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Respiratory Flashcards

1
Q

When is respiration possible?

A

25 weeks

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2
Q

Pulmonary hypoplasia

A

Poorly developed bronchial tree with abnormal histology

Assoc w/ CDH and b/l renal agenesis

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3
Q

Bronchogenic cysts

A

Abnormal budding of the foregut and dilation of terminal or large bronchi

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4
Q

Club cells

A

Nonciliated; low-columnar/cuboidal with secretory granules
Located in small airways
Secrete component of surfactant; degrade toxins; act as reserve cells

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5
Q

Type I pneumocytes

A

97% of alveolar surfaces
Line the alveoli
Squamous; thin for optimal gas diffusion

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6
Q

Type II pneumocytes

A

Secrete surfactant from lamellar bodies
Cuboidal and clustered
Precursors to type I

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7
Q

Neonatal RDS

A

Surfactant deficiency -> alveolar collapse (ground glass on XR)

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8
Q

Therapeutic supplemental O2 SE in neonates

A

Retinopathy of prematurity
Intraventricular hemorrhage
Bronchopulmonary dysplasia

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9
Q

Screening tests for fetal lung maturity

A

L/S (≥ 2 is healthy)
Foam stability index test
Surfactant-albumin ratio

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10
Q

Conducting zone of respiratory tree anatomy

A

Large airways: nose, pharynx, larynx, trachea, and bronchi

Small airways: bronchioles further dividing into terminal bronchioles

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11
Q

Conducting zone of respiratory tree function

A

Warms, humidi es, and lters air but does not participate in gas exchange

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12
Q

Conducting zone of respiratory tree histology and components

A

Cartilage and goblet cells extend to end of bronchi

Pseudostrati ed ciliated columnar cells primarily make up epithelium of bronchus; transition to cuboidal cells

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13
Q

Respiratory zone of the respiratory tree anatomy

A

Lung parenchyma; consists of respiratory bronchioles, alveolar ducts, and alveoli

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14
Q

Respiratory zone of the respiratory tree function

A

Gas exchange

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15
Q

Respiratory zone of the respiratory tree histology

A

Mostly cuboidal cells in respiratory bronchioles, then simple squamous cells up to alveoli
Cilia terminate in respiratory bronchioles

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16
Q

Relation of the pulmonary artery to the bronchus

A

Right Anterior; Left Superior

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17
Q

Location of carina

A

Posterior to ascending aorta and anteromedial to descending aorta

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18
Q

Inhaled foreign body

A

Right lung: right main stem bronchus is wider, more vertical, and shorter
Basal segment if upright; posterior segment if supine

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19
Q

Where does the common carotid bifurcate?

A

C4

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20
Q

Where does the trachea bifurcate?

A

T4

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21
Q

Where does the abdominal aorta bifurcate?

A

L4

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22
Q

Tidal volume

A

Air that moves into lung with each quiet inspiration, typically 500 mL

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23
Q

Residual volume

A

Air in lung after maximal expiration

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24
Q

Elastic recoil

A

Tendency for lungs to collapse inward and chest wall to spring outward

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25
Taut form of hemoglobin
Right shift of dissociation curve: ↑ O2 unloading ↑ Cl−, H+, CO2, 2,3-BPG, and temperature favor taut form
26
Methemoglobin
Oxidized form of Hb (ferric, Fe3+); does not bind O2 as readily but binds cyanide (use to treat cyanide poisoning)
27
Normal iron state in Hb
Reduced (ferrous, Fe2+)
28
Methemoglobin presentation and treatment
Cyanosis and chocolate-colored blood | Methylene blue and vitamin C
29
Carboxyhemoglobin
Hb bound to CO in place of O2 ↓ oxygen-binding capacity with left shift; ↓ O2 unloading CO binds Hb 200x more than O2
30
Carboxyhemoglobin presentation and treatment
Geadaches, dizziness, and cherry red skin | 100%/hyperbaric O2
31
Causes of right shift of O2/Hb curve
``` Acid CO2 Exercise 2,3-BPG Altitude Temperature ```
32
Physiological effects of a right shift
↓ affinity of Hb for O2 (↑ unloading of O2 to tissue)
33
Which way is a FHb curve shifted?
Left
34
[Hb], %O2 sat of Hb (SaO2), PaO2 and total O2 in anemia
[Hb]: ↓ SaO2: normal PaO2: normal Total O2: ↓
35
[Hb], %O2 sat of Hb (SaO2), PaO2 and total O2 in CO poisoning
[Hb]: normal SaO2: ↓ PaO2: normal Total O2: ↓
36
[Hb], %O2 sat of Hb (SaO2), PaO2 and total O2 in polycythemia
[Hb]: ↑ SaO2: normal PaO2: normal Total O2: ↑
37
Response to high altitude
↓ Pao2 -> ↑ ventilation -> ↓ Paco2 -> respiratory alkalosis -> altitude sickness ↑ EPO, 2,3BPG, mitochondria, renal excretion of HCO3
38
Response to exercise
↑: CO2 production, O2 consumption, ventilation | ↓: pH
39
Rhinosinusitis
Obstruction of sinus drainage into nasal cavity | Maxillary sinuses drain into middle meatus
40
Most common location of epistaxis
Anterior segment of nostril (Kiesselbach plexus)
41
Location of a life threatening nose bleed
Posterior segment (sphenopalatine artery, a branch of maxillary artery)
42
Sign of a PE
V ̇/Q ̇ mismatch, hypoxemia, respiratory alkalosi
43
Clinical presentation of a PE
Sudden-onset dyspnea, pleuritic chest pain, tachypnea, tachycardia
44
Flow volume loop in obstructive lung diseases
> volume (↑ TLC, FRC, RV); decreased FEV1/FVC | Loops shifts to the left
45
Flow volume loop in constrictive lung diseases
Increased FEV1/FVC | Loops shifts to the right
46
Pulmonary functions tests in obstructive lung diseases
↓↓ FEV1, ↓ FVC: ↓ FEV1/FVC ratio (hallmark) | V ̇/Q ̇ mismatch
47
Chronic bronchitis
Wheezing, crackles, cyanosis Hypertrophy and hyperplasia of mucus-secreting glands (↑ Reid index >50%) Dx: productive cough for > 3 months in a year for > 2 consecutive years
48
Emphysema types
Smoking: centriacinar (upper lobes) | α1-antitrypsin deficiency: panacinar, lower lobes
49
Emphysema pathology and clinical findings
Large air spaces ↓: recoil, Dlco ↑: compliance, elastase ↑: AP diameter, lucency; flat diaphragm, pursed lips
50
Asthma
↓ inspiratory/ expiratory ratio | mooth muscle hypertrophy and hyperplasia, Curschmann spirals, Charcot-Leyden crystals
51
Bronchiectasis
Purulent sputum, recurrent infections, hemoptysis, digital clubbing Chronic necrotizing infection of bronchi Poor ciliary motility (smoking, Kartagener), CF, ABPS
52
Restrictive lung diseases pulmonary tests
↓ lung volumes | FEV1/FVC ratio ≥ 80%
53
Interstitial lung diseases
Type of restrictive dz ↓ pulmonary diffusing capacity, ↑ A-a gradient Pneumoconioses, Sarcoidosis, idiopathic, Wegners etc
54
Idiopathic pulmonary fibrosis
Restrictive lung dz FEV1/FVC ratio ≥ 80% ↑ collagen deposition, “honeycomb” lung appearance and digital clubbing
55
Hypersensitivity pneumonitis
Type III/IV hypersensitivity reaction to environmental antigen Seen in farmers and those exposed to birds
56
Inhalation injury and sequelae
Bronchoscopy shows severe edema, congestion of bronchus, and soot deposition (18 hours after inhalation injury; resolution at 11 days after injury)
57
Pneumoconioses sequelae
↑ risk of cor pulmonale, cancer, and Caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulmonary nodules)
58
Pneumoconioses types
Asbestos from the roof, but affects the base (lower lobes) | Silica and coal from the base (earth), but affect the roof (upper lobes)
59
Asbestosis
“Ivory white,” calcified, supradiaphragmatic and pleural plaques are pathognomonic ↑ risk of bronchogenic Ca, pleural effusion Asbestos (ferruginous) bodies are golden-brown fusiform rods resembling dumbbells; found in alveolar sputum sample, visualized using Prussian blue stain
60
Berylliosis
Aerospace and manufacturing industries Granulomatous (noncaseating); responds to steroids Affects upper lobes
61
Anthracosis
asymptomatic condition found in many urban dwellers exposed to sooty air
62
Silicosis
Associated with foundries, sandblasting, mines Macrophage release fibrogenic factors: fibrosis Silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB Affects upper lobes “Eggshell” calci cation of hilar lymph nodes on CXR
63
Mesothelioma
Malignancy of the pleura associated with asbestosis | Psammoma bodies; cytokeratin and calretinin ⊕ in almost all mesotheliomas
64
Acute respiratory distress syndrome dx
Diagnosis of exclusion: 1. respiratory failure within 1 week of alveolar insult 2. bilateral lung opacities 3. ↓ PaO2/FiO2 < 300 (hypoxemia due to ↑ intrapulmonary shunting and diffusion abnormalities) 4. no evidence of HF/fluid overload
65
Acute respiratory distress syndrome pathology
Endothelial damage → ↑ alveolar capillary permeability → protein-rich leakage into alveoli → diffuse alveolar damage and noncardiogenic pulmonary edema → formation of intra- alveolar hyaline membranes
66
Sleep apnea
Cessation of breathing > 10 s | Hypoxia → ↑ EPO release → ↑ erythropoiesis
67
Central sleep apnea
No respiratory effort due to CNS injury/toxicity, HF, opioids Cheyne- Stokes respiration
68
Obesity hypoventilation syndrome
Hypoventilation ↑ PaCO2 during waking hours | Pickwickian syndrome
69
Heritable PAH
Inactivating mutation in BMPR2 gene (normally inhibits vascular smooth muscle proliferation); poor prognosis
70
PE findings in pleural effusion
↓ breath sounds, dull percussion, ↓ fremitus
71
PE findings in atelectasis
↓ breath sounds, dull percussion, ↓ fremitus | Tracheal deviation toward lesion
72
PE findings in simple pneumothorax
↓ breath sounds, hyperresonant percussion, ↓ fremitus
73
PE findings in tension pneumothorax
↓ breath sounds, hyperresonant percussion, ↓ fremitus | Tracheal deviation away from lesion
74
PE findings in consolidation
Bronchial breath sounds, egophony, dull to percussion, ↑ fremitus
75
Transudate pleural effusion
↓ protein content | Due to ↑ hydrostatic pressure or ↓ oncotic pressure
76
Exudate pleural effusion
↑ protein content Due to malignancy, pneumonia, collagen vascular disease, trauma (↑ vascular permeability) Must be drained
77
Lymphatic pleural effusion
Due to thoracic duct injury from trauma or malignancy. | Milky- appearing fluid; triglycerides
78
Primary spontaneous pneumothorax
Due to rupture of apical subpleural bleb or cysts | Occurs most frequently in tall, thin, young males
79
Secondary spontaneous pneumothorax
Due to diseased lung
80
Tension pneumothorax
Air enters pleural space but cannot exit | Trachea deviates away from affected lung
81
Lobar pneumonia
S pneumo most frequently; also Legionella, Klebsiella | Intra-alveolar exudate → consolidation
82
Bronchopneumonia
S pneumoniae, S aureus, H influenzae, Klebsiella | Acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving ≥ 1 lobe
83
Interstitial (atypical) pneumonia
Diffuse patchy inflammation localized to interstitial areas at alveolar walls; diffuse distribution involving ≥ 1 lobe
84
Cryptogenic organizing pneumonia
Noninfectious pneumonia characterized by inflammation of bronchioles and surrounding structure ⊝ sputum and blood cultures, no response to antibiotics
85
Lung abscess treatment
Clindamycin
86
Pancoast tumor
Superior sulcus tumor; occurs in the apex of lung Compression of locoregional structures: Recurrent laryngeal nerve: hoarseness Stellate ganglion: Horner syndrome Superior vena cava: SVC syndrome Brachiocephalic vein: brachiocephalic syndrome (unilateral symptoms) Brachial plexus: sensorimotor deficits
87
Superior vena cava syndrome
An obstruction of the SVC that impairs blood drainage from the head (“facial plethora”; note blanching) and UE
88
Histology of SCC
Neoplasm of neuroendocrine Kulchitsky cells: small dark blue cells Chromogranin A ⊕, neuron-specific enolase ⊕
89
Adenocarcinoma of lung histology
Glandular pattern on histology, often stains mucin⊕
90
Adenocarcinoma
Most common lung cancer in nonsmokers and overall | Activating mutations include KRAS, EGFR, and ALK
91
Squamous cell carcinoma of lung histology
Keratin pearls and intercellular bridges
92
Guaifenesin
Expectorant—thins respiratory secretions; does not suppress cough re ex
93
N-acetylcysteine
Mucolytic—liquifies mucus in chronic bronchopulmonary diseases (eg, COPD, CF) by disrupting disulfide bonds
94
Dextromethorphan
Antitussive (antagonizes NMDA glutamate receptors)

FA note cards (16 decks)

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