RESPIRATORY Flashcards
0
Q
What the collapsing pressure formula?
A
Collapsing pressure (P) = 2 (surface tension)/ radius
1
Q
What is the most important lecithins in surfactant?
A
Dipamitoylphosphatidylcholine
2
Q
What lecithin/sphingomyelin ratio indicates fetal lung maturity?
A
Lecithin/sphingomyelin >2.0
3
Q
Relation pulmonary artery and it’s each bronchus RALS
A
Right anterior
Left superior
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
5
Q
Levels and structure which pass throughout diagram(3)
A
At T8: IVC At T10: esophagus, vagus (CN 10; 2 trunks) At T12: aorta (red), thoracic duct (white),a zigs vein(blue)
6
Q
Levels of Principal bifurcations (3)
A
Common carotid C4
Trachea T4
Abdominal aorta L4
7
Q
Physiologic dead space formula
A
VD = VT × (Paco2 – Peco2)/ Paco2
8
Q
Ecuation of alveolar ventilation
A
VA = (VT − VD) × RR
9
Q
Situations where there is a compliance change? (4-2)
A
⬇️in pulmonary fibrosis, pneumonia, pulmonary edema;
⬆️in emphysema, normal aging.
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
11
Q
Oxygen content formula
A
O2 content = (O2 binding capacity × % saturation) + dissolved O2.
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
13
Q
What is the O2 binding capacity?
A
O2 binding capacity ≈ 20.1 mL O2/dL.
14
Q
What’s the O2 delivery to tissues formula?
A
O2 delivery to tissues = cardiac output × O2 content of blood.
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:
A ⬇️ in emphysema.
T ⬆️ in pulmonary fibrosis
16
Q
What’s the pulmonary vascular resistance formula?
A
PVR = (Ppulm artery – PL atrium) / cardiac output
17
Q
What’s the alveolar gas equation ?
A
PAo2 = PIo2 – (Paco2/0.8)
18
Q
How the CO2 is transported from tissues to lungs?
A
HCO3− (90%).
Carbaminohemoglobin or HbCO2 (5%)
Dissolved CO2 (5%).
19
Q
What’s the Virchow triade?
A
Stasis
Hypercoagulability
Endothelial damage
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)
21
Q
Classic triad of fat emboli
A
Hypoxemia
Neurological abnormalities
Petechial rash
22
Q
What’s the spirometry hallmark of obstructive lung disease?
A
⬇️FEV1/FVC ratio
23
Q
Clinical diagnosis of chronic bronchitis? COPD
A
Productive cough for > 3 months per year (not necessarily consecutive) for > 2 years.
24
Two diferent types of emphysema
Centriacinar SMOKING
| Panacinar ALFA1-ANTITRIPSINA DEFICIT
25
Two important microscopic findings in asthma
Curschmann spirals ( epithelium/mucus plugs)
Charcot-Leyden crystals (eosinophils in sputum)
26
What's the spirometry hallmark for restrictive lung disease?
FEV1/FVC ratio ≥ 80%
27
What's Caplan syndrome?
rheumatoid arthritis and pneumoconioses with intrapulmonary nodules
28
What drugs cause restrictive lung disease?
Bleomycin
Busulfan
Amiodarone
Methotrexate
30
Efects of therapeutic supplemental O2 in NRDS?(3)
Retinopathy
Intraventricular hemorraghe
Bronchopulmonary dysplasia
30
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 .
31
What's is the relation of lecithin/sphingomyelin ratio in neonatal respiratory distress syndrome?
32
What's the principal risk factor to mesothelioma?
ASBESTOSIS!!!
33
What is the localization of Squamous and Small cell lung cancer?S
SENTRAL!!!
34
Four principal features of small cell carcinoma?
ACTH
SIADH
Lambert-Eaton myasthenic syndrome
Paraneoplasic encephalitis
myc oncogene
15% incidence
35
Most common cancer in non smokers?prognosis and histologic finding
Adenocarcinoma subtype Bronchioalveolar
Excellent prognosis
Thickening of alveolar wall
50% incidence
36
Principal features of Squamous cell carcinoma (3)
Cigarette
HyperCalcemia
Cavitation
25%incidence
38
```
Tumor marker of large cell carcinoma
clinical signs (2) incidence.
```
Beta hCG
GYNECOMASTIA
GALACTORRHEA
10% incidence
39
Prognosis of bronchial carcinoid tumor?
| and clinical sign.
Excellent
| Carcinoid syndrome
40
What's dextromethorphan?
Antitussive
| Codein analog
40
Genes implicated in adenocarcinoma lung cancer (3)
KRAS
EGFR
ALK
41
Different H1 blockers and its uses .
| 2
Ine-ate Allergy, motion sickness, sleep aid.
Adine allergy NO SLEEP!!!
43
What is bosentam?and use?
Antogonist of endotheline receptor
| Use in pulmonary hypertension
43
Principal indication of montelukast and zafirlukast?
Aspirin-induced asthma
44
What's epoprostenol and iloprost?
| side efect.
Prostacyclins PGI2
Vasodilator
❎Platelet aggregation
JAW PAIN FLUSHING
45
Use of omalizumab
Monoclonal anti-Ig E antibody
For asthma resistant to inhalants and corticoids
46
What's zileuton? and efect?
5-lipoxygenase inhibitor
| ⬇️Leukotrienes
47
Action of methylxanthines ( theophylline)
Inhibition of phosphodiesterase
⬆️cAMP
❎Adenosine
48
What's Hamartoma?
```
Coin lesion on CRX
Pop corn calcification
Hyaline cartilage
Fat
Smooth muscle
```
49
Use of methacholine and site of action
M3 agonist
| Challenge test to asthma.
50
What is the mechanism implicated in the low effect after 3 consecutive days of using decongestants?
TACHYPHYLAXIS
| negative feed backs of NE release
52
What cells secrete proteases in enphysema?(2)
Macrophages
| Neutrophils
53
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
54
Which vitamin deficiency is related with squamous metaplasia to a keratinizing epithelium?
Vit. A!!!!!!!!!
54
Phrenic nerve carries pain sensation from what kind of pleura?(2)
Diaphragmatic
| Mediastinal
55
What pathway takes both left and right recurrent laryngeal nerves ?
Right loop under subclavian artery
| Left loop under aortic have arch
56
What muscles are innervated by accessory nerve?
Sternocleidomastoid
| Trapezius
57
Which procedure has to be done if there is an indication of intubation but there is an massive pharynx edema?
Cricothyrotomy
Trough Cricothyroid membrane
58
What is the final stage of sarcoidosis?
PULMONARY FIBROSIS!!!
NO hepatic cirrhosis
59
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
60
How is the chemical feature of sweet in cystic fibrosis ?
⬆️Cl
⬆️Na
⬆️Water
61
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
```
62
High risk in the neonate after use of terbutaline as tocolityc? (4)
Intraventricular hemorraghe
Hypoglycemia
Hypocalcemia
Ileus
63
Other names for abnormal retinal vascularization after NRDS?(2)
Retinopathy of prematurity
| Retrolental fibroplasia
64
Complications of surfactant treatment in neonates? (4)
Transient hypoxia
Hypotension
Blockage of an endotracheal tube
Pulmonary hemorrhage
65
What Leukotriene has a potent chemotactic activity?
LTB4!!!!!
67
Function of thromboxanes ? (2)
Vasoconstriction
| Platelet aggregation
67
What are the function of LTC4, LTD4, LTE4?(2)
Bronchospasm
| ⬆️ bronchial mucus secretion
68
Functions of bradykinin ? (3)
Vasodilatation
⬆️Vascular permeability
Pain
69
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
71
Which anatomic structure lacks in cystic fibrosis?
VAS DEFERENTS MALE
72
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
72
What's the most common cause of superior vena cava syndrome?
Non-Hodgkin Lymphoma
73
What lung cancers are associated whit SMOKING!!!!!(2)
Squamous cell carcinoma
| Small cell carcinoma
75
Principal clinical presentation of pancoast tumor (superior sulcus tumor) (2)
Shoulder pain
| Horner's syndrome
76
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
```
76
What is the clinical presentation of chronic rejection after lung transplant?
Obstructive pattern
BRONCHIOLITIS OBLITERANS
Fibrosis, scarring
77
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
78
Histologic characteristic in cytomegalovirus infection
Owl's eye inclusion in infected cells
| Intranuclear inclusion surrounded by a clear halo
79
Where the vagus nerve innervated the ear?
Posterior part of the external auditory canal
80
What autoimmune disease is associated whit Pulmonary Arterial Hypertension???(2)
CREST!!!!
| Systemic Sclerosis
81
Which nerve innervated the tympanic membrane?
CN V3
82
How the pulmonary vascular resistance change in the maximal expiration, maximal inspiration, and normal expiration?
Maximal expiration ⬆️⬆️ PVR
Maximal inspiration ⬆️⬆️ PVR
Normal expiration ⬇️⬇️ PVR
83
How bronchitis and emphysema cause hypoxia?
bronchitis decreasing diameter of conducting airways
| emphysema Dilating alveolar space ⬇️contact whit capillaries
85
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
85
Which part of the Serratous anterior muscle facilitate the arm elevation?
The inferior part fiber to the last 3 ribs (1-8 ribs)
86
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
87
Why the sputum from bacterial pneumonia is green?
MUPYELOPEROXIDASE!!!
produce hypochlorus acid
From chloride and hydrogen peroxide
88
The alpha-1 anti trypsin deficiency cause what type of pneumopathy?
OBSTRUCTIVE!!!!!!
PANACINAR EMPHISEMA!!!!!
90
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
91
In the restrictive disease there is a diminishing of all volumes less...
Reserve volume
91
What is Reid index?
Index of disease severety of obstructive pulmonary disease
Reid index = gland thickness/ wall thickness
Normal
92
What are the symptoms of theophylline intoxication?(3) and where is metabolized?
CNS ( tremor, insomnia, seizures )
Gastrointestinal (vomit , nausea)
Cardiac ( arrythmias )
Metabolized by liver
93
How is the air flow resistance along the bronchial tree?
Medium size bronchi> trachea > terminal bronchioles
94
What kind of markers have small cell carcinoma of the lung?
Neuroendocrine markers
95
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
96
Which kind of channels are impaired in cystic fibrosis?
ATP-gated Cl Pump
97
What are the principal and second risk of asbestosis?
BRONCHOGENIC CARCINOMA!!!!
mesothelioma
98
Which pulmonary segments are implied in aspiration pneumonia at supine position? (2)
Posterior segments of upper lobes
Superior segments of lower lobes
99
What cavitation of upper lobes means in TB?
SECUNDARY TUBERCULOSIS!!!! REACTIVATION
100
What is the fat embolism syndrome (4)
Pulmonary insuffiency
Diffuse neurological impairment
Thrombocytopenia
Anemia
101
What type of patients have negative skin tuberculine test After M. Tuberculosis exposure ?
Immunossuppresed patients
WEAK CELL MEDIATED IMMUNE RESPONSE
HIV sarcoidosis
102
Difference between chronic rejection of lung and kidney transplant?
LUNG bronchiolitis obliterans
| KIDNEY vascular obliteration
103
Explain the cheyne-stokes,kussmaul breathing.
Cheyene-stokes apnea-crescendo-decrescendo-apnea
HCF, TCE, brain tumor , strokes
Kussmaul Apnea-deep breathing-apnea
Diabetic ketoacidosis
104
What are the function of club cells (Clara)
1. Secrete club secretory protein ( protects against airway inflammation and oxidative stress)
2. SURFACTANT
Terminal bronchioles
105
Principal side effects of theophylline? (2)
SEIZURES
| TACHYARRYTHMIAS (⬆️ QT)
106
What is H. influenzae non-typable?
H. Influenzae whit out capsule
Responsible for 90% of HaEMOPhilus infection
It has no Vaccine
107
Are pulmonary adenocarcinomas in situ benigns?
NO!!!!!!
108
why in pulmonar fibrosis there is high flow expiration volume?
wide airways by high radial traction on airway walls
109
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
110
Physiologic response to left shifting oxygen-hemoglobin dissociation curve?
ERYTROCYTOSIS!!!
111
How is the oygen-hemoglobin dissociation curve in sickle cell anemia?
SHIFTED TO THE RIGHT
112
Microscopic findings in ARDS?
Interstitial and intraalveolar edema
| Fribrin deposition whit HYALINE MEMBRANES
113
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
114
Situations with elevated alveolar to arterial gradient (notmal 5-15)?(3)
Right-to-left shunt
Ventilatory/perfusion mismatch
Impaired diffusion
115
Drugs used in Cystic Fibrosis .(2)
Lumacaftor
| Ivacaftor
117
arterial blood gases changes after acute salicylate intoxication?
FIRST respiatory alkalosis
SECOND metabolic acidosis
