respiratory Flashcards
1
Q
a cause of pulmonary hypoplasia
A
diaphragmatic hernia (usually left sided)
2
Q
bronchogenic cysts
A
abnormal budding of the foregut and dilation of terminal or large bronchi.
fluid filled cysts (air filled if infected), asymptomatic, but can drain poorly causing airway compression or infection.
3
Q
3 fxns of club cells
A
some surfactant, degrade toxins, act as reserve cells
4
Q
when does surfactant making being and when is it enough?
A
week 26 and week 35
5
Q
complications of neonatal respiratory distress syndrome
A
PDAm necrotizing enterocolitis
6
Q
what damage can theurapetuic o2 cause in neonatal rds
A
RIB
retinopathy, intraventricular hemmorage, bronchopulmonary dysplasia
7
Q
what airway section has least resistance?
A
terminal bronchioles
8
Q
order of conductin and respiratory zone
A
trachea -> bronchi -> bronchioles -> terminal bronchioles -> respiratory bronchioles -> alveolar sacs
9
Q
where does cartilage and goblet cells end?
A
and the end of the bronchi
10
Q
what is the predominate cell type at the start of the trachea, where and what does it transition too?
A
pseudostratified cilia, transitions at terminal bronchioles to simple cuboidal,
11
Q
ending of airway smooth muscle
A
terminal bronchioles
12
Q
where does cilia terminate?
A
respiratory bronchioles
13
Q
transition from cuboidal to simple squamous?
A
respiratory bronchioles
14
Q
relation of pulmonary artery to bronchi
A
RALS
right anterior, left superior
15
Q
where is carina?
A
posterior to ascending aorta and anteromedial to desceding aorta
16
Q
aspiration while sitting
A
posterobasil segment, right lower lobe
17
Q
supine
A
superior segment of the right lower lobe
18
Q
right sided position
A
right middle lobe or posterior segment of right upper lobe
19
Q
where does ivc penetrate?
A
t8
20
Q
where does esophagus penetrate?
A
t10
21
Q
where does aorta penetrate?
A
t12
22
Q
azygos vein penetration?
A
with aorta
23
Q
thoracic duct penetration?
A
with aorta
24
Q
what does phrenic nerve penetrate with?
A
ive
25
refered phrenic nerve pain
c5 shoulder or c3 c4 trapezius rdige
26
carotid bifurcation
c4
27
tracheal bifurcation
t4
28
abdomical aorta bifurcation
l4
29
define elsatic recoil
tendency of lungs to collapse inward and the chest wall to collapse outward
30
explain frc
at frc airway and alveoli pressure is 0 and intrapleural pressure is negative to keep the alveoli open.
Pulmonary vascular resistance (PVR) is at a minimum
31
situations of high compliace
empysema and normal aging
32
situations of decreased compliance
pulomnary fibrosis, pneumonia, NRDSm pulmonary edema.
33
what increases comliance?
surfactant
34
something that shifts the bohr curve
cl
35
fetal hemoglobin and 23 bpg
increased affinity for o2 due to decreased binding with 23 bpg
36
two causes of methemoglobinemia
nitrites from dietary intake or polluted/high water sources and benzocaine
37
methemoglobinemia presentation
cyanosis and chocalate colored blood
38
how does CO bind to Hb
competitively with 200x affinity
39
co poisoning clincal features
headaches, dizziness, cherry red skin
40
left shift of bohr
renal hypoxia and EPO
41
o2 content of blood equation
o2 content = (1.34 x hb x sa02) + (.003 x pa02)
42
how much can one gram of hb bind?
1.34 ml of 02
43
normal hemoglobin total in blood?
15g/dl
44
total o2 binding capactity
15g/dl * 1.34 ml o2/1g hb = 20.1 ml o2/dl
45
o2 delivery to tissues
CO x o2 content of blood
46
perfusion vs diffusion limited
perfusion limited Pa and PA become equal
47
perfusion limited gases
o2 (normal health), co2, n20
48
diffusion limited gases
CO and o2 in (emphysema or fibrosis)
49
alvolar gas diffusion equation
v gas = a x dk x p1-p2/t
t increased in fibrosis and a decrease in emphysema
50
resistance equation
r = 8nl/pieR rasied to 4th
51
causes of hypoxia
decreased CO
hypoxemia
anemia
co poisoning
52
what is CO bound to hemoglobin called?
carboxyhemoglobin
53
what is co2 bound to hemoglobin called?
carbaminohemoglobin
54
what promotes hb to let go of o2?
co2 in tissues
55
what does o2 due to hemoglobin in the lung?
causes it to release H+ and therefore promotes reformation of co2 (haldane effect)
56
response to high altitude
increased ventilation because decreased pa02 which causes respitatory alkalosis
chronic increased in ventilation
in chronic, get increased in hematocrit
increased 23 bpg
increased mitochondria
increased renal excretion of bicarb
chronic vasocontriction pulmonary hypertension and RVH
57
what causes rhinosinusitis and clinical feature?
obstruction of nasal drainage, pain over affected area
58
which sinus often involved in rhinosinusitis and where does it drain?
maxillary sinus and empties into middle meatus
59
most common causes of rhinosinusitis?
viral uri, may cause superimposed bacterial infection by strep pneumo, h influenza, m catarrhalis
60
epistaxis most commonly from where?
anterior segment of nostril (kiesselbach plexus)
61
where does a life thretaening epistaxis occur form?
spehnopalatine artery, a branch of the maxially artery
62
comon casues of epistaxis?
foreign body, trauma, allergic rhinits, and nasal angiofibromas
63
head and neck cancer common type
squamous cell carcinoma
64
head and neck cancer risk factors
hpv 16 (oropharyngeal), EBV nasophareyngeal. field cancerization -> indenedeptnly developing multiple cancers
65
what could predispose for a dvt?
virchow triad
including stasis, endothelial damage, or hypercoagulable state (factor v leiden mutation)
66
how are d dimers good in dvt
sensitive but not specfifc, rule out
67
acute treatment of dvt
heparin or lmw heparin
treatment and prophylaxis
68
long term prevention of dvt
oral anticoags wargard or rivaroxaban exaples
69
imaging test for dvt?
doppler ultrasound
70
purpose of lines of zahn?
help distinguish pre morterm from post mortem clots
71
fat emboli
assoicated with long bone fractures and liposuction.
classic triad (petechial rash, neurologic abnormalities, hypoxemia)
72
amniotic fluid embolus
can lead to dic post partum
73
air emboli
nitrogen from diving and quick ascension -> treat with hyperbaric o2
also iatrogenic from invasive procedures
74
copd auscultory findings and one effect
wheezes and crackles, 2nd polycythemia
75
atsthma ascultory findings
wheezing and decreased inspiratory to expiratory ratio
76
asthma feature found lower down?
mucous plugging
77
asthma triggers
viral and stress
78
histologic findings of asthma
smooth muscle hypertrophy and hyperplasia
curschmann spirals -> shed epithelium
charcot leyden crystals -> breakdown of eosinophils in sputum
79
bronchiectasis clinical findings
purulent sputum, reccurent infections, hemoptysis, digital clubbing
80
restrictive extrapulmonary poor muscular effort
polio, MG, guillan barre
81
restrictive extrapulmonary appratus problems
scoliosi and morbid obesit
82
idiopathic pulmonary fibrosis features
repated lung injury and healing with increased collagen
honey comb lung appearence and clubbing
83
a restrictive disease you didnt think was restrictive
wegner
84
drug toxicities causing restrive patterns
bleomycin, busulfan, amirodarone, methotrexate
85
hypersensitivey pneumonitis immunology
III/IV
86
hypersensitivey pneumonitis clinical features
dyspnea, cough, chest tightness, headache. seen in farmers and bird keepers. reversible in early stage if stimulus avoided.
87
inhalation injury and sequelae
pulmoaary complication associated with smoke and fire
caused by heat, particlulates, or irritants (NH3).
causes tracheobronchitis, edema, pneumonia, ards.
usually presents second to co inhalation, cyanide poisoning, or arsenic poisoning
beonchoscopy shows edema congestion of bronchus and soot deposition
88
pneumoconiosis with increased risk of cancer, cor pulmonale, caplan syndrome.
CWP, silicosis, and asbestosis (all but berrylisosi)
89
what is caplan syndrome?
rheumatoid arthritis, penumoconisosi, with intrapulmonary nodules
90
asbestosis affect where?
from the roof (insulation) but affects the base
91
silica and coal affect where?
from the earth but affect the upper part
92
asbestosis is associated with?
shipbuilding, roofing, plumbing
93
how to stain asbestosis (ferruginous bodies)?
prussian blue
94
asbestosis has increased risk of?
pleural effusion
95
berrylysosis associated with?
aerospace and manufacturing industry
96
findings histology berrylyosis
noncaseating granulomas
97
berrylysosis affects?
upper lobes
98
silicosis associated with?
foundries, sandblasting, mines
99
silicosis pathology
macs respond to silica and release fibrogenic factors, leading to fibrosis
100
silicosis increase risk for?
TB
may be because disrupts phagolysoome
101
silicosis findings on CXR
egg shell calcifications of hilar lymphnodes
102
mesothelioma can result in?
hemmorhagic plueral effusion (exudative) or pleural thickening
103
is smoking a risk factor for mesthelioma?
no
104
histology of mesothelioma
cytokeratin and calretinin + ... these are - in carcinomas
105
causes of ARDS
sepsis, pancreatitis, pneumonia, aspiration, trauma, shock
106
term for damage in ards
diffuse alveolar damage
107
management of ards
mechanical ventilation at low volumes
108
defintion of sleep apnea
repeated cessation of breathing during sleep -> disrupted sleep -> daytime somnolence
normal pa02 during day
nocturnal hypoxia -> systemic/pulmonary hypertension, arrythmias (atrial fib/flutter), sudden death
hypoxia -> epo -> erythropoesis
109
obstructive sleep apnea common feature
respiartory effort agaisnt airway obstruction
110
obstructive sleep apnea associated with
obesity, loud snoring,
111
obstructive sleep apnea caused by
excess oropharyngeal tissue in adults, adenotonsillar hypertrophy in kids
112
obstructive sleep apnea treatment
weight loss, cpap, surgery
113
central sleep apnea cause
cna injry/toxicity, hf, opiods
114
obstructive sleep apnea associated wiht?
cheynne stroke
115
obstructive sleep apnea treat
positive pressure
116
obestiy hypoventialtion syndrome
obesity greater than BMI > 30 kg/m2 during sleep. also known as pickwickian syndrome
hypoventilation -> increased paco2 during waking hours (retention); pa02 decreased and pac02 increased duing sleep..
117
normal pulpmary pressure and high
MAPAP 10 14 and high is greater than or equal to 25
118
findings histology of PAH
arterioslcerosis, medial hypertrophy, intimal fibrosis and plexiform lesions
119
pulmonary arterial hypertension course
sever respiratory death -> cyanosis and RVH -> death from decompensated cor pulmonale
120
PAH causes
idiopathic PAH
heritable PAH - due to inactivating mutation of BMPR2 gene that inhibits smooth vascular muscle proliferation
121
pleural effusion exam findings
decreased breath sounds, dullness to percussion, decreased tactile fremitus, trachea away from side of lesion if large
122
atelectasis (bronchial obstruction) exam findings
decreased breath sounds, dullness to percussion, dcreased tatile fremitus, toward side of lesion
123
simple pneumothorax exam findings
decreased breath sounds, hyperessonace to percussion, decreaed fremitus - or toward the side of lesion trachea
124
tension pneumothorax exam findings
decreased breath sounds, hyerpressonance to percussion, decreased tactile fremitus, away from lession (trachea)
125
consolidatoin (lobar pneumonia, pulomnary edema) exam findings
bronchial breath sounds, late inspiratory crackles, egophony, bronchophony, whispered pectorilquoy
dull to percussion, increasion tactile fremitus
trachea not devaited
126
pleural effusion causes
restricted lung movement
127
treat pleural effusion with
thoracocentesis
128
transudate effusion
decreased protein content. due to increased hydrostatic pressure (eg heart failure), or decreased oncotic pressure (cirrhosis nephrotic syndrome)
129
exudate effusion
increased protein, cloudy. due to malignancy, pneumonia, truama (occurs in states of increased vascular permeability).
has to be drained to risk of infection.
130
lymphatic effusion
also known as chylothorax. thoracic duct injury from trauma or malignancy. Milky appearing fluid; increased triglycerides.
131
pneumothorax clincal findings
dyspnea, uneven chest expansion
132
causes 2nd spontaneous pneumothorax
diseased lung (bullae in emphysema, infections), mechanical ventilation with use of high pressures -> baotrauma
133
two examples of traumatic pneumothorax
blunt (rib fracture) or penetrating (gunshot)
134
cryptogenic organizing pneumonia
formerly known as bronchiolitis obliterans organzing penumonia (boop).
noninfection pneumonia - inflammation of bronchioles and surround structures
unkown etiology
chronic inflmmatory states (eg rheumatoid arthritis)
or medication side effect (amiodarane)
135
lobar pneumonia bugs
s pneumonia most often, also legionella, klebsiella
136
lobar pneumonia charac
intralveaolar exudate -> consolidation
| can involve entire lobe or lung
137
bronchopneumoni bugs
s pneumonia
staph aureus (secondary) often causes abscess or empyema.
h influ (2nd and copd exacerbation)
klecsiella.
138
interstitial (atypical pneumonia)
mycoplasma
c penumonia
legionella
viruses (rsv - atypical pneumonia in infants, cmv - post lung transplant, influenza in eldery and immunocompromised or preexisting lung disease, adenovirus)
139
congestion
1-2 days
red heavy boggy
vascular dilation
alveolar exudate w/ bacteria
140
red hepatization
3 4 days
red firm love (liver like)
exudate with erythrocytes, neutrophils, fibrin
141
gray hepatization
5 7 days
rbcs disintegrate
exudate with neutrophils
fibrin
142
lung abscess one additional casues and bugs
bacteroides, fusobacterium, peptostreptoccous s aureus
can be from bronchial obstruction ( cancer)
143
svc syndrome clinical features
facial plethora
blanching
144
svc syndrome additonal causes
thrombosis
145
svc syndrome complications
can raise intracranial pressure if severe -> headaches, dizziness, increase risk intracranial artery rupture or aneuryms
146
lung cancer lung finding
wheezes
147
mets of lung cancer
adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly)
148
mets to the lung
breast, colon, prostate, bladder cancer
149
lung cancer complications
recurrent laryngeal nerve
effusions (pericardial, pleural)
150
risk factors for lung cancer
smoking, second hand smoke, radon, asbestos, family history
151
small cell paraneoplastic
neurons (paraneoplastic myelitis, encephalitis, subactue cerebellar degeneration)
152
small cell gene mutation
amplificatoin of myc oncogene
153
small cell cytology
stains for chromogranin a, neuron specific enolase, neural cell adhesion molecule (ncam, cd56), synaptophysin, neurofilaments
can look like large lymphocytes. small round blue cells
154
adenocarcinoma genes
activating mutations of kras, egfr, alk.
155
adenocarcinoma associated with
hypertrophic osteoarthopathy (clubbing)
156
adenocarcinoma pattern
glandular pattern on histology, often stains mucin +
157
squamous cell carcinoma one fact
hilar mass
158
large cell smoking association
LARGE (strong)
159
large cell cytology
pleomorphic giant cell
160
carcinoid of lung prognosis
excellent prognosis,
161
cytology carcinoid
nest of neuroendocrine cells. chromogranin a
salt and pepper
