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FA note cards > Respiratory > Flashcards

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
Q

Taut form of hemoglobin

A

Right shift of dissociation curve: ↑ O2 unloading
↑ Cl−, H+, CO2, 2,3-BPG, and temperature favor
taut form

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26
Q

Methemoglobin

A

Oxidized form of Hb (ferric, Fe3+); does not bind O2 as readily but binds cyanide (use to treat cyanide poisoning)

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27
Q

Normal iron state in Hb

A

Reduced (ferrous, Fe2+)

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28
Q

Methemoglobin presentation and treatment

A

Cyanosis and chocolate-colored blood

Methylene blue and vitamin C

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29
Q

Carboxyhemoglobin

A

Hb bound to CO in place of O2
↓ oxygen-binding capacity with left shift; ↓ O2 unloading
CO binds Hb 200x more than O2

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30
Q

Carboxyhemoglobin presentation and treatment

A

Geadaches, dizziness, and cherry red skin

100%/hyperbaric O2

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31
Q

Causes of right shift of O2/Hb curve

A 
Acid
CO2
Exercise
2,3-BPG
Altitude
Temperature
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32
Q

Physiological effects of a right shift

A

↓ affinity of Hb for O2 (↑ unloading of O2 to tissue)

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33
Q

Which way is a FHb curve shifted?

A

Left

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34
Q

[Hb], %O2 sat of Hb (SaO2), PaO2 and total O2 in anemia

A

SaO2: normal
PaO2: normal
Total O2: ↓

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35
Q

[Hb], %O2 sat of Hb (SaO2), PaO2 and total O2 in CO poisoning

A

SaO2: ↓
PaO2: normal
Total O2: ↓

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36
Q

[Hb], %O2 sat of Hb (SaO2), PaO2 and total O2 in polycythemia

A

SaO2: normal
PaO2: normal
Total O2: ↑

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37
Q

Response to high altitude

A

↓ Pao2 -> ↑ ventilation -> ↓ Paco2 -> respiratory alkalosis -> altitude sickness
↑ EPO, 2,3BPG, mitochondria, renal excretion of HCO3

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38
Q

Response to exercise

A

↑: CO2 production, O2 consumption, ventilation

↓: pH

39
Q

Rhinosinusitis

A

Obstruction of sinus drainage into nasal cavity

Maxillary sinuses drain into middle meatus

40
Q

Most common location of epistaxis

A

Anterior segment of nostril (Kiesselbach plexus)

41
Q

Location of a life threatening nose bleed

A

Posterior segment (sphenopalatine artery, a branch of maxillary artery)

42
Q

Sign of a PE

A

V ̇/Q ̇ mismatch, hypoxemia, respiratory alkalosi

43
Q

Clinical presentation of a PE

A

Sudden-onset dyspnea, pleuritic chest pain, tachypnea, tachycardia

44
Q

Flow volume loop in obstructive lung diseases

A

> volume (↑ TLC, FRC, RV); decreased FEV1/FVC

Loops shifts to the left

45
Q

Flow volume loop in constrictive lung diseases

A

Increased FEV1/FVC

Loops shifts to the right

46
Q

Pulmonary functions tests in obstructive lung diseases

A

↓↓ FEV1, ↓ FVC: ↓ FEV1/FVC ratio (hallmark)

V ̇/Q ̇ mismatch

47
Q

Chronic bronchitis

A

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
Q

Emphysema types

A

Smoking: centriacinar (upper lobes)

α1-antitrypsin deficiency: panacinar, lower lobes

49
Q

Emphysema pathology and clinical findings

A

Large air spaces
↓: recoil, Dlco
↑: compliance, elastase
↑: AP diameter, lucency; flat diaphragm, pursed lips

50
Q

Asthma

A

↓ inspiratory/ expiratory ratio

mooth muscle hypertrophy and hyperplasia, Curschmann spirals, Charcot-Leyden crystals

51
Q

Bronchiectasis

A

Purulent sputum, recurrent infections, hemoptysis, digital clubbing
Chronic necrotizing infection of bronchi
Poor ciliary motility (smoking, Kartagener), CF, ABPS

52
Q

Restrictive lung diseases pulmonary tests

A

↓ lung volumes

FEV1/FVC ratio ≥ 80%

53
Q

Interstitial lung diseases

A

Type of restrictive dz
↓ pulmonary diffusing capacity, ↑ A-a gradient
Pneumoconioses, Sarcoidosis, idiopathic, Wegners etc

54
Q

Idiopathic pulmonary fibrosis

A

Restrictive lung dz
FEV1/FVC ratio ≥ 80%
↑ collagen deposition, “honeycomb” lung appearance and digital clubbing

55
Q

Hypersensitivity pneumonitis

A

Type III/IV hypersensitivity reaction to environmental antigen
Seen in farmers and those exposed to birds

56
Q

Inhalation injury and sequelae

A

Bronchoscopy shows severe edema, congestion of bronchus, and soot deposition (18 hours after inhalation injury; resolution at 11 days after injury)

57
Q

Pneumoconioses sequelae

A

↑ risk of cor pulmonale, cancer, and Caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulmonary nodules)

58
Q

Pneumoconioses types

A

Asbestos from the roof, but affects the base (lower lobes)

Silica and coal from the base (earth), but affect the roof (upper lobes)

59
Q

Asbestosis

A

“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
Q

Berylliosis

A

Aerospace and manufacturing industries
Granulomatous (noncaseating); responds to steroids
Affects upper lobes

61
Q

Anthracosis

A

asymptomatic condition found in many urban dwellers exposed to sooty air

62
Q

Silicosis

A

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
Q

Mesothelioma

A

Malignancy of the pleura associated with asbestosis

Psammoma bodies; cytokeratin and calretinin ⊕ in almost all mesotheliomas

64
Q

Acute respiratory distress syndrome dx

A

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
Q

Acute respiratory distress syndrome pathology

A

Endothelial damage → ↑ alveolar capillary permeability → protein-rich leakage into alveoli → diffuse alveolar damage and noncardiogenic pulmonary edema → formation of intra- alveolar hyaline membranes

66
Q

Sleep apnea

A

Cessation of breathing > 10 s

Hypoxia → ↑ EPO release → ↑ erythropoiesis

67
Q

Central sleep apnea

A

No respiratory effort due to CNS injury/toxicity, HF, opioids
Cheyne- Stokes respiration

68
Q

Obesity hypoventilation syndrome

A

Hypoventilation ↑ PaCO2 during waking hours

Pickwickian syndrome

69
Q

Heritable PAH

A

Inactivating mutation in BMPR2 gene (normally inhibits vascular smooth muscle proliferation); poor prognosis

70
Q

PE findings in pleural effusion

A

↓ breath sounds, dull percussion, ↓ fremitus

71
Q

PE findings in atelectasis

A

↓ breath sounds, dull percussion, ↓ fremitus

Tracheal deviation toward lesion

72
Q

PE findings in simple pneumothorax

A

↓ breath sounds, hyperresonant percussion, ↓ fremitus

73
Q

PE findings in tension pneumothorax

A

↓ breath sounds, hyperresonant percussion, ↓ fremitus

Tracheal deviation away from lesion

74
Q

PE findings in consolidation

A

Bronchial breath sounds, egophony, dull to percussion, ↑ fremitus

75
Q

Transudate pleural effusion

A

↓ protein content

Due to ↑ hydrostatic pressure or ↓ oncotic pressure

76
Q

Exudate pleural effusion

A

↑ protein content
Due to malignancy, pneumonia, collagen vascular disease, trauma (↑ vascular permeability)
Must be drained

77
Q

Lymphatic pleural effusion

A

Due to thoracic duct injury from trauma or malignancy.

Milky- appearing fluid; triglycerides

78
Q

Primary spontaneous pneumothorax

A

Due to rupture of apical subpleural bleb or cysts

Occurs most frequently in tall, thin, young males

79
Q

Secondary spontaneous pneumothorax

A

Due to diseased lung

80
Q

Tension pneumothorax

A

Air enters pleural space but cannot exit

Trachea deviates away from affected lung

81
Q

Lobar pneumonia

A

S pneumo most frequently; also Legionella, Klebsiella

Intra-alveolar exudate → consolidation

82
Q

Bronchopneumonia

A

S pneumoniae, S aureus, H influenzae, Klebsiella

Acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving ≥ 1 lobe

83
Q

Interstitial (atypical) pneumonia

A

Diffuse patchy inflammation localized to interstitial areas at alveolar walls; diffuse distribution involving ≥ 1 lobe

84
Q

Cryptogenic organizing pneumonia

A

Noninfectious pneumonia characterized by inflammation of bronchioles and surrounding structure
⊝ sputum and blood cultures, no response to antibiotics

85
Q

Lung abscess treatment

A

Clindamycin

86
Q

Pancoast tumor

A

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
Q

Superior vena cava syndrome

A

An obstruction of the SVC that impairs blood drainage from the head (“facial plethora”; note blanching) and UE

88
Q

Histology of SCC

A

Neoplasm of neuroendocrine Kulchitsky cells: small dark blue cells
Chromogranin A ⊕, neuron-specific enolase ⊕

89
Q

Adenocarcinoma of lung histology

A

Glandular pattern on histology, often stains mucin⊕

90
Q

Adenocarcinoma

A

Most common lung cancer in nonsmokers and overall

Activating mutations include KRAS, EGFR, and ALK

91
Q

Squamous cell carcinoma of lung histology

A

Keratin pearls and intercellular bridges

92
Q

Guaifenesin

A

Expectorant—thins respiratory secretions; does not suppress cough re ex

93
Q

N-acetylcysteine

A

Mucolytic—liquifies mucus in chronic bronchopulmonary diseases (eg, COPD, CF) by disrupting disulfide bonds

94
Q

Dextromethorphan

A

Antitussive (antagonizes NMDA glutamate receptors)

FA note cards (16 decks)

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