Respiratory Flashcards
1
Q
first stage of lung development - what happens, when
A
lung bud from respiratory diverticulum
4 weeks
2
Q
embryonic stage
A
4-7 weeks
3
Q
pseudoglandular stage
A
5-16 weeks
endodermal tubules become terminal bronchioles
4
Q
canalicular stage
A
16-26 weeks
terminal bronchioles –> respiratory bronchioles –> alveolar ducts
5
Q
saccular
A
26 weeks - birth
alveolar ducts –> terminal sacs
terminal sacs seperated by primary septae
6
Q
alveolar
A
32 weeks - 8 years
7
Q
when is respiration possible in the fetus?
A
25 weeks
8
Q
when do pneumocytes develop?
A
saccular stage
9
Q
what makes terminal sacs into adult alveoli?
A
secondary septation
10
Q
alveoli at birth, at 8 years
A
20-70 million
300-400 million
11
Q
hiatial hernia, bilateral renal agenesis associated with
A
poorly developed bronchial tree in R lung
12
Q
what causes bronchogenic cysts?
A
abnormal budding of foregut, dilation of terminal bronchi
13
Q
XR sees round sharply defined air-filled densities
A
bronchogenic cysts
14
Q
cells that secrete surfactant
A
type II pneumocytes
15
Q
pneumocyte shapes
A
type I - squamous
II - cuboidal
16
Q
what are club cells?
A
columnar/ cuboidal cells with secretory granules
secrete component of surfactant
17
Q
neonate, ground glass appearance of lung fields
A
neonatal respiratory distress syndrome
18
Q
test for fetal lung maturity
A
Lecithin/sphingomyelin ratio >2
lecithin should be higher
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)
20
Q
What are the complications of RDS?
A
metabolic acidosis, PDA, necrotizing enterocolitis
21
Q
Rx RDS
A
maternal steroids before birth, artificial surfactant
22
Q
Supplemental O2 in RDS can cause
A
RIB
Retinopathy of prematurity
Intraventricular hemorrhage
Bronchopulmonary dysplasia
23
Q
epithelium of bronchus
A
pseudostratified ciliated columnar cells
24
Q
terminal bronchioles cells
A
cuboidal cells
25
where does airway smooth muscle extend to?
end of terminal bronchioles (only in conducting zone)
26
where do cilia terminate?
respiratory bronchioles
27
Which bronchus is more vertical?
Right
28
superior segment of right inferior lobe
| inferior segment
inhalation whilst supine
| upright
29
where is the pulmonary artery in relation to the bronchus at the hilum?
RALS
Right anterior
Left superior
30
What passes the diaphragm at T10 with the oesophagus?
Vagus nerve
31
What passes the diaphragm at T12?
aortic hiatus, thoracic duct, azygous vein
32
Where is pain from the diaphragm referred?
c5 - shoulder tip
| c3, 4 - trapezius ridge
33
what is residual volume?
air in the lung after max expiration
34
functional residual capacity =
residual volume + expiratory reserve volume
35
vital capacity =
tidal volume + inspiratory reserve volume + expiratory reserve volume
36
difference between minute ventilation and alveolar ventilation
alveolar ventilation does not include dead space
37
alveolar ventilation =
(tidal volume - dead space) x rate
38
average tidal volume
500 ml/breath
39
average dead space
150 ml/breath
40
At functional residual capacity
alveolar + airway pressure
intrapleural pressure
O
| -ve
41
high lung compliance
lung easier to fill
42
what decreases lung compliance?
pulmonary fibrosis, pneumonia, pulmonary edema
43
Hb T
taut - deoxygenated
| releases O2
44
Hb R
relaxed - oxygenated
| high affinity for O2
45
What causes Hb to favour the taut form?
Cl, H, CO2, 2,3-BPG
46
why does fetal Hb have a greater affinity?
decreased affinity for 2,3-BPG
47
methemoglobin
oxidized, does not bind O2 readily, binds cyanide
48
Iron in Hb
Fe2+ - reduced
49
chocolate coloured blood + cyanosis
methemoglobinemia
50
What can be used to treat cyanide poisoning?
inducing methemoglobinemia (use nitrites, then thiosulfate)
51
Rx for methemoglobinemia
methylene blue + vitamin C
52
Right shift in dissociation curve means
| caused by
more offloading
| Acid, CO2, exercise, 2,3-BPG, altitude, temperature
53
O2 content of blood =
(1.34 x Hb x Sats) + (0.0003 x PaO2)
54
how much O2 can 1g Hb bind?
1.34ml
55
What is the normal amount of Hb in blood?
15g/dL
56
alveolar gas equation
alveolar PO2 = pIO2 - (PaCO2 / resp quotient)
57
respiratory quotient =
0.8
58
Which area of lung has a higher V/Q ratio?
apex - wasted ventilation
59
why does TB like the apex?
higher O2
60
how does CO2 bind to Hb?
N-terminus of globin
61
How is CO2 transported?
HCO3- (90%), carbaminoHb (5%), dissolved CO2 (5%)
62
Haldane effect
Hboxygenation dissociates H+ and shifts equilibrium to CO2 formation
63
Bohr effect
Tissues release H+, shifting curve to the right and offloading O2
64
what happens to cause altitude sickness?
respiratory alkalosis
65
What factors are increased in altitude sickness?
EPO, ventilation, 2,3-BPG, mt., HCO3- excretion
66
V/Q ratio between apex to base levels out
exercising
67
sinusitis pathogens
viral
| secondary bacterial - s. pneumoniae, H flu, M catarrhalis
68
head and neck ca
squamous cell carcinoma
69
Homan sign
dorsiflexion --> calf pain (DVT)
70
Lines of Zahn
found in
are
thrombi forming before death
| pink - plt + fibrin and red - RBCs
71
hypoxemia, neurological abnormality, petechial rash
fat emboli
72
consequence of amniotic fluid emboli
DIC
73
reid index >50%
chronic bronchitis
| thickness of mucosal gland layer to thickness of wall between epithelium
74
centriacinar emphysem
smoking, upper lobes
75
panacinar emphysema
a1 antitrypsin deficiency, lower lobes
76
Curschmann spirals
are
found in
whorled mucus plugs
| asthma
77
leyden crystals
are
found in
needle-like crystals, eosinophil breakdown in sputum
| asthma
78
bronchiectasis
chronic necrotizing infection of bronchi causing permanently dilated airways
79
Kartagner syndrome associated with
bronchiectasis
80
bronchopulmonary aspergillosis
bronchiectasis
81
eosinophilic granuloma
pulmoary langerhans cell histiocyosis
82
drugs causing restrictive lung disease
bleomycin, busulfan, amiodarone, methotrexate
83
hypersensitivity pneumonitis type
III/IV
84
hypersensitivity pneumonitis e.g.
bird fancier's lung
85
pneumoconioses
asbestosis, nerylliosis, coal worker, silicosis
86
asbestosis risk for
bronchogenic carcinoma, mesothelioma
87
Affects lower lobes
asbestosis
88
fusiform rods, prussian blue stain
asbestosis
89
increased risk of pleural effusion
asbestosis
90
Affects upper lobes
beryllium, coal workers pneumoconiosis, silicosis
91
beryllium found in
aerospace and manufacturing
92
granulomatous on histology
berylliosis
93
anthacosis
sooty air urban populations, asymptomatic
94
silicosis associated with
foundries, sandblasting, mines
95
what happens in silicosis?
mpgs releases fibrogenic factors
96
increased risk with silicosis
TB
97
eggshell calcification of hilar lymph nodes
silicosis
98
Causes of ARDS
```
SPARTAS
Sepsis
Pancreatitis
Pneumonia
Aspiration
uRemia
Trauma
Amniotic fluid embolism
Shock
```
99
What happens in ARDS?
| what does it lead to?
neutrophils release toxic substances, activate coagulation cascade, produce ROS
protein rich leakage into alveoli
noncradiogenic pulmonary edema
100
intra-alveolar hyaline membranes
ARDS
101
central sleep apnea
CNS injury/ toxicity, HF, opioids
102
obesity hypoventilation syndrome
raised PaCO2
103
Pulmonary htn
> 25 mmHg
104
pulmonary htn causes
arteriosclerosis, medial hypertrophy, intimal fibrosis of pulmonary arteries
105
heritable pulmonary arterial htn
BMPR2 gene, amphetamines, cocaine, CTDs, HIV, portal htn, congenital heart disease, schistomiasis
106
atelectasis
bronchial obstruction
107
atelectasis trachea
towards lesion
108
causes of transudative pleural effusion
HF, nephrotic syndrome, cirrhosis, hypothyroidism, Mieg's syndrome
109
causes of exudative pleural effusion
malignancy, infection/inflammation, collagen vascular disease, trauma
110
lymphatic pleural effusion
chylothorax
| thoracic duct injury
111
milky fluid, high triglycerides, pleural effusion
lymphatics
112
primary spontaneous pneumothorax
rupture of apical subpleural bleb/ cysts
113
secondary spontaneous pneumothorax
barotrauma from mechanical ventilation, diseased lung
114
organisms lobar pneumonia
s. pneumoniae, legionella, klebsiella
115
organisms bronchopneumonia
s. pneumoniae, s. aureas, H flu, klebsiella
116
interstitial pneumonia
atypical pneumonia
117
atypical pneumonia organisms
mycoplasa, chlamydia, legionella, RSV, CMV, influenza, adenovirus
118
causes of lung abscess
aspiration, or bronchial obstruction
119
treatment lung abscess
clindamycin
120
lung abscess organisms
anaerobes - bacteroides, fusobacterium, peptosteptococcus
| S. aureas
121
hemorrhagic pleural effusion
mesothelioma
122
psammoma bodies
mesothelioma
123
pancoast tumour
superior sulcus tumour
| carcinoma in the apex
124
pancoast syndrome
invades cervical sympathetic chain
125
hoarseness, Horner syndrome, SVC syndrome, sensorimotor defect
Pancoast tumour
126
SVC syndrome
impaired blood drainage from the head
127
blanching after cap refil, edema or upper extremities, jugular distension
pancoast tumour
| thrombosis from indwelling catheter
128
pneumonic coin lesion
lung ca
129
lung cancer mets
adrenals, brain, bone, liver
130
which lung cancers are central?
squamous and small cell (Sentral)
131
peripheral lung cancers
adenocarcinoma, large cell carcinoma
132
what can Small CC produce?
ACTH, SIADH, antibodies against presynaptic Ca, antibodies against neurons
133
Kulchitsky cells
small dark blue, small cell ca
134
Lambert-Eaton myasthenic syndrome
antibodies against presynaptic Ca channels
135
genes in adenocarcinoma
KRAS, EGFR, ALK
136
hypertrophic osteoarthropathy
clubbing
137
glandular patter cancer
adenocarcinoma
138
thickening of alveolar walls, tall columnar cells containing mucus
adenocarcinoma
139
squamous cell ca can produce
PTHrP
140
keratin pearls and intercellular bridges
squamous CC
141
large cell ca
bad prognosis
142
pleomorphic giant cells
large cell ca
143
large cell ca can secrete
B-hCG
144
carciniod symptoms
flushing, diarrhoea, wheeze
145
nests of neuroendocrine cells
bronchial carcinoid tumour
146
first generation antihistamine
en/ine/ate
147
use of antihistamines (1st generation)
allergy, motion sickness, sleep aid
148
s.e 1st gen antihistamines
sedation, antimuscarinic, anti-a-adrenergic
149
second generation antihistamines
-adine
150
use 2nd gen antihistamines
allergy
151
guanifenesin
expectorant
152
N-acetlycysteine
muceolytic - disrupts disulphide bonds
153
dextromethorphan mechanism
antitussive (antagonist of NMDA glutamate Rs)
154
dextromethophan
synthetic coedine
155
pseudoephedrine mechanism
a-adrenergic agonists, decongestant
156
use pseudoephedrine
reduce hyperemia, edema, nasal congestion, open obstructed eustachian tubes
157
s.e. pseudoephedrine
htn, CNS stimulation/ anxiety
158
bosentan
Endothelin-1 antagnoist, decreasing pulmonary vascular resistance
159
sildenafil
inhibits cGMP PDE-5
| vasodilator
160
epoprostenol, iloprost
| s.e.
PGI2 --> vasodilation
inhibits plt aggregation
flushing, jaw pain
161
salmetarol s.e
tremor, arrhythmia
162
fluticasone
stops TNF-a production (NF-kb)
163
ipratropium
muscarinic antagonist
164
montelukast
block leukotriene receptors
165
best for aspirin induced asthma
montelukast
166
zileuton - family, does
antileukotriene
| 5-lipoxygenase pathway inhibitor
167
omalizumab
binds unbound serum IgE, blocks FceRI
168
theophylline
| family, mechanism
methylaxanthines
| inhibits phosphodiesterase
169
careful with theophylline
P-450
| blocks adenosine action
170
methacholine
M3 agonist
| bronchial challenge to diagnose asthma
171
decreased FVC, very decreased DLCO
Pulmonary artery htn
172
Rx of NSAID asthma
Zileuton
173
lung cancer and smoking
squamous cell carcinoma
