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Step 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

first stage of lung development - what happens, when

A

lung bud from respiratory diverticulum

4 weeks

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2
Q

embryonic stage

A

4-7 weeks

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3
Q

pseudoglandular stage

A

5-16 weeks

endodermal tubules become terminal bronchioles

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4
Q

canalicular stage

A

16-26 weeks

terminal bronchioles –> respiratory bronchioles –> alveolar ducts

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5
Q

saccular

A

26 weeks - birth
alveolar ducts –> terminal sacs
terminal sacs seperated by primary septae

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6
Q

alveolar

A

32 weeks - 8 years

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7
Q

when is respiration possible in the fetus?

A

25 weeks

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8
Q

when do pneumocytes develop?

A

saccular stage

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9
Q

what makes terminal sacs into adult alveoli?

A

secondary septation

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10
Q

alveoli at birth, at 8 years

A

20-70 million

300-400 million

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11
Q

hiatial hernia, bilateral renal agenesis associated with

A

poorly developed bronchial tree in R lung

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12
Q

what causes bronchogenic cysts?

A

abnormal budding of foregut, dilation of terminal bronchi

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13
Q

XR sees round sharply defined air-filled densities

A

bronchogenic cysts

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14
Q

cells that secrete surfactant

A

type II pneumocytes

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15
Q

pneumocyte shapes

A

type I - squamous

II - cuboidal

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16
Q

what are club cells?

A

columnar/ cuboidal cells with secretory granules

secrete component of surfactant

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17
Q

neonate, ground glass appearance of lung fields

A

neonatal respiratory distress syndrome

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18
Q

test for fetal lung maturity

A

Lecithin/sphingomyelin ratio >2

lecithin should be higher

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19
Q

what are the risk factors for neonatal respiratory distress syndrome?

A

maternal diabetes (increased fetal insulin), premature, C section (decrease fetal GC release)

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20
Q

What are the complications of RDS?

A

metabolic acidosis, PDA, necrotizing enterocolitis

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21
Q

Rx RDS

A

maternal steroids before birth, artificial surfactant

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22
Q

Supplemental O2 in RDS can cause

A

RIB
Retinopathy of prematurity
Intraventricular hemorrhage
Bronchopulmonary dysplasia

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23
Q

epithelium of bronchus

A

pseudostratified ciliated columnar cells

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24
Q

terminal bronchioles cells

A

cuboidal cells

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25
Q

where does airway smooth muscle extend to?

A

end of terminal bronchioles (only in conducting zone)

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26
Q

where do cilia terminate?

A

respiratory bronchioles

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27
Q

Which bronchus is more vertical?

A

Right

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28
Q

superior segment of right inferior lobe

inferior segment

A

inhalation whilst supine

upright

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29
Q

where is the pulmonary artery in relation to the bronchus at the hilum?

A

RALS
Right anterior
Left superior

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30
Q

What passes the diaphragm at T10 with the oesophagus?

A

Vagus nerve

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31
Q

What passes the diaphragm at T12?

A

aortic hiatus, thoracic duct, azygous vein

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32
Q

Where is pain from the diaphragm referred?

A

c5 - shoulder tip

c3, 4 - trapezius ridge

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33
Q

what is residual volume?

A

air in the lung after max expiration

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34
Q

functional residual capacity =

A

residual volume + expiratory reserve volume

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35
Q

vital capacity =

A

tidal volume + inspiratory reserve volume + expiratory reserve volume

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36
Q

difference between minute ventilation and alveolar ventilation

A

alveolar ventilation does not include dead space

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37
Q

alveolar ventilation =

A

(tidal volume - dead space) x rate

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38
Q

average tidal volume

A

500 ml/breath

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39
Q

average dead space

A

150 ml/breath

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40
Q

At functional residual capacity
alveolar + airway pressure
intrapleural pressure

A

O

-ve

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41
Q

high lung compliance

A

lung easier to fill

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42
Q

what decreases lung compliance?

A

pulmonary fibrosis, pneumonia, pulmonary edema

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43
Q

Hb T

A

taut - deoxygenated

releases O2

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44
Q

Hb R

A

relaxed - oxygenated

high affinity for O2

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45
Q

What causes Hb to favour the taut form?

A

Cl, H, CO2, 2,3-BPG

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46
Q

why does fetal Hb have a greater affinity?

A

decreased affinity for 2,3-BPG

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47
Q

methemoglobin

A

oxidized, does not bind O2 readily, binds cyanide

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48
Q

Iron in Hb

A

Fe2+ - reduced

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49
Q

chocolate coloured blood + cyanosis

A

methemoglobinemia

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50
Q

What can be used to treat cyanide poisoning?

A

inducing methemoglobinemia (use nitrites, then thiosulfate)

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51
Q

Rx for methemoglobinemia

A

methylene blue + vitamin C

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52
Q

Right shift in dissociation curve means

caused by

A

more offloading

Acid, CO2, exercise, 2,3-BPG, altitude, temperature

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53
Q

O2 content of blood =

A

(1.34 x Hb x Sats) + (0.0003 x PaO2)

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54
Q

how much O2 can 1g Hb bind?

A

1.34ml

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55
Q

What is the normal amount of Hb in blood?

A

15g/dL

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56
Q

alveolar gas equation

A

alveolar PO2 = pIO2 - (PaCO2 / resp quotient)

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57
Q

respiratory quotient =

A

0.8

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58
Q

Which area of lung has a higher V/Q ratio?

A

apex - wasted ventilation

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59
Q

why does TB like the apex?

A

higher O2

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60
Q

how does CO2 bind to Hb?

A

N-terminus of globin

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61
Q

How is CO2 transported?

A

HCO3- (90%), carbaminoHb (5%), dissolved CO2 (5%)

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62
Q

Haldane effect

A

Hboxygenation dissociates H+ and shifts equilibrium to CO2 formation

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63
Q

Bohr effect

A

Tissues release H+, shifting curve to the right and offloading O2

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64
Q

what happens to cause altitude sickness?

A

respiratory alkalosis

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65
Q

What factors are increased in altitude sickness?

A

EPO, ventilation, 2,3-BPG, mt., HCO3- excretion

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66
Q

V/Q ratio between apex to base levels out

A

exercising

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67
Q

sinusitis pathogens

A

viral

secondary bacterial - s. pneumoniae, H flu, M catarrhalis

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68
Q

head and neck ca

A

squamous cell carcinoma

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69
Q

Homan sign

A

dorsiflexion –> calf pain (DVT)

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70
Q

Lines of Zahn
found in
are

A

thrombi forming before death

pink - plt + fibrin and red - RBCs

71
Q

hypoxemia, neurological abnormality, petechial rash

A

fat emboli

72
Q

consequence of amniotic fluid emboli

A

DIC

73
Q

reid index >50%

A

chronic bronchitis

thickness of mucosal gland layer to thickness of wall between epithelium

74
Q

centriacinar emphysem

A

smoking, upper lobes

75
Q

panacinar emphysema

A

a1 antitrypsin deficiency, lower lobes

76
Q

Curschmann spirals
are
found in

A

whorled mucus plugs

asthma

77
Q

leyden crystals
are
found in

A

needle-like crystals, eosinophil breakdown in sputum

asthma

78
Q

bronchiectasis

A

chronic necrotizing infection of bronchi causing permanently dilated airways

79
Q

Kartagner syndrome associated with

A

bronchiectasis

80
Q

bronchopulmonary aspergillosis

A

bronchiectasis

81
Q

eosinophilic granuloma

A

pulmoary langerhans cell histiocyosis

82
Q

drugs causing restrictive lung disease

A

bleomycin, busulfan, amiodarone, methotrexate

83
Q

hypersensitivity pneumonitis type

A

III/IV

84
Q

hypersensitivity pneumonitis e.g.

A

bird fancier’s lung

85
Q

pneumoconioses

A

asbestosis, nerylliosis, coal worker, silicosis

86
Q

asbestosis risk for

A

bronchogenic carcinoma, mesothelioma

87
Q

Affects lower lobes

A

asbestosis

88
Q

fusiform rods, prussian blue stain

A

asbestosis

89
Q

increased risk of pleural effusion

A

asbestosis

90
Q

Affects upper lobes

A

beryllium, coal workers pneumoconiosis, silicosis

91
Q

beryllium found in

A

aerospace and manufacturing

92
Q

granulomatous on histology

A

berylliosis

93
Q

anthacosis

A

sooty air urban populations, asymptomatic

94
Q

silicosis associated with

A

foundries, sandblasting, mines

95
Q

what happens in silicosis?

A

mpgs releases fibrogenic factors

96
Q

increased risk with silicosis

A

TB

97
Q

eggshell calcification of hilar lymph nodes

A

silicosis

98
Q

Causes of ARDS

A 
SPARTAS
Sepsis
Pancreatitis
Pneumonia
Aspiration
uRemia
Trauma
Amniotic fluid embolism
Shock
99
Q

What happens in ARDS?

what does it lead to?

A

neutrophils release toxic substances, activate coagulation cascade, produce ROS
protein rich leakage into alveoli
noncradiogenic pulmonary edema

100
Q

intra-alveolar hyaline membranes

A

ARDS

101
Q

central sleep apnea

A

CNS injury/ toxicity, HF, opioids

102
Q

obesity hypoventilation syndrome

A

raised PaCO2

103
Q

Pulmonary htn

A

> 25 mmHg

104
Q

pulmonary htn causes

A

arteriosclerosis, medial hypertrophy, intimal fibrosis of pulmonary arteries

105
Q

heritable pulmonary arterial htn

A

BMPR2 gene, amphetamines, cocaine, CTDs, HIV, portal htn, congenital heart disease, schistomiasis

106
Q

atelectasis

A

bronchial obstruction

107
Q

atelectasis trachea

A

towards lesion

108
Q

causes of transudative pleural effusion

A

HF, nephrotic syndrome, cirrhosis, hypothyroidism, Mieg’s syndrome

109
Q

causes of exudative pleural effusion

A

malignancy, infection/inflammation, collagen vascular disease, trauma

110
Q

lymphatic pleural effusion

A

chylothorax

thoracic duct injury

111
Q

milky fluid, high triglycerides, pleural effusion

A

lymphatics

112
Q

primary spontaneous pneumothorax

A

rupture of apical subpleural bleb/ cysts

113
Q

secondary spontaneous pneumothorax

A

barotrauma from mechanical ventilation, diseased lung

114
Q

organisms lobar pneumonia

A

s. pneumoniae, legionella, klebsiella

115
Q

organisms bronchopneumonia

A

s. pneumoniae, s. aureas, H flu, klebsiella

116
Q

interstitial pneumonia

A

atypical pneumonia

117
Q

atypical pneumonia organisms

A

mycoplasa, chlamydia, legionella, RSV, CMV, influenza, adenovirus

118
Q

causes of lung abscess

A

aspiration, or bronchial obstruction

119
Q

treatment lung abscess

A

clindamycin

120
Q

lung abscess organisms

A

anaerobes - bacteroides, fusobacterium, peptosteptococcus

S. aureas

121
Q

hemorrhagic pleural effusion

A

mesothelioma

122
Q

psammoma bodies

A

mesothelioma

123
Q

pancoast tumour

A

superior sulcus tumour

carcinoma in the apex

124
Q

pancoast syndrome

A

invades cervical sympathetic chain

125
Q

hoarseness, Horner syndrome, SVC syndrome, sensorimotor defect

A

Pancoast tumour

126
Q

SVC syndrome

A

impaired blood drainage from the head

127
Q

blanching after cap refil, edema or upper extremities, jugular distension

A

pancoast tumour

thrombosis from indwelling catheter

128
Q

pneumonic coin lesion

A

lung ca

129
Q

lung cancer mets

A

adrenals, brain, bone, liver

130
Q

which lung cancers are central?

A

squamous and small cell (Sentral)

131
Q

peripheral lung cancers

A

adenocarcinoma, large cell carcinoma

132
Q

what can Small CC produce?

A

ACTH, SIADH, antibodies against presynaptic Ca, antibodies against neurons

133
Q

Kulchitsky cells

A

small dark blue, small cell ca

134
Q

Lambert-Eaton myasthenic syndrome

A

antibodies against presynaptic Ca channels

135
Q

genes in adenocarcinoma

A

KRAS, EGFR, ALK

136
Q

hypertrophic osteoarthropathy

A

clubbing

137
Q

glandular patter cancer

A

adenocarcinoma

138
Q

thickening of alveolar walls, tall columnar cells containing mucus

A

adenocarcinoma

139
Q

squamous cell ca can produce

A

PTHrP

140
Q

keratin pearls and intercellular bridges

A

squamous CC

141
Q

large cell ca

A

bad prognosis

142
Q

pleomorphic giant cells

A

large cell ca

143
Q

large cell ca can secrete

A

B-hCG

144
Q

carciniod symptoms

A

flushing, diarrhoea, wheeze

145
Q

nests of neuroendocrine cells

A

bronchial carcinoid tumour

146
Q

first generation antihistamine

A

en/ine/ate

147
Q

use of antihistamines (1st generation)

A

allergy, motion sickness, sleep aid

148
Q

s.e 1st gen antihistamines

A

sedation, antimuscarinic, anti-a-adrenergic

149
Q

second generation antihistamines

A

-adine

150
Q

use 2nd gen antihistamines

A

allergy

151
Q

guanifenesin

A

expectorant

152
Q

N-acetlycysteine

A

muceolytic - disrupts disulphide bonds

153
Q

dextromethorphan mechanism

A

antitussive (antagonist of NMDA glutamate Rs)

154
Q

dextromethophan

A

synthetic coedine

155
Q

pseudoephedrine mechanism

A

a-adrenergic agonists, decongestant

156
Q

use pseudoephedrine

A

reduce hyperemia, edema, nasal congestion, open obstructed eustachian tubes

157
Q

s.e. pseudoephedrine

A

htn, CNS stimulation/ anxiety

158
Q

bosentan

A

Endothelin-1 antagnoist, decreasing pulmonary vascular resistance

159
Q

sildenafil

A

inhibits cGMP PDE-5

vasodilator

160
Q

epoprostenol, iloprost

s.e.

A

PGI2 –> vasodilation
inhibits plt aggregation
flushing, jaw pain

161
Q

salmetarol s.e

A

tremor, arrhythmia

162
Q

fluticasone

A

stops TNF-a production (NF-kb)

163
Q

ipratropium

A

muscarinic antagonist

164
Q

montelukast

A

block leukotriene receptors

165
Q

best for aspirin induced asthma

A

montelukast

166
Q

zileuton - family, does

A

antileukotriene

5-lipoxygenase pathway inhibitor

167
Q

omalizumab

A

binds unbound serum IgE, blocks FceRI

168
Q

theophylline

family, mechanism

A

methylaxanthines

inhibits phosphodiesterase

169
Q

careful with theophylline

A

P-450

blocks adenosine action

170
Q

methacholine

A

M3 agonist

bronchial challenge to diagnose asthma

171
Q

decreased FVC, very decreased DLCO

A

Pulmonary artery htn

172
Q

Rx of NSAID asthma

A

Zileuton

173
Q

lung cancer and smoking

A

squamous cell carcinoma

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