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Pharmacology > respiratory > Flashcards

respiratory Flashcards

1
Q

a cause of pulmonary hypoplasia

A

diaphragmatic hernia (usually left sided)

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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.

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3
Q

3 fxns of club cells

A

some surfactant, degrade toxins, act as reserve cells

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4
Q

when does surfactant making being and when is it enough?

A

week 26 and week 35

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5
Q

complications of neonatal respiratory distress syndrome

A

PDAm necrotizing enterocolitis

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6
Q

what damage can theurapetuic o2 cause in neonatal rds

A

RIB

retinopathy, intraventricular hemmorage, bronchopulmonary dysplasia

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7
Q

what airway section has least resistance?

A

terminal bronchioles

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8
Q

order of conductin and respiratory zone

A

trachea -> bronchi -> bronchioles -> terminal bronchioles -> respiratory bronchioles -> alveolar sacs

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9
Q

where does cartilage and goblet cells end?

A

and the end of the bronchi

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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,

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11
Q

ending of airway smooth muscle

A

terminal bronchioles

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12
Q

where does cilia terminate?

A

respiratory bronchioles

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13
Q

transition from cuboidal to simple squamous?

A

respiratory bronchioles

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14
Q

relation of pulmonary artery to bronchi

A

RALS

right anterior, left superior

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15
Q

where is carina?

A

posterior to ascending aorta and anteromedial to desceding aorta

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16
Q

aspiration while sitting

A

posterobasil segment, right lower lobe

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17
Q

supine

A

superior segment of the right lower lobe

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18
Q

right sided position

A

right middle lobe or posterior segment of right upper lobe

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19
Q

where does ivc penetrate?

A

t8

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20
Q

where does esophagus penetrate?

A

t10

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21
Q

where does aorta penetrate?

A

t12

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22
Q

azygos vein penetration?

A

with aorta

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23
Q

thoracic duct penetration?

A

with aorta

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24
Q

what does phrenic nerve penetrate with?

A

ive

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25
Q

refered phrenic nerve pain

A

c5 shoulder or c3 c4 trapezius rdige

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26
Q

carotid bifurcation

A

c4

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27
Q

tracheal bifurcation

A

t4

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28
Q

abdomical aorta bifurcation

A

l4

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29
Q

define elsatic recoil

A

tendency of lungs to collapse inward and the chest wall to collapse outward

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30
Q

explain frc

A

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

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31
Q

situations of high compliace

A

empysema and normal aging

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32
Q

situations of decreased compliance

A

pulomnary fibrosis, pneumonia, NRDSm pulmonary edema.

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33
Q

what increases comliance?

A

surfactant

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34
Q

something that shifts the bohr curve

A

cl

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35
Q

fetal hemoglobin and 23 bpg

A

increased affinity for o2 due to decreased binding with 23 bpg

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36
Q

two causes of methemoglobinemia

A

nitrites from dietary intake or polluted/high water sources and benzocaine

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37
Q

methemoglobinemia presentation

A

cyanosis and chocalate colored blood

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38
Q

how does CO bind to Hb

A

competitively with 200x affinity

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39
Q

co poisoning clincal features

A

headaches, dizziness, cherry red skin

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40
Q

left shift of bohr

A

renal hypoxia and EPO

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41
Q

o2 content of blood equation

A

o2 content = (1.34 x hb x sa02) + (.003 x pa02)

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42
Q

how much can one gram of hb bind?

A

1.34 ml of 02

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43
Q

normal hemoglobin total in blood?

A

15g/dl

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44
Q

total o2 binding capactity

A

15g/dl * 1.34 ml o2/1g hb = 20.1 ml o2/dl

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45
Q

o2 delivery to tissues

A

CO x o2 content of blood

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46
Q

perfusion vs diffusion limited

A

perfusion limited Pa and PA become equal

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47
Q

perfusion limited gases

A

o2 (normal health), co2, n20

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48
Q

diffusion limited gases

A

CO and o2 in (emphysema or fibrosis)

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49
Q

alvolar gas diffusion equation

A

v gas = a x dk x p1-p2/t

t increased in fibrosis and a decrease in emphysema

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50
Q

resistance equation

A

r = 8nl/pieR rasied to 4th

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51
Q

causes of hypoxia

A

decreased CO
hypoxemia
anemia
co poisoning

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52
Q

what is CO bound to hemoglobin called?

A

carboxyhemoglobin

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53
Q

what is co2 bound to hemoglobin called?

A

carbaminohemoglobin

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54
Q

what promotes hb to let go of o2?

A

co2 in tissues

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55
Q

what does o2 due to hemoglobin in the lung?

A

causes it to release H+ and therefore promotes reformation of co2 (haldane effect)

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56
Q

response to high altitude

A

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

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57
Q

what causes rhinosinusitis and clinical feature?

A

obstruction of nasal drainage, pain over affected area

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58
Q

which sinus often involved in rhinosinusitis and where does it drain?

A

maxillary sinus and empties into middle meatus

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59
Q

most common causes of rhinosinusitis?

A

viral uri, may cause superimposed bacterial infection by strep pneumo, h influenza, m catarrhalis

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60
Q

epistaxis most commonly from where?

A

anterior segment of nostril (kiesselbach plexus)

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61
Q

where does a life thretaening epistaxis occur form?

A

spehnopalatine artery, a branch of the maxially artery

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62
Q

comon casues of epistaxis?

A

foreign body, trauma, allergic rhinits, and nasal angiofibromas

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63
Q

head and neck cancer common type

A

squamous cell carcinoma

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64
Q

head and neck cancer risk factors

A

hpv 16 (oropharyngeal), EBV nasophareyngeal. field cancerization -> indenedeptnly developing multiple cancers

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65
Q

what could predispose for a dvt?

A

virchow triad

including stasis, endothelial damage, or hypercoagulable state (factor v leiden mutation)

66
Q

how are d dimers good in dvt

A

sensitive but not specfifc, rule out

67
Q

acute treatment of dvt

A

heparin or lmw heparin

treatment and prophylaxis

68
Q

long term prevention of dvt

A

oral anticoags wargard or rivaroxaban exaples

69
Q

imaging test for dvt?

A

doppler ultrasound

70
Q

purpose of lines of zahn?

A

help distinguish pre morterm from post mortem clots

71
Q

fat emboli

A

assoicated with long bone fractures and liposuction.

classic triad (petechial rash, neurologic abnormalities, hypoxemia)

72
Q

amniotic fluid embolus

A

can lead to dic post partum

73
Q

air emboli

A

nitrogen from diving and quick ascension -> treat with hyperbaric o2

also iatrogenic from invasive procedures

74
Q

copd auscultory findings and one effect

A

wheezes and crackles, 2nd polycythemia

75
Q

atsthma ascultory findings

A

wheezing and decreased inspiratory to expiratory ratio

76
Q

asthma feature found lower down?

A

mucous plugging

77
Q

asthma triggers

A

viral and stress

78
Q

histologic findings of asthma

A

smooth muscle hypertrophy and hyperplasia

curschmann spirals -> shed epithelium

charcot leyden crystals -> breakdown of eosinophils in sputum

79
Q

bronchiectasis clinical findings

A

purulent sputum, reccurent infections, hemoptysis, digital clubbing

80
Q

restrictive extrapulmonary poor muscular effort

A

polio, MG, guillan barre

81
Q

restrictive extrapulmonary appratus problems

A

scoliosi and morbid obesit

82
Q

idiopathic pulmonary fibrosis features

A

repated lung injury and healing with increased collagen

honey comb lung appearence and clubbing

83
Q

a restrictive disease you didnt think was restrictive

84
Q

drug toxicities causing restrive patterns

A

bleomycin, busulfan, amirodarone, methotrexate

85
Q

hypersensitivey pneumonitis immunology

86
Q

hypersensitivey pneumonitis clinical features

A

dyspnea, cough, chest tightness, headache. seen in farmers and bird keepers. reversible in early stage if stimulus avoided.

87
Q

inhalation injury and sequelae

A

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
Q

pneumoconiosis with increased risk of cancer, cor pulmonale, caplan syndrome.

A

CWP, silicosis, and asbestosis (all but berrylisosi)

89
Q

what is caplan syndrome?

A

rheumatoid arthritis, penumoconisosi, with intrapulmonary nodules

90
Q

asbestosis affect where?

A

from the roof (insulation) but affects the base

91
Q

silica and coal affect where?

A

from the earth but affect the upper part

92
Q

asbestosis is associated with?

A

shipbuilding, roofing, plumbing

93
Q

how to stain asbestosis (ferruginous bodies)?

A

prussian blue

94
Q

asbestosis has increased risk of?

A

pleural effusion

95
Q

berrylysosis associated with?

A

aerospace and manufacturing industry

96
Q

findings histology berrylyosis

A

noncaseating granulomas

97
Q

berrylysosis affects?

A

upper lobes

98
Q

silicosis associated with?

A

foundries, sandblasting, mines

99
Q

silicosis pathology

A

macs respond to silica and release fibrogenic factors, leading to fibrosis

100
Q

silicosis increase risk for?

A

TB

may be because disrupts phagolysoome

101
Q

silicosis findings on CXR

A

egg shell calcifications of hilar lymphnodes

102
Q

mesothelioma can result in?

A

hemmorhagic plueral effusion (exudative) or pleural thickening

103
Q

is smoking a risk factor for mesthelioma?

104
Q

histology of mesothelioma

A

cytokeratin and calretinin + … these are - in carcinomas

105
Q

causes of ARDS

A

sepsis, pancreatitis, pneumonia, aspiration, trauma, shock

106
Q

term for damage in ards

A

diffuse alveolar damage

107
Q

management of ards

A

mechanical ventilation at low volumes

108
Q

defintion of sleep apnea

A

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
Q

obstructive sleep apnea common feature

A

respiartory effort agaisnt airway obstruction

110
Q

obstructive sleep apnea associated with

A

obesity, loud snoring,

111
Q

obstructive sleep apnea caused by

A

excess oropharyngeal tissue in adults, adenotonsillar hypertrophy in kids

112
Q

obstructive sleep apnea treatment

A

weight loss, cpap, surgery

113
Q

central sleep apnea cause

A

cna injry/toxicity, hf, opiods

114
Q

obstructive sleep apnea associated wiht?

A

cheynne stroke

115
Q

obstructive sleep apnea treat

A

positive pressure

116
Q

obestiy hypoventialtion syndrome

A

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
Q

normal pulpmary pressure and high

A

MAPAP 10 14 and high is greater than or equal to 25

118
Q

findings histology of PAH

A

arterioslcerosis, medial hypertrophy, intimal fibrosis and plexiform lesions

119
Q

pulmonary arterial hypertension course

A

sever respiratory death -> cyanosis and RVH -> death from decompensated cor pulmonale

120
Q

PAH causes

A

idiopathic PAH

heritable PAH - due to inactivating mutation of BMPR2 gene that inhibits smooth vascular muscle proliferation

121
Q

pleural effusion exam findings

A

decreased breath sounds, dullness to percussion, decreased tactile fremitus, trachea away from side of lesion if large

122
Q

atelectasis (bronchial obstruction) exam findings

A

decreased breath sounds, dullness to percussion, dcreased tatile fremitus, toward side of lesion

123
Q

simple pneumothorax exam findings

A

decreased breath sounds, hyperessonace to percussion, decreaed fremitus - or toward the side of lesion trachea

124
Q

tension pneumothorax exam findings

A

decreased breath sounds, hyerpressonance to percussion, decreased tactile fremitus, away from lession (trachea)

125
Q

consolidatoin (lobar pneumonia, pulomnary edema) exam findings

A

bronchial breath sounds, late inspiratory crackles, egophony, bronchophony, whispered pectorilquoy

dull to percussion, increasion tactile fremitus

trachea not devaited

126
Q

pleural effusion causes

A

restricted lung movement

127
Q

treat pleural effusion with

A

thoracocentesis

128
Q

transudate effusion

A

decreased protein content. due to increased hydrostatic pressure (eg heart failure), or decreased oncotic pressure (cirrhosis nephrotic syndrome)

129
Q

exudate effusion

A

increased protein, cloudy. due to malignancy, pneumonia, truama (occurs in states of increased vascular permeability).

has to be drained to risk of infection.

130
Q

lymphatic effusion

A

also known as chylothorax. thoracic duct injury from trauma or malignancy. Milky appearing fluid; increased triglycerides.

131
Q

pneumothorax clincal findings

A

dyspnea, uneven chest expansion

132
Q

causes 2nd spontaneous pneumothorax

A

diseased lung (bullae in emphysema, infections), mechanical ventilation with use of high pressures -> baotrauma

133
Q

two examples of traumatic pneumothorax

A

blunt (rib fracture) or penetrating (gunshot)

134
Q

cryptogenic organizing pneumonia

A

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
Q

lobar pneumonia bugs

A

s pneumonia most often, also legionella, klebsiella

136
Q

lobar pneumonia charac

A

intralveaolar exudate -> consolidation

can involve entire lobe or lung

137
Q

bronchopneumoni bugs

A

s pneumonia

staph aureus (secondary) often causes abscess or empyema.

h influ (2nd and copd exacerbation)

klecsiella.

138
Q

interstitial (atypical pneumonia)

A

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
Q

congestion

A

1-2 days

red heavy boggy

vascular dilation
alveolar exudate w/ bacteria

140
Q

red hepatization

A

3 4 days

red firm love (liver like)

exudate with erythrocytes, neutrophils, fibrin

141
Q

gray hepatization

A

5 7 days

rbcs disintegrate

exudate with neutrophils
fibrin

142
Q

lung abscess one additional casues and bugs

A

bacteroides, fusobacterium, peptostreptoccous s aureus

can be from bronchial obstruction ( cancer)

143
Q

svc syndrome clinical features

A

facial plethora

blanching

144
Q

svc syndrome additonal causes

A

thrombosis

145
Q

svc syndrome complications

A

can raise intracranial pressure if severe -> headaches, dizziness, increase risk intracranial artery rupture or aneuryms

146
Q

lung cancer lung finding

147
Q

mets of lung cancer

A

adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly)

148
Q

mets to the lung

A

breast, colon, prostate, bladder cancer

149
Q

lung cancer complications

A

recurrent laryngeal nerve

effusions (pericardial, pleural)

150
Q

risk factors for lung cancer

A

smoking, second hand smoke, radon, asbestos, family history

151
Q

small cell paraneoplastic

A

neurons (paraneoplastic myelitis, encephalitis, subactue cerebellar degeneration)

152
Q

small cell gene mutation

A

amplificatoin of myc oncogene

153
Q

small cell cytology

A

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
Q

adenocarcinoma genes

A

activating mutations of kras, egfr, alk.

155
Q

adenocarcinoma associated with

A

hypertrophic osteoarthopathy (clubbing)

156
Q

adenocarcinoma pattern

A

glandular pattern on histology, often stains mucin +

157
Q

squamous cell carcinoma one fact

A

hilar mass

158
Q

large cell smoking association

A

LARGE (strong)

159
Q

large cell cytology

A

pleomorphic giant cell

160
Q

carcinoid of lung prognosis

A

excellent prognosis,

161
Q

cytology carcinoid

A

nest of neuroendocrine cells. chromogranin a

salt and pepper

Pharmacology (33 decks)

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