fibrosis, scarring
Stages of sarcoidosis (4)
Stage I bilateral hilliar lymphadenopathy
Stage II PLUS pulmonary infiltrates in upper lobes
Stage III ONLY lungs infiltrates
Stage IV LUNG FIBROSIS
Histologic characteristic in cytomegalovirus infection
Owl’s eye inclusion in infected cells
Intranuclear inclusion surrounded by a clear halo
Where the vagus nerve innervated the ear?
Posterior part of the external auditory canal
What autoimmune disease is associated whit Pulmonary Arterial Hypertension???(2)
CREST!!!!
Systemic Sclerosis
Which nerve innervated the tympanic membrane?
CN V3
How the pulmonary vascular resistance change in the maximal expiration, maximal inspiration, and normal expiration?
Maximal expiration ⬆️⬆️ PVR
Maximal inspiration ⬆️⬆️ PVR
Normal expiration ⬇️⬇️ PVR
How bronchitis and emphysema cause hypoxia?
bronchitis decreasing diameter of conducting airways
emphysema Dilating alveolar space ⬇️contact whit capillaries
Where the thoracentesis have to be done in midclavicular, midaxilar,paravertebral lines?
midclavicular 6-8th ribs
midaxilar 8-10th ribs
paravertebral lines 10-12 th ribs
Which part of the Serratous anterior muscle facilitate the arm elevation?
The inferior part fiber to the last 3 ribs (1-8 ribs)
How are the relations of visceral and parietal pleura in the midclavicualr line , midaxilar line and paravertebral line ?
▪️. Visceral P. Parietal P.
🔹midclavicular 6th. 8th
🔹midaxilar 8th. 10th
🔹paravertebral 10th. 12th
Why the sputum from bacterial pneumonia is green?
MUPYELOPEROXIDASE!!!
produce hypochlorus acid
From chloride and hydrogen peroxide
The alpha-1 anti trypsin deficiency cause what type of pneumopathy?
OBSTRUCTIVE!!!!!!
PANACINAR EMPHISEMA!!!!!
How the patients whit pulmonary fibrosis and obstructive pneumopathy change its breathing in orther to minimize the breathing work?
Fibrosis ⬆️ respiratory rate
DPOC ⬇️ respiratory rate
In the restrictive disease there is a diminishing of all volumes less…
Reserve volume
What is Reid index?
Index of disease severety of obstructive pulmonary disease
Reid index = gland thickness/ wall thickness
Normal
What are the symptoms of theophylline intoxication?(3) and where is metabolized?
CNS ( tremor, insomnia, seizures )
Gastrointestinal (vomit , nausea)
Cardiac ( arrythmias )
Metabolized by liver
How is the air flow resistance along the bronchial tree?
Medium size bronchi> trachea > terminal bronchioles
What kind of markers have small cell carcinoma of the lung?
Neuroendocrine markers
Which cells have the clearance of particles lodge at up to terminal bronchioles and distal to terminal bronchioles?
Proximal to terminal bronchioles. CILIATED CELLS
distal to terminal bronchioles MACROPHAGES
Which kind of channels are impaired in cystic fibrosis?
ATP-gated Cl Pump
What are the principal and second risk of asbestosis?
BRONCHOGENIC CARCINOMA!!!!
mesothelioma
Which pulmonary segments are implied in aspiration pneumonia at supine position? (2)
Posterior segments of upper lobes
Superior segments of lower lobes
What cavitation of upper lobes means in TB?
SECUNDARY TUBERCULOSIS!!!! REACTIVATION
What is the fat embolism syndrome (4)
Pulmonary insuffiency
Diffuse neurological impairment
Thrombocytopenia
Anemia
What type of patients have negative skin tuberculine test After M. Tuberculosis exposure ?
Immunossuppresed patients
WEAK CELL MEDIATED IMMUNE RESPONSE
HIV sarcoidosis
Difference between chronic rejection of lung and kidney transplant?
LUNG bronchiolitis obliterans
KIDNEY vascular obliteration
Explain the cheyne-stokes,kussmaul breathing.
Cheyene-stokes apnea-crescendo-decrescendo-apnea
HCF, TCE, brain tumor , strokes
Kussmaul Apnea-deep breathing-apnea
Diabetic ketoacidosis
What are the function of club cells (Clara)
- Secrete club secretory protein ( protects against airway inflammation and oxidative stress)
- SURFACTANT
Terminal bronchioles
Principal side effects of theophylline? (2)
SEIZURES
TACHYARRYTHMIAS (⬆️ QT)
What is H. influenzae non-typable?
H. Influenzae whit out capsule
Responsible for 90% of HaEMOPhilus infection
It has no Vaccine
Are pulmonary adenocarcinomas in situ benigns?
NO!!!!!!
why in pulmonar fibrosis there is high flow expiration volume?
wide airways by high radial traction on airway walls
Which gas is block and what does not block in diffusion -limited equilibration at capillary-alveolar system ?
❎O2 cannot pass – cannot equilibrate
✅CO2 can pass– can equilibrate
Physiologic response to left shifting oxygen-hemoglobin dissociation curve?
ERYTROCYTOSIS!!!
How is the oygen-hemoglobin dissociation curve in sickle cell anemia?
SHIFTED TO THE RIGHT
Microscopic findings in ARDS?
Interstitial and intraalveolar edema
Fribrin deposition whit HYALINE MEMBRANES
Stages of Lobar pneumonia ?(4)
Congestion (24 hrs) bacteria in alveoli
Red hepatization (2-3 days) RBCs, Neutrophilis, fibrin
Gray hepatization(4-6 days) RBCs disintegrated
Resolution enzymatic digestion
Situations with elevated alveolar to arterial gradient (notmal 5-15)?(3)
Right-to-left shunt
Ventilatory/perfusion mismatch
Impaired diffusion
Drugs used in Cystic Fibrosis .(2)
Lumacaftor
Ivacaftor
arterial blood gases changes after acute salicylate intoxication?
FIRST respiatory alkalosis
SECOND metabolic acidosis
